Not only healthcare professionals but also local governments must have knowledge of infectious disease in order to maintain the health of disaster victims. We conducted a survey to determine local government awareness and response to infection prevention. In total 611 surveys (64.8%) were returned. We found a link between two items: “Being able to respond adequately at the time of disaster” and “Knowledge of infectious disease.” Therefore, local governments consider it is difficult to respond adequately without knowledge of infectious diseases. It is clear that knowledge of infectious diseases is necessary for the person in charge of disaster prevention.
In 2008, seasonal influenza affected as many as 22 people in our hospital, causing staff members to take leaves of absence with subsequent deterioration of patient services. Therefore, in 2009, oseltamivir was administered as a preventive measure and early treatment against transmitting 2009/H1N1 influenza. The preventive protocol consisted of “administering oseltamivir 1C orally for 4 days when a housemate was considered to have caught influenza.” The early oral treatment consisted of “a temporary suspension from work, and an oral administration of oseltamivir 2C for 2 days, in case the affected person develops a fever and influenza is suspected.” In addition, a questionnaire survey on the status of the disease and of the oral treatment was conducted, in each respective category. Oseltamivir 4C was distributed in advance to all staff members, and was collected after the end of the season. A total of 43 people received preventive medication, including 30 nurses and nursing aides, 6 occupational therapy and physical therapy staff members (PT–OT), 2 office workers, 1 pharmacist, 1 medical doctor, 1 laboratory technician, and 2 others. Individuals who developed symptoms included 37 children, 2 spouses, and 4 others including friends. The individuals who received preventive medication were not affected by influenza, and showed no side effects during the oral administration of the drug. Seventeen individuals received early oral treatment, including 13 nurses and nursing assistants, 1 medical doctor, 1 office worker, 1 laboratory technician, and 1 other. Nine individuals lived together with other people, but none transmitted the infection to their housemates. This study suggested that administering oseltamivir orally as a preventive medication and early treatment was effective as a countermeasure against hospital-acquired 2009/H1N1 influenza infection.
Antiseptic hand rub is recommended in medical facilities. However, it is reported that staff frequently use less than the recommended quantity of alcohol-based hand rub when washing their hands. Furthermore, the hand rub is often not rubbed into the fingertips. The aim of this study was to verify whether there is a significant difference in the bacterial elimination effect according to the quantity of the hand rub used and also if the degree of thoroughness in rubbing the hand rub into the fingertips makes a significant difference or not. Participants were divided into fingertips rubbing groups and fingertips non-rubbing groups. Each group did a antiseptic hand rub using both the standard quantity (3 mL) and half the standard quantity (1.5 mL) of alcohol-based hand rub. The numbers of bacteria on the fingertips, fingers and palms were counted using the agar stamp method before and after the hand rub. In the fingertips non-rubbing group, the bacterial elimination rate ON the fingertips was significantly lower compared to the fingers and palms (both 3 mL and 1.5 mL p<0.001). Also the log10 reduction of the fingertips was significantly lower in the non-rubbing group compared to the fingertips rubbing group (3 mL p<0.01, 1.5 mL p<0.001). Furthermore, in the fingertips non-rubbing group, the log10 reduction of the fingertips was significantly lower when 1.5 mL of hand rub was used than when 3 mL of hand rub was used (p<0.01). There was no difference in the bacterial elimination effect between the fingers and palms according to the quantity of hand rub or whether the hand rub was used on the fingertips. Furthermore it is necessary to recognize that the bacterial elimination effect will decrease if the quantity of hand rub used is less than half the recommended quantity.
Infections in patients under hemodialysis have adverse consequences such as increased morbidity and mortality, costs, and hospitalization rates. In order to prevent infections in these patients, a national system to survey infections in the dialysis setting was needed. There was no such system in Japan, so we created, tested and established a system with some modification of criteria for infections. From March 2008 to March 2010, 19 centers participated in the system and monitored several outcome events, including infections of the vascular access site. The infection rate of non-cuffed catheter was remarkably high among various access types. Compared with The Dialysis Surveillance Network data in US, the infection rates of non-catheter access were lower, whereas that of non-cuffed catheter was lower. There was a contradiction in our initial criteria for infection, so we added modifications. Otherwise, the surveillance system worked very efficiently. The next step is to decrease infection rates through surveillance, especially those of non-cuffed catheters. This would require detailed analysis of the infected cases and standardization of infection control practices in managing dialysis catheters. We believe that continuing data collection through our established surveillance system would contribute to this purpose.
Pharmacy surveillance for early detection of the outbreak of infectious diseases monitors the number of prescriptions which prescribe anti-influenza virus drug, anti-herpes-group-virus drug, pain relief, drug for common cold, and antimicrobials. Recently, as outbreaks of drug resistant bacterium had emerged, international comparison of antimicrobials use has been performed in countries other than Japan. The method is considered for estimation of the number of antimicrobials use for outpatients in the whole of Japan in a year. Antimicrobials were classified as penicillin, cephem, macrolide, quinolones, and others, and the number of prescription counted. Then using the distribution of amount in a prescription estimated by the previous research, we estimated the total amount of antimicrobials used in the whole of Japan in a year. Amount of antimicrobials used was shown as Defined Daily Dose in a day per 1000 population. The review period was August 2010 until July 2011. Amount of antimicrobials used was high in December, low in August, and the largest volume used was macrolide. DDD in a day per 1000 population was 10.16 in average in the whole of Japan. Western Japan used more volume than Eastern Japan. Compared with other countries, Japan was ranked at middle to lower. International comparison of antimicrobials used is more valuable if performed regularly, even if not in real time. Pharmacy surveillance can provide estimates at any time as shown, which proves the usefulness of pharmacy surveillance.
TQM, which stands for “Total Quality Management,” is an approach that many companies employ to solve problems and achieve goals. Because this approach is useful for economically developing medical services that meet patient needs, it is also actively used in the medical field. In 2006, our hospital had no central unit for management of disinfectants, and there were sequential cases of inappropriate use of agents. In order to solve this problem, we planned to simultaneously review the methods of managing disinfectants and to list the selected agents according to the Quality Control story of the TQM method. We aimed to identify the unit for management of disinfectants and to reduce the selected agents by 20%. As a result, the responsibility for selection of disinfectants was delegated to the Infection Control Team (ICT), which clarified where the responsibility lay. The number of selected agents was reduced by 39.4%, leading to a cost reduction of 1,118,598 yen on a single–year basis. The usage of hand-washing soap increased to 185% compared to the previous year, and the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection decreased. While the economic effect was maintained after the TQM effort, a statistically significant decrease in the MRSA infection rate was observed from 2006 to 2010 (p=0.0260). As a workplace cross-sectional unit of ICT involved in the TQM effort, we were able to solve a hospital-wide problem regarding disinfection and to simultaneously show the efficacy of hand-washing for preventing contact infection with numerical values, such as MRSA infection rates. For the future, we advocate that a workplace environment with a stronger consciousness of disinfection be created without diminishing this effort.
With the concern regarding the spread of drug-resistant bacteria, it is important for nurses, who provide first-line care to patients, to work in coordination with each other to improve nursing care and infection control throughout the whole region. Therefore, to establish an infection control network for nurses who administer infection control at clinics and hospitals, we conducted a survey on infection control at medical facilities and the need for such a nurse infection control network. For the analysis, we divided the 104 facilities (effective response rate: 19.6%) into three groups: clinics without beds, clinics with beds, and hospitals. The rates of medical facilities which included standard precautions in their infection control manuals were 22.9% among clinics without beds, 60.6% among clinics with beds, and 86.1% among hospitals. The rates of medical facilities which had provided descriptions of the procedure and timing of hand cleaning were 45.7% among clinics without beds, 54.5% among clinics with beds, and 86.1% among hospitals. We observed that many nurses in charge of infection control had felt the need to establish a nurse infection control network. However, only 71.4% of the nurses working at clinics without beds, answered that they wished to participate in the network due to reasons such as being too busy. The type of need for the infection control network differed between the clinics without beds, clinics with beds, and hospitals. The survey results indicated that infection control is still insufficient in small medical facilities. We believe that it is necessary to nurture an environment that makes it easy for even the staff of small medical facilities with a shortage of manpower to participate in the network through means such as the Internet, as well as facilitate the exchange of information and advice between different facilities through building such a network.
Focusing on hospital pharmacists and nurses, a questionnaire was used as a consciousness survey of measures to prevent contact infection. From February to April 2009, we received answers to the questionnaire from 119 pharmacists and 299 nurses. The significant items (p<0.05) for the pharmacists were “Recognition of Clostridium difficile and washing hands”, “Recognition of efficacy of alcohol disinfection against Pseudomonas aeruginosa”, and “Consciousness of indirect contact infection via medical charts”. The items significant for the nurses were “Timing to use quick-drying alcohol disinfecting wipes”, “Consciousness of contact infection with MRSA”, “Grasp of infectious carriers and patients with infection”, and “Washing hands and hand hygiene”. The item with especially large significant difference between the pharmacists and the nurses was “Consciousness of indirect contact infection via hospital clothes (27%, 66%), white coats (65%, 82%), stethoscopes (6%, 71%), bed railings (56%, 84%), and overbed tables (49%, 71%)”. To contribute to horizontal infection prevention, activities to further utilize the expertise of pharmacists and nurses in team medical care are required.
Antimicrobial susceptibility rates for clinical isolates of Pseudomonas aeruginosa in an acute-care community hospital between 2008 and 2010 were analyzed in order to promote appropriate use of antimicrobial agents and to prevent the emergence of multiple drug resistance P. aeruginosa (MDRP). A total of 1343 strains isolated from both inpatients and outpatients were determined for their susceptibility to antimicrobial agents, including piperacillin (PIPC), ceftazidime (CAZ), cefozopran (CZOP), imipenem/cilastatin (IPM/CS), meropenem (MEPM), ciprofloxacin (CPFX), amikacin (AMK), and gentamicin (GM). Of 1343 isolates tested, the resistance rates decreased from 6.4% to 3.3% between 2008 and 2010 for IPM/CS; similarly, 2.7% to 1.4% for MEPM, and 13.4% to 5.5% for CPFX. The non-susceptibility rates for aminoglycosides ranged between 0.4% and 2.2% for AMK, and between 1.7% and 4.0% for GM. On the other hand, the overall rates of non-susceptibility for PIPC, CAZ, and CZOP gradually increased during the same surveillance period. Only one episode of MDRP isolation was documented in a patient referred from another hospital. Diminished rates of resistance of P. aeruginosa to carbapenems could be partly ascribed to reduced consumption of carbapenems. Combined efforts of monitoring antimicrobial resistance, infection control activity, and shortening hospital stay are helpful to promote optimal use of antimicrobial agents.
We experienced an outbreak of vancomycin-resistant enterococci (VRE) starting in April 2009. Our acute care hospital consists of 8 wards and 382 beds. We verified a total of 30 VRE carriers in 6 wards excluding the pediatric ward and the obstetrical and gynecological ward. The first carrier was a 66-year-old woman in the East 4 ward (neurosurgery). As we detected VRE from 4 patients in whom we suspected cross infection, we examined all the patients in the ward, and found 2 more carriers. Around the same time, 8 patients in either the West 4 or East 5 ward were found to be carriers, so we examined all patients in all wards. Subsequently, we found carriers in the West 5, East 6, and West 6 wards as well. We restricted new admittance to as well as discharge and transfer from those wards containing carriers until the infection statuses of all patients were confirmed. Once confirmed, we placed the carriers in cohort isolation, and performed active surveillance with culturing on admission as well as on a regular basis in non-carrier patients. We gave strict instructions to every ward as to disinfection of the environment and prevention of contagion. Still, a new carrier emerged, so we decided that it could no longer be left up to each ward to control the situation, and gathered all the carriers in the East 4 ward for intensive, isolated management. We also not only gave instructions to the medical staff, but made sure that the cleaning staff was adequately instructed as well. Consequently, the number of carriers rapidly decreased. It took us 14 months to extinguish the outbreak. The VRE isolated from the 30 carriers all possessed vanB, and pulsed-field gel electrophoresis suggested that all organisms potentially belonged to the same strain.