Three hundred and fifteen nursing school students (279 women and 36 men, mean age 18.1±0.6) who entered the school between 2007 and 2009, inclusive, were inoculated with hepatitis B (HB) vaccine, and the immunogenicity of the HB vaccine was evaluated. Seroconversion to anti–HB surface (HBs) antigen by the primary series of vaccinations performed during the first academic year was seen in 97.8% of women and 97.2% of men in April of the second academic year. An additional single dose or full three-dose series induced seroconversion in 100% of both female and male non-responders to the primary series. Among the students who responded to the primary vaccination, 3.9%(5/129) became seronegative (anti–HBs titer, <10 mIU/mL) during the first year, and 10.1%(13/129) during the two years after seroconversion by the primary series of vaccinations. Among those with secondary vaccine failure, booster inoculation induced prompt response, indicating that booster inoculation may not be necessary in the following academic years until graduation. Meanwhile, one student who showed a high level of anti–HBs antibody titers after completion of the primary series of vaccination, transiently became anti–HBs antigen positive, suggesting that vaccination may not prevent HBV infection completely.
The present study sought to determine the efficacy of an antimicrobial use monitoring system by investigating the level of carbapenem antibiotic usage and the sensitivity of Pseudomonas aeruginosa to imipenem (IPM) and meropenem (MEPM) antibiotics in 14 prefectural hospitals in Niigata, Japan. Antimicrobial consumption was measured in defined daily doses per 100 bed days (DDDs/100 bed days). Of the 14 hospitals studied, 7 implemented the antimicrobial use monitoring system in fiscal year (FY) 2009. Compared with the baseline year of 2007, no change in mean carbapenem antibiotic consumption was observed at any of these 7 hospitals in FY 2009 (1.7 vs. 1.7, p=0.24). Similarly, no significant change was observed in the mean resistance rate of P. aeruginosa to IPM (28% vs. 18%, p=0.23) or MEPM (20% vs. 12%, p=0.47). Meanwhile, at the 7 hospitals that did not implement the monitoring system, carbapenem antibiotic consumption increased significantly over the same period (2.8 vs. 3.1, p=0.02), but there was no significant change in P. aeruginosa resistance to IPM (41% vs. 34%, p=0.14) or MEPM (34% vs. 38%, p=0.07). In FY 2009, resistance to MEPM was significantly higher at hospitals that did not implement the monitoring system than at the hospitals that did (p<0.01). The findings of this study suggest that implementing the antimicrobial use monitoring system had the effect of containing both increases in carbapenem antibiotic consumption and decreases in sensitivity of P. aeruginosa to IPM and MEPM, but fell short of actually reducing consumption and increasing sensitivity.
Recently, quick-drying disinfectant including 0.2 w/v% chlorhexidine gluconate/foam-alcohol (CHG–FA) have been launched in Japan. In this study, the hand antiseptic effect and side effect of rough skin were compared for CHG–FA with 0.2 w/v% benzalkonium chloride/liquid-alcohol (BAC–LA), which is the standard product, or 0.2 w/v% chlorhexidine gluconate/gel-alcohol (CHG–GA). These three types of disinfectant showed similar antiseptic effects immediately after hand disinfectant. There was no difference in the side effect of rough skin. In conclusion, the antiseptic property of CHG–FA is effective, and is useful for hand disinfectant in clinical situations.
A total of 1697 central catheters remained indwelling for 20030 days from April 2008 to March 2010 in our hospital. A total of 41 central line-associated bloodstream infection (CLABSI) cases occurred, and the rate (CLABSIR) was 2.05 (per 1000 catheter days). This BSIR of 2.05 is higher than the half percentile (1.4) in the data from the Japanese Healthcare Associated Infections Surveillance Committee. We must continue to survey and decrease the BSI by applying simple procedures such as handwashing, maximal barrier precautions, chlorhexidine disinfection, avoiding femoral veins, and short indwelling duration of central catheters.
A checklist of actions against tubercular infection intended for the early detection and treatment was internally compiled and came into use in our hospital in 2008. It has been used for new inpatients at all wards and for outpatients who require long-time treatment. The items to check focused on the medical history of tuberculosis for patients as well as their family, and on the chest x-ray diagnosis and the respiratory condition. Furthermore, early diagnosis with sputum examination was given to the patients with suspected tuberculosis according to the checklist. The utilization rate of the checklist escalated from 77.4% at the beginning of operation to 96.8% one year later. The number of contact investigations decreased from 6 to 0 for the same one year period before and after introduction of checklist, but increased again to 6 for the following one year. The checklist was used for all 6 cases, and 5 of 6 cases received sputum specimen collection test on admission, but results were all negative. However, tubercle bacilli were detected after admission in cases that showed different symptoms and progress from typical tuberculosis. The increase of checklist utilization was achieved by mainly two factors: enlightenment activity of infection control team, and sharing and visualization of the utilization rate of all medical departments. Early detection of atypical tuberculosis by utilizing the checklist was clearly difficult. However, the utilization of the checklist enabled medical staff to keep the possibility of tuberculosis in mind when seeing patients, so may be effective to prevent the spread of typical tuberculosis infection.
Surveillance of injectable antimicrobial consumption was conducted at Rosai-Hospital to elucidate the relationship between carbapenem consumption and imipenem/cilastatin (IPM/CS) or meropenem (MEPM) resistance rates in Pseudomonas aeruginosa in the Tohoku region using the antimicrobial use density (AUD). Some hospitals have high AUD values of third-generation cephalosporins and carbapenems. The consumption of IPM/CS or MEPM and sensibility rates in Pseudomonas aeruginosa are used differently in each facility. This study provided the opportunity to review the appropriate use of specific antimicrobial measures in each facility. In the future, survey of the trends of specific antimicrobial use and surveillance of bacterial susceptibility should be continued to ensure correct use of antimicrobial agents.
Many smaller hospitals have no infectious disease specialist, clinical nurse specialist, or clinical microbiological laboratory technician. Under such conditions, pharmacists must provide a lead in infection control. In 2008, Niitsu Medical Center Hospital experienced an outbreak of multidrug-resistant Pseudomonas aeruginosa (MDRP), and board certified infection control pharmacy specialists were pivotal in promoting the correct use of antimicrobial agents to improve the antimicrobial resistance rate of P. aeruginosa to imipenem (IPM) and amikacin (AMK). As a result of the promotion of implementation of bacterial culture testing, rounds for correct use of antimicrobial agents, and therapeutic drug monitoring (TDM) of antimicrobial agents, the susceptibility of P. aeruginosa to IPM and AMK was improved.
A questionnaire about the activities of pharmacists against infection was sent to infection authorization pharmacists, infection control physicians, and infection control nurses in Niigata Prefecture. The results indicate that it is important for future pharmacist business development against infection to actively investigate selection of antimicrobial agents and medication design with emphasis on correct use of antimicrobial agents, and correct use of antiseptics. Therefore, the infection authorization of pharmacists should be increased, and the range of sterile manufacture of injections extended further in the medication manufacturing business.