In Japan, 10% povidone-iodine solution (10% PVP–I) is commonly used for precatheter preparation. Recently, the CDC 2011 guidelines for the prevention of intravascular catheter-related infections clearly recommended skin preparation with alcohol containing >0.5% CHG as a means of preventing catheter-related bloodstream infection (CRBSI). Since then, CHG–alcohol products have been more widely used. Japanese pharmaceutical regulations limit CHG content in skin antiseptics to a maximum of 1%. Under these circumstances, we present some properties of 1 w/v% chlorhexidine gluconate in ethanol formulation (1% CHG–EtOH). We found that 1% CHG–EtOH had comprehensive advantages of antimicrobial efficacy (long-lasting effects), safety in use (low potential for skin irritation) and clinical efficacy (reduced CRBSI in clinical studies). Considering these findings, 1% CHG–EtOH is expected to perform well at the catheter insertion site to reduce the risk of CRBSI.

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  Two types of environmental antiseptic wipes, A and B, were manufactured using nonwoven fabrics. We evaluated the growth-inhibitory effects of the wipes on bacterial strains such as extended-spectrum β–lactamase (ESBL) (CTX M–1 type) Escherichia coli, carbapenem and quinolone resistant Pseudomonas aeruginosa (two-drug-resistant P. aeruginosa), Acinetobacter baumanii (A. baumanii), MRSA, and vancomycin-resistant enterococcii (VRE) (vanB type) under various conditions. The residual performance of the wipes was examined by wiping once on surfaces contaminated with bacteria. The residual level of the antiseptic agent of wipe A was within the detection limit. The growth of ESBL–producing E. coli, A. baumanii and MRSA was inhibited by not less than 99.99% 4 h after wiping, and that of the other 2 bacterial strains was slightly inhibited from 4+ to 2+ or 1+ by the use of wipe B, indicating retention of the antiseptic agent. In the case of a bacterial fluid prepared from skimmed milk, wipe A showed slight growth inhibitory effect on all bacterial strains, whereas wipe B exhibited strong growth inhibitory effect on two-drug-resistant strain P.aeruginosa and VRE by not less than 99.99%, along with slight growth inhibitory effect on the other 2 bacterial strains. The reduction in bacterial count was determined by wiping once the right side (with wipe A) and the left side (with wipe B) of a toilet seat, and comparing the final bacterial count, considering the count of bacteria adhering to the surface of the toilet seat before wiping as control. Wipe B showed a statistically significant difference with respect to reduction in bacterial count compared to wipe A. We attribute the observed results to the fact that wipe B contains a 10–times higher quantity of benzalkonium chloride than wipe A and surfactant. Moreover, the use of an increased amount of nonwoven fabric for constructing wipe B contributed to the effectiveness for the control of nosocomial infections.

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  Microbial contamination by methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) was investigated of environmental surfaces and infant toys in 2 pediatric outpatient facilities. Microbial contamination of infant slippers was evaluated before and after wiping with 80% alcohol. In the facility in which wiping with 70% isopropanol was performed every day (disinfection facility), methicillin-resistant S. aureus (MRSA) was not detected but methicillin-sensitive S. aureus (MSSA) was detected on 9.1% of environmental surfaces. In contrast, in the facility without regular disinfection (nondisinfection facility), MRSA was detected on 14.3% of environmental surfaces, and MSSA on 28.6% of environmental surfaces. In particular, 3.0×10³ MRSA was detected from infant slippers. After wiping infant slippers with 80% alcohol, MRSA was not detected, and the MSSA contamination density was reduced (p<0.05). MRSA was detected on 20% of infant toys in the nondisinfection facility, and on 3.6% of infant toys in the disinfection facility. After wiping the toys with 80% alcohol, MRSA and MSSA could not be detected. The present findings suggest that environmental surfaces and toys need to be regularly disinfected with 80% alcohol periodical in pediatric facilities.

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  Needlestick injury is important to prevent, but in case of occurrence, correct procedures should be followed to prevent health care workers from infection of blood transmitted virus. Anonymous questionnaires were distributed to 285 medical institutions located in X prefecture in September 2010. The survey asked about the precautions against needlestick injury and post-injury prophylaxis. The purpose of the survey was to analyze and to improve the present situation of needlestick injury prevention in the prefecture. One hundred and fifty-nine (55.8%) medical institutions filled out the questionnaire. Analysis of the responses identified many problems. Vaccination rates for hepatitis B (44.0%), use of a portable sharp container or placing a sharp object container in each hospital room (35.2%), and use of gloves during injection or collecting blood (47.8%) were not correctly performed. These issues were solved in each institution. For example, post-injury prophylaxis medicines for HIV were stored in 24.5% of the institutions. Therefore, prompt blood tests, and post-injury prophylaxis could not be provided in all medical institutions. The findings suggest that a system in which medical institutions provide mutual support is necessary to prevent infection by blood transmitted virus.

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  A retrospective study in 2006 to examine the state of central line-associated bloodstream infection (CLA–BSI) in our Intensive Care Unit found that the rate of CLA–BSI was 7.82 (per 1,000 catheter days), which was extremely high. Therefore, the ICT conducted surveillance of CLA–BSI from 2007, and assessed various interventions for preventing CLA–BSI. The efficacy of infection control ensured that the rate was reduced to 1.9 in the latter half year of 2011, compared with 5.9 in the former half of 2007, when such interventions were started. These results confirmed that introducing various interventions for prevention and infection control, as well as avoiding catheter-indwelling in the femoral vein, and introducing both closed systems of infusion catheter lines and maximal barrier precautions, have helped to reduce the rate of CLA–BSI. The ICT must continue to monitor and reduce CLA–BSI, to prevent a crisis of CLA–BSI and provide feedback to medical personnel.

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  We routinely perform staining and culture of samples flushed with sterile saline through the biopsy channel of endoscopes used at our institutes; this procedure is termed the cleanliness survey and is used to monitor the cleanliness and disinfection of endoscopes. Bacteria have been occasionally detected in this cleanliness survey; therefore, we administered a questionnaire to the endoscope cleaning staff at our institute. This questionnaire comprised questions about methods and suggestions concerning the cleaning and disinfection of endoscopes in order to raise awareness of the importance of these procedures. The results of the questionnaire survey indicated that the cleaning and disinfection methods were compliant with the guidelines of the Japanese Society of Environmental Infections. However, there were individual differences in the number of times a contaminated endoscope was brushed and the management of this cleaning brush. We also compared the six-month positive-culture rate (culture-positive number/investigation number) obtained before the survey with that obtained after the survey, and observed that this rate decreased from 17.1% to 7.7%, indicating that endoscope cleanliness improved after the survey. Therefore, the questionnaire survey was useful for confirming the efficacy of the cleaning and disinfection methods and in increasing the awareness of cleaning staff. In addition, a consultant was requested to educate the staff on the cleaning and disinfection of endoscopes, and this was a good opportunity to hear the cleaning staff's opinions. In conclusion, it is important to conduct questionnaires and routine cleanliness surveys for maintaining and increasing cleaning staff awareness.

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  Teamwork among medical professionals is essential in preventing hospital infections. We conducted a questionnaire survey of Japan Red Cross hospital pharmacists nationwide on the role of pharmacists in such teams. Responses were received from 68 of 92 hospitals (73.9%). 63.2% of the hospitals had received payment for infection prevention measures. 69.1% had notification systems for antimicrobial agent control. With regard to the timing of the notification (form submission), submission was possible after use of MRSA drugs at 66.2% of hospitals. Pharmacists conducted blood level analyses for patients at the request of physicians in 39.7% of hospitals, and the physician adjusted the dosage based on the results in 45.6% of hospitals. 29.4% of pharmacists recommended dosage adjustments based on the results of the pharmacist's analysis. 89.7% of the responding hospitals used generic antimicrobial agents. Surveys on the amount of antiseptics used were performed by pharmacists at 45.6% of hospitals. As part of anti-infection measure education, pharmacists gave lectures at least once a year to all employees in 64.7% of hospitals. Pharmacists contribute in all required areas in hospital infection control teams, such as antimicrobial agent management and anti–MRSA drug blood level analyses.

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  Multidrug-resistant Pseudomonas aeruginosa, MDRP, is one of the most important gram-negative bacteria in hospital infection control. P. aeruginosa is occasionally isolated from urine samples and colonize in moist hospital environments. Although urine collection tests are indispensable in diagnosis and evaluations of endocrine diseases and renal diseases, physicians frequently order and continue urine collection tests without clear purposes. To prevent contamination of the hospital environment, urine collections should follow appropriate indications. Because of the increased number of MDRP isolated from patients in 2010 in our hospital, we reviewed and intensified infection control measures. One of the measures was to develop guidelines for urine tests in hospital wards to demonstrate the appropriate indications and procedures. A urine test was approved only ‘in the absence of other alternatives’ and for ‘a minimum period’. Physicians need to submit a written application before ordering a urine collection test. Summary of urine collection tests is submitted to the infection control committee to check for inappropriate orders. Before enforcement of the guidelines, about three thousand person-day urine collections per month were conducted in the hospital wards. After enforcement of the guidelines, the number of urine collections dramatically decreased to twelve person-day per month. Isolations of MDRP had decreased by 75% year on year in fiscal year 2011, demonstrating the effects of an appropriate monitoring system for urine collection tests as an infection control measure against MDRP.

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