A physical removal effect can be expected by the scrub method used as a hand hygiene technique, but quantitative evaluation of the effect is difficult by visual inspection using fluorescent material. This study examined the mass extraction ratio by measurement of fluorescent material in the water after washing the hands with a fixed quantity of fluorescent material. As a result, the mass extraction ratio was significantly lower than the area extraction ratio by visual inspection, and the deviation of the area extraction ratio and mass extraction ratio were significantly different from individual to individual, so that the problem with subjective evaluation by visual inspection was revealed. Therefore, the physical removal effect as the mass extraction ratio in hand hygiene techniques apparently improves the objectivity of evaluation, and the mass extraction ratio is a useful indicator to evaluate the effects of interventions and hand hygiene techniques.
We launched a campaign to encourage blood cultures at our hospital to enhance the quality of infectious disease diagnosis and treatment. To evaluate the effect of this campaign, surveys were conducted on patients hospitalized over a three-year period from 2009 to 2011 to investigate the number of blood cultures, the rate of positive results, contamination rates, and isolated bacteria. The number of blood cultures increased from 1,404 in 2009 to 1,631 in 2010 and 1,833 in 2011, and the number of culture sets taken annually for 1,000 patient-days increased from 9.2 to 11.4 and 13.3 sets, respectively. The rate of multiple blood culture sets of adults increased from 52.0% to 56.5% and 87.4%. Contamination rates were reduced steadily from 4.1% to 3.4% and 2.4%. Isolation rates of enteric bacteria went up from 21.8% to 28.5% and 33.9%. A marked increase in the rate of multiple blood culture sets is considered to reflect growing awareness about its importance among clinicians on the strength of the infection control team's campaign. A decrease in contamination rates should reflect the effects of sampling training sessions, and creation of a sampling manual on electronic medical record terminals.
The spread of methicillin-resistant Staphylococcus aureus (MRSA) increased in the A ward from December 2009 to April 2011. The Infection Control Team (ICT) and the Infection Control Committee (ICC) reinforced infection measures; however, the transmission was not controlled. We investigated the presence or absence of MRSA transmission between healthcare workers (HCWs) and patients using MRSA typing by polymerase chain reaction (PCR). The present study tried to determine the effect of identifying MRSA transmission between HCWs and patients, and subsequently informing authorities of the transmission and preventive measures. The presence or absence of nasal colonization of MRSA in HCWs was determined in March 2010. MRSA typing of 8 isolates from HCWs and 42 isolates from patients between January 2009 and March 2010 was also performed. New MRSA acquisitions increased from 2 in December 2009 to 3 in January 2009, and then to 6 in February 2010. Reinforcement of standard precautions decreased the number of transmissions to 1 in March 2010, but the number of transmissions increased again from 1 in March 2010 to 3 in April 2010. Eight isolates from HCWs and 42 isolates from patients were classified into 4 and 16 types, respectively, by PCR. MRSA typing revealed that 4 types from both HCWs and patients were identical. This information was reported to the A ward and the ICC, and the colonized HCWs were decolonized. The prevalence of transmission among newly admitted patients during 5 months before and after the intervention decreased from 13.4% (15 of 112 patients) to 0.6% (1 of 154 patients) (p<0.001). Identifying MRSA transmission between HCWs and patients, and subsequently informing authorities of this transmission effectively controlled the spread of MRSA in this study.
The Gunma ICD conference was established in December 2010 in Gunma Prefecture, and the first survey to support infection control (cross-checking) for our hospital was performed in August 2011. ICT members and other staff in our hospital were able to realize the importance of external monitoring of infection control. On the other hand, ICD (infection control doctor) and ICN (infection control nurse) who came to the survey had the opportunity to learn about infection control of the other facility. We believe that this survey provides benefits to both host and visiting sides. We shared this experience with many facilities. After that, we aim to improve the level of infection control in the regional network.
In the past decade, the strategy of care for inpatients has remarkably advanced. Currently, it is essential not only to treat the primary disease, but also to prevent complications and provide suitable care. Therefore, standard oral management must be immediately developed to prevent aspiration pneumonia and maintain oral health condition. Various protocols have been reported from several facilities, but no standardized method for oral management has been established. Here we report the development and improvement progress of oral care in our hospital. Oral care rounds have been started as one of the ICT and NST activities in our hospital. At the beginning, observation and assessment were written subjectively on the electric medical record. Then assessment table version 1 was established to record objective assessments. According to version 1, we concluded that desiccation and contamination of the lip, palate, or tongue could be one of the essential factors, and the presence of teeth is also a risk factor as well. In the assessment table version 2, we attempted to score these risk factors. Therefore, precise analysis is available due to this assessment table based on objective parameters.
We have our ice machines placed at each of our hospital wards regularly cleaned and maintained by the supplier. One of the machines turned out to be very dirty and had developed a bacterial biofilm on the surface of the upper wall above the water pan. At the request of the Infection Control Team (ICT) controlling bacterial contamination surveillance, we performed bacterial culture testing. The results revealed that the water pan was contaminated by numerous heterotrophic bacteria and fungi. We suspected that the ice may be contaminated as well and conducted a survey of the ice made by ice machines placed in three different wards. We also tested the ice made by three different home freezers for comparison. Heterotrophic bacteria, Sphingomonas paucimobilis (S.paucimobilis), and Methylobacterium sp., were detected from all the tested ice samples, and fungi were detected from some ice samples. Our study indicates that monitoring the microbiological cleanliness of ice machines is necessary, and it is desirable to use home freezers and to use clean tap water after running at least 1 liter.
Pseudomonas aeruginosa (P. aeruginosa) is a gram-negative bacteria causing nosocomial infections. Antibiotic susceptibility patterns of P. aeruginosa are different in each hospital. This study investigated the optimal use of antibiotics in severe cases of P. aeruginosa infection in our hospital. We analyzed susceptibility patterns of broad-spectrum antibiotics against P. aeruginosa in our hospital. Antibiotics use to achieve maximum bactericidal effects were compared with real antibiotics use in our hospital using Monte Carlo simulation. Ninety percent of P. aeruginosa detected in our hospital were susceptible to PIPC/TAZ and MEPM. However, almost all P. aeruginosa showed resistance to IPM and CFPM. The use of IPM or CFPM to achieve maximum bactericidal effects was more than three times per day. Our use of IPM or CFPM was different from the optimal use. Nevertheless, even if we use IPM more times in a day, IPM cannot exert the maximum bactericidal effects and might lead to treatment failure. Decisions on antibiotics use should be based on clinical data in each hospital because there are differences in detecting resistant bacteria. Our study suggests that investigation and information in treatment strategy using antibiotics are required.