In recent years, alcohol-based hand antiseptics with improved effectiveness against non-envelope viruses, which are difficult to eliminate, have been introduced into many health care settings. However, only a few studies on the efficacy have been reported. Therefore, we investigated effect of the continuous use of hand antiseptics on hand skin. Forty nurses were divided into two groups, one group used an alcohol-based hand antiseptic with acid pH adjusted with phosphoric acid (Phosphoric acid alcohol, P–AL) and the other used conventional neutral solution for one month during the cold season when skin irritation tends to occur. Transepidermal water loss (TEWL), keratinocyte moisture content, skin pH, keratinocyte exfoliation and run length ratio (RLR) were measured as objective indicators and skin condition was evaluated before and after the study. A questionnaire survey regarding to the hand skin condition was conducted as a subjective indicator. Objective evaluation showed significant improvement in keratinocyte moisture content after the study with the use of P–AL. However, the other objective and subjective indicators found no significant difference between the solutions and no sign of skin irritation. This study demonstrates that the use of P–AL does not harm the hand skin of health care workers even in the cold season when skin irritation tends to occur, and suggests the possibility of continuous use of P–AL for general infection control and prevention against non-envelope viruses.
This study aimed to identify the awareness of specialized practices to facilitate infection control and influencing factors among certified expert nurses, with a focus on organizational, personal, and task- and role-related aspects of these factors. The subjects were certified expert nurses working in general hospitals with more than 500 beds, with practical experience of more than 1 year. The survey was conducted between October 2010 and September 2011. A qualitative and inductive approach was employed to analyze interview data. As a result, the factors affecting specialized practices for infection control among certified expert nurses could be classified into 3 categories: organizational, personal, and task- and role-related. Three categories were identified in relation to organizational factors: [acceptance by the head nurse on the ward], [negative effects of the organizational climate on the ward], and [the presence of someone offering support in the organization]. There were 2 categories for personal factors: [communication skills] and [motivation for role performance]. Six categories were included in task- and role-related factors: [difficulties with interventions], [relationships with doctors], [limitations in terms of personal time], [role performance as a member of the Infection Control Team (ICT)], [presence of a link nurse], and [experience as a certified expert nurse]. These categories may be used to develop support systems for certified expert nurses in infection control.
The use of gloves in the healthcare setting is encouraged as a simple and effective method to prevent contact infection. Nevertheless, gloves do not provide complete protection against hand contamination which may lead to bacterial transmission by inappropriate use. In this study, a new training method for hand hygiene education to guarantee hand decontamination by medical glove use was introduced. The study included medical students who attended microbiology courses from 2008 through 2011. The students were divided into four groups to examine different methods of hand treatment prior to glove use. Each group worked for 30 minutes after putting on gloves. Hand hygiene was evaluated by direct counting of bacterial isolates collected by the stamp agar culture method. The results showed that colony counts of bacteria were significantly decreased by hand-washing or hand-rubbing before wearing the gloves. Hand-washing with chlorhexidine was superior to hand-rubbing with alcohol-based hand rub in reducing spore-forming bacteria. Hand-rubbing with alcohol-based hand rub after removing the gloves was also effective. Although the students who participated in the training varied each year, the results were comparable. This method appears to be useful for providing practical knowledge on the correct timing and the effects of hand hygiene of using gloves.
Sustained effects of hand washing before operation and its impact on the skin, and evaluation of use of a scrub pharmaceutical, which mainly consists of a foam of chlorhexidine gluconate (CHG) and liquid medium, was compared with 2 liquid scrub pharmaceuticals including CHG. In addition, the sustained effect of hand washing with foam scrub pharmaceutical using different volumes was also investigated. Applying 6 mL (one shot) of scrub pharmaceutical to 16 healthy adult subjects, the sustained effect of hand washing was studied, and viable cells were counted twice, just after hand washing conducted before operation and at 5 hours after washing according to the “glove juice method”. In the case of the foam scrub pharmaceutical, a similar study was carried out under conditions to reduce the one shot volume from 6 mL to 2 mL and to 4 mL. Applying to 14 healthy adult subjects through cleaning process of both the inner forearms 5 times per day for 4 days, the effect on the skin was studied, and then the water content measured in the horny cell layer of the inner forearms and the subjects were surveyed by questionnaire on the “objective evaluation and impression from use” through scored skin images. The difference in sustained effect for hand washing between foam and liquid scrub pharmaceutical was not significant until 3 hours after 6 mL use (one shot), so both had similar effects. Use of more than 4 mL (one shot) was favorable for the foam scrub pharmaceutical. As for the effect on skin, on the 4th day after the test started, all 3 pharmaceuticals induced similar extents of skin chapping compared to the skin surface before the test started, but there was no significant difference between the 3 pharmaceuticals. Foam scrub pharmaceutical was highly evaluated in terms of impression from use. The sustained hand washing effect of the foam scrub pharmaceutical was the same as that of the liquid type, suggesting a good impression from use.
The present study investigated the risk of blood exposure to the eyes of circulating nurses, and considered the relevance of circulating nursing services, surgery information, and perception of blood splashes of nurses. Blood exposure was detected by the luminol test. The sheets of 143 eye guards were collected. Blood was detected on 41 sheets (28.7%). The test of differences found a significant difference in the presence or absence of blood exposure with the following parameters: operative time, total blood loss, amount of bleeding from the gauze, and gauze count. Logistic regression analysis showed total blood loss and gauze count as risk factors for blood exposure. The gauze count increases the risk of blood exposure around the eye of the circulating nurses in operating room. Therefore, we need to protect around the eyes at all times, and to consider the process of gauze count.
Until recently, the kit used in our hospital to determine Clostridium difficile infection (CDI) detected only toxins A and B. However, we recently switched to a kit that detects both toxins and antigens, after production of the previously used kit was discontinued. Accordingly, hospital staff expected that the change in kits could lead to confusion in the clinical setting concerning the interpretation of “antigen-positive toxin-negative” cases. To investigate whether countermeasures for CDI should be implemented, culture tests were performed for antigen-positive toxin-negative cases and correlations with fever and increased inflammatory marker values were examined. Isolation cultures were performed for specimens obtained from 31 antigen-positive toxin-negative cases, examined using the new kit with the direct method in August and September 2012. The isolates were then retested using the same kit. The presence of diarrhea, fever, and increased inflammatory marker values was also surveyed. Diarrhea was observed in all 31 cases. The preparation of isolation cultures was successful in 24 of the 31 cases. Retesting of these cases gave positive results for toxins in 17 cases and negative results in seven cases. Fever was observed in 13 cases (76.5%) and increased inflammatory marker values were observed in 12 cases (70.6%) of the 17 toxin-positive cases on retesting. Of the remaining 14 cases (seven toxin-negative cases on retesting and seven unsuccessful isolation culture cases), fever was observed in six cases (42.9%) and increased inflammatory marker values were observed in six cases (42.9%). There were no significant differences between the two groups. However, the possibility of CDI cannot be excluded in antigen-positive toxin-negative cases exhibiting diarrhea, fever, and increased inflammatory marker values. Therefore, contact infection countermeasures should be implemented quickly and treatment initiation should be considered in such cases in the future, as is now applied for toxin-positive cases identified using the direct method.