[in Japanese]

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[in Japanese]

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  The World Health Organization recommends the measurement of antimicrobial consumption using defined daily dose (DDD) as the gold standard method. However, the DDD measure, which is only the aggregated purchase data of antimicrobials, cannot easily assess the appropriateness of antimicrobial use. The present study evaluated antimicrobial consumption in our hospital from January 1, 2005 to June 30, 2013 using the days of therapy (DOT) method, which is recommended as an antimicrobial stewardship program metric. Time series analysis of ceftazidime consumption showed significant decreases in the values measured by the DDD method and the DOT method, but no significant change in the DDD/DOT ratio, which indicated that reduction of patient numbers or shortened treatment duration had lead to the decrease in total ceftazidime consumption. Analysis of meropenem consumption showed significant increases in the values measured by the DDD method and the DDD/DOT ratio, but no significant change in the values measured by the DOT method, which indicated that elevation of the daily dose had lead to increased total meropenem consumption. Analysis of teicoplanin consumption found significant increases in the values measured by the DDD/DOT ratio and significant decrease in the values measured by the DOT method, but no significant change in the values measured by the DDD method, which indicated that elevation of the daily dose and reduction of patient numbers or shortened treatment duration had lead to no change in total teicoplanin consumption. From these results, we conclude that the measurement of antimicrobial consumption using the DDD method with the DOT method was useful for trend analysis of antimicrobial consumption and promotion of appropriate use.

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  Vancomycin hydrochloride (VCM) is mixed with bone cement during procedures such as joint prosthesis fixation for the prevention and treatment of infection. Such mixing of VCM with bone cement in the operating room requires aseptic manipulation. Therefore, VCM injection vials are sterilized with ethylene oxide gas (EOG) before transportation into the operating room. Since EOG is a group 1 carcinogen, any residue may have adverse effects on the human body. The present study examined the presence or absence of EOG contamination in VCM injection vials sterilized with EOG, the appropriate degassing period for safe use, and the possible decrease in the VCM titer caused by contact with EOG. The mean EOG contamination in the VCM injection vials after sterilization was 66.7 ppm immediately after aeration for 17 hours (n=3) following the sterilization and 8.3 ppm immediately after aeration for 41 hours (n=3). Subsequently, the vials were left to stand in the room. EOG in the vials disappeared after 14 days in the vials aerated for 17 hours and after 1 day in those aerated for 41 hours. The VCM titer did not decrease after EOG sterilization (n=5). Therefore, for the safe use of EOG-sterilized VCM for operations such as joint prosthesis fixation, we recommend that the sterilized vials should be aerated for 17 hours and left in a room for 14 days or more for degassing. If the VCM is to be used sooner, we recommend that the sterilized vials should be aerated for 41 hours and left in a room for 1 day or more for degassing.

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  Healthcare-associated infection is sometimes mediated through contamination of the hand, nasal cavity or uniforms of medical staff. Standard precautions can prevent infection mediated by the hands and fingers, but not that by uniforms. We investigated the amount and types of bacteria attached to the uniforms of medical staff according to the type of occupation and the site where the uniform is worn. Six people of 3 types of occupation, nurses (Ns), doctors (Drs) and physical therapists (PTs), who worked at Wakayama Medical University Hospital were recruited. The subjects wore clean uniforms for 3 days and performed their usual tasks. After 3 days of work, the amount and types of attached bacteria were surveyed using a swab culture method at 13 parts of the uniform, each using an area of 100 cm². Among the types of occupation, the quantity of attached bacteria per 100 cm² was greatest in PTs at 5.95 CFU, followed by Drs at 3.24 CFU and Ns at 1.83 CFU, but the differences were not statistically significant (p=0.165). Among the uniform sites, the quantity of bacteria on both sides of the sleeves and shirttails was significantly greater than at other sites (p=0.0010). The most frequently detected bacterium was coagulase-negative staphylococci followed by Staphylococcus aureus. For infection control, in addition to the enforcement of hand-washing, prevention of contamination of the sleeves and shirttails of uniforms may be necessary, especially for PTs.

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  The significance of clinical practice for medical students is continuing to increase in conformity with international standards, but the clinical practice of infection control is less well developed. The present study evaluated infection control education using simulations involving 94 medical students. A survey was conducted to evaluate the knowledge of standard precautions and cleaning, disinfection and sterilization techniques before and after practice in the surgical operation center. Before the practice, 91% of the students were aware of the standard precautions, but 68% considered that the intentions were unfamiliar. After the practice, 97% of the students understood the standard precautions, and 95% believed that they could practice the standard precautions. The students displayed a significant increase in knowledge about cleaning, disinfection and sterilization after the practice. Standard precautions are not included in the learning purpose of the objective structured clinical examination, so addition should be considered. The present results indicate that education using simulation is effective for the understanding of standard precautions, as well as for cleaning, disinfection and sterilization techniques. The standard precautions are diverse and present difficulty in clinical practice, so continuous education should be provided throughout the training from medical student to physician.

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  This study investigated the current status of measures against infectious diseases and the challenges at elderly care facilities. A survey on measures against infectious diseases was conducted with the participation of 140 welfare facilities for care of the elderly and 66 long-term care facilities for the elderly in Prefecture A between March and August 2013, to which 81 facilities responded (response rate, 39.3%). The most common measures against infectious diseases conducted at these elderly care facilities were the development of manuals (100.0%), the establishment of a committee on infectious diseases (95.1%), and the provision of staff education (84.0%). However, insufficient measures were taken for staff education (56.8%) and drills on outbreaks of infectious diseases (42.0%). Influenza vaccination for facility workers was performed at a high rate (98.8%), and all elderly care facilities vaccinated their residents. Influenza outbreaks were observed every year at 1.8% and in nonconsecutive years at 29.1% of the welfare facilities, whereas influenza outbreaks were observed in non-consecutive years at 56.0% of the long-term care facilities. Norovirus outbreaks did not occur every year at any of the elderly care facilities, but were observed in non-consecutive years at 30.9% of the welfare facilities and 40.0% of the long-term care facilities. Elderly care facilities have recently been establishing systems to control infectious diseases. However, influenza and norovirus outbreaks are still observed in 30–50% of elderly care facilities, so appropriate infection control and education systems must be developed at these facilities.

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  Antimicrobial use and antimicrobial resistance rates were studied at 7 medical facilities, which belonged to the Northern Nagano medical district, during a 5-year period from January 2007 to December 2011. The results showed that cefotaxime+ceftriaxone- or levofloxacin-resistant rates in Escherichia coli were significantly increasing not only in each facility but also in the whole network (Infection Control Network of Northern Nagano), and antimicrobial use was tending to increase within the whole network. According to the results, we considered that antimicrobial use and resistance rates in E. coli required surveillance in the whole region as well as in each facility. On the other hand, the carbapenem-resistant rate in Pseudomonas aeruginosa was hardly changing both in each facility and the whole network, and carbapenem use was also unchanged in the whole network. Therefore, antimicrobial use and resistance (AUR) surveillance for P. aeruginosa should be maintained in each facility, and confirming the AUR surveillance level of individual facilities in the region should be useful.

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