The Groshong valve-type peripherally inserted central venous catheter (PICC) was introduced for patients with malignant disease who require long-term treatment at the Department of Hematology and Oncology. This study included 80 of 148 patients treated with the central venous catheter (CVC) before the introduction of the PICC (CVC group), and 57 of 66 patients treated with the PICC (PICC group). Central line-associated bloodstream infection (CLABSI) rates were 5.3/1,000 catheter-days (CDs) in the CVC group and 1.0/1,000 CDs in the PICC group, showing a significantly lower rate of CLABSIs in the PICC group than in the CVC group (p<0.01). PICC insertion caused no complications. The mean indwelling time was 72.8 days in the PICC group, which was at least twice that in the CVC group (p<0.01). Maintenance of the Groshong valve-type PICC required only a weekly saline flush, so this catheter was suitable for chemotherapy patients who required repeated hospitalization. The lower CLABSI rate and longer indwelling time of the PICC significantly reduced the number of catheters required per patient to 1.2 in the PICC group compared to 1.9 in the CVC group (p<0.01). Therefore, the PICC was effective in preventing infection, ensuring safe infusion, and providing a cost-effective CVC device for patients requiring long-term treatment at the Department of Hematology and Oncology.
The complex-type chlorine-based disinfectant cleaner is a tablet-type agent which is dissolved in 500 mL of tap water, and the prepared solution (0.1% of available chlorine) displays a light red color. The stability and color degradation of the prepared solution were examined. The prepared solution was put into airtight glass containers and stored under the following conditions: 1) under room light at 23℃ to 30℃, 2) under direct sunlight at 24℃ to 34℃, 3) under shaded conditions at room temperature, 4) under shaded conditions at high temperature (40℃), and 5) under shaded conditions at 4℃. The available chlorine concentration (measured by an iodine titration technique), pH, and absorbance at 520 nm of the prepared solution were measured immediately, and 3, 7, and 14 days after preparation. The available chlorine concentration and pH of 0.1% sodium hypochlorite solution were measured as controls. The available chlorine concentration of the prepared solution fell under the various test conditions to 1) 71% and 58%, 2) 68% and 53%, 3) 70% and 59%, 4) 44% and 17%, and 5) 93% and 89%, at 7 days and 14 days after preparation, respectively. The temperature of the storage area clearly affected the stability of the prepared solution. pH, absorbance, and available chlorine concentration of the prepared solution were all reduced. Moreover, the color degradation of the prepared solution reflected the available chlorine concentration. The available chlorine concentration of 0.1% sodium hypochlorite solution fell under conditions 1) 95% and 91% and 2) 54% and 32%, at 7 days and 14 days after preparation, respectively, but not under conditions 3), 4), and 5). The available chlorine concentration of 0.1% sodium hypochlorite solution fell under direct sunlight, but pH was almost constant under all conditions. These findings show that the available chlorine concentration of a prepared solution falls gradually at room temperature, and the prepared solution retains the required properties for one week. However, high temperature storage must be avoided. In addition, the decrease of available chlorine concentration is well reflected in the color intensity, so that the residual available chlorine concentration can be checked by observation of the solution color.
This study evaluated the combined use of adenosine triphosphate (ATP) bioluminescence and microbiological assays for monitoring environmental surfaces in a teaching hospital to develop a method for rapid detection of microbial contamination that could constitute a health risk to patients. ATP bioluminescence assay and microbiological screening were performed of various surfaces of toilet facilities in outpatient wards. In each of the five sites screened, the ATP levels were significantly higher than on a cleaned, disinfected stainless steel surface, indicating that all screened surfaces were “high-touch” surfaces and the surfaces harbored significantly higher levels of certain organic matter. The microbiological assay confirmed that the microbiological contamination had spread throughout the screened sites. The ATP values of the samples positive for microbes occurred in a significantly higher range than those of the samples negative for microbes (p<0.01). However, no linear relationship was established between the ATP values and aerobic colony counts of the screened sites. These results clearly imply that the use of ATP bioluminescence to measure the microbial contamination of an environment yields qualitative rather than quantitative data. In conclusion, ATP monitoring is a rapid and convenient method to assess environmental contamination and persistence of microbes and to monitor the effectiveness of current cleaning practices.
The Jichi Medical University Hospital has designed “a cart for supporting procedures for vessel puncture” that is equipped with incisive blood vessel puncture devices and a ‘sharps’ disposal container, in order to prevent needlestick injuries that occur with the failure to provide a ‘sharps’ disposal container at the patient’s bedside, and introduced the cart for clinical use in 2010. The total number of cart placements, total number of reported needlestick injuries, and number of incidents that occurred with failure to provide a ‘sharps’ disposal container at the patient’s bedside were examined during the period from 2007 to 2013, and the effects of the cart introduction were evaluated in reducing the frequency of needlestick injury incidents. The total reported number of needlestick injuries remained the same before and after the cart introduction. However, the number of incidents that occurred with failure to provide a ‘sharps’ disposal container at the patient’s bedside reduced significantly (p<0.01) with the introduction of the cart. A negative correlation was observed between the total number of cart placements and the number of incidents associated with failure to provide a ‘sharps’ disposal container (correlation function, r=−0.83; p<0.05). Introduction of the cart for supporting procedures for vessel puncture would be beneficial for facilities that report a high number of needlestick injury incidents due to the failure to provide a ‘sharps’ disposal container at the patient’s bedside.
To clarify changes in infection control in medical facilities after the revision of medical fees, including those for infection control, questionnaire surveys were conducted in May 2008, January 2011, and August 2013; the second and third surveys were made after the revisions of medical fees in April 2010 and April 2012, respectively. A total of 1,000 facilities were selected from medical facilities with beds throughout Japan, and were asked to cooperate with the study; 539, 494, and 574 facilities participated in the first, second, and third surveys, respectively. The infection control team (ICT) availability rate in each survey was 78% (539 responses), 77% (494), and 88% (574), respectively; a marked increase in the rate was observed in the third survey. The rate of facilities charging additional fees was 46% in the second survey, 90% of which had 300 beds or more, and 85% in the third survey (additional fee category 1: 60%; 2: 25%), with a marked increase in the proportion of facilities with less than 300 beds. These changes in additional fee charges may be explained by the increased frequency of ICT rounds. During the study period, the rates of facilities making 1 or more ICT rounds weekly increased from 16% in the first survey to 35% in the second and 54% in the third surveys. Furthermore, antibacterial drug management was promoted in a large number of facilities, and rates of facilities requiring permission or reporting for carbapenem use increased from 45% in the first survey to 59% in the second and 75% in the third surveys. A similar tendency was also observed in relation to anti–MRSA injections, with the rate was higher than 70% in the third survey. The numbers of ICT members and other specialists had also increased. These findings confirm that infection control approaches and systems have been strengthened in medical facilities, regardless of the number of beds, since the revision of medical fees in April 2012.
When a large-scale disaster strikes, medical institutions give priority to a large number of hospitalized patients in critical condition. Therefore, the logistic support for evacuees in shelters receives low priority. Consequently, infection prevention precautions taken by individual evacuees become important. This study aimed to gain a better understanding of such precautions in order to develop measures to prevent the spread of infection during disasters. Structured interviews regarding hand hygiene and environmental sanitation were conducted with 80 evacuees of the Great East Japan Earthquake who had lived in emergency shelters. About 60% of evacuees reported the absence of facilities to wash their hands immediately after the earthquake. Restored water supply, and the arrival of relief goods, led to improved hand hygiene among the evacuees. However, given the importance of individual hygiene habits, day-to-day involvement might be necessary to ensure hand hygiene precautions among evacuees. We also found that only about 25% of evacuees were aware of external support for infection prevention behavior and sanitary control guidance. The hygiene environment was maintained in shelters with leaders who had received guidance on infection prevention behavior. This finding suggests the importance of a leader who manages the group in order to prevent the spread of infection. We should provide support to ensure that evacuees can ensure infection prevention behavior.
A questionnaire survey of infection prevention measures was conducted to assess the overall state of the institutions and the satisfaction level of the employees at 143 medical institutions of the National Hospital Organization. Claims for payment for infection prevention measures made by the institutions based on the criteria found that, of 109 institutions that responded, 66 claimed Payment 1 (62.9%), 33 claimed Payment 2 (31.4%), and 10 claimed none (9.5%). Institutions that claimed Payment 1 tended to have a larger number of beds for general patients, whereas institutions that claimed Payment 2 or none had fewer beds. Furthermore, the average number of hospitalization days tended to be significantly lower in institutions that claimed Payment 1 (p=0.01). The number of physicians and nurses was greater in institutions that claimed Payment 1 than in those that claimed Payment 2 or none. The proportion of employees who answered they were “satisfied” was significantly higher in institutions that claimed Payment 1, whereas the proportion of employees who answered they were “unsatisfied” was significantly higher in those that claimed none (p=0.01). The improvement factor of “appropriate use of antibiotics” was the highest at 11.0 in institutions that claimed none. Therefore, promoting “appropriate use of antibiotics” was considered to be urgent in those institutions. In institutions with few staff and claimed no payment, the improvement factor of “thorough practice of infection prevention measures” was high (10.2), possibly because such institutions cannot easily allocate full-time staff to the infection control team. These results indicate that investigating the overall condition of institutions and the satisfaction level of the employees for infection prevention measures enables evaluation of their infection control measures and determination of points for improvement.
This study evaluated delays caused by both the patient and physician in the detection of pulmonary tuberculosis (TB) and examined associated factors in hospitals without TB units. We conducted a case series study using the data triangulation method. Seven patients (6 males and 1 female) diagnosed with TB from July 2010 to September 2011 at a General Hospital, and 4 physicians who established the diagnosis were interviewed using semi-structured questions about the progress from symptom appearance to diagnosis. Information on delays introduced by patients was not obtained from the medical records. However, from the interview data, patient-associated delay was identified in 6 of 7 patients extending from several months to several years. Information of physician-associated delay was not obtained from both medical records and interviews. The factors associated with the patients were “symptom that did not lead to seeking for medical care,” “delay of the notice of medical examination findings,” “lack of knowledge about TB,” and “lack of follow up after abnormal findings at the periodical medical examination.” The symptoms that did not cause patients to seek medical care included constitutional symptoms such as febricula, appetite loss, and fatigue, in addition to the respiratory symptoms thought to be the typical symptom of TB. In particular, the elderly tended to overlook these symptoms which were regarded as a result of aging. If aggravation of any symptom is noticed, health care professionals should suggest medical care to shorten the patient-associated delay. In addition, physicians should seek consciousness and knowledge about TB, and continuation of medical screening systems such as examination of the respiratory organs by a physician or double check of the chest radiograph by a radiologist, and the management of past history are important to reduce physician-associated delay.