The cost-effectiveness of measures for preventing the spread of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections in our hospital were assessed by costs of the consumption of gloves (pieces/patient-days), aprons (pieces/patient-days), alcohol-based hand rubs (ABHRs) (mL/patient-days) and antibiotics in the period 2006–2009. A new nosocomial MRSA case, including colonized or infected patients, was defined as a MRSA case if the patient had no known history of MRSA before admission. Patients were excluded from MRSA cases if a clinical culture was positive for MRSA within 48 hours of admission. The hospital charges related to MRSA infection were calculated. The number of cases of MRSA in 2009 (about 100) was decreased compared with 2006. Hospital charge related to MRSA infection was about 67 million yen in 2006 and about 27 million yen in 2009. A statistically significant correlation was observed between number of MRSA cases and consumption of gloves, aprons and ABHRs, which indicated number of cases of MRSA was inversely related to standard precautions and hand hygiene. The costs of consumption of gloves, aprons and ABHRs in 2009 increased by about 58 million yen, about 330 yen/patient/day, compared with 2006, indicating the costs to reduce the number of MRSA cases. However, if additional charges for infection control were accepted in 2009, infection control would be enhanced in the hospital.
Bloodstream infection data were analyzed from all 614 patients who had undergone central venous catheter insertion from 2009 to 2012 in the hematology ward of our hospital and the infection prevention measures were evaluated. The incidence of bloodstream infection was 6.85 (per 1000 days of catheter use) in 2009, but dropped to 3.4 in 2012. A comprehensive approach to prevent bloodstream infection using a combination of techniques supported by clear evidence has been proposed. Our hospital has also implemented a noteworthy bundle approach comprising various measures including maximal sterile barrier precautions. Future thorough implementation of the bundle approach may further decrease the infection rate.
Maximum sterile barrier insertion and use of antiseptics during insertion are important for preventing central line-associated bloodstream infection (CLABSI). However, few studies have investigated the effect of medical care after the insertion of catheters. A procedure manual was developed showing the correct way to replace the intravascular catheter site dressing, and directed every nurse in charge to follow the manual. After standardizing the procedure, the CLABSI rate was compared before and after intervention. The CLABSI rate was 4.34 cases/1,000 catheter-days in the pre-intervention period (April 2012–March 2013) vs. 1.52 in the post-intervention period (April 2013–March 2014). This educational intervention focused on correct replacement of the catheter site dressing resulted in a significant decrease in the incidence of CLABSI.
This study investigated the types of skin antiseptic solution used for vascular access (VA) in hemodialysis patients and the reasons for selection. Seven hundred health-care facilities were randomly selected from the total of 3,827 hemodialysis centers in Japan, and a self-completed questionnaire was mailed to the chief nurses of the selected health-care facilities to conduct an anonymous survey. Three hundred and twenty-six facilities returned the questionnaires (46.5% response rate), and the answers from 323 facilities were analyzed (99.1%). Usage of ethanol was high in patients with arteriovenous fistulas (38.1%), and povidone-iodine was used for many cases of all VA types except arteriovenous fistulas (arteriovenous grafts 74.8%; superficial arteries 72.1%; short-term VA catheters 72.0%; long-term VA catheters 65.8%). Usage of chlorhexidine gluconate-ethanol was 18.4% for short-term VA catheters and 21.8% for long-term VA catheters. In a few cases, weakly and strongly acidic water were used for arteriovenous fistulas, physiological saline (normal saline) for short-term VA catheters, and physiological saline (normal saline) or tap water for long-term VA catheters. The reason for choosing the antiseptic solution was significantly related to the first choice of antiseptic solution for all five VA types. Knowledge regarding the skin antiseptic solutions in the Centers for Disease Control and Prevention guidelines was significantly related to the first choice of antiseptic solution for short- and long-term VA catheters. This study found many types of skin antiseptic solutions were used for all five VA types. More solid evidence for correct selection of the optimum skin antiseptic solutions for each of the VA types is needed.
A structured questionnaire survey involving nurses and care workers from 6,000 facilities (healthcare settings and nursing care homes) in Japan was conducted to clarify the details of perineal cleansing as part of infection-control measures taken by these facilities. A total of 1,930 completed questionnaires (32.2%) with effective answers were collected. Totals of 937 (response rate: 48.5%) questionnaires were collected from facilities with general beds, 600 (31.1%) from facilities with beds for patients requiring long-term care, and 393 (20.4%) from nursing care homes. In approximately 70% of the facilities being investigated, more than half of the target subjects (facility users and hospitalized patients) used diapers. In these facilities, 2 healthcare providers generally conducted perineal cleansing for every patient for a maximum of 10 minutes using 1 or 2 pairs of gloves. However, only 34% of providers did not use masks or aprons. Healthcare providers commonly put on gloves and aprons before touching patients, but the timing of taking off the gloves differed between the facilities. The differences between the facilities conducting perineal cleansing were as follows; the number of healthcare providers and time required for each patient, usage of personal protective equipment, timing of change gloves and apron, and technical education. No differences were found between the facilities in hand hygiene using running water after perineal cleansing, and care taken to not touch the surroundings during perineal cleansing to prevent the contamination of environments around patients undergoing perineal cleansing.
The Japanese literature on anaphylactic shock caused by chlorhexidine gluconate was surveyed, and 84 Japanese cases from articles published since 1974 were analyzed. Among 77 cases in which sites and concentrations were documented, chlorhexidine gluconate was used off-label in 57 cases (74.0%) and used for approved indications in only 10 cases. Sex ratio was 2.2:1 (55 males and 25 females) and adult cases (62, aged 16 to 64 years) were more prevalent than those of children (7, aged 15 years or younger) and the elderly (11, aged 65 years or older). The results of this survey suggest that compliance with approved indications, such as sites and concentrations, is important for the prevention of anaphylactic shock when using chlorhexidine gluconate.
In our hospital, hepatitis B surface (HBs) antigen/HBs antibody tests were carried out on all staff members as hepatitis B virus (HBV) infection control measures regardless of previous information, and HB vaccination were given to staff with negative HBs antigen and HBs antibody until 2010. The infection control team (ICT) drew up a new HB vaccination program based on the guidelines published by the Japanese Society for Infection Prevention and Control, and planned new principles for HBs antigen/HBs antibody tests and HB vaccination in 2011. We investigated the results of the vaccination rate and cost effectiveness based on the new principles for HB infection control. In the new vaccine program, HBs antigen/HBs antibody tests were only performed on the staff with negative HBs antibody in the previous year and newly employed staff, finding 118 of 238 staff were antibody negative. Forty-eight (40.7%) of these 118 staff members completed 1-cycle vaccination consisting of three injections of vaccine. Thirty-six (75%) of these 48 staff members became seropositive and 10 members remained seronegative. The seropositivity check was not performed because of retirement in 2 members. The new vaccine program reduced costs by about 740,000 yen in total, about 490,000 yen by reduction of antigen/antibody tests and about 250,000 yen by reduction of vaccinations. The new vaccine program may allow appropriate selection of staff members for tests and vaccination and to check the seropositivity of vaccinated staff, whereas the previous protocol could not monitor the effectiveness of vaccination.
Public health practitioners must use specialist knowledge to deploy countermeasures against outbreaks of infectious disease in local communities. A questionnaire was sent to 147 public health practitioners attached to 47 prefectural administration offices and 100 public health centers run by designated cities (city public health centers). The questionnaire intended to identify difficulties encountered by the public health practitioners in performing their duties, and to determine their participation status and training needs. The response rate was 36.7% (54/147). Compared with prefectural administration offices, city public health centers generally appeared to be more active in anti-infection activities involving medical surveillance and educational settings. This indicates that city public health centers put community-associated countermeasures in place whereas prefectural administration offices have administrative functions. A high proportion of public health practitioners (70–80%) were involved in promotion activities and consultation on anti-infectious disease measures. A small proportion of the public health practitioners (≤30%) found some of their anti-infectious disease duties particularly difficult. A majority of the public health practitioners had participated in anti-tuberculosis seminars/training, and approximately 60% recognized the need for such seminars/training. High training needs were found for “multi-drug resistant bacteria,” “vaccination,” “human T-lymphotropic virus 1,” “sexually transmitted diseases,” and “anti-infectious diseases health guidance,” but low participation rates in such seminars and training should be addressed in the future. High training needs were also identified for “new influenza strains” and “responses to infectious disease outbreaks.” Seminars and training on crisis management for anti-infectious disease measures were the most desired provisions among the public health practitioners.