Drug-resistant bacterial infections in patients can aggravate disease conditions and prolong treatment durations, resulting in increased use of medical resources, and hinder measures aimed at moderating already strained health care costs. This study quantitatively estimated the additional medical resources used for drug-resistant bacterial infections, focusing on cases with penicillin-resistant Streptococcus pneumoniae (PRSP) infections judged by the Japan Nosocomial Infection Surveillance (JANIS). JANIS data and Diagnosis Procedure Combination/Per-Diem Payment System data were analyzed. The JANIS program collects data directly from voluntarily participating hospitals. The patients with PRSP infection were defined by the JANIS data. All subjects were categorized based on their diseases and surgical procedures as recorded in the data. Pairs of subjects with and without PRSP infections in each category were then matched according to a propensity score. To investigate the additional medical resources used due to PRSP infections, the differences in mean length of stay (LOS) and hospitalization costs were calculated between the matched pairs. The results showed that among all subjects, patients with PRSP infections had a mean LOS duration that was 2.79 days longer than uninfected patients. For patients under 5 years of age, PRSP infections resulted in an increase of 2.08 days in LOS and an additional 110,634 yen in hospitalization costs. This study presents a quantitative estimate of additional medical resources used due to PRSP infections. These drug-resistant bacterial infections resulted in clear increases in LOS among all patients, as well as increases in LOS and hospitalization costs in patients under 5 years of age. These findings have wide potential applications and can support technical assessments for infection control based on cost effectiveness. Comprehensive infection control measures that target drug-resistant bacterial infections are expected to be further developed.
This study investigated the current status of dialysis-associated infections, which greatly affects the prognosis of dialysis patients, and evaluated the effectiveness of surveillance and concurrent interventions carried out to decrease infection rates. The initial benchmark infection rate for short-term catheters in our healthcare facility when the surveillance started was 48.61/1,000 dialysis-days, which was significantly higher than the Research Group's rate of 14.55. Comprehensive interventions included improving maximum sterile barrier precautions during catheter insertion and education; furthermore, long-term catheters were introduced. The infection rates were reduced from 33.40 to 9.20 (p=0.05) before (July 2010–June 2012) and after long-term catheter introduction (July 2012–June 2013); the improved rate is comparable to that of the Research Group (8.21). The mean dwell time of short-term catheters also decreased slightly. These results suggest the effectiveness of surveillance in reducing infection rates.
Comparison of the total number of blood cultures per sickbed in fiscal 2011 with the cooperating hospital, Aizawa Hospital, found that only 1/3 of the staff of the cooperating hospital understood that blood cultures were not obtained. Therefore, active education about blood cultures was performed based on the numbers of blood cultures in a senior medical staff meeting. Electronic medical record displays were used to provide information about blood cultures in specific antimicrobial order. As a result, the collection of blood cultures per 1,000 inpatient-days increased from 11.7 before education to 16.7 in the first year and 21.3 in the second year after education, or almost double the number of blood cultures. This data was shared with cooperating hospitals to show the effect of education on use of blood cultures.
Active surveillance was performed to determine the prevalence of multidrug-resistant bacteria in patients with chronic neurological disease who were under respite care. Twenty-six patients were enrolled between April 2010 and August 2014. Positive screening cultures were obtained from sputum samples in 20 patients and from urine samples in 24 patients. Staphylococcus aureus was detected in 8 patients, of whom 6 (75.0%) had methicillin-resistant strains. Escherichia coli was detected in 9 patients (1 from sputum and 8 from urine), of whom 8 (88.9%) showed resistance to fluoroquinolones. Extended-spectrum β-lactamase-producing Enterobacteriaceae were cultured from 9 patients (3 from sputum and 6 from urine). The medical devices frequently used to treat these patients were considered to be the sources of the multidrug-resistant colonization.
Catheter-associated urinary tract infection (CAUTI) accounts for approximately 40% of hospital infections, and 80% of CAUTI cases occur after operation involving urethra catheters and urine collection bags (urine bag). A preliminary investigational study found that urine bags were left on the floor and those bags might be contaminated. In order to implement appropriate handling of urine bags, holders were installed for urine collection bags (holder) and buckets for urine waste fluid (bucket). However, knowledge and motivation about CAUTI prevention among operating room nurses and the utilization rate of those products remained low before this study. The aim of this study was to increase appropriate handling of holders and buckets to prevent CAUTI due to contaminated urine bags. As a multi-disciplinary intervention including educational meetings, post-hoc tests, and on-site audit activities, utilization rate of holders rose from 35.9% to 81.8% and that of buckets was kept high. Use of a holder was effective to prevent contamination of the drainage port by stability in the urine bag. Giving concise information on the effectiveness of holders and prevention of CAUTI as well as feedback of on-site audit were useful for raising the motivation of operating room nurses to prevent CAUTI by using holders and buckets.
A total of 66 patients treated with linezolid for more than 4 days between May 2006 and June 2014 in our hospital were investigated. Thrombocytopenia was observed in 31 patients (47.0%). The 66 patients were divided into two groups, with and without development of thrombocytopenia. The following objective variables were considered as risk factors for thrombocytopenia after linezolid administration: age, creatinine clearance (CCr), daily dosage of linezolid, duration of administration of linezolid before administration of platelets, albumen value, alanine aminotransferase value, aspartic aminotransferase value, and C-reactive protein value. Univariate analysis found significant correlation with CCr and duration of administration of linezolid. Multivariate analysis found significant correlation with CCr and duration of administration of linezolid. Therefore, CCr and duration of administration of linezolid are risk factors for thrombocytopenia. Renal function of the patients should be evaluated before administration of linezolid, and the duration of administration of linezolid should be minimized.
During clinical training, medical and paramedical students who directly communicate with patients in various places, including the bedside, may be exposed to infectious diseases, and, in turn, become a source of infection themselves. A questionnaire survey was conducted involving faculty members of universities educating medical, nursing, and pharmacy students, to clarify the status of infection control education in their faculties, focusing on 20 lecture and 14 practice programs. Responses were obtained from 46 faculties of medicine (response rate: 58%), 97 of nursing (41%), and 53 of pharmacy (72%). Six lecture programs (standard precautions, transmission-based precautions, methicillin-resistant Staphylococcus aureus infection control, norovirus infection control, purposes and methods of hand hygiene, and needlestick injuries) and 5 practice programs (hand rubbing using antiseptic hand rubs, hand scrubbing with running water and soap, and methods to appropriately wear and remove surgical masks, sterilized gloves, and gowns) were provided in more than 70% of the universities in each field. In contrast, lecture programs, such as Clostridium difficile infection control, and practice programs, such as methods to appropriately wear and remove N95 respirators and personal proactive equipment, were provided in less than 50% of universities in some fields. These results revealed that the content of infection control education provided before clinical training varies among not only fields, but also faculties, highlighting the necessity of determining lecture and practice programs that should be provided before clinical training in medical and paramedical faculties.