The Japanese Society for Infection Prevention and Control (JSIPC) was established by Ueda et al. in 1986. The establishment of the JSIPC was based on two key principles. First, to initiate discussion on infections in current society. Second, to involve a wide range of stakeholders to increase awareness of infection. The recent experiences caused by the Ebola outbreak, spread of resistant bacteria, and the infections associated with the earthquake disaster have caused re-recognition that infections could outbreak in any social situation and hospital infection is just one example. The importance of the team approach in medical care is now widely accepted. Our multidisciplinary team approach is appreciated as a representative example of the team approach in medical care. As a result, medical service fees have been increased. The JSIPC has been very important to encourage team construction with the involvement of multiple stakeholders. The conditions allowing recent domestic and foreign infections suggest that the initial concept of the JSIPC is still important, although the principles have been understood for 30 years. Consequently, the JSIPC still has a major role for the prevention of infections in various societal units worldwide such as hospitals and local populations.
Healthcare-associated infection (HAI) risk assessment is a continuous process of visualizing and evaluating HAI risks through epidemiological surveillance. Therefore, it is a systematic and proactive prevention activity aimed at improving healthcare quality. The present study describes the process of HAI risk assessment and introduces quality indicators used to evaluate HAI risks and prevention efforts.
The Centers for Disease Control and Prevention guidelines recommend replacing peripheral venous catheters every 72–96 h (routine replacement), but studies in recent years have shown that venous catheter replacement is clinically safe to perform only if events occur that make replacement unavoidable, such as phlebitis. This indication is known as the clinically-indicated replacement method. The present historical control study attempted to verify the safety and cost effectiveness of clinically-indicated replacement in a single hospital which had introduced the replacement method. Patient characteristics and event rate were investigated using the peripheral vein catheter-related surveillance records and medical records. Costs and rates of onset of bloodstream infection, phlebitis, extravasation, and occlusion (events) were compared in the 2 months before and after introduction, excluding the first month after introduction of the clinically-indicated replacement method. The calculated cost included the material cost, personnel expenses, and disposal costs per transfusion treatment. No significant increase was found in the onset of events after the switch from the routine replacement method to the clinically-indicated replacement method. Cost minimization analysis found the increment cost was −268 yen per infusion therapy procedure after the switch from the routine replacement method to the clinically-indicated replacement method.
The new law regarding prevention of hospital infection, which promotes local medical cooperation with healthcare facilities with additional charges, was enforced in 2012. The efficacy of this law was evaluated by a survey of 395 targeted hospitals in Osaka Prefecture in October 2013 and the results from 145 (36.7%) respondent hospitals were summarized. After enforcement of the law, the development of cooperation with other institutions was recognized in the hospitals charging additional fees, especially using the category 2 charge. Further cooperation is desirable in hospitals without additional charges. Collaboration between hospitals with and without additional charges is necessary for the improvement of infectious disease prevention. Better infection control could be achieved by the use of infection control networks established by both the participating hospitals and governmental institutions such as public health centers.
Hand hygiene plays a major role in preventing infections. We analyzed the effect of a hand hygiene campaign for decreasing healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) at our hospital. Monthly data were retrospectively reviewed from February 2013 to March 2014. Consumption values of alcohol-based hand scrub before and after the campaign were 5.8 and 11.6 L/1000 patient-days, respectively (p<0.01). Moreover, the isolation rate of MRSA significantly decreased after the campaign from 2.5% to 1.5% (p<0.01). Aggressive hand hygiene campaigns are useful to decrease the isolation rate of HA-MRSA.
To determine the risk factors for the isolation rate of MRSA, we monitored hand disinfectant use, hand soap use, antimicrobial use density, nursing intensity and other characteristic of hospital from fiscal 2010 to 2011 in 5 hospitals in Niigata. Statistically significant correlation was observed between the isolation rate of MRSA and nursing intensity (R=0.8982, p=0.04) in univariate analysis. Statistically marginally significant correlations and differences was observed between the isolation rate of MRSA and all cephalosporin use (R=0.7606, p=0.14), and adoption of a notification system (63.0% vs 83.6%, p=0.15). Nursing intensity was found to be a significant factor (R=0.8982, p=0.04) by multiple regression analysis. These results suggest that hand hygiene quality and use of personal protective equipment was declining with increased nursing intensity, which resulted in increased isolation rate of MRSA. On the other hand, we considered that appropriate antibiotic use is important, because all cephalosporin use and adoption of a notification system was marginally significant factors. The results suggest that nursing intensity is one of the factors that affect the isolation rate of MRSA.
Aggressive vaccination programs for medical workers are performed to prevent vocational infection in hospitals that adopt additional infection prevention measures. However, vaccination for medical workers is not adequate for other hospitals or at nursing welfare facilities. The spread of rubella that started in 2012 has increased the need for vaccination at our mixed care hospital with 161 beds. We investigated the past history and vaccination for epidemic virus infections, and measured serum antibody titer and encouraged further vaccination based on the results. The records of infection, antibody titer, and two times vaccination were confirmed by 14 of the 217 full-time employment staff, suggesting a very low rate of immunization (6.5%). The percentage by which antibody titer exceeded the standard titer measured by the EIA method was 70.5% (153 persons) for measles, 78.3% (170 persons) for rubella, 60.4% (131 persons) for mumps, and 100% (217 persons) for chickenpox. Therefore, the relationship between infection or vaccination in the past and positive antibody rate was low. Vaccination partly depends on individual payments but the overall rate was low. Successful appropriate epidemic virus infection measures must encourage vaccination based on the results of antibody titer measurements, in spite of records of infection and vaccination in the past. The expenses of vaccination should be paid by the medical facility.
Healthcare-associated infections (HAIs) are associated with longer hospitalization, poor outcome, and increasing costs. Therefore, prevention and control of HAIs are important in current healthcare facilities. Full-time or full-time equivalent infection control practitioners are expected to play an important role in the prevention and control of HAIs. Therefore, a questionnaire survey was conducted to evaluate differences in the prevention and control of HAIs, including Clostridium difficile infection (CDI), in the presence and absence of full-time or full-time equivalent infection control practitioners. This study was a part of the study, “Prevention measures and incidence of C. difficile-associated diarrhea among hospitalized patients in the National Hospital Organization (NHO),” and was conducted in the 47 facilities that had an infection control team among the 144 NHO facilities in Japan in August 2010. The total number of questionnaire items was 22, which were classified into 5 categories: the system of prevention and control of HAIs, the roles and responsibilities of the infection control team, compliance with standard precautions, environmental equipment, and CDI management. Of the 47 facilities, 26 (55.3%) had full-time or full-time equivalent infection control practitioners. Compared to facilities that had no full-time or full-time equivalent infection control practitioners, the facilities with these practitioners had consultations for prevention and control of HAIs, a reporting system for antibiotics, cleaning more than 5 days per a week in general wards, and patient and family education regarding CDI. This study suggests that the presence of full-time or full-time equivalent infection control practitioners is very important in the prevention and control of HAIs.