For adults, periodical vaccination with the Streptococcus pneumoniae vaccine and the influenza vaccine are recommended. Since two types of Streptococcus pneumoniae vaccines are available in Japan, administration methods of these 2 vaccines are demonstrated.
The bactericidal activities and sustained effects of three commercially available antimicrobial products against multidrug-resistant Pseudomonas aeruginosa (MDRP) and multidrug-resistant Acinetobacter (MDRA) were evaluated. Potassium peroxymonosulfate based disinfectant cleaner (RST), sodium hypochlorite (NaOCl) and ethanol for disinfection (EtOH) demonstrated rapid bactericidal activities in the suspension test and the wiping test. Three disinfectants were applied to wells of a multiwell plate and dried. Wells were exposed to MDRP or MDRA at 3, 6, and 24 hours after application. Only RST demonstrated persistent bactericidal activity against MDRP and MDRA for up to 24 hours after application under experimental conditions. These results showed that RST is effective for preventing touch contamination from high-touch surfaces.
The “Additional Reimbursement for Infection Prevention (ARIP)” legislation was newly established in 2012. We have investigated the status of infection control at our facility and examined the changes in promoting infection control, and the economic burden on the facility of infection control supply consumption. We compared the usage of items used for infection control, the number of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, and the MRSA infection incidence density rate in two time periods under the different ARIP categories for our facility, namely, “ARIP 2” and “ARIP 1.” We observed the ARIP recompense for the cost of items. The usage of items used for infection control increased under ARIP 1 intended to promote infection control. The increase was significant especially for hand hygiene-related items, paper towels, disposable gowns, and cleaning wipes in the general ward (p<0.05). The number of patients with MRSA colonization tended to decrease (p=0.0470). The MRSA infection incidence density rate decreased (p=0. 0312). The cost of consumable items to the facility was reduced under ARIP 1. Therefore, ARIP 1 was the driving force and resource for promoting infection control. Consequently, ARIP 1 achieved economies by reduction of health care-associated infections including MRSA infection.
Occurrence of adverse effects during placement of peripheral venous catheters was compared using non-sterile and sterile dressing materials. This survey included all cases of new placement of peripheral venous catheters and documented cases of catheter dislodgment from May 1, 2015, through August 31, 2015. Non-sterile dressings were used in a total of 215 cases and sterile dressings in a total of 145 cases. Few peripheral venous catheter bloodstream infections are expected with this number of cases, so no bloodstream infection occurred in both groups. There were no significant differences in incidence of phlebitis, obstruction of catheter lumen and extravascular leakage between the two groups.
To increase the quality of the treatment of infectious diseases with appropriate blood cultures, we have encouraged the cultivation of multiple sets of blood cultures since 2011 via promotional activities. To evaluate the changes in blood cultures in our hospitals, we compared several quality control indexes of the blood cultures before and after beginning our promotional activities. The number of blood cultures has increased 2.2x, the number of blood cultures per 1,000 patient days has increased 2.4x, the rates of multi-set cultures significantly increased from 2.7% to 92.2%, and positive rates of blood culture in adult patients decreased from 21.7% to 13.5%. Of the single set positive cases in multi-set blood cultures, 72.0% of isolated bacteria were regarded as pathogens, 16.8% as contaminants, and 11.2% could not be identified conclusively. After the promotional activities, isolation rates of enteric bacteria including Escherichia coli have increased, and those of coagulase-negative staphylococci (CNS) have decreased. The marked increase in the number of blood cultures, patients with blood cultures, and the rate of multi-set blood cultures is thought to reflect recognition of the importance of blood cultures among clinicians due to the promotional activities run by the infection control team. Moreover, evaluation using quality control indexes of blood cultures is indispensable for appropriate blood culture and infectious disease treatment.
The inappropriate use of antimicrobial agents can prolong infection treatment durations and encourage the development of drug-resistant bacteria, which may result in the proliferation of infections that are difficult to treat and induce higher healthcare expenditures. This study estimated the proportion of hospitals that appropriately utilize antimicrobial agents, and investigated the potential effects of appropriate utilization on reducing drug expenditure. The analysis used 2 different datasets. The antimicrobial agent susceptibility data from the Clinical Laboratory Division of the Japanese Nosocomial Infection Surveillance (JANIS) program under the Ministry of Health, Labour and Welfare was designated “JANIS data”. The data from a government survey on the post-implementation effects of the diagnosis procedure combination (DPC) reimbursement system was designated “DPC data”. These data were collected from hospitals that are reimbursed under the DPC system. Using the DPC data, we identified patients who had been hospitalized between January 2008 and December 2013 with a major diagnosis of pyelonephritis for inclusion in analysis. A total of 45 study subjects were identified with 50 hospitalization records after taking into account multiple hospitalizations. Based on clinical practice guidelines for the use of antimicrobial agents, we found that antimicrobial agents were appropriately used in 31.1% of the patients. The most frequently used initial antimicrobial agents were tazobactam/piperacillin, followed by meropenem. If the patients who had received inappropriate utilization of antimicrobial agents had undergone appropriate antimicrobial therapy, the reduction in pharmaceutical expenditure would be approximately 8,909 yen per patient. This study verifies that existing JANIS data and DPC data can be used to assess the appropriateness of antimicrobial agent utilization and to estimate the associated reductions in pharmaceutical expenditure. This method could be applied to examine the appropriateness of antimicrobial agent utilization and its economic effects in a large-scale multi-institutional study as a countermeasure against the development and spread of drug-resistant bacteria.
Quadrivalent influenza vaccines were newly available and distributed in Japan from the 2015–16 influenza season. Adverse drug reactions to influenza vaccines among adults are rarely reported, so we carried out a questionnaire survey of adverse drug reaction following quadrivalent influenza vaccination coverage of our medical university and university hospital workers. Overall, 75.3% of adverse drug reactions, mainly solicited injection-site symptoms such as redness, swelling and pain, etc. were reported. No severe adverse drug reactions were reported. The type and frequency of adverse drug reaction were similar to previous reports, and quadrivalent influenza vaccination was well tolerated in adults.