Observation of hand-hygiene practices and alcohol-based hand rub consumption surveillance are the two major methods widely used in Japanese hospitals to evaluate hand hygiene adherence. To capture an accurate picture of hand-hygiene practices, unobtrusive direct observation of various departments and professions, at various times of the day by a trained observer is necessary. Some studies have found poor correlation between alcohol-based hand rub consumption and hand-hygiene rates, suggesting the former to be an inappropriate indicator of hand hygiene adherence. Although it is ideal to observe all five hand-hygiene moments recommended by the WHO, it is often not feasible to unobtrusively observe practices performed at the bedside. Therefore, some hospitals choose to observe hand hygiene before and after patient contact. It is reported this before/after-contact monitoring method can be used as a surrogate indicator of rates based on all five moments, if certain conditions are met. Offering real time feedback of hand-hygiene rates is the first step toward improvement. Tables and graphs showing trends and comparing rates between departments offer bedside staff an incentive to improve their hand-hygiene practices. Involving patients and recruiting hand-hygiene champions are also effective. Their activities must always be endorsed by the hospital leadership who is responsible for fostering safety culture, which is crucial for improving hand-hygiene adherence.
This study aimed to analyze needlestick and sharps injuries occurring inside and outside patient rooms and to thereby identify high-risk equipment and clarify the situations of case occurrences. We requested 118 institutions participating in the Japan-EPINet Surveillance to provide recorded data on all cases of needlestick and sharps injuries that occurred between April 2013 and March 2015 in each institution. Data from 6,201 cases were collected from 87 institutions. In total, 1698 cases of needlestick and sharps injuries occurring inside patient rooms and 593 occurring outside patient rooms were reported. The type of device most frequently causing such injuries was the disposable syringe needle (inside patient rooms, 30.6%; outside patient rooms, 35.9%), followed by winged needles (inside patient rooms), and pre-filled cartridge syringes (outside patient rooms). The most frequent case occurrence situation was "during use of the item on the patient" inside patient rooms and "while disassembling the device or equipment" outside patient rooms. The most common case occurrence situation inside patient rooms by device type was "while recapping the used needle" (23.9%) for disposable syringe needles, "during use of the item" (48.4%) for winged needles, "while disassembling the device or equipment" (21.9%) for pre-filled cartridge syringes, and "during use of the item" (30.2% and 35.4%, respectively) for IV catheter stylets and vacuum tube blood collection needles. The most common case occurrence situation outside patient rooms by device type was "before use of the item on the patient" (21.6%) for disposable syringe needles, "while disassembling the device or equipment" (27.2%) for pre-filled cartridge syringes, and "while placing the item in a disposable container" (24.4% and 29.4%, respectively) for IV catheter stylets and vacuum tube blood collection needles. The types of device liable to cause needlestick and sharps injuries and the case occurrence situations varied between injuries inside patient rooms and those outside patient rooms. Needlestick and sharps injuries may be decreased by taking advantage of these characteristics.
The frequency of urinary tract infections (UTIs) is higher in children than in adults. Reportedly, Escherichia coli is suspected as the main phlogogenic microbe in UTIs. The substrate specific extended-spectrum β-lactamase (ESBL) producing E. coli has been frequently detected; therefore, selecting the initial treatment has become important. Here, we evaluated the clinical background and checked urine cultures of children for ESBL producing E. coli. Of the 88 E. coli specimens detected in these urine cultures, 12 were ESBL producing E. coli (13.6%). For patients who were diagnosed with recurrent UTI, had a history of medical intervention, or confirmed fluoroquinolone (broad-spectrum antibacterial drug) resistance, the rate of ESBL producing E. coli was significantly higher than for other cases. Therefore, if you happen to encounter a child patient with UTI, it is important to obtain a thorough clinical history of patients with UTIs, including previous medical intervention, considering that ESBL producing E. coli is resistant to fluoroquinolones.
Background: Effective subglottic secretion drainage (SSD) has been reported to reduce incidence of ventilator-associated pneumonia (VAP). The objective of the study is to assess the efficiency of SSD under various conditions. Methods: 56 patients with endotracheal tube placement participated in the study. We assessed the efficiency of SSD by the incidence of successful secretion removal at random occasions. We analyzed the impact of their age, gender, BMI, posture, cough reflex, consciousness, airway pressure, the route of intubation, ICU length of stay, and pneumonia on the efficacy using multivariable logistic regression. Results: The odds ratio of successful SSD between patients with tracheostomy and oral intubation was 5.23 (95% C.I., 0.86-31.96). Conclusion: The route of intubation (tracheostomy or oral) was the only parameter that affected the efficacy of SSD with significance. The results supported early tracheostomy from a perspective of VAP prevention, but further investigation is required to decide the optimal timing.
The inappropriate management of urinary bladder catheters or contamination of automatic urine collection machines has caused an outbreak of diseases due to antimicrobial resistant bacteria. Therefore, the appropriate hygiene maintenance of urine disposal and indication of urine collection should be observed religiously. In our hospital, the standard procedure manuals for handling urine have not been prepared; hence, the working group comprising multidisciplinary members, including Infection Control Team members, was organized and came into action from 2012. The use of automatic urine collection machines in the patients' room lavatories and reusable plastic urinals was forbidden, and instead, disposable, paper-made urine collection cups were introduced for urine collection. The standard procedure manual for urine disposal was designed and fully disseminated to all employees. As the result, the total number of cases of measuring urinary output and urine collection decreased by 43% and 69% respectively; moreover, the proportion of urine collection decreased significantly from 42.9% to 23.2% (p<0.001) in the next year. In addition, we received favorable opinions from staffs and patients through questionnaires after introducing the manual. We will continue this activity and make an effort to achieve standardized hygienic urine disposal.
Candida albicans (C. albicans) is one of major causes of catheter-related blood stream infections (CRBSI) and causes a higher mortality. It was reported that adding multivitamins to parenteral nutrition solutions promotes the growth of C. albicans. In these days, amino acid, water-soluble vitamin-added comprehensive electrolyte infusion was released in Japan. In particular, biotin has been reported to be closely-involved in the growth of fungus, there is concern regarding the risk of CRBSI. In this study, the effects of biotin or the other water-soluble vitamins (SVs) on the growth of C. albicans in Peripheral Parenteral Nutrition (PPN) solutions were investigated. Two commercial PPN solutions, [BFLUID® (BF) ] and, [PAREPLUS® (PP) ] were used as test solutions. Furthermore, BF was supplemented with biotin or the other SVs to prepare test solutions [BF-biotin (+) and BF-biotin (-), respectively]. A certain number of C. albicans was added to each test solutions in sterile plastic flasks, and all flasks were allowed to stand at room temperature. The number of colony forming units (CFU/mL) was counted at 0, 24, 48, and 72 hours after the addition of C. albicans. C. albicans increased rapidly in PP and BF-Biotin (+), but increased slowly in BF and BF-Biotin (-). These results suggest that biotin promotes the growth of C. albicans in PPN solutions, and that the risk of CRBSI might increase in the PPN solution containing biotin rather than conventional PPN solutions, if contamination by C. albicans occurs.
A questionnaire survey to understand the current status of managing indwelling urinary catheters in non-acute care settings and to investigate how catheter-associated urinary tract infections should be prevented in a care setting was conducted. The subjects included were as follows: 106 patients of the visiting nursing system (VNA), 146 of the special nursing home for the elderly (SNHFE), 77 of the geriatric health services facility (GHSF), and 130 of the long-term care bed (LTCB), in a Prefecture. We investigated the status of catheter management in compliance with each indicator in the Guideline for Prevention of Catheter-associated Urinary Tract Infections, 2009. The number of valid responses were 175 (ratio of valid responses, 38.1%), of which the usage rate of the indwelling urinary catheters were 10.5%, 3.5%, 3.8%, and 24.6%, in VNA, SNHFE, GHSF, and LTCB, respectively. The reasons for using catheters in VNA, other than medical use, included "burden reduction for caregiver" (19.5%) or "urinary incontinence care" (15.6%), whereas those for using catheters in LTCB were "bedsore treatment" (29.4%), "urinary retention and neuropathic bladder (24.7%)," and "terminal care" (14.1%). The usage rate of closed urinary drainage system in VNA, SNHFE, GHSF, and LTCB were 39.3%, 34.8%, 20.8%, and 28.3%, respectively. No difference was observed among the types of facility with respect to the status of complying with the guideline; however, the tendency of using sterilized gloves in the facility care was low. While choosing materials, such as a closed system, that are useful for preventing infection, there was a discrepancy between its necessity and usage rate. Thus, comprehensive managements, including improvement of catheter material or structure, and educational programs for preventing infections while considering the current situation of non-acute care are believed to be necessary.