The purpose of this study was to develop an educational program for direct observers based on the "Five Moments for Hand Hygiene" concept proposed by the World Health Organization. This program adopted the videos that we devised to depict the training and to assess direct observers' skills as training materials. First, it was ascertained in advance that there was no disagreement with respect to the results of direct observation with the test video between the two certified nurses in infection control (CNIC) who had undergone training for hand hygiene direct observation. Subsequently, we set up a 4-hour education program (consisting of a 1-hour lecture, a 2-hour observation exercise with educational videos, and 1 hour of tests and model answers with comments). We then conducted this program on 99 CNICs. The educational program participants were divided into two groups, one group of nurses to be tested before starting and again after completion of the program and the other group to be tested only after completion of the program, to allow comparison of test responses between pre- and post-training statuses in the former group as well as an intergroup comparison of post-training test responses. According to the response results from the group having undergone pre- and post-training tests (n = 43), the number of hand hygiene opportunities increased significantly from a pre-training value of 19.9±6.6 to a post-training value of 24.1±3.0 and the calculated compliance rate decreased significantly from 75.6%±19.5% to 65.9%±9.2%; hence, both the number of hand hygiene opportunities and the compliance rate approached those of model responses (25% and 64%, respectively). In the group having undergone the post-training test only (n = 53), the number of hand hygiene opportunities was 24.2±3.1, which was not appreciably different from the post-training value in the group having undergone both pre- and post-training tests. These results suggest that this education program can improve the ability of direct observation.

Given the several opportunities to come in contact with moist biological substances, it is important to observe standard precautions during oral care. However, there have been only few investigations on such precautions. In this study, we surveyed oral care methods and cleaning solution spattering, as well as the necessity for personal protective equipment. A total of 106 oral care procedures, in which 91 nurses performed oral care for 26 unconscious patients with cerebrovascular disease, were analyzed. Adenosine triphosphate (ATP) measurements were used to calculate the relative light unit (RLU) of cleaning solution spatters swabbed from the nurses' wrist, face shield, and apron surfaces before and after oral care. The mean age of patients was 76 years. On oral examination, 13 patients had furred tongue, 14 had oral dryness, and 11 had gingival bleeding. A history of aspiration pneumonia was also noted in 11 patients. Methicillin-resistant Staphylococcus aureus was isolated from the sputum of five patients and Pseudomonas aeruginosa from the sputum of two patients. The mean number of nurses' years of experience was 11.9, and the mean time spent performing oral care was 4 min and 5 s. The mean wrist RLU was 636.2 before oral care, which significantly increased to 836.2 after oral care (p = 0.0003). The same trend was noted for face shields and aprons (p < 0.01). RLU was high when a toothbrush, sponge brush, suction, or bed elevation was used during oral care or when the procedure took ≥5 min. Bleeding was observed 40 times during oral care procedures, suggesting the occurrence of blood-containing droplets. These results re-emphasize the necessity of using personal protective equipment, such as gloves, face shields, and aprons, during oral care.

The purpose of this study was to elucidate the current state of hand hygiene and related factors among caregivers employed at long-term healthcare facilities. Structured observations and a survey using questionnaires were conducted. Among 140 caregivers at five long-term healthcare facilities in one prefecture, 95 caregivers who met the inclusion criteria were included in this study. A total of 668 occasions of hand hygiene performances of the 95 caregivers were observed. Hands were washed at 487 occasions (73%), with the mean time taken to wash hands of 15.6±7.7 s and use of hand disinfectant observed at 181 instances (27%). Investigation of factors related to hand hygiene indicated that being "busy" had the maximum relation to hand washing duration (β=-0.527, p=0.001) and hand hygiene frequency (β=0.362, p=0.001). Being busy decreased the hand washing duration (p=0.001) but increased the hand hygiene frequency (p=0.001). Additional factors related to hand washing duration were caregivers' age (β=0.324, p=0.001) and level of knowledge (β=0.204, p=0.024). Hand hygiene frequency was associated with years of experience in caregiving (β=0.248, p=0.024). In addition, investigation of attitudes toward infection control indicated that those with a positive attitude toward infection control washed their hands for a longer period of time compared with those with a negative attitude toward infection control (p=0.001). Analysis of methods of hand hygiene indicated that caregivers washed their hands more than they used hand disinfectant and hand washing duration was shorter than the recommended duration. These results indicate a need for enhanced hand hygiene, which may be accomplished by providing comprehensive and individualized education that takes into consideration age, experience, knowledge, and attitudes. Placing a priority on hand disinfection, which requires less time than hand washing when caregivers are busy, may ensure that caregivers utilize effective and efficient handwashing methods.

Background: Few data on multidrug-resistant organisms (MDROs) and educational intervention to improve the antimicrobial use in Japanese long-term-care hospitals have been reported.

Method: This study reports the current epidemiology on MDROs in a long-term-care hospital. Also, we performed a multifaceted educational intervention on antimicrobial stewardship and retrospectively compared several quality control indexes, such as appropriate antibiotic use, prevalence of MDROs, blood culture, and therapeutic drug monitoring, of clinical practice on infectious diseases before and after the intervention. The baseline and intervention periods were from April through September 2015 and from April through September 2016, respectively. The intervention included bed-side consultations with emphasis on gram staining, institutional lectures with didactic educational materials, producing annual cumulative antibiogram, and so on.

Results: The antimicrobial use density of cefmetazole increased 2.2 times, whereas that of meropenem and levofloxacin decreased by 30% and 46%, respectively. The fluoroquinolone resistance of Escherichia coli and the proportion of extended-spectrum beta-lactamase (ESBL)-producing E. coli before and after the intervention were 71% and 65% and 68% and 68%, respectively. The number of blood cultures per 1000 hospital admissions before and after the intervention were 281 and 859, respectively.

Conclusions: Our data revealed that ESBL-producing E. coli was extensively prevalent. Also, the use of broad-spectrum antibiotic decreased, which could be due to the regular institutional lectures where all physicians attended and shared relevant information efficiently. In addition, gram staining may have contributed to the reduction of broad-spectrum antibiotic use because physicians could estimate causative organisms and use narrower-spectrum antibiotics as an empiric therapy.

Objective: To monitor the hygienic status of the Division of Nutrition kitchen of Shizuoka Cancer Center, Shizuoka, Japan, using adenosine triphosphate (ATP) swab testing.

Methods: Between June 2011 and December 2015, ATP swab testing was performed 25 times on eight statuses located outside unsterile areas of the Division of Nutrition kitchen of Shizuoka Cancer Center [countertop, food trolley (doors and handle), conveyor belt (belt), moveable work table, sink, fridge, and oven handles]. Relative light unit (RLU) values of each status were measured based on swab ATP levels, which were measured using Lumitester^® PD-20. The number of times each status was positive for contamination (RLU ≥500; standard methods of analysis in food safety regulation; Ministry of Health, Labour and Welfare, Japan) was investigated. To evaluate whether the hygienic status was maintained over time, the correlation between RLU values and the number of times the swab test had previously been performed was also investigated for each status.

Results: The median swab test result for all eight statuses was 361 RLU (range, 39-3494). Each status had an RLU of ≥500, a median of nine (5-17) times, and a high level of contamination was observed on the conveyor belt [1095 RLU (43-16973) ] in 17 of the 25 tests (68%). A correlation was observed between the RLU value and the passage of time for the conveyor belt (r=-0.39; p=0.05) but not for the other seven statuses (with median RLU of ≤500).

Conclusion: Contamination of the machines was maintained over time in the present 5-year survey of the hygienic status of the hospital food preparation in the Division of Nutrition kitchen of Shizuoka Cancer Center using ATP swab testing.

Ward pharmacists have many opportunities to come in contact with patients; therefore, the implementation of appropriate infection control is very important. We made efforts to raise awareness of hand hygiene among ward pharmacists using visual ways such as a fluorescent paint and a survey on bacterial contamination of hands and evaluated the utility based on the results of alcohol-based hand rub usage and a questionnaire survey. Ward pharmacists could recognize that they touch many places when contacting patients using the fluorescent paint; also, they could recognize the effect and importance of hand hygiene from the survey on bacterial contamination. At the time of drug administration guidance, the average usage per month of an alcohol-based hand rub significantly increased from 125 mL to 325 mL and the rate of hand hygiene significantly increased from 25.0% to 63.3%. Furthermore, all ward pharmacists answered that they were able to maintain hand hygiene before and after contacting patients. This study suggests that educational activities using visual ways are effective in raising awareness of hand hygiene among ward pharmacists.

Small portable devices worn as a name tag hanging around the neck or as a pen in front shirt pocket are sold in Japan. It is claimed that these devices can inactivate viruses and kill bacteria by releasing chlorine dioxide gas and that they are good for the control of air-borne pathogens. The reliability of such claims was investigated in four selected devices from four companies. The devices were scrutinized for their virucidal and bactericidal abilities against air-borne viruses and bacteria on agar plates, respectively, under temperature and humidity similar to room conditions in winter season set at 23°C and 30%, respectively.

The viral fluid of influenza A/Aichi/2/68 strain virus that propagated in the allantoic fluid of fertilized hens' egg was atomized using a nebulizer in a 25 m³ space closed environment; 80 L of air was sampled at a distance of 20 cm from the device, filtrated through a gelatin filter to trap the aerosol that contained the virus, and the amount of active virus was titrated using plaque assay. Viral loads were found to be similar between viral samplings in the air collected from the site close to the device for all devices and in the controlled air, indicating that no virucidal activity was found against the air-borne influenza viruses with selected devices in these conditions.

For bacterial experiments, an agar plate on which an aliquot of Staphylococcus aureus or Pseudomonas aeruginosa stock in the broth was spread and placed above the device at a 20-cm distance for 20 min and incubated to count the number of bacterial colonies. The amount of live bacteria on the plate was also found to be similar between the groups of those placed in the air close to the device and those in the controlled air for all devices and for both bacteria species, indicating no bactericidal activity against these bacteria with selected devices in these conditions.

In addition, the gas concentrations of chlorine dioxide released by devices were measured at a 10-cm distance from each device. The detected gas concentration was found very low or zero ppb in every product.