A self-administered questionnaire survey on the current status of infection control in clinics affecting visiting nursing stations was administered, with responses from 108 of 404 clinics (26.7%) in two Japanese cities. The most common organizational source of information on infectious diseases was "Prefectural Medical Association/City Medical Association" in 72 cases, with the most commonly used resource being "national or prefectural circular letters" in 75 cases. In terms of infection prevention actions, implementation of cross-infection prevention measures tended to score highly, while levels of implementation of occupational infection prevention measures tended to be low. Clinics that responded that they "have infection control guidelines," "have an infection control committee," "have annexed branches," and "obtain information on infectious diseases from specialized books" scored highly overall in implementation of infection prevention measures (p<0.01). Of the 71 clinics that issued visiting nursing instructions, 60 (84.5%) provided information on infectious diseases to visiting nursing stations, but there was no standardization of timing, with 44 of those clinics (73.3%) providing this information "when the infectious disease was confirmed at consultation" and 29 of those clinics (48.3%) providing it "when visiting nursing began." Because many clinics that use syringe needles with safety devices supply the same needles to visiting nursing stations, and some clinics provide instructions on disposal methods for dangerous materials to visiting nurses dealing with waste materials, it seems that infection control by clinics has an influence on infection control by visiting nursing stations, and improved infection control and coordination by clinics could raise the standard of infection control in visiting nursing stations.
In recent years, specifications with more stringent hygienic requirements have been needed for toilet seats with electronic bidet sprayers to prevent their contamination and transmission of pathogens responsible for healthcare-associated infections. Some of the latest models of bidet toilet seats are designed to electrolyze tap water and produce hypochlorous acid water (neutral electrolyzed water) to cleanse the spray nozzles1,2). This study was performed to clarify the optimal conditions of nozzle cleansing eradication of bacteria effect with low-concentration neutral electrolyzed water using clinical and environmental isolates of Pseudomonas aeruginosa as a common pathogen causing healthcare-associated infection. Exposure to neutral electrolyzed water having a chlorine concentration of 0.5 mg/L for 30 s or longer, or of 1.0 mg/L for 5 s or longer, led to a 2-log or more decrease in the level of P. aeruginosa for 90% or more of the strains of both clinical and environmental isolates, thereby demonstrating the eradication of bacteria effect. The results suggest that, for eradication of bacteria against P. aeruginosa, neutral electrolyzed water is effective even at low concentrations, provided that the exposure time and intervals are optimized.
We investigated the minimum killing concentrations of chlorhexidine gluconate (CHG) and olanexidine gluconate (OLN) on clinically isolated Staphylococcus aureus strains. The concentration of CHG that inhibited growth of 50% of S. aureus strains (MKC50) was 0.1250%; the concentration that inhibited growth of 90% strain (MKC90) was 0.5000%. For OLN, MKC50 was 0.0020% and MKC90 was 0.0156%. Of the 137 strains, 18 strains (13.7%) had the qacA/B gene, the increase in MKC by holdings qacA/B was not observed. OLN showed bactericidal effect at low concentration compared with CHG.
Our hospital regularly performs an environmental investigation for Legionella, four times a year for the feed-water system, as part of our countermeasures to prevent hospital infection. Since Legionella pneumophila serogroup 5 (SG 5) was detected in the water feed on the first floor, where the emergency center is located, we took countermeasures to deal with the accumulated water, but repeatedly detected the bacteria. Suspecting systematic contamination by colonization of Legionella bacteria, we investigated all sites of the feed-water system in the area where the emergency center is located, to clarify the cause of the contamination and take appropriate countermeasures.
L. pneumophila SG 5 was detected at 12 sites. The water temperature, which was measured in the investigation, was 30°C or higher at seven sites. This was considered to be caused by the piping route, which was through the mechanical and boiler rooms in the basement. As countermeasures, we repaired the piping route and successfully controlled the systematic contamination by Legionella by lowering the water temperature. Rust was found to have accumulated in the lumen of dismantled feed-water pipes and was considered to form a hotbed for the increase of Legionella.
We successfully controlled the systematic contamination of the feed-water system by Legionella, which was detected during a regular environmental investigation for the bacteria, by immediately taking appropriate countermeasures. Although there has been no development of hospital infection by Legionella in our hospital, such a development would not only cause detriment to patients but also have a large impact on hospital management. Hospital administrators should monitor the detection of Legionella bacteria in the feed-water system on a daily basis as a part of risk management and make efforts to reduce the risk of legionellosis by taking countermeasures to reduce the detection of the bacteria to below the detection limits in the early phase.
To determine the performance rate of antimicrobial therapeutic drug monitoring (TDM) in Niigata, we conducted a questionnaire survey from June to July 2015. Responses were obtained from 103 out of 125 facilities. TDM performance rate was found to be significantly increased compared to the TDM performance rate as reported in our previous questionnaire survey conducted in 2007 (from 41% in 2007 to 70% in 2015). The centers with a significantly increased rate had an infection control team. In multivariable analysis, board-certified pharmacists and infection control nurses were significantly positively associated with vancomycin TDM performance. Only board-certified pharmacists were significantly positively associated with teicoplanin and arbekacin TDM performance. Overall, our results revealed the change in antimicrobial TDM performance rate from 2007 to 2015 in Niigata. Moreover, we found that board-certified pharmacists are important for antimicrobial TDM performance. Cooperation and support from infection control teams and infection control nurses are necessary to increase antimicrobial TDM performance.
In the treatment of infectious disease, the rapid application of a medical policy is necessary to ensure the effectiveness of blood cultures on vital prognosis. Blood culture rounds are being administered by ICT members on the same day when blood cultures indicate the presence of MRSA or candida. For this reason, to enable blood culture rounds that most efficiently target the necessary points, ICT members create a checklist for blood cultures positive for MRSA and candida, sharing information and making the infection control support system reflect infection-related information, choices in antibacterial medications, etc. Further, by applying information technology to the gathering of basic patient information, such as antibacterial medication history and changes in lab results that took a large amount of time previous to the round, this information can be simply auto-summarized and improve efficiency. The MRSA bacteremia and candidemia checklists are made by pulling from those found in the Medication Guidelines for Combating MRSA and Guidelines for the Diagnosis and Treatment of Deep Mycosis and entering them into the electronic medical records. Items regarding diagnosis/treatment, risk factors, etc. are entered in either a checklist or multiple-choice format. Aiming for efficiency in this way has resulted in rounds being conducted in less time and ICT members assembling in a timely manner. The change to the checklist format during rounds has enabled rounds to be conducted quickly and in full, and by displaying the results in the same format in electronic medical records, communication and information-sharing with the attending physician has been streamlined, enabling treatment to be administered earlier.
Once a large-scale disaster occurs, we need a lot of help to care for many patients. On the day of the Kumamoto earthquake in 2016, we decided to accept the 111 patients, who could not receive treatment in their hospital. By the announcement of the Kumamoto prefectural assembly, 250 volunteers got together on the day. When volunteers participate in clinical practice, we must control the infection very strictly, for both patients and volunteers. There are risks such as contracting a virus or bacteria from the outside and spreading of an infection. Thus, we surveilled the complaint and the infection control. By the surveillance, we could prevent the infection from spreading. The number of occurrences is seven at Day 1. During this period, we kept it 2.5±1.4. The rate of the patients with symptoms was examined separately in the group cured by volunteers or medical staff. As a result, there was no difference between the groups (8.8% vs. 6.9%, p=0.4). Based on this, we concluded that the assessments of risks and surveillance are very useful for volunteers' participation in medical fields even at a disaster.
A 10-month-old male was transferred to our hospital because of fever, convulsion, and exacerbation of hydrocephalus. Although acid-fast bacilli smear of blood, spinal fluid, gastric juice, and intratracheal sputum was negative, image analysis strongly suggested miliary tuberculosis with meningitis. We isolated the patient and initiated treatment for tuberculosis. The patient's mother reported a history of tuberculosis in her childhood and respiratory symptoms. She was diagnosed with active pulmonary tuberculosis on the patient's fourth day of hospitalization. Confirmation of the diagnosis of tuberculosis in the child required 3 weeks. This case of tuberculosis in an infant and his mother yielded the following lessons: Prompt isolation of the patient is important even prior to a confirmed diagnosis of tuberculosis. A precise history of the patient's family members is required because of their potential as a source of infection. Tuberculosis-positive family members are a potential source of hospital infection because they are often present with the child in the hospital.