This present study was conducted to determine whether preventive measures against occupational infection among perinatal nursing staff differ depending on clinical department. The purpose of the present study was to compare the preventive measures against occupational infection from the following perspectives: (i) education, (ii) past exposure to blood and body fluids, (iii) past experience of needle-stick and cut injuries, and (iv) presence or absence of written reports of such injuries. In 2014, anonymous self-administered questionnaires were mailed to 430 perinatal nursing staff working at obstetric care facilities of 25 facilities operating in Niigata Prefecture. Subjects were classified into the following two groups: (i) a "multiple clinical departments" group comprising the subjects working at hospitals with multiple clinical departments, including obstetrics and gynecology departments, and (ii) an "obstetrics and gynecology department" group comprising the subjects working at a single-department obstetrics and gynecology hospital or at an obstetrics and gynecology clinic. The data were compared between the two groups. A valid response was obtained, with 148 subjects in the "multiple clinical departments" group and 118 subjects in the "obstetrics and gynecology department" group. Over 70% of the subjects in both groups had educational experiences in preventive measures against occupational infection. The subjects in the "obstetrics and gynecology department" group did not gain many educational and training opportunities to learn the standard precaution within their institutions (p<0.001). Over 90% of the subjects in both groups had a history of skin and mucosal exposures during birth assistance, however, without significant difference between both groups. Over the past year, needle-stick and cut injuries were experienced by 3.4% of the subjects in the "multiple clinical departments" group and 12.9% of the subjects in the "obstetrics and gynecology department" group (p=0.005). Furthermore, 98% of the subjects in the "multiple clinical departments" group acknowledged the presence of written reports for needle-stick and cut injuries; however, these reports existed for only 77% of the subjects in the "obstetrics and gynecology department" group (p<0.001). Perinatal nursing staff experiences a high probability of blood and body fluid exposures regardless of clinical department, and the current situation indicates that measures to prevent occupational infections are insufficient. The future challenges are as follows: (i) enhancing the training regarding standard precaution and (ii) strengthening the preventive measures against needle-stick and cut injuries, and skin and mucosal exposure, and the introduction of written reports of injuries for the nursing staff working at single-department obstetrics and gynecology hospitals or obstetrics and gynecology clinics.
Several types of needleless, three-way connector stopcocks are used in Japan. We performed bacterial contamination and disinfection tests on six of them to determine the surfaces that are most easily contaminated. Six three-way stopcocks (products A to F) that are used in clinical practice in Japan were evaluated. Bacterial contamination and disinfectivity tests were conducted on each of these needleless connectors. The rubber valve material at the point of syringe insertion was isoprene in stopcocks A and B and silicone in stopcocks C-F. Split-septum-type needles were used for stopcocks A-D and mechanical needles for stopcocks E and F. We conducted the bacterial contamination test in two stages. The first-stage test was positive in stopcocks C and D. The other four tested negative. Stopcocks C and D also had positive disinfection tests. During the second stage, stopcock E was not testable by the bacterial contamination test, whereas stopcock F had a positive test. Stopcocks E and F had positive disinfection tests. Stopcocks A and B had negative bacterial contamination and disinfectant tests during both the first and second stages of our trial. The results of the bacterial contamination disinfection test suggest that the rubber valve material of the syringe insertion part (isoprene) and the needle part that has a split-septum design were most effective for avoiding an infected surface.
Totally implantable central venous access ports (CV ports) are increasingly being used in cancer chemotherapy these days as they can be managed in the outpatient and home care settings. The objective of this study was to clarify the actual condition problems of complications and management of CV ports in order to prevent blood stream infections in patients with implanted CV ports.
Fifty-two patients participated in this study. Four patients experienced CV port complications, and all of their CV ports were removed. The breakdown of the complications was one each of central line associated bloodstream infection (CLABSI), subcutaneous pocket infection, skin defect (exposure of CV port), and catheter occlusion. There were 0.50 cases each of CLABSI and subcutaneous pocket infection per 1000 catheters. When the presence and absence of infections were compared, there was a statistically significant difference with both the leakage of therapeutic agents from the insertion site and skin-related problems. As for the usage rate due to the presence or absence of leakage of therapeutic agents and skin-related problems, there was a statistically significant difference between experiencing leakage of therapeutic agents and skin-related problems and all others. Experiencing leakage of therapeutic agents and skin-related problems included CLABSI and subcutaneous pocket infection, suggesting that leakage of therapeutic agents and skin-related problems have an association with CV-port-related blood stream infections. Prevention of leakage of therapeutic agents and skin management are essential for preventing CV-port-related blood stream infections. Medical professionals urgently need to address prevention of leakage of therapeutic agents by integrating accurate information about CV ports and incorporating training in on-site education programs.
To evaluate that "patient days" could be a substitute of "catheter days" to be used as a denominator in surveillance of peripheral venous catheter related blood stream infections (PCRBSI).
In a single acute care tertiary hospital, from April 2012 to September 2015, we assessed the correlation of patient days and catheter days using a Pearson correlation. We compared changes of PCRBSI rates by month between using patient days as a denominator versus using catheter days.
The mean of patient days per month was 20,320, and the mean of catheter days per month was 11,178. Patient days were strongly correlated with catheter days (r=0.851, P<0.01). Monthly trends of PCRBSI rates were almost identical using both metrics as the denominator.
These findings suggest that patient days and catheter days are equally useful for the evaluation of PCRBSI rates in a hospital where peripheral venous catheters are frequently used.
A total of 237 healthcare workers who had successfully acquired protective levels of anti-HBs antibodies (≥10 mIU/mL) by recombinant hepatitis B vaccine were followed up for a period of five years. Only 2.0% of the vaccinees who had acquired anti-HBs antibody levels of 10-49 mIU/mL four months after the third dose of vaccine had anti-HBs antibody levels higher than 10 mIU/mL five years later, and only 16.7% of the vaccinees who had acquired anti-HBs antibody levels of 50-99 mIU/mL four months after the third dose of vaccine had anti-HBs antibody levels higher than 10 mIU/mL five years later. On the other hand, 87.0% of the vaccinees who had acquired anti-HBs antibody levels of ≥400 mIU/mL four months after the third dose of vaccine had anti-HBs antibody levels higher than 10 mIU/mL five years later. Persistence of anti-HBs antibodies depends on the anti-HBs titer at four months after the third dose of recombinant hepatitis B vaccine.