The Sanitary Management Manual for Central Kitchens legislated by the Japanese Ministry of Health, Labor and Welfare was revised on June 16, 2017. Based on the revised manual, employees in central kitchens need to undergo Norovirus testing with high sensitivity every month from October to March, which is when Norovirus outbreaks occur. In the present study, we investigated the differences among 4 methods of Norovirus testing from the viewpoints of sensitivity, user time, total examination time, and running costs. All samples obtained from 53 healthy volunteers were tested for Norovirus using the GeneXpert^® system, the TaKaRa Norovirus GI/GII testing Kit, the TaqMan Probe assay, and the Quick NaviTM-Noro2. Among them, the GeneXpert^® system, TaKaRa Norovirus GI/GII testing Kit, and TaqMan Probe assay were all highly sensitive, at the level required by the "sanitary management manual for large cooking facilities." The user working times of the GeneXpert, TakaRa, TaqMan, and Quick Navi testing methods for 53 samples were 106, 260, 687, and 76 min, respectively. The total examination times of the 4 were 2,434, 320, 857, and 91 min. The running costs of the 4 were 202,089, 73,644.4, 152,249, and 79,500 JPY, respectively. Based on these studies, we concluded that the TaKaRa Norovirus GI/GII testing Kit is suitable for the screen testing for Norovirus detection, and the GeneXpert^® system for the follow-up testing of Norovirus-detected staff. We should understand the characteristics of the 4 methods and chose an appropriate one depending on the purpose.

Background: Bacterial contamination of surgical instruments has been suggested to increase the risk of surgical site infection (SSI). In addition, since there are many opportunities to use electric scalpels, there is a high possibility of bacterial contamination compared with other surgical instruments.

Methods: We examined electric scalpels used in surgical operations for bacterial contamination. Target surgeries included hepatectomy (BILI-O), pancreatic surgery (BILI-PD), colon surgery (COLO), and rectal surgery (REC). Bacterial isolates were identified biochemically or by mass spectrometry.

Results: We isolated 147 colonies from electric scalpels used in 30 of 31 (96.8%) intestinal surgeries. Bacteria considered to originate from the skin, such as coagulase-negative staphylococci and Staphylococcus aureus [45 (30.6%) and 6 (4.1%) isolates, respectively], and from the intestinal tract, such as Bacillus spp., Enterococcus spp., and Escherichia coli [23 (15.6%), 20 (13.6%), and 5 (3.4%) isolates, respectively], were isolated. In 4 of 31 cases (12.9%), incisional SSI occurred, and in 3 cases (75%) the bacteria detected from the electric scalpels and the causative bacteria of the incisional SSI were consistent. The causative bacteria were Enterococcus faecalis, E. coli, Pseudomonas aeruginosa, and others.

Conclusions: Electric scalpels were contaminated not only with skin-derived bacteria but also with intestine-derived bacteria. Some instruments were heavily contaminated, and their use for wound closure might also contaminate the surgical site, thereby increasing the probability of incisional SSI.

It has been asserted that the climate of an organization affects the hand hygiene behavior of individuals. The objective of this study was to develop a scale to measure the aspects of organizational climate related to the hand hygiene of nurses and to examine its reliability and validity.

To ensure the content validity of the organizational climate scale to be developed, an item pool created by referring to resources, such as previous scales and interventional studies of aspects of organizational culture related to hand hygiene, was reviewed by 8 experts on infection control, and a pilot survey of 51 nurses was then conducted. A questionnaire survey for scale development was next conducted of nurses working in outpatient care and wards at 2 medical institutions.

The responses of 510 nurses (45.1%) were included in the analysis. Following the item analysis, an exploratory factor analysis was performed. As a result, version 1.0 of a scale of organizational climate related to the hand hygiene of nurses was developed, consisting of 34 items in 5 dimensions: the supplies environment of the unit (4 items), the unit environment (6 items), the supervisory environment of the unit (8 items), the hand hygiene activities environment of the hospital (7 items), and the hospital environment (9 items). Cronbach's alpha coefficient for the overall scale was 0.935, confirming its reliability based on internal consistency. Subscale items were confirmed to be interpretable constructs of aspects of organizational climate that affect hand hygiene behavior. There were no statistical problems for model fitting in the confirmatory factor analysis, and the scale was determined to have construct validity.

The scale of organizational climate related to the hand hygiene of nurses (version 1.0) developed in this study demonstrated the possibility of measuring how the climate of an organization affects the hand hygiene behavior of nurses working in acute hospitals.

Chlorous acid water was recently approved as a food additive in Japan and chlorous acid water-based sanitizers are commercially available. Chlorous acid water is relatively stable under protein-rich conditions and causes little irritation to the human mucosa or skin. In this study, we evaluated the potential of chlorous acid water-based sanitizers for sanitation in hospital environments. The safety and convenience of this sanitizer for healthcare staff were assessed using a questionnaire survey. In comparing chlorous acid water-based sanitizers with those containing quaternary ammonium salt, the number of staff complaints about roughened skin on the hands or hand eczema deceased significantly, whereas the rate of hospital staff reporting eye and nose irritation was similar. There was no significant change in the rate of sanitizer preparation time and workload for sanitizer preparation except for the use of safety goggles. The incidence of both human norovirus gastroenteritis and Clostridioides difficile-associated diarrhea decreased after the test use of chlorous acid water for hospital sanitation. Although the cost for personal protective equipment decreased periodically, accompanied by a reduction of these hospital infections, the total cost for infection control increased by nearly 220,000 JPY per year because chlorous acid water-based sanitizers are expensive. Together, these results indicate that chlorous acid water is a safe and effective sanitizer that can be used for routine hospital sanitation applications. However, its cost effectiveness should be taken into account.

The aim of the current study was to investigate the significance of an age-stratified antibiogram. We compared the antimicrobial susceptibility rates of the most common bacteria isolated from children, non-elderly adults, and elderly adults in our hospital between April 2015 and March 2016: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, and Pseudomonas aeruginosa.

In gram-positive bacteria, the bacteria isolated from children showed significant differences compared to those from the adult groups as follows: methicillin-sensitive S. aureus showed lower sensitivity to macrolides; methicillin-resistant S. aureus showed higher sensitivities to levofloxacin (LVFX) and minocycline; and S. pneumoniae showed lower sensitivity to penicillin G with the meningitis criteria. No significant differences were observed between the non-elderly and elderly groups. In gram-negative bacteria, the bacteria isolated from children and elderly adults showed relatively lower sensitivities than those from non-elderly adults. In particular, E. coli showed lower sensitivities to multiple kinds of drugs, including ampicillin/sulbactam, cephem antibiotics, LVFX, trimethoprim/sulfamethoxazole, and fosfomycin. The isolation rate of drug-resistant bacteria was the lowest in the non-elderly group, which implies the necessity for care and attention in empiric therapy for children and the elderly. Our results suggested that developing an age-stratified antibiogram would be useful in treating infectious diseases, especially in empiric therapy for children and elderly adults.

The Vaccination Guidelines for Healthcare Professionals, published by the Japanese Society for Infection Prevention and Control, defines criteria for antibody titers to control measles, rubella, mumps, and varicella infections. A measles and rubella outbreak began in Japan in 2018. However, the actual situation of infection control measures, including measles, for healthcare personnel working in healthcare facilities in Niigata Prefecture has not been well assessed. To promote these control measures, we surveyed the current status of infection control measures against measles, rubella, mumps, and varicella viruses for healthcare personnel in 126 hospitals in Niigata Prefecture. Of the 89 facilities that responded to the questionnaire, 61 (68.5%) carried out checks of the vaccination history or measured antibody titers for the above-mentioned viruses among their healthcare personnel. Of the facilities that measured antibody titers, 17 (29.3%) used the criteria indicated on examination reports provided by commercial clinical examination facilities, and 36 (62.1%) used the criteria indicated in the Vaccination Guidelines for Healthcare Personnel.

The criteria indicated in the Vaccination Guidelines for Healthcare Personnel are used to evaluate antibody titers to control infection of healthcare personnel. Thus, the criteria provided by the Vaccination Guidelines for Healthcare Personnel are usually stricter than those in the examination reports from commercial clinical examination facilities. The results suggest that some healthcare facilities use the criteria indicated on the examination reports provided by the commercial clinical examination facilities as criteria for infection control without recognizing the differences between these evaluation criteria.