It is important to have strong communication skills to explain complicated medical treatments briefly and accurately. This also applies to the field of infection control. To do that, teamSTEPPS tools such as checkback, SBAR, callout, etc., are useful. However, these are not only tools for accurate transmission, but also team building tools. These tools also help teams organize to prevent outbreaks in advance. In order for these to be fully used, assertive communication is ideal.
Aerosols or droplets that float in the air contain pathogens such as bacteria, fungi, and viruses. In this study, we investigated the distribution of airborne bacteria using an air sampler under the state where the human is in action.
We sampled airborne bacteria from the general environment at 12 sites in the university. Airborne bacteria were present at all sites. The strains of CNS, Micrococcus spp., Corynebacterium spp., and Bacillus spp. detected in the general environment at a high frequency (>75%) are often identified as skin indigenous bacteria. Staphylococcus aureus was detected in approximately 25% of the samples along with methicillin-sensitive S. aureus (MSSA).
Furthermore, we investigated the change in the number of airborne bacteria in the laboratory. The results demonstrated that, during laboratory training, the number of bacteria increased nine fold compared to the number before training. CNS, Micrococcus spp. is involved in the increase. Moreover, MSSA was also detected as one of the airborne bacteria during training.
We further aim to sample the air in hospital environments using Air Sampler and investigate the distribution of airborne bacteria under different conditions.
BACKGROUND. The flasher disinfector (FD) is designed to help reusable urinals and bedpans to be emptied, cleaned, and disinfected. In Europe, FD is a Class medical device; the washing evaluation method is standardized according to the International Organization for Standardization (ISO). In Japan, the FD is not managed as a medical device by the Pharmaceuticals and Medical Devices Act; therefore, the washing evaluation method is not standardized. To reduce the risk of infection through excrement, it is important to confirm the reusable excretion container is washed thoroughly.
OBJECTIVE. Visual evaluation, using the ISO certificated test-soil, and measuring the amount of luminescence (relative light unit; RLU) of adenosine triphosphate (ATP) was examined as a means of evaluating FD cleanliness.
METODS. Visual evaluation was done according to a 4-grade scale after using ISO certificated test-soil. After visual evaluation, the correlation between the logarithm of the ATP (RLU) and each scale was examined.
RESULTS. By visual evaluation, the test-soil inside the bedpan was completely removed. Remaining test-soil was observed on the bedpan's handle and cap when the test soil was applied to the bedpan's entire surface. When the test-soil was applied only inside the bedpan, it was removed completely. A correlation was confirmed between the logarithm of the ATP (RLU) and the visual evaluation score.
CONCLUSIONS. In this study, the FD washing evaluation by the visual evaluation and ATP measurement might be recommended for bedpans used in each healthcare site.
A 7-10 day course of post-exposure prophylaxis (PEP) with a neuraminidase inhibitor for influenza is recommended for inpatients. Since it was reported that a three-day regimen had a prophylactic effect comparable to the longer regimen, we shortened the PEP duration in our infection control manual. Inpatients who had been in close contact with index patients with influenza were given oseltamivir 75 mg once daily for three days as a general rule. In cases with a higher risk of an outbreak, healthcare personnel were also offered oseltamivir 75 mg once daily for seven days at the suggestion of the infection control team. We retrospectively investigated all cases who received any kind of PEP in the last two seasons in our hospital, and evaluated the prophylactic effect of the three-day regimen. From November 2016 to April 2018, there were 42 events requiring PEP for inpatients or healthcare personnel. The sources of exposure were 25 healthcare personnel and 17 inpatients, and the influenza virus types consisted of 31 of type A, 10 of type B, and one unidentified type. PEP was used in 339 cases (inpatients, 250 cases; healthcare personnel, 89 cases). The drugs used were as follows: oseltamivir, 296 cases; laninamivir, 41 cases; zanamivir, one case; peramivir, one case. Oseltamivir was administered in 88 cases (healthcare personnel) for seven days, 123 cases (inpatients) for three days, 3 cases (inpatients with impaired renal function) for two days, and 81 cases (hemodialysis patients) for one day. One of the 123 oseltamivir was a three-day-regimen case, and one of the 41 laninamivir cases developed type-A influenza.
In this study, the prophylactic efficacy of the three-day regimen of oseltamivir as PEP was 99.2%, which is comparable to that of longer, previously reported regimens. We believe that the three-day regimen as PEP for influenza is sufficiently efficacious for inpatients.
There are few reports in Japan on the new ventilator-associated event (VAE) surveillance proposed by the Centers for Disease Control and Prevention in 2013. We conducted VAE surveillance and conventional ventilator-associated pneumonia (VAP) surveillance on patients aged >18 years who were on mechanical ventilation in the intensive care unit (ICU) at the Niigata University Medical and Dental Hospital and retrospectively compared their clinical features. Of the 290 cases, 14 of ventilator-associated conditions, 7 of infection-related ventilator-associated complications, 8 of possible VAP (PVAP), and 7 of conventional VAP (3.6, 1.8, 2.1, and 1.8/1000 ventilator days, respectively) were included in this study. Compared with non-VAE and non-VAP cases, PVAP and VAP cases had significantly increased mechanical ventilator days and ICU length of stay. Hospital and ICU mortalities were also significantly high in PVAP cases. Four out of seven VAP cases were consistent with PVAP, and the main reason for this discordance was that the deterioration of oxygenation did not meet the VAE criteria. Although VAE surveillance has lower sensitivity to cases using conventional VAP identification, it may be more useful in terms of prognostic prediction in Japan.
Taking measures against nosocomial infections among housekeeping workers in medical facilities is essential for both the workers' health and prevention of further infections. We conducted questionnaire surveys to the fiduciaries of 1,895 housekeeping companies that are accredited by the Japan Health Enterprise Foundation and had 491 replies (25.9%.) The survey consisted of 16 questions concerning infection prevention and management practices (e.g., the presence of an infection prevention and control manual; a health examination at hiring; vaccinations; training sessions on infection control and prevention; meetings between the housekeeping staff and the fiduciary; and meetings with a client medical facility).
As a result, 13 out of the 16 above practices had statistically higher implementation rates among housekeeping companies with client facilities of 300 beds or more-irrespective of the number of the housekeeping company's employees (i.e., 100 workers or more or not.)
Nonetheless, the survey also the housekeeping workers' possible exposure to blood and/or body fluid. While 60.9% of the housekeeping companies with client facilities of 300 beds or more answered that they had an incidence of their workers' exposure to blood and/or body fluid at least once in the previous three years.
Many medical facilities with 300 beds or more have actually increased infection prevention measures-the Japanese medical fee system allows them to charge a higher fee for added prevention measures. However, in Japan, there are limited numbers of medical facilities with 300 beds or more, which may cast a shadow on the outlook that increased precautions can positively affect the rate at the housekeeping company level nationwide. It is urgent to raise awareness about infection prevention and control among housekeeping companies working in medical facilities.
There is no report on hygiene management for multicenter and microbial contamination of ointments and creams in a ward. In this study, we prepared a questionnaire to investigate microbial contamination of ointments and creams in three hospitals within the Nagasaki Society of Hospital Pharmacists. We further investigated the expiration dates of the ointments and creams by touching two times daily with a finger for 6 months. There is no manual of hygiene management of ointments and creams in the three hospitals. Microbial contamination was not admitted for 128 ointments and creams in the three hospitals for 6 months, in spite of the difference between the base agent and the preservative agent. Therefore, the ointments and creams stored in a ward must be used within 6 months of preparation, providing there is proper hygiene management such as not touching them with bare hands.
Practicing hand hygiene in healthcare settings is the most important means of preventing cross infections and the spread of multidrug-resistant bacteria. It is the basis of healthcare-associated infection control protocols. Nursing students undergoing clinical training are required to practice hand hygiene as members of a medical team. For that reason, they need to understand hand hygiene procedures, along with the "My 5 Moments for Hand Hygiene" and act accordingly in clinical settings. However, few studies have investigated nursing students' knowledge of hand hygiene or their hand hygiene compliance. This study aimed to elucidate nursing students' knowledge of hand hygiene and the rate of compliance to guide future teaching methods. We conducted an anonymous, self-administered questionnaire survey targeting nursing students of three four-year universities and two career colleges when they completed their entire clinical training program. The survey focused on their knowledge of hand hygiene, the actual hand hygiene practiced, and factors associated with their hand hygiene practices. Very few students could give correct answers about the effects of antiseptic hand rub use on pathogenic microorganisms, "appropriate hand hygiene procedures for different situations" or "My 5 Moments for Hand Hygiene," showing their lack of solid knowledge. Although they did not understand "My 5 Moments for Hand Hygiene" accurately, half of the respondents answered that they had been able to perform hand hygiene procedures correctly during their clinical training because "they copied what nurses were doing." This suggests many nursing students under clinical training have difficulty making their own judgments about appropriate hand hygiene procedures for each situation.
The 2007 CDC guidelines changed the term "nosocomial infection" to "healthcare associated infection," recognizing the increased importance of infection control at home and in care facilities. Also, in the medical law revised in the same year, although a nosocomial infection management structure was implemented, adoption was not carried out in homes. Therefore, in this research, we examined the trend of research on home infection control in nursing domestic literature and decided on future topics. Between 2007 and 2014, using the Medicine Central Journal and CiNii, keyword searches for "home" and "infection management," "infection prevention," "infection control," and "infection measures." Word combinations were performed, along with a theme search in the thesaurus using "at home" and "infection control" word combinations. From the extracted literature, 33 papers, excluding reviews and commentaries, conference proceedings were selected with consideration of the publication year, the number of publications, research subjects, data collection methods, and research contents. The number of papers was one to eight per year, with eight in 2009 (24.2%) being the highest, and the research subjects were 27.7% "home care patients." The data collection method was 48.6% "questionnaire survey," and 75.8% "observational study." The research topics are "fundamental techniques of infection control," "medical treatment infection control," and "Organizational infection control." In the future, it will be necessary to increase this research and the number of topics.
In 2013, The Centers for Disease Control and Prevention (CDC) revised the definition of Ventilator-Associated Pneumonia (VAP) surveillance, and VAP in Ventilator-Associated Events (VAE). Although VAE affects not only the treatment period and prognosis, but also the medical economy, there is no report on the effect of VAE occurrence on the Japanese medical economy. For the VAE, we calculated the cost (procedure, drug fee, material cost), from hospitalization to discharge, from patients with infection-related Ventilator-Associated Complication (IVAC), and compared them in terms of age and sex. We examined the additional medical expenses of the onset group by matching VAE patients with disease-free patients on a one-to-one basis. In the IVAC onset group, the additional medical cost was 2.38 million yen on average, but there was no statistically significant difference compared to the non-onset group.
Overseas reports indicate that combination therapy with tazobactam/piperacillin (T/P) and vancomycin (VCM) frequently causes acute kidney injury (AKI). In this study, we retrospectively compared AKI frequency in cases receiving T/P + VCM and those receiving meropenem (MEPM) and VCM, another combination used in our hospital for empiric similar coverage. AKI incidence in the T/P + VCM (Eight of 25 cases; 32.0%) was significantly higher than that in the MEPM + VCM (five of 63 cases; 7.9%). A multivariate analysis identified T/P use as the only independent risk factor for AKI (odds ratio 6.77, 95%CI 1.43-32.09). Kidney function should be monitored carefully when T/P + VCM is used regardless of VCM trough values.