Infective endocarditis (IE) is a rare infectious disease, affecting approximately 5-10 people per 100,000 people per annum. Antibiotic prophylaxis for IE before dental treatment has been recommended for patients with predisposing cardiac conditions since 1950s because IE is associated with a high mortality and morbidity. However, the recommendations were partially or totally abandoned in 1990s in the US and Europe because the effectiveness of such antibiotic prophylaxis was not proved in these nations. The revised guidelines by the Japanese Circulation Society in 2017 recommend antibiotic prophylaxis both for highest risk and moderate-risk patients. This article outlines the history of antibiotic prophylaxis and reviews the evidence base for the use of antibiotic prophylaxis to prevent IE.
The Department of Home Medical Care was founded in Okinawa Chubu Hospital in 2011, and since then, we have been working with the aim of strengthening cooperation with regional comprehensive care systems. Giving advice on infection control at the time of discharging has also become an increasingly important task for us. By providing family doctors with clinical information on drug resistance and infection control policies, we have tried to make communication easier with practitioners of home medical care. As the number of elderly people living in each community will further increase, hospitals need to be more actively involved in home medical care. However, the guidelines of infection control for acute care hospitals cannot be applied directly to home medical care. Rather, an insight is needed to find clues for home care infection control strategies from the lifestyles established by patients and their supporters. Daily life infection control should not be instructed unilaterally by experts, but should rather be formed as a common value through the involvement of patients, families, and supporters. Daily life has a remarkable diversity. While respecting home medical care that has maintained this diversity, we will continue our support work so that infection control can be made a reality.
In surgical site infection (SSI), surveillance/direct observation by certified nurse in infection control (CNIC) has been more important than that by surgeon or ward staff alone because of the correct estimation of the incident rate of SSI. Only 42.1% of hospitals in Japan have performed SSI surveillance by CNIC, suggesting the possibility of underestimation of the incident rate of SSI.
When we retrospectively re-evaluated the cases of SSI surveillance by CNIC in 2016, the 2.6% (13/498 cases) of incident rate of SSI assessed by surgeon alone increased to 8.8% (44/498 cases), with a statistically significant difference (p<0.001). In 2017, the incident rate of SSI was 9.8% (13/133 cases) and 15.8% (21/133 cases) determined by surgeon alone and surgeon with CNIC, respectively, and there was no statistically significant difference between these rates (p = 0.099).
In conclusion, direct observation of SSI by CNIC may reduce the underestimation of the incident rate of SSI and contribute to the correct assessment of SSI by surgeon.
The use of disinfectants in our hospital was inconsistent because of the large number of disinfectant items available in the field. We set up a project team for the purpose of ensuring the proper use of disinfectants in the hospital (i.e., the Disinfectant Stewardship Team). We then interviewed all departments to investigate their actual use of disinfectants. Based on these interviews, we tried to standardize the method for using disinfectants.
We conducted an interview comprising 25 items in all 71 departments, including wards and outpatients, central medical, and administrative departments, wherein 629 disinfectants were used from April 2015 to March 2016. Referring to the interview results and guidelines, we revised the hospital's infectious disease control manual.
As a result of the interviews, we identified the disposition of several improper and unnecessary uses of disinfectants scattered throughout the departments. Therefore, we reviewed and organized the appropriate use of disinfectants. The infectious disease control manual was also revised into a pocket manual to encourage proper use and disseminated to the staff. We accepted questions about nonrecommended use of disinfectants after this revision. Then, the Disinfectant Stewardship Team answered the questions. Following the implementation of the above measures, the recommended disinfectant delivery rates increased from 48.8% to 52.9% and the inadvisable disinfectant delivery rates decreased from 8.6% to 1.2%.
It was suggested that standardization could be achieved after the situation of disinfectant use was understood by performing interventions based on field confirmations and interview surveys regarding the proper use of disinfectants.