The risk and importance of water hygiene in healthcare facilities are widely recognized worldwide. However, in Japan, little attention is paid to hospital water hygiene.
Much research covering hospital water hygiene and outbreaks has been conducted. The causative organism in water varies from Legionella spp. to non-tuberculosis mycobacterium or Enterobacteriaceae. Water faucets, water basins, water pipes, water tanks, heater-cooler devices, ventilators, and nebulizers in the facilities are also at risk.
Chlorine disinfectant in the water is commonly used in Japan, and various other disinfectants are used in other countries. Management of adequate temperature control, regular flushing of water faucets, and maintenance of the concentration of chlorine are implementable and reasonable strategies for Japan.
The style of the water basin or water outlet is a key factor for the prevention of water-related infections. However, automatic water faucets, which are commonly used in Japan, might be a major obstacle as the temperature of the dispensed water is too low, and automatic time of water flow is inadequate to kill organisms. We have to develop Japanese guidelines covering water hygiene and safety, considering national and cultural factors.
During injection, the needle is inserted directly into the patient's tissue; thus, the pharmacist should prepare the needle, syringe, and drug to be administered under a sterile condition. However, nurses often prepare these things in the general ward, which is under a non-sterile condition. Hence, nosocomial infections due to microbial contamination still occur occasionally. Pharmacists involved in the infection control should make efforts to maintain aseptic operation and preparation hygiene management at the time of injection preparation at their own facilities. And the pharmacist should supervise the procedures in the preparation of the things to be used for injection. In this paper, we review the procedures in the preparation under sterile conditions by pharmacists and summarize the points to be noted regarding the preparation under non-sterile conditions by nurses.
Whenever a new antibacterial drug is applied clinically, resistant bacteria emerge. However, the strain carrying the resistance factor has disadvantages with regard to survival, such as slower growth speed, compared with the susceptible strain. Therefore, resistant bacteria are thought to survive only in special environments, such as medical facilities. However, in recent years, resistant bacteria that cause community infections have emerged, overcoming these adverse situations. In this manuscript, I outline what kind of strategies the resistant Gram-negative organisms spread in the community. In addition, I will discuss the current status and future prospects of the development of treatment option for infectious disease with personal views.
Objective: The purpose of this study was to identify the risk factors of peripherally inserted central venous catheter (PICC) -related blood stream infection (BSI) in patients admitted to the neonatal intensive care unit (NICU).
Methods: A retrospective cohort study on NICU patients with a PICC for the first time between January 2008 and December 2015 in Kurume University Hospital. We enrolled 507 patients.
Results: PICC-related BSIs occurred in 40 cases (7.9%), including 33 cases of clinical sepsis, with an incidence rate of 5.9/1000 device days. As potential risk factors of PICC-related BSIs, 12 variables (number of gestational weeks, birth weight, male sex, chromosomal aberrations, congenital heart disease, congenital gastrointestinal disease, catheter insertion site, number of catheter lumens, glove use during insertion, blood transfusion, total parenteral nutrition (TPN), steroid therapy) were identified by univariate logistic regression analyses. Multivariable logistic regression models, which were constructed via a step-by-step modelling procedure considering temporal relationships between those potential risk factors, indicated that male sex, presence of congenital heart disease, low number of gestational weeks, low birth weight, gloveless insertion, and the use of TPN solutions were independent risk factors of PICC-related BSIs. Among them, modifiable factors were gloveless insertion and the use of TPN solutions.
Conclusion: It is important to use gloves as an aseptic technique when PICC is carried out in the NICU. Appropriate use of TPN solutions may help prevent PICC-related BSI.
Parenteral nutrition using central venous catheter (CVC) is common in patients with inflammatory bowel disease (IBD), such as ulcerative colitis (UC) and Crohn's disease (CD). We investigated the risk factors for central line-associated blood stream infections (CLABSI) in patients admitted on the ward of digestive tract internal medicine. Patients with home parenteral nutrition were excluded. In addition to 13 factors related to the host and 3 factors for the management of CVC, disease activity (UC, Mayo score; CD, CD activity index) was evaluated. A total of 562 patients were included (UC 562, CD 334). The incidences of CLABSI were 9.6% in total, 8.3% in patients with UC, and 10.5% in patients with CD, and rates per 1,000 device days were 4.9, 4.4, and 5.3, respectively. Independent risk factors for CLABSI were the use of biological product (odds ratio: 4.98, 95% confidence interval: 1.81-13.69) in patients with UC and men (5.38, 1.85-15.64) and moderate/severe disease activity (2.54, 1.20-5.38) in patients with CD. Routine bath/shower during the CVC use decreased the risk (UC: 0.17, 0.06-0.44; CD: 0.33, 0.15-0.72). In conclusion, the identified risk factors for CLABSI in IBD were different from the common risk factors reported previously. Routine hygiene management with bath/shower was required to prevent CLABSI.
The sporicidal effect of excess liquid from sporicidal wipes was evaluated in comparison to sodium hypochlorite against the spores of three strains of Clostridioides difficile under dirty (3.0 g/L albumin plus 3.0mL/L sheep erythrocytes) conditions. The wipes were soaked in 20 mL distilled water for 4 min. The excess liquid from the soaked wipes was subsequently used in the experiment. Sodium hypochlorite of 0.1% (1,000 ppm) did not exhibit adequate sporicidal activity even after 10 min of contact, whereas sporicidal wipes killed the spores within 5 min. Our results suggest that using sporicidal wipes is effective for disinfecting environments contaminated with C. difficile spores.