This study aimed to clarify the awareness of behaviors of infection prevention among physiotherapists. Semi-structured interviews were conducted with 18 physiotherapists who worked in the rehabilitation room at five facilities. The contents related to infection prevention awareness and behavior were analyzed using qualitative inductive analysis and evaluated to encode for some of the similarities, such as contents similar category contents. Infection prevention awareness of physiotherapists was encoded as 432 and classified into 98 sub categories, 28 categories, and 5 core categories. Core categories with a large number of codes such as "The gap in infection prevention awareness among professions, and awareness of crisis management" and "Difficulty of rehabilitation adjustment due to the increase in the number of infectious disease patients and a sense of crisis to super-aged society" were generated. Infection prevention behavior of physiotherapists was encoded as 684 and classified into 93 sub categories, 25 categories, and 7 core categories. Core categories with a large number of codes such as "A systematic wearing and removing of protective clothing against infectious diseases and instructions, and regular white uniforms/linen changing" and "Strict cleaning on a daily basis, and if contaminated, cleaning according to an infectious disease information report and confirmation" were generated. Physiotherapists who have a lot of patient contacts need to understand the following regarding the standard precautions: it is not decided based on the absence of infection or health condition and implementation of compliance. In addition, they should judge themselves according to infection cases and aim to acquire knowledge with evidence.
In the interests of safe vaccination, it is important to recognize in advance the errors occurring in vaccination and to devise suitable countermeasures. However, there are many unclear aspects of circumstances associated with minor errors in manual drug preparation procedures, which may represent a blind spot in efforts to improve the vaccination process. In response, we investigated errors occurring in influenza vaccination from October 2017 to February 2018, including near misses during drug preparation.
Valid responses were received from 101 doctors and nurses. The total number of errors was 562. Among these, 81.8% (311/380) of doctor errors and 77.5% (141/182) of nurse errors occurred during drug preparation, most of which appeared to be near misses. However, there were cases in which the response after the error occurred was inappropriate, which led to the error being transmitted unmitigated to the vaccinees. Furthermore, there were cases in which errors occurred that had the potential to result in health damage to the vaccinees, but no explanation was given to the vaccinees and their families. Additionally, there were cases where the error was not reported to any authority inside or outside the hospital. There were 48 cases of needle stick injuries to health care professionals.
The findings of this investigation suggested that improvement of the manual skills of health care professionals and the creation of an environment that made errors difficult to commit would be effective in the prevention of errors in drug preparation. Moreover, to prevent health damage to vaccinees, we concluded that it was important to identify easily occurring errors and to actively review each process, including appropriate methods of response after an error has occurred.
Countermeasures for drug-resistant bacteria constitute an important issue in infection control measures in hospitals. At our hospital, 15 years have passed since the Infection Control Team (ICT) was formed in August 2004 and supportive measures for the appropriate use of antimicrobial agents were implemented. Long-term measures and their effects of reducing multidrug-resistant bacteria were evaluated, and some knowledge was obtained. A notification system for the use of specific antimicrobial agents in conjunction with the ordering system was introduced, and ICT antimicrobial rounds were initiated as part of Antimicrobial Stewardship (AS) activities. Furthermore, positive blood culture patient rounds were implemented and guidelines for the perioperative use of antimicrobial agents were prepared. Additionally, an AS Team was established in 2018 to strengthen measures for ensuring appropriate use.
For carbapenem antimicrobial agents, the antimicrobial use density decreased from 2.20 (2004) to 0.61 (2017) and the mean number of administration days decreased from 8.40 (2006) to 5.89 (2010). The proportion of meropenem-sensitive Pseudomonas aeruginosa cases recovered from 71.6% (2008) to 97.1% (2018). The number of patients with multidrug-resistant P. aeruginosa (MDRP) decreased from 28 (2008) to 0 (2018), and the number of patients with two-drug-resistant P. aeruginosa decreased from 10 (2010) to 0. In particular, MDRP has not been detected for 29 consecutive months as of October 2019. Long-term continuous measures and education were considered to have resulted in stably low incidence rates of resistant bacteria.
The risk of encountering a variety of human-to-human Infections, including emerging infectious diseases, should be adequately and appropriately addressed in the emergency department. However, no guidelines have been developed anywhere in the world based on sufficient evidence on Infection control in the emergency department. Each facility examines and implements its own countermeasures. The Japanese Association for Acute Medicine has established the "Committee for Infection Control in the Emergency Department" in cooperation with the Japanese Association for Infectious Diseases, the Japanese Society for Infection Prevention and Control, the Japanese Society for Emergency Medicine, and the Japanese Society for Clinical Microbiology. A joint working group has been established to consider appropriate measures. This group conducted a comprehensive and multifaceted review of Infection control measures for emergency outpatients and related matters, and released a Checklist for Infection Control in Emergency Departments. This checklist has been prepared so that even small emergency departments with few or no emergency doctors can control Infection by following the checklist, without committing any major mistakes. The checklist includes a control system for Infection control, education, screening, and vaccination, promptly responding to suspected Infections, and managing the risk of Infection in facilities. In addition, the timing of the check and the interval at which the check is performed are specified as categories. We hope that this checklist will contribute to improving Infection control in the emergency department.
(JJAAM. 2020; 31: 73-111)