In Japan, patients with coronavirus disease 2019 (COVID-19) need to be hospitalized. We admitted patients with mild-to-severe disease as well as asymptomatic carriers at a designated hospital; however, we were also aware of the potential issues of shortage of personal protective equipment (PPE) and nosocomial infections among healthcare workers. Therefore, we opened an entire ward as a living place for asymptomatic to mildly symptomatic patients, thereby lessening the number of donning and doffing of PPE and minimizing the workload and risk of healthcare workers of being infected in the hospital. For those with severe disease, we considered the corridor of intensive care unit as the so called "orange zone" to use PPE to minimize the workload and risk. Here, we have described the details of our strategy.
It is generally recognized that most Bacillus cereus blood stream infections are caused by the contamination of infusion solution due to contaminated hands of healthcare personnel and skin of patients. The contamination of hands and skin with B. cereus spores frequently occur from contaminated hospital linens such as reused towels. Disposable medical gloves can also be a source of B. cereus spore contamination. The present study was therefore undertaken to quantitatively measure the attachment behavior of B. cereus spores to the surface of disposable gloves made from various materials, such as latex, nitrile rubber, and vinyl chloride plastic. Our modified bead extraction method was used for the assay. The number of spores attaching to gloves was highest for vinyl chloride gloves, followed by latex gloves and nitrile rubber gloves, and the difference in the numbers of attached spores between vinyl chloride gloves and nitrile rubber gloves was significant (P = 0.028, <0.05). We therefore recommend nitrile rubber gloves for medical use rather than other gloves.
In Tama-Nanbu Chiiki Hospital, a pharmacist-initiated antimicrobial stewardship program was started to optimize the use of antimicrobial agents in the hospital. Previously, at 10 months after the start of the program, the therapy durations for both 4th cephem and carbapenem were shortened. However, at that time, the resistance rate of Pseudomonas aeruginosa for both agents did not markedly change. Currently, we evaluated the correlation between the resistance rate of Pseudomonas aeruginosa and above mentioned antibiotics at 3 years after intervention. Although the day of therapy (DOT) was almost the same as that at 10 months of intervention, we achieved decreased resistance of Pseudomonas aeruginosa for both antibiotics. A positive correlation was observed between 4th cephem resistance rate in Pseudomonas aeruginosa and DOT (0.90, p = 0.04).
To reduce the antimicrobial resistance rate, a longer period of intervention is recommended.
We standardized the sodium hypochlorite immersion disinfection method and revised the infection control manual through the activities of the Disinfectant Stewardship Team (DST). In this study, we conducted an actual survey on immersion disinfection using sodium hypochlorite as part of the revised manual compliance check.
After the manual was revised, the survey period was from September 2018 to March 2019. The targets were 22 departments in all hospital wards. The survey contents confirmed the disinfection status of sodium hypochlorite by direct observation and hearing. Furthermore, the concentration of sodium hypochlorite was confirmed using a colorimetric method.
A total of 43 cases were investigated. Of these, 41 cases in which all contents were investigated were analyzed. The overall compliance rate was 36.6% (15 cases). In terms of the compliance rate for each content, the concentration was 58.5% (24 cases), disinfection status was 71.0% (29 cases), and immersion time was 83.0% (34 cases). Deficiencies in concentration had an effect on the decline in overall compliance.
Investigation of the actual condition of immersion disinfection with sodium hypochlorite revealed the inappropriate use in hospital wards. In addition, improvement points could be clarified by evaluating the compliance status of each content, including concentration measurement.