In Japan, the outbreak percentage of norovirus is high in nursery schools and restaurants. Some death cases have occurred in hospitals and Geriatric Health Service Facilities. The worldwide impact is estimated to $4.2 billion for healthcare and $60.3 billion for the economy. The development of a vaccine is an urgent task. The risk assessment, the early detection of infected persons, isolating patients, hand hygiene, and environmental disinfection are important for prevention of norovirus outbreaks. Risk assessment requires grasping the epidemic information and the evaluation of education. It is important to understand how well the daily standard precautions are in place.

Environmental hygiene is an important factor in controlling healthcare associated infections. Most healthcare facilities in Japan outsource environmental hygiene work such as cleaning, and not only hospital staff but also outsourced staff assume an important role in healthcare-related infection control. Improving the quality of environmental hygiene cannot be expected by outsourced staff alone unless infection control personnel are actively involved. We have built a team to respond to environmental hygiene and have developed a system for hospital staff and outsourced staff to work together. As a result, the sense of purpose of the outsourced staff and the quality of environmental hygiene have improved. Our team has ever controlled outbreaks from drug-resistant bacteria, influenza, and CD infections. It is suggested that the activities and systems of our team have been successful.

The problem is that if the in-hospital environment is improved to some extent by the ICT round, it is likely to become a mere system. Since 2015, Osaka university hospital has started an environmental round (a round to evaluate the environment of each department) and an infection control round (a round to evaluate the achievement status of infection control for patients) as ICT rounds with four different professions. We regularly review and discuss the round method, results and issues, and improve the quality of round activities. As a result, each department began to evaluate the risk of infection control and to consider ICT round as one of the processes to solve the problems of their own. It is hoped that more effective infection control measures will be implemented if the department can independently consider and implement infection control measures. Implementing isolation precautions tailored to the patient condition will lead to more effective isolation precautions.

Significant number of MRSA had been isolated from patients at the ward of neonatal intensive care unit (NICU) /growing care unit (GCU) for two years. Since standard countermeasures by hospital manual were not effective to control the prevalence, additional strategy was conducted based on the analyses of risk factors for MRSA acquisition after admission. Independent risk factors for MRSA acquisition were admission to NICU [odds ratio (OR): 33.82, 95% confidence interval (CI): 2.43-470.39], use of open-bed (OR: 19.45, 95% CI: 3.94-96.49), and patients with cleft lip and palate (OR: 28.41, 95% CI: 1.75-460.74). Medical care by the staff other than NICU (P = 0.020) and conduction of rehabilitation (P = 0.002) were also selected by univariate analyses. Based on these results, several interventions were implemented. Compared with standard countermeasures period, MRSA acquisition rate was significantly decreased during additional strategy period [from 3.30 to 1.70/1000 patients day (P = 0.031) ]. In case of prolonged MRSA outbreaks in spite of vigorous standard management, additional new strategy should be introduced based on the assessment of the problems that caused outbreaks.

Most Japanese nurses certified in infection control work as full-time infection preventionists. Therefore, this study assessed competency in certified nurses in infection control and identified factors that influence competency in infection prevention practices. We conducted a cross-sectional study in November and December 2013 using a self-administered questionnaire to assess competency in infection prevention practices. Questionnaires were mailed to 1,711 nurses listed on the Japanese Nursing Association website. Data were analyzed using descriptive statistics, univariate analysis, and multivariate regression analysis to compare competency status among career stages and identify associations between total competency scores and attributes among certified nurses in infection control. This study included 970 respondents. Significant differences were observed in mean competency scores between novice, competent, proficient, and expert nurses. In the multivariate regression analysis, the factors associated with competency included years of nursing experience, years of experience as a certified nurse in infection control, experience as a full-time infection preventionist, and enrollment in a graduate or master's course. The study results could inform the development of a competency assessment tool and systematic educational program for nurses certified in infection control.

This study aimed to clarify the effects of an intervention to improve hand hygiene compliance based on the Health Action Process Approach (HAPA) theory in the education of novice nurses.

The study was conducted according to a two-year plan wherein nurses in the same hospital were allocated to an intervention group and a comparison group each year. The intervention included action planning on hand hygiene, coping planning to tackle possible problems, and hand hygiene practice and self-evaluation.

Nineteen nurses in the intervention group and 21 nurses in the comparison group were included in the final analyses. On the Hand Hygiene Cognitive Scale for novice nurses based on the HAPA theory, scores for coping planning, action planning, and outcome expectancies two months after the intervention were significantly higher in the intervention group (p =.025,.029, and.001, respectively). The intergroup comparison on the rate of practice at My five moments for hand hygiene showed that the change from baseline to immediately after the intervention was significantly larger in the intervention group (p =.045). The rate of practice satisfying the criteria for both My five moments for hand hygiene and the duration of the entire procedure did not significantly differ between the two groups. Factors hampering the action that were extracted from the group work included [non-personal factors hampering action], which comprised subcategories, such as "I am too busy to spare the time."

These findings suggest that the HAPA-theory-based intervention in this study enhanced the cognitive aspect of hand hygiene and was effective for hand hygiene practices embodied in My five moments for hand hygiene to a certain extent. However, the results failed to show the obvious effect of the practices' rate satisfying the criteria for both My five moments for hand hygiene and the duration of the entire procedure, suggesting an influence of non-personal factors, such as insufficient time allocated to hand hygiene.

The bedpan washer disinfector (BWD) is a device that uses water, detergent, and steam to clean and disinfect toilet bowls and urinary tract. Toilet bowls and urinary tracts can cause the spread of infection if not properly cleaned and disinfected by BWD. In this study, we investigated the washing effects of BWD and operational issues using pseudo-pollutants. The subjects of the experiment were bed pans, bucket containers for portable toilets, and urinary tract. The washing evaluation was carried out according to the methods of England and Sweden specified in ISO / TS 15883-5: 2005. After applying pseudo-pollutants, washing was performed with BWD. Neither the British nor Swedish methods could completely remove the pseudo-pollutants, and the results between the two methods were inconsistent. The two washing evaluation methods differed in the washing evaluation results of BWD, and the accuracy as a tool for guaranteeing validation remained questionable. In addition, it was suggested that washing with BWD would result in insufficient washing of the handle of the urinary tracts, and that urine might remain at the joint of the urinary tract.