Airborne precaution is a fundamentally important measure of infection prevention, the observance of and stringent compliance to which requires thorough knowledge and understanding of the principles of clinical implication of transmission-based precautions.

However, having a lot of knowledge about the subject does not necessarily mean that one can perform and execute their expertise properly. Principle is one thing, and practice is another.

There lies a spectrum of knowledge characteristics in between, with their properties ranging from declarative to procedural, schematic, and strategic. To obtain practical skills and achieve expertise as an infection preventionist, the principles and theories of infection control measures must be transformed into strategic knowledge.

Moreover, given that infection control is practiced through the interaction of healthcare personnel, careful attention should be paid to the behavioral science in humans in daily clinical practice: actions like communication, judgment, and decision making are unavoidably influenced in an unconscious manner by a variety of cognitive pitfalls called biases, such as search satisficing, anchoring, and diagnosis momentum. These intuitive behaviors lack carefulness or mindfulness required for controlled operation of reasoning, rendering professional judgment, and decision making even among those who have achieved strategic knowledge.

Comprehensive understanding of both knowledge characteristics and common traps of cognitive biases is necessary in the clinical context whenever possible in practical healthcare settings.

To safely carry out treatment and nursing for patients with emerging infectious diseases, it is essential for medical personnel to wear appropriate personal protective equipment according to the risk of infection. The purpose of this research is to clarify the present condition and needs for protective clothing for infection control. A questionnaire survey was conducted for doctors, nurses, and other medical staff. Under the protective clothing, we found that personnel wear personal clothes, white coats for examination, scrub wear, nurses' white garments, etc. In addition, plastic gowns are worn on protective clothing. The items that emphasize protection against infections were the infection protection performance at the time of wearing, the safety of protective equipment (breathing protective gear, goggles, face shields, gloves, etc. ), and easy-to-understand detachable manuals. Further, we surveyed their onsite needs and received many free descriptions.

We experienced an outbreak of respiratory syncytial virus (RSV) infection in a growing care unit (GCU) and estimated the financial burden from the cost required for treatment and the decrease in hospital revenue that was assumed to have been affected by the outbreak. A total of 5 patients developed RSV infection, and all patients were isolated in the pediatric ward and ICU. The GCU was closed for 2 weeks, and admission to the pediatric ward and ICU was restricted for 5 weeks. The estimated cost of treatment was 5.18 million yen, whereas the decrease in monthly hospital revenue for the Department of Neonatology and Pediatrics from the average monthly revenue of the same month for the last 5 years was 17.45 million yen. Early detection of affected individuals, early use of palivizumab, and arranging an isolation room in newborn wards may reduce the financial burden caused by the outbreak of RSV infection.

This study aimed to assess changes in oral antibiotic use and bacterial resistance through the antimicrobial stewardship (AS) program at an outpatient department in Fukuoka City Hospital, a medium-sized hospital. Antimicrobial use density (AUD) and days of therapy (DOT) of each antibiotic class administrated orally to outpatients in the hospital from 2011 to 2020 and resistance rates of each antibiotic in bacterial isolates from the patients were evaluated. Means of the AUD and DOT for every year and the resistance rates during the period after AS (2016-2020) were compared with those during the period before AS (2011-2015), respectively. The means of the AUD and DOT of third-generation cephalosporins, macrolides, and fluoroquinolones in the period after AS were significantly lower than those in the period before AS. The rates of levofloxacin resistance in Escherichia coli and Pseudomonas aeruginosa and erythromycin resistance in Streptococcus pneumoniae also decreased during the period after AS. AS optimized antimicrobial use, which may lead to decreased antimicrobial resistance rate in each microorganism. Several target values of the National Action Plan on Antimicrobial Resistance in Japan were achieved. These observations suggest that AS, even if it is performed in a medium-sized hospital, contributes to the proper use of antibiotics and to the reduction of detection rates of resistant organisms.

We experienced a measles outbreak that coincided with a seasonal influenza pandemic. We proactively prevented the transmission of the disease to contacts in the outpatient clinic; from two new patients, there were two secondary infections other than household infections. For most contacts in the emergency room, despite the busy season, careful triage by interview, space separation measures according to symptoms, and extraction of high-risk contacts such as unvaccinated infants and pregnant women proved to be effective. Other challenges that emerged in this experience and potential countermeasures for them are also discussed in this paper.