We find it difficult to conduct an antimicrobial stewardship program during the COVID-19 pandemic. It is important to understand the reason for this difficulty and know its structure. However, an appropriate antimicrobial stewardship is imperative even during a pandemic. In fact, it has become even more important than before, as it can ultimately benefit COVID-19 patients as well. Accurate diagnosis is a presupposition to stewardship as it provides accurate treatment. Accurate treatment is indeed the appropriate stewardship. To achieve accurate treatment, scientific vigor needs to be pursued. A "gut feeling" at the bedside should not be brought into practice without sound scientific evaluation.

We informed our hospital staff about a COVID-19 vaccine by ICT and established a corresponding COVID-19 vaccination leave. Furthermore, we evaluated the decision-making ability of our staff based on the influence of our hospital activity and another information, what they considered. It was observed that the staffs were influenced by the information regarding ICT, but did not consider the COVID-19 vaccination leave to be important. Therefore, it was thought that we should adopt effective techniques and be flexible with the vaccination.

Background: Vancomycin-resistant Enterococci (VRE) can cause outbreaks through contact transmission. In this study, we experienced a VRE outbreak in a cancer center in Japan. Herein we report for the first time the VRE transmission pathway and risk factors for VRE acquisition in a cancer center.

Methods: After identifying the first case of VRE, stool screening for VRE and multifaceted infection-control were implemented in the entire ward. To determine risk factors for VRE acquisition, we conducted a case-control study comparing VRE-positive and -negative patients.

Results: Of the 177 patients who underwent screening tests, 13 were positive for VRE, of whom 9 (69.2%) were male and 4 (30.7%) were female. The age range was 52-83 years (median, 67.0), and all patients had solid tumors. Only one patient was treated for VRE infection, and no deaths due to VRE infection were reported.

Conclusion: In our study, "diaper use" was a risk factor for VRE acquisition. It is important to thoroughly implement infection control measures, primarily hand hygiene and use of personal protective equipment, as well as environmental cleaning to terminate an outbreak.

Although there have been previous reports of Aspergillus and Mucor infections in immunocompromised hosts during hospital renovation work involving the breakup and removal of ceiling material, there have been no previous reports investigating the number of fungi scattered during such events. We report the monitoring of fungal dissemination via air sampling during the renovation carried out in our hospital parking area. Many fungi were collected after the removal of the parking area concrete floor, which were identified as Aspergillus fumigatus and Rhizomucor pusillus via Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. During the process of tearing down or removing parts of old structures in hospitals for renovation, especially those made of concrete, it is crucial for inpatients with immunodeficiency to be cared for in rooms with high-efficiency particulate air filter ventilation and filtration. Additionally, outpatients with immunodeficiency must be directed to enter through an entrance situated away from construction work while wearing N95 masks.

Although nasopharyngeal swab is widely used, the use of saliva for the detection of SARS-CoV-2 is also accepted. However, the method of saliva collection has not yet been well investigated. Thus, to make the assay using saliva more reliable, we compared the positivity rates and viral loads in three paired samples of nasopharyngeal and tongue swabs and saliva retained in the floor of the mouth, which were simultaneously obtained from 21 patients with SARS-CoV-2. Viral RNA was detected in 95.2% (20/21) of nasopharyngeal swab, 85.7% (18/21) of tongue swab, and 52.4% (11/21) of retained saliva samples. The viral loads were in the following order: nasopharyngeal swab > tongue swab > retained saliva samples. Our results indicated that a tongue swab is usable and provides more sensitivity for SARS-CoV-2 detection than natural saliva. However, it is important to consider the possibility of a false negative and that re-examination would be required if the result is negative but a SARS-CoV-2 infection is highly suspected.

In this study, a certified nurse in infection control (CNIC) provided an intervention to ward staff dealing with COVID-19 patients. We examined ways of understanding infection-control nursing and their effects on psychological stress reduction. A conference was held as an intervention to improve the quality of nursing for long-term hospitalized COVID-19 patients, and consultations and group discussions were held by the CNIC. Pre- and post-intervention, the participants were asked to complete a survey consisting of open-ended questions regarding their understanding of infection-control nursing as well as stress assessment. Open-ended coding was performed on the free-text responses, and descriptive statistics were used to analyze the stress assessment results.

The results indicated that infection ward staffs were anxious about becoming infected while caring for patients in zones designated as "infection areas." Therefore, their behavior within the infection area was evaluated based on the medical staff's exposure risk assessment. Additionally, as a specific nursing practice method, we introduced a rooftop walk for patients accompanied by a nurse and regular environmental checks in the infection area.

Before the intervention, 41.7% of the infection ward staff believed that infection-control nursing "does not include involvement with the patient/entering the infection area; " however, after the intervention, this proportion dropped to 0%. In the stress assessment, 83.3% of the subjects were afraid or anxious about infection before the intervention, but this reduced to 72.7% after the intervention, indicated that those feelings had slightly decreased.

Based on the results, the intervention by the CNIC changed the ward nursing staffs' perception of infection-control nursing, thereby leading to the reduction of stress in nursing.

Conventional lecture-style education is usually delivered for healthcare workers in hospitals. However, this is passive learning and can accomplish limited teaching efficiency. In this report, we describe the details of our activities to incorporate active learning techniques at a regular infection prevention seminar in our hospital, which successfully resulted in a high-level of satisfaction from the participants. This study was conducted in May and June 2021 among the employees of the Marugame Medical Center. As a preliminary task, they were asked to develop "My 5 Moments," which was defined as situations that they frequently encounter in their daily work and perform hand hygiene. They then made a presentation of their ideas at the seminar. We evaluated the changes in the implementation of hand hygiene among nurses working in wards before and after the seminar. Furthermore, we conducted a questionnaire survey to evaluate the effectiveness of this participatory workshop. Of the 391 employees, 365 (93.4%) participated in the seminar, and 231 (66.8%) worked on the pre-assignments in each occupational group. Various "My 5 Moments" were presented by each occupational group, which provided a good opportunity to reacquaint us with the daily work of individuals in other professions. The Wilcoxon signed-rank test demonstrated that the number of hand hygiene among the nurses significantly increased after the seminar (median: 14.2 times/day vs 20.0 times/day; p = 0.007). In the post-workshop questionnaire, we received valid responses from 356 participants (91.0%). Compared with the lecture-style education, the participatory education was favored by 74.5% of the participants, with 26.8% reporting it was "very good" and 47.7% reporting it was "good." This study demonstrated the feasibility of incorporating an active learning technique into a regular infection prevention seminar. The generalizability and long-term impact of this approach should be evaluated in future studies.