The number of COVID-19 patients in Japan surpassed 7.8 million by the end of April 2022, and the opportunities for the surgical treatment of COVID-19 patients are increasing. The following is the sequence of surgical indications in patients with COVID-19. 1. Surgery should be delayed after seven weeks of infection due to the high incidence of postoperative complications. 2. Surgery should be performed after 10 days of infection to reduce the risk of infection to medical staff. 3. If alternative non-surgical treatment is difficult, emergency surgery with appropriate infection control measures is recommended. The indications for laparoscopic surgery do not need to change even in patients with COVID-19, but it is important to understand the risk of surgical smoke.

Recently, epidemic types of methicillin-resistant Staphylococcus aureus (MRSA) have significantly changed in both hospital and community setting in Japan. Before 2010, about 80% of MRSA strains isolated from hospitals were the typical healthcare-associated MRSA (HA-MRSA) with staphylococcal cassette chromosome (SCC) mec type II. However, USA400-like community-associated MRSA (CA-MRSA) with SCCmec type IV have become dominant since 2014 in hospitals. Meanwhile, skin infections caused by the highly virulent CA-MRSA USA300-clone have been increasing. The USA300-clone is associated with intractable skin infections and necrotizing pneumonia as it carries a cytolytic pore-forming toxin, Panton-Valentine leukocidin (PVL), and arginine catabolic mobile element, which promotes colonization on the skin. For the past decade, the USA300-clone had limited prevalence and was not considered a serious problem in Japan. However, the USA300-clone has been recently spreading both in clinics and hospitals. In this review, the transition and current status of molecular epidemiological features of HA-MRSA and CA-MRSA in Japan are described using our data.

The fluorescent marker method is a simple and inexpensive way to evaluate the cleanliness of healthcare environments in real time. However, quantitative relationships between fluorescent signal and microbial removal have not been established.

Here, a quantitative method was developed using pixel values from digital photographic images of fluorescent markers, and the relationship between the rate of removal of fluorescent markers and the rate of removal of microorganisms from three surfaces: stainless steel and black and white vinyl chloride was determined.

Specific amounts of solutions of commercially available fluorescent markers were applied adjacent to the samples of S. aureus, and the surfaces were photographed before and after wiping with a hydrophobic wipe. The fluorescent marker was quantified based on an assumed exponential relationship between the fluorescent marker and measured pixel values with respect to the maximum pixel value (255); coefficients of correlation between the calculated and actual amounts of fluorescent marker were in excess of 0.99 for each surface. The coefficients of determination for the removal rates of S. aureus and fluorescent marker on the white and stainless steel surfaces were 0.46 and 0.61, respectively. Notably, the agreements were good only when the fluorescent marker removal rate was 90% or higher. These results confirm the possibility in quantifying the amount of fluorescent marker on a surface using digital image data, and this measurement can be used to estimate surface cleanliness.

[Objective] The purpose of this study is to understand the current status of microbial contamination in water supply system of dental units and evaluate effective countermeasures against microbial contamination.

[Subject and methods] Water samples were collected before flushing and after 10 s of flushing from three-way syringe before medical treatment on Monday and Friday.

Disinfectant treatment was performed for units with disinfection function after the medical treatment on Friday, and water was collected after discharging the disinfectant and after 10 s flushing before medical treatment on Monday day after a holiday. In this study, the unit was disinfected after the end of clinic hours on Friday although it is recommended to be performed after the end of clinic hours every day. After sampling, we counted the bacterial colony forming units (CFU).

[Result] The number of microorganisms was significantly higher in the units that had been used for a long time than in the other units.

A significant difference was observed in the number of microorganisms before and after flushing in the unit with short-use units, but the effect was low in the unit with long-use ones.

The number of microorganisms had been few regardless of before and after flushing in units with disinfection function.

[Discussion] Long-use units tend to have high number of microorganisms and have weaker flushing effects, suggesting the need to improve the current flushing method.

Although there were many specific bacterial species in each unit, the flora showed diversity.

It suggested that microorganisms may have entered from a three-way syringe or turbine hand piece used during the treatment.

Influenza outbreak in the National Cancer Center Hospital at the end of summer season was reported. The Infection Control Team (ICT) intervened after receiving reports of two confirmed influenza diagnoses on September 2, 201X; a syndrome survey was initiated on September 3, 201X to detect staff with flu-like symptoms as early as possible. It was thought to be related to the ward event held on August 30, and wearing masks and practicing thorough hand hygiene in that ward was advised. The physical condition of the participants in the event was also assessed.

In the Pharmacy Department, there were several non-participating staff with flu-like symptoms in the ward events; hence, environmental wiping to prevent the spread of the disease in the department was strengthened.

By the evening of September 4, 18 staff members (pharmacists, nurses, and dieticians) had developed the disease, and on September 7, two inpatients were found to have the disease, but not after that.

Propagation across multiple professions was found to be due to participation in several events.

In the pharmacy department, several staff were found to have flu-like symptoms even before participating in the related events; hence, portable hand sanitizers were introduced to reinforce hand hygiene.

The manual on how to respond to an outbreak was revised.

As a result of the rapid response of ICT, the disease was contained and a serious outbreak was prevented. The existing manual was found to be inadequate; thus, it was revised. While keeping in mind the possible infections such as influenza infection outside the epidemic season, the need for adequate and standardized infection control measures is being reaffirmed.

Several residents of intensive-care geriatric homes have underlying diseases or comorbidity, making them prone to developing fever due to infection. This study aimed to clarify the actual frequency of fever among residents of an intensive-care geriatric home and to identify the factors associated with the occurrence of fever. The medical records of 295 residents of five intensive-care geriatric homes in the Kinki region, Japan were retrospectively reviewed. Primary tabulations included age, sex, body mass index (BMI), presence of underlying disease, level of care required, requirement for mealtime assistance, requirement for voiding assistance, means of transportation, use of indwelling urinary catheter, and onset of fever. The association between variables were then analyzed. Only 134 patients consented to participate in the study; 84 developed fever that required a doctor's examination over a 1-year period and had a total of 175 visits. The most common diagnoses at the time of fever were common cold, urinary tract infection, pneumonia, aspiration pneumonia, and bronchitis, accordingly. Multiple logistic regression analysis showed that geriatric patients with underlying medical conditions and those who needed dietary assistance were more likely to develop fever than those who did not. The results of this study suggest that thorough infection control measures for residents of intensive-care geriatric homes with underlying medical conditions and those who require dietary assistance may contribute in reducing the risk of developing fever.

This study aimed to clarify the actual conditions of COVID-19 infection control in Japan's nursing homes (NH). An anonymous self-administered questionnaire survey was conducted among 500 facility managers from 500 randomly selected NH. Of the 66 returned questionnaires, 64 had valid responses (12.8%). Medical qualifications were not observed in 56.3% of the respondents. Additionally, the responses "There is a manual available to detect and manage a resident with suspected COVID-19," "Training on COVID-19 measures for staff," and "Staff training participation rate" accounted for 81.3%, 67.2%, and 67.1%, respectively. However, 64.1% answered "There is a countermeasure for staff who cannot participate in infectious disease control training." "Infection control specialists" were few, and the "Infection control status" varied between facilities. Establishing a system that facilitates access to support from infection control specialists and training infection control personnel in NH is necessary.

This study aimed to investigate the effectiveness of antifungal stewardship (AFS) and the intervention points of AFS among patients with candidemia in small and medium-sized hospitals. To this end, hospitalized patients from whose blood cultures Candida spp. were isolated from April 2016 to March 2020 were included. The patients were assigned to the pre-intervention group (2016-2017) and post-intervention group (2018-2019), and the changes in patient outcomes before and after aggressive AFS were compared. Overall, 51 patients (28 and 23 in the pre-intervention and post-intervention groups, respectively) were included in the study, and four were excluded. The 30-day mortality rates were 39.3% and 39.1% in the pre-intervention and post-intervention groups, respectively, with the intergroup difference not being significant. The rate of change in the type of antifungal medication significantly increased from 7.1% in the pre-intervention group to 44.0% in the post-intervention group (p<0.05). Multivariate logistic regression analysis for 30-day mortality showed that the administration of appropriate antifungal medication within 72 hours on a positive blood culture and Candida glabrata isolates were factors associated with a reduction in the risk of mortality (p<0.05). These results indicate that early identification of Candida spp. and early initiation of appropriate antifungal therapy are the intervention points that should be focused on in the AFS approach. In many small and medium-sized hospitals without infectious disease specialists, many of the roles of these specialists are played by pharmacists. Our findings indicate that it is important for pharmacists to play a leading role in candidemia management.