Infection prevention and control during surgery should be centered not only on preventing surgical site infection but also on controlling the occupational risks for the anesthesiologists and other medical workers, maintaining the work environment (i.e., air-conditioning/cleaning/disinfection), and proper handling of surgical instruments. It covers a wide range of infection control measures. In recent years, the items of infection control have been incorporated into the guidelines created from the aspect of medical quality including medical safety, and the guidelines for surgical site infection control have been enhanced according to the specificity of the clinical department in the surgical field.

Background: Understanding the current status of infectious disease treatment and antimicrobial resistance in ryoyo wards (supportive care beds in Japanese long-term care facilities) is important for clarifying and addressing any issues.

Methods: We conducted a point prevalence survey from January to May 2020, targeting 1,032 medical institutions with ryoyo wards. Basic information on the institution, patient status, and treatment details of patients who were using antimicrobial agents on the day of the survey were recorded.

Results: Valid responses were obtained from 80 medical institutions (response rate: 7.8%). Of the 6, 729 patients in ryoyo wards, 9.4% were on antimicrobials. Antimicrobial users had a median age of 87.0 years and 49.5% were male. Antimicrobials were used for treatment in 92.4% and prophylaxis in 7.6% of users. Of antimicrobial users, 36.4% had pneumonia and 24.4% had urinary tract infections (UTIs). Among patients with UTIs, 42% of E. coli and 38% of Klebsiella species detected by urine culture were resistant to third-generation cephalosporins. Among patients with pneumonia, 29.3% and 14.1% were treated with third-generation cephalosporins and carbapenems, respectively. Among patients with UTIs, 24.1%, 19.5%, and 7.5% were treated with fluoroquinolones, third-generation cephalosporins, and carbapenems, respectively.

Conclusion: High prevalence of extended spectrum beta lactamase-producing bacteria and broad-spectrum antimicrobial use were the main characteristics of infectious disease treatment in ryoyo wards. It is necessary to monitor the use of antimicrobial agents and drug-resistant bacteria continuously in ryoyo wards and develop effective intervention measures for treating infections.

The susceptibility of Bacillus cereus spores to 10% povidone-iodine was measured at 0°C, 20°C, and 37°C, respectively. The spores of 15 B. cereus blood isolates and 15 isolates from healthy adult skin, respectively, were used for the measurement. The spore solution was prepared 9 days after the culture of B. cereus on NGKG plates, and spore formation was confirmed microscopically. No B. cereus strain in the spore form was highly resistant to any conditions of 10% povidone-iodine treatment. Approximately 99% of the spores of most strains were killed after a 5-min treatment with 10% povidone-iodine irrespective of treatment temperature, whereas 1% of spores survived a 30-min treatment. The spores of 5 blood isolates and 3 healthy skin isolates were more sensitive to 10% povidone-iodine, and only 0.1% of the spores survived the 5-min treatment. No apparent differences in susceptibility to povidone-iodine between the blood and skin isolates were observed. From these results, 5-min treatment using 10% povidone-iodine for skin disinfection is applicable when contamination of B. cereus spores on the skin is expected to be mild or low.

This study examines the efficacy of different sanitization methods on bedsheets that are conventionally considered useful against environmental bacteria in hospitals. The study was conducted as a randomized controlled trial using the counterbalance method. Sterilization effect was examined in four groups: ethanol sheet cleaning and ethanol spray group, disinfectant ethanol spray group, commercial germicidal spray group, and control group. Beds in a clinical practice room were randomly selected, and the effect of each intervention on the removal of bacteria from the beds was examined. The detected number of bacteria decreased significantly more in the ethanol sheet cleaning and ethanol spraying group compared with the control group (P < 0.05). A significant reduction in the number of detected bacteria was also observed in the disinfectant ethanol spray group and commercial germicidal spray group. Gram-positive bacteria, gram-negative bacteria, glucose-nonfermenting gram-negative rods, and fungi were detected in the control group. In contrast, in the ethanol sheet cleaning and ethanol spray group, only Staphylococcus hominis was detected. In the ethanol spray group, Micrococcus luteus, gram-positive coccus, Bacillus subtilis, amyloliquefaciens, and gram-positive bacillus were detected. In the commercial germicidal spray group, Micrococcus luteus, Dermacoccus nishinomiyaensis, Pseudomonas oryzihabitans, Penicillium decumbens, and gram-positive coccus were detected. Thus, these results reveal that all sanitization methods that are conventionally considered useful are effective in terms of removing bacteria present on bedsheets. These findings suggest that patients with weakened immunity should use thoroughly sterilized bedsheets and sterilization is required after high-frequency contacts because bacteria left after each intervention are capable of causing opportunistic infections.

In Japan, critical care beds for ventilatory management were limited during the coronavirus disease 2019 (COVID-19) pandemic. Our hospital treated moderate COVID-19 pneumonia and began using high-flow nasal cannula (HFNC) for patients with the aim of reducing transfers to critical care hospitals. We conducted a retrospective study to determine the outcomes, influencing factors, and effects of avoiding intubation using HFNC. HFNC was implemented when SpO₂ was <93% using a simple mask (O₂, 5 L/min). We performed intubation when oxygenation was not maintained at 60%-70% FiO₂. HFNC was used in negative-pressure rooms or patient rooms at a distance from the green zone. In addition to contact and droplet precautions, staff members undertook precautions against the airborne spread of COVID-19. Thirty-four patients used HFNC and scheduled for intubation when respiratory failure progressed. In these patients, 20 (58.8%) were relieved by HFNC alone and 14 (41.2%) were intubated. Compared to the intubation criteria in the early phase of the pandemic, we could reduce ventilator use by a total of 151 person-days. In hospitals that treat moderate COVID-19, using HFNC for severe COVID-19 pneumonia with certain infection control can be safe, help patients avoid intubation, and improve the conditions in overwhelmed hospitals.