Povidone iodine, alcohol, and chlorhexidine gluconate are commonly used for skin antisepsis in surgical settings. Recently, a randomized controlled trial confirmed the effectiveness of oranexidine, a new skin antiseptic, for this purpose. However, many disinfectants are not recommended for disinfecting mucous membranes. Therefore, it is important to understand the efficacy and precautions of each agent before making a choice. This article aims to describe the indications, contraindications, and precautions for the agents frequently used in gastrointestinal surgical field antisepsis and summarize the results of recent studies on the efficacy of these agents.

Hand hygiene is the basis of infection control. Pharmacists working in hospitals have many opportunities to interact directly with inpatients and outpatients owing to the enhancement of ward operations. As a result, pharmacists have an increased risk of being exposed to and acting as carriers of infectious diseases. Pharmacists, like other medical professionals, need to have appropriate knowledge and practice of hand hygiene, but they are not sufficiently aware of infection control procedures, including hand washing. We report an attempt by pharmacists to improve their compliance with hand hygiene practices.

Scrub typhus (ST), Japanese spotted fever (JSF), and severe fever with thrombocytopenia syndrome (SFTS) are all tick- or mite-borne infectious diseases. In late years, the number of JSF and SFTS patients is increasing in Japan. A causative pathogen of ST and JSF is rickettsia, and tetracyclines are effective for these rickettsial infection. SFTS is a viral infection; however, the effective antiviral agent has not yet been elucidated. Clinical pathognomonic features (high fever, rash, and eschar) are common in ST and JSF, and these symptoms are extremely similar between these two rickettsial infections. Ninety percent of ST patients defervesce within 48 h after the administration of tetracyclines, although it takes several days to reach to defervescence using tetracyclines and some cases become serious state in JSF. It is suspected that the cytokine storm participates in severe rickettsial infections. It is important that we perform standard precaution including eye protections and N95 respirators during treatment of these tick- or mite-borne infectious diseases to prevent nosocomial infection. Alcohol-based products are effective for sterilization of these pathogens.

The prevalence of Clostridioides difficile PCR-ribotype 027 (RT027) is low in Japan. We report an outbreak caused by RT027 that took place in a regional core hospital in Japan. From February to June in 2019, there were 18 new patients with C. difficile infection (CDI) in ward A. The peak of the outbreak was in March when the CDI incidence was 69.9/10,000 patient-days. Of the 18 CDI patients in ward A, specimens from 12 episodes on 11 patients were available for the analysis, and all 12 isolates were identified as RT027. Since RT027 was not recovered from any CDI patients from other wards, it was suggested that the outbreak was confined to the single ward. By thoroughly implementing basic infection control, the incidence of CDI in ward A decreased, and RT027 has not been recovered since July 2019. All 12 RT027 isolates were susceptible to moxifloxacin and gatifloxacin, suggesting that RT027 strain responsible for the outbreak represents the pre-epidemic RT027 genetic background from which the epidemic RT027 lineages emerged. Further studies are needed to clarify the epidemiology and clinical significance of RT027 C. difficile in Japan.

Our hospital has performed a regular environmental inspection for Legionella bacteria at 123 sites in our feed-water system since 1997. Based on data collected since 2008, Legionella bacteria have been detected at 47 sites, such as bathrooms, lavatories, common shower units for patients, and dental units. The same type of Legionella bacteria has been detected repeatedly at 24 sites. These findings suggest that these bacteria took root in the feed-water system, which served as a favorable environment for growth and proliferation of the bacteria. It was difficult to implement effective environmental measures against Legionella bacteria for many years. However, we were able to take early and appropriate actions at individual sites by understanding daily proliferation of the bacteria and identifying the causes of growth based on the repeated environmental inspections. This suggests that it is important to perform monitoring on a periodic basis to maintain the effectiveness of any implemented measures. To date, there have been no cases of hospital-acquired legionellosis in our hospital. The quarterly regular environmental inspection costs 224,844 yen per year, but this regular inspection for Legionella bacteria is effective in preventing hospital-acquired legionellosis in control of hospital-acquired infections. It is important for individual facilities to take measures based on their particular facility structure in order to reduce infection risks for hospitalized patients and improve cost efficiency.

During the cluster that occurred during the Omicron BA.5 epidemic, we experienced 24 cases of novel coronavirus infection (hereinafter referred to as COVID-19) at a nursing home in Okinawa prefecture. In this study, we demonstrated their clinical features, radiological findings, and laboratory results. Since this special nursing home for the elderly is located in the same building as the general hospital, which is a major medical institution for COVID-19, it was easy to perform chest CT and laboratory tests. The median age of the 24 cases was 91 years. None of the cases had respiratory failure at onset. Of the 21 cases in which chest CT could be performed, 11 had findings consistent with COVID-19 pneumonia. In principle, patients diagnosed with COVID-19 pneumonia were admitted to a designated medical institution and treated with remdesivir. In the nursing home, oral antiviral drugs were administered from early onset. Antibiotics were administered in combination with aspiration pneumonia in cases in which chest CT revealed aspiration pneumonia. One of the 24 cases (4.2%) died of respiratory failure associated with exacerbation of aspiration pneumonia. This report is valuable due to the fact it presents the clinical features, radiological findings, and laboratory results of COVID-19 in the very elderly.

When mixing and compounding injectable agents, performing aseptic manipulations on a clean bench maintained according to the requirements of the US Federal Standard Class 100 (≤100 pcs/ft³) is crucial for the prevention of contamination by airborne particulates or microbes. Owing to air turbulence generated by the compounding manipulations and other factors, the level of cleanliness in the clean bench may be affected by the configuration environment. We configured clean benches in different environments with mean airborne particulate counts of (A) 1,000, (B) 30,000, and (C) 300,000/ft³ and with the sash opened to 20 and 40 cm and measured the amount of particulate matter and microbes when preparing intravenous hyperalimentation infusions. For the particulate count, Class 100 was maintained in all configuration environments when the sash was opened to 20 cm, but Class 100 was not maintained in any of the environments when the sash was opened to 40 cm. When the sash was opened to 20 cm, no microbes were detected; however, at 40 cm, microbes were detected in all environments, with the level exceeding the NASA reference range (≤0.1 pcs/ft³) in environment C. Therefore, the configuration environment of the clean bench and size of the sash opening impact the level of cleanliness regarding the amount of particulate matter and microbes in a clean bench. This study prescribes conditions necessary for maintaining cleanliness in clean benches from an air cleanliness perspective when pharmacists are mixing and compounding injectable agents in hospital wards or pharmacies.

In order to prevent the spread of COVID-19 epidemic, our hospital has banned all visits since the spring of 2020. However, in the neonatal unit, due to the necessity of visits for attachment formation, promotion of parent-child interaction, and acquisition of childcare skills, we have decided to implement visits with adequate infection control measures as part of treatment and nursing care. In implementing the visitation, we discussed with the Infection Control Department and shared the objectives with the physician's family regarding the infection status of COVID-19.

Restrictions on visitation were eased in stages, depending on the family situation, visitation status, and the spread of infection. As a result, no close contacts or infected patients were reported in the neonatal unit, even with the implementation and relaxation of visitation. The family members were also able to practice infection control behaviors.

We examined risk factors for the occurrence of a COVID-19 outbreak in the psychiatric ward of A hospital. From January 16 to February 3, 2022, a case-control study was conducted of staff and patients in the physical complications unit of A hospital who were found to be infected with COVID-19. Univariate and logistic regression analysis showed that the risk factors were as follows: for staff, care of infected patients who sang loudly (OR: 11.2, 95% CI: 1.06-119.00, p = 0.04) and number of care interventions (OR: 2.4, 95% CI: 1.07-5.45, p = 0.03), and for patients, roommates' loud singing (OR: 21.1, 95% CI: 2.80-158.00, p < 0.01) and roommates being infected (OR: 24.4, 95% CI: 3.03-197.00, p < 0.01). It has been shown that mask-wearing by infected people can effectively reduce the exposure of others to droplets and aerosols. Many patients in psychiatric hospitals have difficulty wearing masks. However, masks can be worn in some cases if it is only temporary. Therefore, requesting patients to wear masks before providing care near them will help to prevent staff exposure. In addition, adequate ventilation to prevent the accumulation of aerosols, as well as the use of N95 masks for protection, is considered effective.

The outbreak occurred due to carbapenemase-producing Enterobacterales (CPE) in our hospital from September to November 2019. CPE was detected in four patients in the same ward. Three patients stayed in the same room, and the other was in the next room. The active screening was performed on patients in the ward. We also underwent 163 environmental surveillances including sampling from faucets, drainage systems, and sink surfaces. Although there were no reports of new CPE carriage from other patients, CPE was isolated from 13 locations, mostly around the drainage systems. Molecular carbapenemase identification with the pulsed-field gel electrophoresis and the polymerase chain reaction were performed. The gene identified included bla_IMP-19 in the three patients who had been in the same room and bla_IMP-1 in the other patient and drainage systems. All patients required assistance with daily activities, and person-to-person transmission via the hands of medical staff was the primary conduit for transmitting resistant pathogens. Implementation of standard precautions and environmental sterilization could terminate the outbreak due to CPE. Approximately 1 year later, the environmental survey was performed again. CPE isolation was limited to only one location in the waste drain. In addition to environmental sterilization, standard precautions including hand hygiene and cleaning the water environment were significant to prevent recurrence.

A working group was formed to strengthen measures to prevent surgical site infections in the perioperative period. The group compared different surgical glove materials and promoted double gloving as a best practice standard to reduce surgical site infections. The group recommended abolishing latex gloves to prevent allergic reactions.

We investigated glove-wearing behavior in 16 surgical departments to identify gloves that could most effectively reduce barriers to adoption of double gloving. Three sets were used experimentally on 80 surgical doctors and 47 operating room nurses. After the trial, we conducted an anonymous self-administered questionnaire survey and evaluated according to three items: operability, wearing comfort, and skin symptoms. Based on the evaluation results, we introduced latex-free, double gloving that does not affect surgical operations. As a result, double gloving became the operational standard, and the compliance rate increased from 51% in 2019 and 49% in 2020 to 99% in 2021.

We will continue to promote the double gloving to prevent surgical site infections and occupational infections. We will periodically review the choice of glove together with surgical doctors and operating room nurses, taking into account factors such as glove quality, price, and user experience.

Feedback-focused surgical site infection (SSI) surveillance was conducted in 508 patients undergoing colorectal surgery. Infection control team provided the results and analyses of surveillance data to surgeons, operating room nurses, and surgical ward nurses as an intervention to prevent SSI. We investigated the effect of our surveillance on the control of SSI. The study period was from January 2013 to December 2020 and was divided into three periods: the intervention period from January to December 2015, the early period from January 2013 to December 2014, and the late period from January 2016 to December 2020. In the feedback, we tried to provide opportunities for the subjects to voluntarily exchange opinions about SSI prevention measures. The mean incidence of SSI showed a statistically significant decrease, from 30.2% in the early period to 13.4% in the late period (P<0.001). The results of a logistic regression analysis of risk factors for SSI development revealed that male gender (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.320-3.980; P<0.01) was an independent risk factor for SSI development and that endoscopy (OR, 0.39; 95% CI, 0.233-0.665; P<0.001) and the late period with feedback (OR, 0.51; 95% CI, 0.299-0.853; P=0.01) were independent protective factors for SSI development. This suggests that feedback-focused SSI surveillance reduces the incidence of SSI.