The trends and problems of sexually transmitted infections in Japan are identified from the following four viewpoints: 1) epidemiology, 2) increase in syphilis incidence and Stop! syphilis project, 3) drug resistance of Neisseria gonorrhoeae, and 4) emergence of Mycoplasma genitalium. The epidemiological information obtained using surveillance data for the following five diseases under Category V of the Infectious Disease Law: syphilis from notifiable disease surveillance, genital chlamydial infection, genital herpes, condyloma acuminatum, and gonococcal infection from the sentinel surveillance. On the other hand, data from welfare science research are also introduced. Syphilis incidence rapidly increased from 2012 to 2018; however, in 2019 and 2020 the reported number decreased. This might be due to the Stop! syphilis project and the COVID-19 pandemic. Ceftriaxone resistant strains of N. gonorrhoeae with MIC of ≥0.5 μg/mL are scattered around the world. Mycoplasma genitalium, which is the third most common sexually transmitted cause of male urethritis after gonococcus and chlamydia, is also becoming an issue regarding multi-drug resistance.
The objective of this study was to examine the nature of antimicrobial resistance (AMR) measures by clarifying the actual state of such measures at private nursing homes and long-term care insurance facilities. Infection control staff at a total of 2,800 randomly sampled facilities for the elderly (private nursing homes, designated facilities covered by public aid providing long-term care to the elderly, long-term care health facilities, and medical long-term care sanatoriums) were surveyed using a self-administered questionnaire.
The responses of 254 (9.1%) facilities were tabulated. The conditions for hindering the spread of antimicrobial-resistant bacteria were being met at private nursing homes, but outbreaks of methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-Lactamase-producing bacteria, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, multidrug-resistant Acinetobacter, and vancomycin-resistant enterococci infections had occurred like at other types of facilities. AMR measures at facilities for the elderly, such as availability of manuals, training, and measures upon admission, were insufficient. Screening upon admission was only implemented at 22%-33% of the facilities, and the target bacterium in screening was almost always limited to MRSA. There were also issues with care that facilitates the spread of antimicrobial-resistant bacteria (such as urethral indwelling catheter management and diaper care). Accordingly, this demonstrated the risk of the spread of antimicrobial-resistant bacteria from overlooked carriers.
These findings suggest that because AMR measures at facilities for the elderly do not require screening upon admission, it may be effective to strengthen contact precautions in addition to standard precautions during provision of care that facilitates the spread of antimicrobial-resistant bacteria to all residents. Medical care and long-term care fee incentives are also needed to promote support from public health centers and regional core hospitals.
Background: Infection control is important in in-hospital nurseries. There is a concern that healthcare workers who are parents may become carriers and transmit infectious diseases to infants and patients.
Study objective: The purpose of this study was to evaluate the effectiveness of a hygienic intervention to prevent infectious diseases from spreading among infants and nursery teachers at an in-hospital nursery.
Methodology: A hygienic intervention consisting of education on hand hygiene, cough etiquette, and environmental cleaning was implemented for infants and nursery teachers at the in-hospital nursery. Hand hygiene adherence of infants and nursery teachers, before and after the intervention, were compared using the χ2 test. The relative risk of contracting an infectious disease and the percentage of infection-related absence among infants, before and after the intervention, were also assessed.
Results: Consent was obtained for 29 infants (100% consent rate) and from 22 nursery teachers (92% consent rate). The hand hygiene adherence of the infants significantly improved from 78.2%, before the intervention, to 97.4%, after the intervention (p<0.001). Hand hygiene adherence of the nursery teachers also significantly improved from 37.6%, before the intervention, to 78.2%, after the intervention (p<0.001). On the other hand, the incidence of infectious diseases among the infants was 11.47/1,000 person-days, before the intervention, and 11.31/1,000 person-days, after the intervention, and the relative risk with its 95% confidence interval was 0.99 (0.53-1.83). The percentage of absenteeism due to infection was 2.17% before, and 2.75% after the intervention, and the relative risk with its 95% confidence interval was 1.26 (0.24-6.68).
Conclusions: The hygienic interventions implemented in this study did not change the incidence of infectious diseases and absenteeism among the infants, but improved hand hygiene adherence among infants and nursery teachers in an in-hospital nursery.
One of the problems of cover-up type protective clothing (protective clothes) is to make heat stress on health care workers. Thus, the purpose of this research is to survey the effects of local torso cooling with cooling devices on the human body.
The design of this study is an "intervention design." So when nurses simulate 120 minutes' nursing procedures, 16 link nurses were divided randomly into two groups; one using cooling devices (intervention group) and the other using conventional clothes (control group). The indicators of heat stress (thermal sensation, comfort index, temperature in-and-out of the clothes, tympanic temperature, forehead temperature, and fogging of goggles) were measured every 30 minutes.
The results showed that torso cooling is more effective in thermal sensation immediately after wearing and in comfort index from after wearing 30 to 120 minutes, i.e., every 30 minutes, (p<0.05 p<0.001, respectively) respectively. Between tympanic temperature and forehead temperature, there was no significant difference. In the intervention group, the grade of fogging of goggles was relatively weak as compared with the control group.
Results indicated that local torso cooling increased the "comfort index" by controlling skin surface temperature. Furthermore, the fact that the temperatures in both groups were not significantly different indicated that thermoregulation mechanisms made possible to control the temperature by vasodilation associated with sweating. Thus, the temperature of the intervention group was relatively low. The results for fogging of goggles had been strengthened in the control group might be explained also by the effect of gradual rise of temperature.
This study indicated that "local torso cooling" effectively improved heat stress.
In Japan, seasonal influenza vaccine is routinely administered subcutaneously. In contrast, intramuscular administration is recommended overseas because of the mild local adverse reaction and appropriate increase in the influenza antibody titer. Thus far, the difference in the preventive effect of the vaccine on influenza incidence and the level of pain experienced during the injection between the subcutaneous and intramuscular routes of administration have not been elucidated. Regarding the influenza vaccination at our hospital, staff and nursing students choose either a subcutaneous or an intramuscular route of administration. Therefore, in this prospective observational cohort study, we investigated the difference between the two routes of vaccine administration by comparing influenza incidence, level of pain during the injection, and post-administration adverse reaction. By law, influenza cases must be reported to the workplace or school. Hence, the incidence rate of influenza is calculated according to the number of reported cases. The incidence of influenza was 11.3% (65/574) and 8.2% (258/3147) among individuals who received the vaccine subcutaneously and intramuscularly, respectively. Furthermore, a univariate analysis showed a significantly lower incidence of influenza among individuals who received the intramuscular injection than among those who received the subcutaneous injection (P=0.02). Based on logistic regression adjusted for sex, age, cohabitation with people under 15 years of age, and measures to prevent infection, influenza incidence was significantly lower in the intramuscular injection group (odds ratio 0.73, P=0.04). Additionally, the level of pain during the injection and post-administration adverse reactions were assessed among 320 nursing students (subcutaneous administration, 77; intramuscular administration, 243). The median score of pain experienced during the injection (where 0 was defined as painless and 10 was defined as very painful) was 4 in the subcutaneous injection group and 2 in the intramuscular injection group. The intramuscular injection group experienced significantly less pain (P<0.001). Based on a multivariate regression analysis adjusted for fear of injection, the level of pain due to the injection was significantly lower in the intramuscular group (regression coefficient of −1.26, P<0.001). Post-administration pain and swelling were also milder in the intramuscular group. In conclusion, intramuscular administration of the influenza vaccine resulted in lower influenza incidence, less pain during injection, and less severe post-administration adverse reaction than the subcutaneous administration of the vaccine. As intramuscular administration of the influenza vaccine is generally considered an excellent method of administration, we hope that this method will become widely accepted in Japan.
Purpose: Blood culture guidelines suggest that a positive rate of 5% to 15% and a contamination rate of 2% to 3% or less are appropriate. It is said that blood collection from the groin area increases contamination; however, in our hospital, blood collection from the groin area is predominantly performed. From 2016, we followed the disinfection method according to the guideline and determined whether the contamination from the groin area can be reduced. In order to eliminate the difference in procedures between individuals, only the samples collected by one physician were taken for verification.
Method: From 2014 to 2019, we conducted descriptive statistics and past-origin cohort studies on blood culture conducted by one doctor among blood cultures submitted at the Izumo-Shimin Hospital.
Results: Eight hundred sets were analyzed. The blood collection was done 94.4% in the groin area, 5.6% in the upper limbs, and the collection rate for multiple sets was 99.0%. From 2016, when the disinfection method was changed according to the guidelines, both the positive rate and the contamination rate of blood collection from the groin area decreased, and the contamination rate of blood collection from the groin area from 2016 to 2018 was 1.7%. The contamination rate of blood collection from the upper limb was 0%, but no significant difference was observed.
Discussion: Although blood culture blood collection from the groin area tends to increase contamination, it is considered that a contamination rate within the appropriate range is possible if proper skin disinfection according to the guidelines is performed.
In-hospital isolation for patients with seasonal influenza is currently dependent on the facilities. In this study, we validated in-hospital isolation for patients who were diagnosed with seasonal influenza and admitted to our hospital from December 2018 to March 2020 using both viral copy numbers calculated by real-time RT-PCR method and viral culture. We collected each nasopharyngeal swab sample at the date of admission, and at three and seven days from admission, respectively, and determined viral copy numbers and cultivated viruses collected from each patient. Four patients were evaluated (73-90 years old; male: female, 3:1). The viral copy numbers decreased with time in three of the four patients (increased again at seven days from admission in the other patient). As for the viral culture, three of the four patients were positive both at the date of admission and three days from admission and negative at seven days from admission. The remaining patient was positive only at the date of admission. Thus, both viral shedding and infectiousness decrease with time in patients with seasonal influenza. The longest fever duration was six days in two patients, both of whom were complicated by pneumonia. On the basis of our findings, the longest indicated in-hospital isolation for inpatients with seasonal influenza is seven days after symptom onset or 24 hours after defervescence.
Disease-specific infection control measures have been in place in our country for a long time; however, at present, standard precautions, which are control measures against non-specific diseases, are the backbone of medical-related infection control. Normally, standard precautions are implemented to reduce the risk of infection among both patients and healthcare providers. Since these measures are geared toward and implemented for all patients regardless of their infectious disease status, a possible secondary effect is that patients with infectious diseases can undergo medical treatment without feeling discriminated against. The present study examined the ethical behavior of healthcare providers as experienced by hepatitis B virus (HBV) carriers to investigate whether the implementation of standard precautions affected the respect for human rights of patients with infectious diseases. We have identified the year that standard precautions were spread in Japan as 2003, and the scores for 24 items related to the ethical behavior of healthcare providers (124 respondents in the pre-promotion group and 37 respondents in the post-promotion group) were compared using the Mann-Whitney U test (significance level, α=0.05). The results showed that significant differences were found in the scores of eight items related to the discriminatory procedures, explanation of the disease by the physician, and support following disclosure of the diagnosis, indicating an improvement in ethical behavior.
The implementation of standard precautions was suggested to have ethical value, not only for preventing infections but also for decreasing discrimination and prejudices experienced by HBV carriers as well as for reducing fear of infecting others around them.
Of nine samples from high-grade ethanol products sold by sake breweries, seven (77.8%) were contaminated with 5-44 colony forming units (cfu) of bacteria per 100 mL. The most common bacteria detected were Bacillus species and Paenibacillus species. No microbial contamination was observed in two samples (22.2%) from high-grade ethanol products nor in all three (100%) hospital-grade disinfectants (76.9-81.4 vol% ethanol). We conclude that although high-grade ethanol produced by sake breweries poses no problem as a hand sanitizer, it is unadvisable to use it for other purposes such as for sanitizing vials and infusion apparatus.