Catheter-associated urinary tract infections (CAUTIs) account for 10%-20% of all healthcare-associated infections. Prolonged length of catheterization has recently been highlighted as one of the significant risk factors for CAUTI. Therefore, current guidelines and protocols published by professional organizations recommend multifaceted interventions, including efforts to limit catheter use, to prevent CAUTIs. This paper discusses evidence-based practices for preventing CAUTIs using a comprehensive program developed by the Agency for Healthcare Research and Quality as a reference.
The issue of antimicrobial resistant bacteria is a globally significant problem. At the Annual Meeting of the World Health Organization (WHO) in 2011, antimicrobial resistance (AMR) was featured as a major agenda topic. Since then, activities to recognize AMR as a global health crisis and to develop measures taken to combat this threat have been developed centered around the WHO. In May 2015, the World Health Assembly endorsed the Global Action Plan on AMR, and urged all member states to develop relevant national action plans within two years. In response to this, in Japan, the National Action Plan on AMR was developed accordingly by the Ministerial Meeting in April 2016.
This Plan will drastically change the scope of measures taken to combat infectious diseases in the future. The framework for regional cooperation will be supported not only by an in-hospital network, but by a comprehensive regional network that involves the broad cooperation of the wider regional community. Within this framework, regional surveillance on infection control will be further improved, and will be utilized in the regional network. This will lead to further improvements in the quality of practices taken to contain infectious diseases.
On the medical front, the implementation of the Action Plan will bring significant changes to established standards for infection control in Japan. The systems and measures being developed for AMR include infection control measures not only in hospitals, but a variety of other medical settings as well, and they are being structured in a way that involves not only AMR, but a number of other issues related to infectious diseases overall. This will undoubtedly have a significant impact on the establishment of a better and more sustainable healthcare environment for the future. AMR control is deeply associated with the improvement of healthcare quality and medical safety issues, and as such, the sheer importance of the critical role that infection control experts play in this effort cannot be overemphasized.
Outsourced staff are responsible for 86.1% of hospital cleaning in Japan, and it has become commonplace to entrust cleaning tasks to businesses.
It has become common knowledge that hospital cleaning is indispensable for controlling healthcare associated infections, although it has become abundantly clear that infection control knowledge and techniques among hospital cleaning subcontractors, who bear the brunt of this task, are inadequate. In recent years, hospital cleaning outsourced staff have frequently been unable to deal with the demands of cleaning medical facilities, which has increased stress among infection control teams (ICT). However, this is not merely a problem that affects hospital cleaning outsourced staff.
I believe that three obligations must be fulfilled in order for outsourced staff to provide adequate hospital cleaning services. The first is that the ICT should be included proactively when the contract is drawn up, the second is that outsourced staff should perform cleaning that is compliant with the specifications in the contract, and lastly, the ICT bears the responsibility to perform inspections and give feedback. In this way, the role of ICT is great. If you want to improve the quality of cleaning at your own facility, you should perform internal reviews.
In recent years, according to the development of the transportation network and changes in the social environment, emerging and re-emerging infectious diseases have become a major threat that will be easily introduced into our country at any time. Even if the index case returned from abroad was infected with a contagious and serious emerging and re-emerging infectious disease, the initial signs and symptoms are usually fever or respiratory condition in most cases, which are the same as that of common diseases within Japan. Therefore, we often pay no attention to such patients, they easily pass through the triage system of medical facilities and sometimes become a trigger of hospital-acquired infection or spread out in the community.
'Suspect and remind these diseases' is always a key point to make a correct diagnosis, detailed medical history including a travel history and reliable test results of specimen with appropriate sampling would strongly support it. In addition, the healthcare workers required adequate vaccination and personal protective equipment on daily basis to avoid themselves from infection, and also to provide an infectious control measures with specifying a source and a route of infection, after confirming the diagnosis of these unique diseases.
We need to learn by experience of several outbreaks such as measles, MERS and influenza A (H7N9), for developing 'Best practices' to control the hospital-acquired infection caused by imported infectious diseases.
The appearance of multidrug-resistant bacteria markedly increases the medico-economic burden, such as by causing severe infection and prolonging the admission period. We proposed highly effective antimicrobial drugs to physicians using an anti-biogram to decrease the use of antimicrobial drugs with anti-Pseudomonas activity. Furthermore, we investigated pneumonia, which requires a long admission period, and standardized treatment using a critical path (CP). The introduction of CP reduced the number of prescriptions for carbapenem preparations, which had been used for patients in whom sufficient therapeutic effects were not obtained due to the inadequate use of antimicrobial drugs or those in whom causative bacteria could not be identified. As a result, the percent antimicrobial use density and percent days of therapy using carbapenem preparations with antimicrobial drugs having anti-Pseudomonas activity before the start of CP were 43.7 and 34.1%, respectively. After the start of CP, the values were 23.6 and 25.8%, respectively, showing decreases. Concerning the antimicrobial drug sensitivity (%) of Pseudomonas aeruginosa, the cefepime sensitivity before and after the start of activities was 71.3 and 93.6%, respectively. The meropenem sensitivity was 64.4 and 92.9%, respectively. The doripenem sensitivity was 65.0 and 94.7%, respectively. The ciprofloxacin sensitivity was 68.8 and 92.9%, respectively; significant improvements were achieved (P<0.01). Our activities may have decreased the use of broad-spectrum antimicrobial drugs without reducing the quality of medical practice, while maintaining the antimicrobial drug sensitivity of P. aeruginosa.
It is essential for midwives to protect their faces using personal protective equipment, such as face shields, during childbirth assistance in order to prevent occupational infections. The purpose of this study was to investigate blood exposure to the face shield used by midwives during childbirth assistance and to clarify the risk of blood exposure to the face in association with characteristics of the delivery. There were 161 vaginal deliveries during the study period, of which face shields worn during labor in 70 cases were collected (collection rate 43.5%).
Blood exposure was observed on all face shields (100%), and the average exposure score was 26.6 (SD 20.1, range 5-125). The blood exposure score by area were as follows: mask area was 18.6 (SD 17.0, range 0-116), periocular area was 2.8 (SD 17.0, range 0-22), forehead area was 3.3 (SD 3.7, range 0-17), right side was 2.7 (SD 4.2, range 0-20), and the left side was 1.1 (SD 1.9, range 0-10). The mean duration of wearing the face shields by midwives was 41.5 minutes (SD 30.5, range 11-141), and blood exposure was detected even for the shortest duration of 11 minutes. Multiple regression analysis was performed with the blood exposure score as a dependent variable, whereas the independent variables were the presence/absence of perineal incision, amount of bleeding until third delivery, infant weight, and duration of wearing the face shield. Based on the results of the analysis, episiotomy was found to be significantly associated with the blood exposure score (p < 0.05). Altogether, in this study, it was revealed that the risk of exposure to blood on the face was very high, as blood exposure was detected on all the face shields collected in this study. Altogether, we conclude that facial protection must be practiced as a standard precaution during delivery in order to reduce the risk of occupational infections.
The purpose of this study was to compare the reporting rate of NSIs by age group between doctors and nurses. We requested 118 institutions participating in the Japan-EPINet Surveillance to provide data on all the reported incidents of NSIs that occurred between April 2013 and March 2015 in each institution. In total, 6,201 cases were collected from 86 institutions; of those, 4,455 cases were reported by doctors or nurses. We analyzed 3,703 cases where the source patient was identifiable (Doctors: 1,326 cases, Nurses: 2,377 cases) and calculated the percentage of NSIs where the source patient was seropositive for either hepatitis B or hepatitis C. The percentage of hepatitis seropositive NSIs for doctors (23.8%, 95%CI: 21.5-26.0%) was higher than for nurses (13.9%, 95%CI: 12.5-15.3%). Even when age adjusted, the percentage of hepatitis seropositive NSIs for doctors was significantly higher than that for nurses (p < 0.01). For nurses, the percentage of hepatitis seropositive NSIs was constant regardless of age group (p = 0.77). However, among doctors, the percentage of hepatitis seropositive NSIs was higher with increased age (p < 0.01). Several studies have proved that NSIs tend to be underreported when the source patient was seronegative. The results from this study show that the reporting rate was lower among doctors than among nurses and the reporting rate was especially low among older doctors. It is necessary to enlighten doctors about the importance of reporting all NSIs.
Among healthcare-associated infections, urinary tract infections (UTI) have a high incidence rate, and approximately 80% of cases with UTI are due to indwelling urinary catheters. Data of all 970 hospitalized patients with indwelling urinary catheters (excluding children) were used to determine the catheter utilization ratio, catheter-associated urinary tract infection (CAUTI) incidence rate, and medical condition of patients with CAUTI and suspected to identify methods for improving infection control. The catheter utilization ratio during the study period was 0.11 and the CAUTI incidence rate was 0.36 (1,000 catheter-day). Once a week, the facility where this study was conducted implements in-hospital rounds targeting patients with long-term indwelling urinary catheter who have had their catheters placed for ≥4 weeks for preventing the occurrence of CAUTI. After placing a urinary catheter, it is vital to regularly review its continued placement. The implementation of in-hospital rounds targeting patients with long-term indwelling urinary catheter may contribute to a decline in the catheter utilization ratio and CAUTI incidence rate. In this study, the duration of indwelling urinary catheters was >4 weeks in five out of eight patients with onset of CAUTI and suspected. This result may be assigned that further improvement may be expected by shortening indwelling urinary catheters durations in patients targeted for in-hospital rounds and strengthening intervention in patients with long-term indwelling urinary catheters.
The aim of this study was to develop a hand hygiene cognitive scale for novice nurses using the Health Action Process Approach (HAPA).
A questionnaire survey on hand hygiene was administered to 209 nurses working at university hospitals. There were 83 effective responses (39.7%). These were subjected to exploratory factor analysis using maximum likelihood method and Promax rotation, and the five factors structure comprising 20 items, which included the main elements of the HAPA, was obtained.
The cumulative contribution rate was 71.07%. Cronbach's α values for the factors "self-efficacy," "intention," "coping planning," "action planning," and "outcome expectancies" were 0.92, 0.91, 0.91, 0.86, and 0.77, respectively. "Self-efficacy" is related to self-efficacy for practicing hand hygiene, "Intention" is the intention to practice hand hygiene, "coping planning" and "action planning" are concrete plans for practicing hand hygiene, and "outcome anticipation" is the anticipated result of hand hygiene practice. Each item concerning the outcome was included. Confirmatory factor analysis of these factors provided the following results: goodness of fit index = 0.772, adjusted goodness of fit index = 0.703, comparative fit index = 0.910, and root mean square error of approximation = 0.090.
Although there is a need for improvement in the future, this study developed a hand hygiene cognitive scale for novice nurses that included the major elements of the HAPA.
In our hospital, active screening has been initiated to prevent the transmission of multidrug-resistant bacteria. This screening was performed in patients transferred from other hospitals, and those with emergency admission previously hospitalized elsewhere. Patients were informed regarding this screening by the attending physicians using the instruction form. The screening was performed by obtaining rectal swabs on the day of admission. Target bacteria were carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). We used selection culture media for each of these bacteria. Upon detection of colonies on the CRE selection media, we additionally performed confirmation testing to identify carbapenemase-producing Enterobacteriaceae (CPE). From December 2016 to November 2017, 260 screening tests were performed in 245 patients. Positive results were as follows: CPE (2 cases, 0.8%), VRE (0 cases), and MRSA (23 cases, 8.8%). Both cases with CPE were transferred from other hospitals for surgical operations. Contact precautions were maintained from admission to discharge, including during the presence of these patients in the operating theater.
We sufficiently investigated the burden of the laboratory staff and economic support and explained the necessity of this screening to the physicians and nursing staff prior to the initiation of the screening. Thus, there was no obvious confusion since the initiation of the screening. The detection of CPE-positive cases on admission indicates that this screening procedure is effective in preventing the transmission of multidrug-resistant bacteria between hospitals.
Few studies have focused on the difficulties in implementing counteractive measures against infection during an epidemic outbreak in psychiatric wards. Thus, it is not clearly known how such outbreaks should be handled. Recently, our hospital experienced an influenza B outbreak in a closed ward for chronic psychiatric patients, and faced difficulties in implementing counteractive measures. We had difficulty controlling the infection because common counteractive measures that are used in general wards, such as isolation of affected patients, could not be used. Moreover, use of a rapid test and preventative administration of anti-influenza drug were rejected. Many difficulties with the control of infection arise if influenza is brought into the department of psychiatry. We believe that the nature of difficulties varies depending on the type of patients hospitalized in the ward. It is essential to develop feasible plans for counteractive measures against infection that are suitable for the peculiar circumstances in psychiatric wards.