A survey on infection control in emergency departments in Japan.

AIM: Infection control in the emergency department is important for hospital risk management; however, few clinical guidelines have been established. This study aimed to determine whether hospitals in Japan have infection control manuals, and investigate the contents of manuals, consulting systems, and isolation facilities for emergency departments. METHODS: A total of 517 hospitals certified as educational institutions for board-certified acute care physicians in Japan were requested between March and May 2015 to provide a written evaluation of the infection control in the emergency department. RESULTS: A total of 51 of 303 (16.8%) hospitals had no manuals regarding infection control in the emergency department. Among 250 hospitals having emergency department manuals, 115 (46.0%) did not include contents regarding disinfection and sterilization for imaging examination rooms, and only 44 (17.6%) had criteria for contacting the emergency medical service when patients are suspected of, or diagnosed with, communicable diseases. Of the 303 hospitals, 277 (91.4%) prepared specific manuals for the 2009 pandemic influenza. Of the 303 hospitals, 80 (26.4%) did not prepare manuals for the Ebola virus disease outbreak in West Africa in 2014. Furthermore, 92 (30.4%) of the 303 hospitals did not have any negative-pressure isolation rooms. CONCLUSIONS: Practices and guidelines necessary for infection control in the emergency department were not sufficiently covered in the hospitals studied. Education, information sharing, and a checklist for preparing manuals are needed to establish better infection control systems in emergency departments.

Sharp injuries in Japanese operating theaters of HIV/AIDS referral hospitals 2009-2011.

The aim of this study was to identify how doctors and nurses experienced sharps injuries in operating rooms and the risks for these injuries by analyzing data from 78 Japanese hospitals participating in the nationwide EPINet surveillance system. The years of professional experience of the cases were classified into tertiles separately for doctors and nurses. Suture needles accounted for 54.9% of injuries in doctors and 48.3% of injuries in nurses. Among doctors, injuries occurred most frequently during the use of an item (range: 58.1-64.3%), while among nurses, injuries occurred most frequently (range: 24.7-29.0%) between steps of a multi-step procedure. The frequency of injury by a suture needle held by someone else was 41.1-47.3% (range) among doctors, and 27.0-48.1% (range) among nurses. In conclusion, sharps injuries in the operating room need to address the circumstances of injury and holder of devices based on the specific risk for doctors and nurses to decrease the number of injuries.

Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

BACKGROUND: Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. OBJECTIVES: The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. METHODS: An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. RESULTS: In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). CONCLUSIONS: The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

Incidence rate of needlestick and sharps injuries in 67 Japanese hospitals: a national surveillance study.

BACKGROUND: Determining incidence rates of needlestick and sharps injuries (NSIs) using data from multiple hospitals may help hospitals to compare their in-house data with national averages and thereby institute relevant measures to minimize NSIs. We aimed to determine the incidence rate of NSIs using the nationwide EPINet surveillance system. METHODOLOGY/PRINCIPAL FINDINGS: Data were analyzed from 5,463 cases collected between April 2009 and March 2011 from 67 Japanese HIV/AIDS referral hospitals that participated in EPINet-Japan. The NSI incidence rate was calculated as the annual number of cases with NSIs per 100 occupied beds, according to the demographic characteristics of the injured person, place, timing, device, and the patients' infectious status. The NSI incidence rates according to hospital size were analyzed by a non-parametric test of trend. The mean number of cases with NSIs per 100 occupied beds per year was 4.8 (95% confidence interval, 4.1-5.6) for 25 hospitals with 399 or fewer beds, 6.7 (5.9-7.4) for 24 hospitals with 400-799 beds, and 7.6 (6.7-8.5) for 18 hospitals with 800 or more beds (p-trend<0.01). NSIs frequently occurred in health care workers in their 20 s; the NSI incidence rate for this age group was 2.1 (1.6-2.5) for hospitals having 399 or fewer beds, 3.5 (3.0-4.1) for hospitals with 400-799 beds, and 4.5 (3.9-5.0) for hospitals with 800 or more beds (p-trend<0.01). CONCLUSIONS/SIGNIFICANCE: The incidence rate of NSIs tended to be higher for larger hospitals and in workers aged less than 40 years; injury occurrence was more likely to occur in places such as patient rooms and operating rooms. Application of the NSI incidence rates by hospital size, as a benchmark, could allow individual hospitals to compare their NSI incidence rates with those of other institutions, which could facilitate the development of adequate control strategies.

Infection control team activity and recent antibiograms in the Kobe University Hospital.

The hospital infection control team (ICT) has a major role in suppressing or preventing infectious diseases. The purpose of this study was to investigate whether the work of the ICT had affected the antibiograms at the Kobe University Hospital in the past 3 years. The ICT's works are as follows: (1) to monitor whether physicians are instructed in the use of broad-spectrum antibiotics; (2) to check whether measures for preventing the occurrence or spread of infectious disease are performed along with appropriate standard precautions; (3) to provide rapid communication with physicians in bacteremia cases and (4) reporting the antibiograms in the hospital. In addition, we investigated changes in the antibiograms every 6 months based on all materials. There were 193 physician interventions in 2010 and 491 in 2011. The representative isolated bacteria included no additional bacteria with lower susceptibilities found over the past 1.5 years compared with the initial 1.5 years in the 3-year investigation period. The ratio for performing two sets of blood culture tests in all blood culture tests showed an upward tendency from 58.1% in 2009 to 71.1% in 2010 and 80.3% in 2011 (r=0.995, P=0.063, b=0.089). In conclusion, since the introduction of an expanded ICT role, our data showed an increased antibiotic susceptibilities in bacteria such as Enteroccus faecalis and the total amount of hand disinfectant agents tended to increase year by year, even though direct statistical analyses could not easily be performed. Further observation may be necessary for a definitive evaluation of ICT activities.