It is important that oral care is carried out in strict adherence to standard precautions. Particular attention should be paid to the methods of disinfecting and sterilizing instruments and devices being used and to the measures of preventing contamination of the surrounding environment. Since patients undergoing oral care on the assumption of surgery are scheduled to receive endotracheal intubation under general anesthesia, an even much higher degree of cleanliness is required in the oral cavity. Oral care surgery is often accompanied by bleeding just as in regular dentistry, so it is desirable to be performed by a dentist who is familiar with thorough standard precautions.
Japan is called a "disaster powerhouse," as it is affected by natural disasters, such as earthquakes, tsunamis, torrential rains, and typhoons almost every year. Immediately after a disaster, wound infections and respiratory tract infections including pneumonia, which are related to trauma and drowning, arise health problems for victims. Thereafter, poor hygiene at the evacuation center and forced long-term living in overcrowded areas cause infections and outbreaks due to influenza virus and infectious gastroenteritis including norovirus. Infectious diseases after natural disasters are problems not only at an individual level but also in a community environment.
It is necessary to accurately grasp which infectious disease is the problem after natural disaster, and we should apply effective medical treatment or infection control. In a situation where the lifeline after a natural disaster is insufficient and medical resources are limited, the identification of pathogenic microorganisms by point-of-care testing (POCT) using immunochromatography (such as Streptococcus pneumoniae and Legionella pneumophila by urinary antigen test, influenza virus antigen test, and norovirus antigen test) is reportedly useful for the treatment of infection and early detection and intervention of outbreaks in evacuation centers.
It is expected that genetic testing will continue to spread in the field of infectious diseases in the future. However, currently, it is impossible to carry out genetic testing as a POCT after a natural disaster. Therefore, even in the absence of a disaster, it is necessary to closely examine past cases of infectious diseases after natural disasters and evaluate which POCT especially in immunochromatography have been established with infectious diseases.
It is well known that the surgical site infection (SSI) is remarked due to the patient's burden, hospital management, and economical problems. There are many investigations for the prevention of SSI. Many guidelines were produced with referring the outcomes of the investigations in many countries. "Global guidelines for the prevention of surgical site infection" was established by the World Health Organization in 2016. It is the first guideline that targets every country in the world. In the next year, the Centers for Disease Control and Prevention and American College of Surgeons renewed their guidelines for prevention of SSI. The purpose of these guidelines is almost same, but the details of the recommendation and the recommendation degrees are different, respectively. Some readers may be at a loss which recommendation they choose. Then, the behaviors in the operation room are selected from the recommendations, and it is explained how we act from the point of view of workers in surgical theater.
With the aim of preventing infectious disease occurrence and spread among patients and staff in hospitals, infection control greatly contributes to medical safety and the improvement of quality of care. Pharmacists play important roles in multidisciplinary initiatives regarding infection control. Pharmacists have been actively involved in infection control at Iwate Medical University Hospital, since a full-time pharmacist was assigned to the Infectious Disease Control Office in April 2004. They have been involved in initiatives such as the transmission-based zoning system, the comprehensive prescription management system for antibacterial agent use, and hand-washing campaigns. In addition, the mission of board-certified infection control pharmacy specialists is to address the importance of taking comprehensive measures, including the proper use of antimicrobial drugs, disinfectants, and medical supplies. To leverage their expertise in infection control activities, pharmacists need to understand the reciprocal relationship between the infection control team and antimicrobial stewardship team and produce tangible outcomes. In this respect, pharmacists should shift their overemphasis from "information gathering and analysis" and to developing "plans." To do so, they should observe infection control from a wider perspective and should propose plans based on scientific and pharmaceutical evidence and operate the activities efficiently, with proper evaluation, for successful results.
At our hospital, we performed DPT vaccination for healthcare workers and measured the titer of anti-pertussis toxin antibodies before and after vaccination and in the long-term post-vaccination course. These results were used to determine the appropriate timing for booster inoculation based on the time at which the antibody titer decreases.
The prevalence of anti-pertussis toxin antibodies in the healthcare workers was 64.4% (67/104 people) before DPT vaccination. The antibody titer significantly increased 4 weeks after DPT vaccination and then decreased over the years after vaccination. After 6 years, 100% (7/7 people) of the healthcare workers still had antibodies, but this rate decreased to 68.5% (24/35 people) at 7 years after vaccination. Therefore, we concluded that monitoring of the antibody titer and booster inoculation as needed are required for healthcare workers at 7 years after DPT vaccination at our hospital. However, the timing of the decrease of the antibody titer and the booster inoculation may differ depending on the level of pertussis toxin and the medical and economic situations in different countries and regions. Therefore, the timing of the booster inoculation should also be based on the local disease level in Japan and overseas.
Commercially available "antimicrobial (Jokin) " products for use on environmental surfaces with claims and descriptions such as "Jokin," "alcohol," and "99.9%" were examined for microbicidal effects on Enterococcus faecalis. We found that 13 of 28 (46.4%) products tested had no bactericidal effects after 5-min contact with the microbes. Of the 14 products with ethanol (ranging from 7.9 to 65.7 vol%), 1 (7.1%) had no bactericidal effect. Of the ten products with chlorine compounds (ranging from 0.06 to 144 ppm), all (100%) had no bactericidal effect. We found that close to half of all products with "antibacterial (Jokin) " effects had no bactericidal effect.
An outbreak of scabies that recently occurred at our hospital was characterized by sporadic cases of infection over a period of 14 months among patients whose sources of infection were not identified - even with a thorough tracing survey - and with whom no close contact was noted. Despite our attempt to provide prophylaxis for all patients whose chances of having scabies could not be ruled out on the basis of their skin conditions, two patients on prophylaxis later developed the infection. We therefore implemented mass prophylaxis. We finally resolved the outbreak by using this strategy after obtaining informed consent. We administered oral ivermectin twice, 1 week apart, to a total of 60 patients, including all patients in the relevant ward and those who had been transferred from the relevant ward to other wards within the last 2 months. Staff were not subjected to mass prophylaxis because they had little direct contact with patients, and none of them was confirmed to have scabies. There is room for considering the implementation of prophylaxis restricted to all patients whose chances of having scabies cannot be ruled out on the basis of their skin conditions.
This study was conducted to estimate the relevance between the factors relating to the practical activities for infection prevention and control, performed by certified nurses in infection control (CNICs). A questionnaire survey was conducted to a total of 2,278 CNICs authorized by the Japanese Nursing Association. The responses were obtained from 708 subjects, and 698 of those were used to analyze as a valid response. Three factors were related to the activities: "holding an administrative position," "working as a full-time CNIC," and "participating in academic meeting or research seminar." In addition, "working in facilities receiving additional reimbursement for infection prevention of medical treatment fee" was also another relating factor. The frequency of practice relevant to "surveillance for healthcare-associated infection" and "occupational infection control" was increased especially in the facilities receiving Type I of additional reimbursement. Working in the facilities with less than 400 hospital beds or staffed by a single CNIC was thought to be a factor relating to the practical activities relevant to "infection control skills."
In this study, we report an outbreak of infectious gastroenteritis in a residential care facility for persons with disabilities that housed 40 residents with 42 care staff. On February 6, 2018, four residents and one staff member were diagnosed with infectious gastroenteritis. The outbreak occurred until February 14, involving 27 cases (21 residents and 6 staff members). In the last four days, the care staff was primarily affected (one resident and four staff members). A retrospective survey of care records identified a resident who was hospitalized due to fever, soft stool, and vomiting on February 4. We concluded this resident to be the first case of this outbreak as the staff member caring for this resident later developed an infectious gastroenteritis. However, the care staff were not trained in infection control and did not use personal protective equipment appropriately when treating the resident. The epidemic curve showed one clear peak with a sustained tail, indicating that the infection control measures introduced after notification of the outbreak were effective. The noteworthy points of this outbreak were as follows: (i) insufficient attention was given to the first resident who developed a fever and enteric symptoms, (ii) the care staff who handled the resident's excretions (vomit or stool) developed infectious gastroenteritis, and (iii) the infection was sustained among care staff in the last part of the outbreak. The majority of care staff in small- and middle-sized residential care facilities for persons with disabilities, which are common in Japan, do not have appropriate training in infection control. Therefore, a sustainable education system for infection control should be established in these facilities to prevent future norovirus outbreaks.