The preventive eŠect against in‰uenza-like illness by low-concentration chlorine dioxide gas was examined among Japan Ground Self Defense Force soldiers and civilians at a particular camp assigned for this study. The chlorine dioxide gas-exposed group consisted of all individuals who worked in a particular building, and the unexposed group consisted of all individuals who worked in the neighboring building. After this trial, a questionnaire survey was carried out to establish the demographic data of each group, how many members had in‰uenza-like illness in each group, and how many members were immunized against in‰uenza. The results showed that the relative risk of in‰uenza-like illness after chlorine dioxide gas exposure was 0.32 (95 conˆdence interval between 0.15 and 0.69), although the vaccination rate in the exposed group was lower than the unexposed group. This result suggests that chlorine dioxide gas has preventive eŠects against in‰uenzalike illness. Key wordschlorine dioxide, in‰uenza-like illness, prevention, prospective cohort study
Team, Anjo Kosei Hospital Abstract Vancomycin-resistant Enterococcus ( VRE ) was detected in a patient's feces for the ˆrst time at our hospital since surveillance of bacterial resistance was begun. The status of the patient, the treatment of the infection, and interventions to stop the spread of the infection were immediately assessed by the infection control team ( ICT ) . Initial screening involved 115 specimens, including patients hospitalized with the VRE patient, physicians and staŠ members, and environmental speci-mens were examined. VRE was detected in two of these specimens. As a result of thorough environmental control, including hand washing and changing of gloves, VRE was not detected after the additional screening, and the spread
は じ め に 近年研究が進んでいる抗菌薬の PK/PDを考慮した適 正な投与法は,効果を十分に発現させ,かつ副作用を軽 減させることが報告されている1,2).これまで当院では 抗菌薬使用マニュアルを整備し,また特定抗菌薬の届出 制を実施することにより,カルバペネム系抗菌薬(IPM /CS と MEPM)の AUD を 2003 年 12.3 から 2006 年 6.1と減少させたことからわかるように,安易に広域抗 菌薬を選択することから脱却し適切な抗菌薬選択へと進 んでいった.また抗 MRSA 薬については Therapeutic Drug Monitoring(以下 TDM)を実施し,適正な投与法 が実践されるようになっていた.しかし他の抗菌薬では まだまだ添付文書どおりの 1 日 2 回投与が主流であ り,投与方法において未だ適正使用されていない状態で あった.そこで当院 ICTは「抗菌薬推奨投与法」の普 及をオーダーリングシステムを使用して行うことを考え 実施した.今回その対策の効果を検討したので報告する. 京都第一赤十字病院の概要 診療科 21,稼動病床数 664床,医師数 117,専攻医 数 34,研修医数 40,救急救命センターと総合周産期母 子医療センターを併設している.2006年度の平均在院 日数は 14.1 日.2006 年 6 月より DPC を導入した. 2006年 10月より検査,薬剤のオーダーリングシステム を導入した.2006 年 12 月に地域医療連携病院,2007 年 1月に地域がん診療連携拠点病院の指定を受けた.
は じ め に 近年,耐性菌の出現や増加の原因となる不適切な抗菌 薬使用の是正が,医療施設における感染管理上の重要な 課題となっている.当院では,2000 年から 2001 年に かけて広域抗菌薬であるカルバペネム系,第四世代セフ ェム系抗菌薬及び抗メチシリン耐性黄色ブドウ球菌薬 (抗MRSA薬)の使用量が著しく増加する傾向がみられ ていたが,それと時期をほぼ同じくして多剤耐性緑膿菌 (MDRP)による尿路感染症を中心としたアウトブレイ クを経験した1).そして,この MDRP によるアウトブ レイクへの対応策の一つとして,カルバペネム系と第四 世代セフェム系抗菌薬及び抗 MRSA 薬の使用に際し て,処方理由と予定使用期間の届け出を義務化した特定 抗菌薬使用前届出制(以下届出制)を 2002年 8月に開始 した.今回,届出制開始 1年前から 5 年間の各種抗菌 薬使用量と,同期間における抗菌薬に対する各種細菌の 耐性化率の変化を解析することにより,届出制の抗菌薬 適正使用化効果について検討したので報告する.
手 指衛生 教育 以上 に,看 護 師 お よび 介護職 員の 看護 ケア後 の手指 衛生 の実 施頻度,実 施方法 を改善 す るか どうか を検討 した.療 養 病床 に勤 務 す る対 象者 に,1回 目は通常 の 資料,2回 目は看 護 ケア に よる細 菌汚 染度 の デー タを示 す資 料 を用 いた2回 の 手指 衛 生教 育 を行 い ,そ の前後 で の手 指衛 生 施行状 況 を調査 した.2回 目の教 育は,期 待 とは 異な り効 果が認 め られな か ったが,こ れ まで の 手 指衛 生の 改善 を 目的 とした研 究報 告 が,そ の効 果 の長期 の持 続 を認 めな か ったの とは 異な り,4 ヵ月間 にわた って効 果が持 続 した.こ の理 由 として は,手 指衛生 に ついて の認識 不足 が改善 した こ とと,こ の間5回 の調査 を行 った こ と自体が動 機付 けに な った ことが考 え られ る(ホ ー ソン効果) . 2回 目の教 育効 果が認 め られな か った理 由 としては,細 菌デー タを効果 的 に教育 に活用 で きなか っ た 問題 が あげ られ るが,手 指 衛 生 を実施 しや す い環境 で の手 指衛 生実 施率 が90%と 高 い実 施率 で
We examined the effect of face masks for the Glutaral. First, in order to find out how face masks were applied in disinfection work, we conducted questionnaire survey at 45 medical facilities in Wakayama prefecture. As the result, we found that the face mask wearing rate was 51.6% and 68 .8 % of them wear disposable surgical masks. Next, in order to examine the effect of face masks, we conducted a service life test and an exhalation resistance test under The National Approval Test of Japan, using several kinds of face masks. As the result of the service life test, the environmental concentration of AG (0.05 ppm or less) set by Ministry of Health, Labor and Welfare was maintained for approximately 172 hours by a G-7 type gas protection mask (G-7: koken) , 33 hours by a Muskie-51 (MS-51: koken) deodorant mask, and 50 minutes by the a Keymate—E200 (KM-E200: kurare) deodorant mask. However, the effect of the surgical mask could not be verified . As the result of the exhalation resistance test, G-7 indicated a higher point of the air-flow resistance (80 Pa) . Yet, MS-51, KM-E200, and the surgical masks indicated lower points of it (13 Pa , 11 Pa, and 5 Pa, respectively) , showing higher air permeability. Furthermore, we conducted a man-test to examine how well face masks fit. As the result of the man-test, MS-51 had the best fitting . From the above findings, it was found that a mask made of activated charcoal fibers which has 3D face-contacting cushion fits curved lines of face, and can be easily used. It also has superior fitting and strong protective ability against GA.
The clinical significance of pertussis infection is underestimated in Japan , so no infection control plan for nosocomial pertussis infection has been established. Our hospital experienced several episodes of nosocomial pertussis exposure, so an infection control plan for pertussis was developed according to the CDC guidelines including surveillance with classifying contacts and chemoprophylaxis. Here we describe our infection control plan and experience with infection control for exposed patients. In addition, the incidence of pertussis infection in adults was examined using agglutinating titers for pertussis in patients with chronic cough . The study found that 23% of patients had suspected pertussis infection. The clinical significance of nosocomial pertussis infection is important to recognize, and early diagnostic methods and criteria for the diagnosis of pertussis should be established to efficiently prevent nosocomial infection .
To prevent nosocomial infection in a community , detailed information is required about any nosocomial infections that might have occurred in the community . With such information infection control measures can be improved and maintained. A questionnaire was sent out to 265 hospitals with 20 or more beds affiliated to the Kagoshima Medical Association . The questionnaire asked the director and/or the chief of the infection control team (ICT) of the hospital about preventive measures against nosocomial infection and occupational exposures to infections or needle stick injuries . Of 265, 132 hospitals (50%) responded to the questionnaire . One problem in Kagoshima Prefecture is the low number hospitals with ICTs (only 58%) , as well the absence of an ICT in 28% of the hospitals with 200 or more beds. There were also significant differences between hospitals in the rates of introduction of preventive measures against nosocomial infection and occupational exposures. The rates of introduction of some measures were lower in Kagoshima Prefecture than reported previously. ICT networks, medical associations and societies , local authorities, and the government should assist hospitals to prevent nosocomial infections in their community .
