When a nosocomial infection occurs, not only does it require a great deal of effort and cost to contain it, but it also puts it in a critical situation that affects the reputation of the hospital. In other words, it can be said that nosocomial infection countermeasures are indispensable for carrying out sound hospital management. Specifically, thorough hand hygiene, prevention of needlestick injury, proper cleaning, disinfection, and sterilization of instruments are important, and it is necessary to raise the awareness of hospital staff regarding nosocomial infections.
Resistant bacteria, which have been highlighted as the causative bacteria of nosocomial infections, are spreading throughout the city. There may be effective antibacterial agents such as methicillin-resistant Staphylococcus aureus (MRSA), but highly resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa, multidrug-resistant Acinetobacter, NDM-1 -producing bacteria, and KPC-producing bacteria. The available antibacterial agents are also limited. At a university hospital in Kyushu, multidrug-resistant Acinetobacter was detected in five patients admitted to the hospital from April last year to April this year, and three of them died.
The source of infection of resistant bacteria in the hospital is mainly eradicated patients, and the routes of transmission of resistant bacteria to patients are (1) patient → patient, (2) patient → in-hospital environment → patient, (3) patient → There are four possible routes: medical equipment → patient, ④ patient → medical staff → patient. In order to prevent outbreaks in the hospital, it is necessary to block all of these transmission routes, but considering the frequency of contact, hand hygiene of medical staff is considered to be the most effective.
In the medical field, some people say that they are too busy to carry out thorough hand hygiene, but it is desirable to raise awareness through regular education and enlightenment activities so that they can carry out their daily work with an awareness of infection control. .. In the past, most of them were pump type, but recently, it seems that no-touch type dispensers that automatically discharge hand sanitizer are becoming popular.
Preventing needlestick injuries is also an important issue as an infection control measure for healthcare professionals. 50,000 needlestick injuries are reported annually, with an estimated 200,000. About one-third of new infections with blood-borne pathogens are medical-related infections. According to the Occupational Infection Control Study Group, the majority of the injured are nurses, but the proportion of nurses has decreased and the proportion of doctors has been increasing in recent years. Needlestick injuries account for 70% of the total in the hospital room, surgical department, and outside the hospital room. The time of occurrence is ➀ until it is stored in a disposal container after use for the patient, (2) it is being used by the patient, and (3) it accounts for about 60% due to three factors at the time of recapping. Among the top 15 types of equipment that cause needlestick injury, needlestick injury with an injection needle is the most frequently reported, and it is speculated that needlestick injury with an injection needle occurs in many situations such as blood sampling, insulin injection, and intramuscular injection of drugs. There is. The number of pincushions of winged needles has decreased due to the spread of "with safety mechanism", but the increase of drug-filled needles is conspicuous (Fig.). In the case where a nurse at a medical institution was infected with hepatitis C from the patient's blood due to needlestick injury at the time of blood sampling, it developed into a lawsuit, and the safety obligation of the medical institution became a problem. Efforts to further improve the effectiveness of the Ministry of Health, Labor and Welfare's nosocomial infection prevention notification (prohibition of recapping, proper placement of disposal containers, utilization of safety equipment) are desired.
However, there are still issues regarding the spread of safety measures products. While intravenous indwelling needles with safety devices are becoming more widespread because the redemption price is set higher than conventional products, safety syringe products are becoming more popular due to the high price and lack of advantage in redemption price. Is late. Considering the current situation where damage caused by injection needles is the most common factor, it can be said that reviewing the redemption price is one of the issues to be considered.
In recent years, the importance of infection control has been highlighted in medical facilities, and there is a growing recognition that proper treatment of used equipment is the basis for preventing the spread of infection.
In large hospitals, the number of facilities introducing traceability systems as a countermeasure against nosocomial infections is increasing. Although it is expensive, it is attracting attention as it leads to infection control and follow-up of sterility guarantee. There are many advantages such as reducing the risk of damage due to metal fatigue from equipment information on frequency of use and useful life, determining the guideline for when to purchase equipment, and avoiding danger to patients, as well as reducing the burden on doctors and nurses who handle equipment. It is believed to be a thing.
In the field of ophthalmology, it is indispensable to make equipment that is difficult to regenerate difficult to reduce the risk of infection in surgery, and many of them use disposable equipment as much as possible for equipment that is difficult to wash with a washing machine. This includes equipment with a light source, US handpieces used for cataract surgery, and the tip of J / A handpieces.
On the other hand, many medical professionals wash their uniforms at a specialized laundry shop contracted by the hospital or a leasing company that provides white coats, but there are also facilities that do laundry work in the hospital. Medical uniforms are contaminated with various pathogens, including Staphylococcus aureus, and blood may adhere to them. From a bacteriological point of view, it is desirable to change uniforms every day, but in reality, it seems that they are often changed once a week. It is said that the uniform cleaning method differs depending on the facility, but proper cleaning using an enzyme-based detergent or the like is required. From the aspect of infection control, it is required to prepare guidelines and add measures for medical fees.
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