ASOURCE Times

140 years of history

Our hospital was established in 1879 as a "hibyoin" for cholera, which was a pandemic in Japan, and has achieved many achievements as a contagious hospital that treats various infectious diseases. Since 2007, we have been providing medical care for many HIV-infected persons as a core hospital for AIDS treatment, and the medical treatment results are one of the best in Japan. In 2010, it was designated as a "Type 1 Infectious Disease Designated Medical Institution" and established a dedicated ward that can handle infectious diseases such as Ebola hemorrhagic fever, plague, Marburg disease, and Lassa fever. In order to treat infectious diseases with high risk, we regularly carry out training such as putting on and taking off protective equipment.

Then, in 2011, we clarified our position as a hospital that provides highly specialized medical care for cancer and infectious diseases, and became a hospital that provides advanced treatment for cancer. Currently, it has been designated as a "cancer medical treatment cooperation base hospital" and a "hematopoietic stem cell transplantation promotion cooperation hospital", and plays a central role in cancer medical treatment in Tokyo. Cancer patients account for 70% of inpatients. Advances in advanced medical care for cancer, on the other hand, will lead to an increase in infectious diseases caused by drug-resistant bacteria. In other words, there are many cases of febrile neutropenia (FN) due to immunodeficiency, and the amount of antibacterial drugs used inevitably increases, and the risk of developing resistant bacteria tends to be high. Therefore, infectious disease control in the hospital is also one of the major issues.

Share monitoring information on antimicrobial use

In the infection control department of this hospital, the infectious disease department and the infection control department cooperate, and there are many occupations such as infectious disease specialists, infectious disease full-time nurses, clinical laboratory engineers, pharmacists, radiologists, nutritionists, and clerical workers who are under the direct control of the director. We have organized an Infection Control Team (ICT) to deal with the situation. In addition, we have set up the Antimicrobial Stewardship Team (AST) to identify issues related to the use of antibacterial drugs, clarify goals, and work speedily.

As infection control measures, we are focusing on ➀ proper use of antibacterial drugs ➁ implementation of surveillance ➂ thorough standard preventive measures. In ➀, ICT and AST pharmacists play a central role in promoting proper use in the ward while sharing monitoring information on the amount of antibacterial drug used with the ward's full-time pharmacist. In particular, since hematopoietic stem cell transplantation is as high as about 120 cases per year, the amount of antibacterial drugs used inevitably increases, and the risk of developing resistant bacteria tends to be higher than in general hospitals. For this reason, AST pharmacists and infection control doctors work together to provide advice and case consultation depending on the case. In conducting surveillance in ➁, we are particularly focusing on collecting data related to drug-resistant bacteria. If resistant bacteria or Clostridioides difficile are detected, ICT members will check the implementation status of medical staff's standards and contact prevention measures, and if there are any problems, they will guide the ward staff. I think that regular checks on resistant bacteria will help prevent outbreaks. ➂ holds ICT seminars (three times a year) and nosocomial infection control seminars (twice a year) for all staff. We also aim to make it a habit by checking basic items such as hand hygiene and wearing a mask every week. For hand hygiene, we check the amount of rubbing hand disinfection used and the direct observation method. Although the amount of disinfection used is increasing, "5 timings" (➀ Before touching the patient ② Before clean and aseptic operation ③ If there is a possibility of being exposed to body fluids ④ After touching the patient ⑤ For items around the patient (After touching) Not all have been enforced, and further enlightenment activities are needed.

In addition, from the viewpoint of infection control measures and operational efficiency, disposable products such as biopsy forceps, guide wires, and Safety (with safety mechanism) products are increasingly used. Medical material costs are incurred, but this may also be a trend of the times.

Outbreak is a business loss

Although it is difficult to see the results of infection control measures, it is necessary to steadily accumulate them on a daily basis. It's too late after the problem occurs. Outbreaks of resistant strains, including MRSA, can shake hospital credibility, increase medical costs, and in some cases force hospital bed closures and hospitalization restrictions, which can be extremely devastating to hospital management. It is important to take daily infection control measures to prevent loss due to outbreaks. One of the factors that cause outbreaks is the lack of awareness and information sharing among staff. It is also important to maintain close communication between staff members and to raise awareness of infection control every time.