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Shin JH, Mizuno S, Okuno T, Itoshima H, Sasaki N, Kunisawa S, Kaku M, Yoshida M, Gu Y, Morii D, Shibayama K, Ohmagari N, Imanaka Y. Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals. BMC Infect Dis 2021; 21:234. [PMID: 33639873 PMCID: PMC7912490 DOI: 10.1186/s12879-021-05921-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Anti-Infective Agents/therapeutic use
- Antimicrobial Stewardship/methods
- Antimicrobial Stewardship/standards
- Catheter-Related Infections/drug therapy
- Catheter-Related Infections/epidemiology
- Catheter-Related Infections/prevention & control
- Cross Infection/drug therapy
- Cross Infection/epidemiology
- Cross Infection/prevention & control
- Drug Resistance, Bacterial
- Hand Hygiene/standards
- Hand Hygiene/statistics & numerical data
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching/standards
- Hospitals, Teaching/statistics & numerical data
- Humans
- Infection Control/methods
- Infection Control/standards
- Japan/epidemiology
- Personnel, Hospital/statistics & numerical data
- Pneumonia, Ventilator-Associated/drug therapy
- Pneumonia, Ventilator-Associated/epidemiology
- Pneumonia, Ventilator-Associated/prevention & control
- Practice Patterns, Physicians'/standards
- Surveys and Questionnaires
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Affiliation(s)
- Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Seiko Mizuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Mitsuo Kaku
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Makiko Yoshida
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Daiichi Morii
- Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, AMR Clinical Reference Center, and Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Cloete B, Yassi A, Ehrlich R. Repeat Auditing of Primary Health-care Facilities Against Standards for Occupational Health and Infection Control: A Study of Compliance and Reliability. Saf Health Work 2019; 11:10-18. [PMID: 32206369 PMCID: PMC7078524 DOI: 10.1016/j.shaw.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011–2012 were compared with follow-up internal audits in 2014–2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results At baseline, 25% of 60 facilities were “noncompliant” (audit score<50%), 48% “conditionally compliant” (score >50 < 80%), and only 27% “compliant” (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion Low baseline compliance with OHS–IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.
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Affiliation(s)
- Brynt Cloete
- School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Rodney Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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Gilmartin HM, Pogorzelska-Maziarz M. International responses to the 2015 APIC MegaSurvey. Am J Infect Control 2019; 47:729-731. [PMID: 31003751 DOI: 10.1016/j.ajic.2019.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
The prevention of health care-associated infections is an international concern. Infection preventionists across the world play a key role in assessing, planning, implementing, and evaluating infection control policies. In 2015, the APIC launched the MegaSurvey to establish the state of the infection preventionist workforce. This brief report will describe and compare responses from the United States, Canada, and "other" countries to establish a professional baseline and set an agenda for future international collaborations.
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Affiliation(s)
- Heather M Gilmartin
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO; Colorado School of Public Health, University of Colorado, Aurora, CO.
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Benson FG, Levin J, Rispel LC. Health care providers' compliance with the notifiable diseases surveillance system in South Africa. PLoS One 2018; 13:e0195194. [PMID: 29630627 PMCID: PMC5891014 DOI: 10.1371/journal.pone.0195194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/14/2018] [Indexed: 11/19/2022] Open
Abstract
Background The optimal performance of a notifiable disease surveillance system (NDSS) is dependent on health care provider (HCP) compliance with communicable disease notification. HCP compliance ensures appropriate investigation and control measures by relevant health care authorities. This study examines the compliance of HCPs with the NDSS in South Africa and factors associated with their compliance. Methods A cross-sectional survey was carried out in three randomly selected provinces. We stratified by type of facility, and recruited clusters of HCPs on survey day to participate. All consenting HCPs in the randomly selected health care facilities on the day of the survey, completed a questionnaire that elicited information on socio-demographic characteristics and notification practices. The data were analysed using STATA® 14, using the identifiers for stratum and cluster as well as the calculated sampling weights. Results The study found that 58% of 919 HCPs diagnosed a notifiable disease in the year preceding the survey. The majority of these professionals (92%) indicated that they had reported the disease, but only 51% of those notified the disease/s correctly to the Department of Health. Paediatricians were less likely to notify correctly (OR 0.01, 95% CI 0.00–0.12, p = 0.001). The factors that influenced notification were HCPs perceptions of workload (OR 0.84, 95% CI 0.70–0.99, p = 0.043) and that notification data are not useful (OR 0.84, 95% CI 0.71–0.99, p = 0.040). The study found no association between correct notification and HCPs’ willingness to notify, experience or training on the NDSS, understanding of the purpose of the NDSS, knowledge of what to notify, or perception of feedback given. Conclusions The compliance of HCPs in South Africa with the NDSS is suboptimal. In light of the important role of HCPs in the effective functioning of the NDSS, information on NDSS usefulness and guidelines on correct notification procedures are needed to increase their compliance.
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Affiliation(s)
- Frew Gerald Benson
- Gauteng Department of Health, Rahima Moosa Hospital, Newclare, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
- * E-mail:
| | - Jonathan Levin
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Laetitia Charmaine Rispel
- Centre for Health Policy, Department of Science and Technology/National Research Foundation, SARChI Chair on the Health Workforce, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan. J Patient Saf 2016; 12:11-7. [PMID: 24717527 DOI: 10.1097/pts.0000000000000108] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Padoveze MC, Fortaleza CMCB, Kiffer C, Barth AL, Carneiro ICDRS, Giamberardino HIG, Rodrigues JLN, Santos Filho L, Mello MJGD, Pereira MS, Gontijo Filho P, Rocha M, Medeiros EASD, Pignatari ACC. Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study. Am J Infect Control 2016; 44:74-9. [PMID: 26412480 DOI: 10.1016/j.ajic.2015.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.
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Hansen S, Zingg W, Ahmad R, Kyratsis Y, Behnke M, Schwab F, Pittet D, Gastmeier P. Organization of infection control in European hospitals. J Hosp Infect 2015; 91:338-45. [PMID: 26542950 DOI: 10.1016/j.jhin.2015.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. AIM This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. METHODS Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. FINDINGS Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. CONCLUSION There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority.
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Affiliation(s)
- S Hansen
- Charité - University Medicine Berlin, Institute for Hygiene, Germany.
| | - W Zingg
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - R Ahmad
- Imperial College Healthcare NHS Trust, London, UK
| | - Y Kyratsis
- School of Health Sciences, City University London, UK
| | - M Behnke
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - F Schwab
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - D Pittet
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - P Gastmeier
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
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Choi JS, Kim KM. Factors influencing the self-perceived practice levels of professional standard competency among infection control nurses in Korea. Am J Infect Control 2014; 42:980-4. [PMID: 25179330 DOI: 10.1016/j.ajic.2014.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study investigated the self-perceived infection control (IC) knowledge and practice levels of professional standards competency (PSC) among Korean infection control nurses (ICNs) to identify factors that may influence PSC. METHODS Using a self-reporting questionnaire method, we collected data from a total of 104 ICNs. RESULTS The average self-perceived IC knowledge level was 3.1 ± 0.8, with hand hygiene scoring the highest at 3.7 ± 0.8. The total proportion of responders who did not meet the expected standard in 4 future-oriented domains was 51.7%. Of the 4 domains, technology had the highest number of respondents meeting the desired standard (57%). There were significant differences in self-perceived levels of PSC in relation to ICN specialist certification and continuing education (eg, extra coursework, conference attendance) in the field. Self-perceived practice levels of PSC also were significantly correlated with age, years of total clinical experience, years of ICN experience, hospital bed count, and IC knowledge. Predictors of self-perceived practice levels of PSC were knowledge and years of ICN experience. CONCLUSION Educational programs are needed to promote knowledge and competency, the lack of which was recognized by the ICNs. Also, various efforts are needed to prevent turnover of ICNs with a high level of competency.
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Mori-Yoshikawa N, Ohmagari N, Kirikae T. Organization of Nosocomial Infection Control Measures and Local Networks for Infectious Disease Control in Middle-Scale Hospitals in Japan. Jpn J Infect Dis 2014; 67:379-81. [DOI: 10.7883/yoken.67.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kim KM, Choi JS. Factors Affecting Core Competencies among Infection Control Nurses in Korea. ACTA ACUST UNITED AC 2014. [DOI: 10.7475/kjan.2014.26.1.11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kyung Mi Kim
- Department of Nursing, Semyung University, Jecheon, Korea
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Her S, Kim KH, Oh HS. A Study on Work Condition, Stress, Role Conflict and Job Satisfaction of Infection Control Nurses Working in General Hospitals. ACTA ACUST UNITED AC 2012. [DOI: 10.7475/kjan.2012.24.4.327] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bacterial flora on cell phones of health care providers in a teaching institution. Am J Infect Control 2010; 38:404-5. [PMID: 20363049 DOI: 10.1016/j.ajic.2009.08.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 07/31/2009] [Accepted: 08/03/2009] [Indexed: 12/11/2022]
Abstract
We conducted a cross-sectional study involving culture of cell phones of 288 health care providers (HCP) during a 6-month period. One hundred nine (43.6%) HCP carried infective organisms on their cell phones. It is recommended that cell phones be cleaned regularly.
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Smith DR. Needlestick injury surveillance and underreporting in Japan. Am J Infect Control 2010; 38:163-5. [PMID: 20176286 DOI: 10.1016/j.ajic.2009.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 08/05/2009] [Indexed: 10/19/2022]
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