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Osone S, Shinoda K, Yamamoto N, Suzuki K, Yano M, Ishida Y, Saito Y, Sawada A, Sano H, Kato Y, Shinkoda Y, Kakazu M, Mori N, Mizutani S, Fukushima K. Current methods of preventing infectious disease and managing febrile neutropenia in childhood cancer patients: a nationwide survey in Japan. Int J Clin Oncol 2023; 28:331-340. [PMID: 36585538 PMCID: PMC9803594 DOI: 10.1007/s10147-022-02282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventing infection and managing febrile neutropenia (FN) is mandatory for children with cancer undergoing chemotherapy. However, the current situation in Japan is unknown. METHODS We conducted a nationwide web-based questionnaire survey in 153 institutions treating childhood cancer in Japan. We asked about the type prophylaxis used to prevent infectious disease and manage FN. If patients with childhood cancer were managed by both pediatricians and surgeons at the same institution, we asked both to reply. RESULTS We received replies from 117 departments at 111 centers: of these, 108 were from pediatricians. Laminar air flow for neutropenic patients, and frequent hand sanitization with ethanol, were widespread. Twenty-eight percent and forty percent of departments performed active surveillance by taking cultures from patients and the environment, respectively, before initiation of chemotherapy. Forty-four percent of departments administered prophylactic intravenous antibiotics according to patient status. Many departments measured serum (1,3)-β-D glucan, procalcitonin, and aspergillus galactomannan at the onset of FN. Twenty-eight percent of departments used carbapenem as empirical therapy for FN. Some departments used prophylactic granulocyte-colony stimulating factor for acute leukemia. Seventy-two percent of departments used prophylactic immunoglobulin for hypogammaglobinemia caused by chemotherapy. Palivizumab was administered widely for respiratory syncytial virus prophylaxis in immunocompromised infants. CONCLUSION As a whole, intensive care for infectious prophylaxis or FN is applied in Japan; however, the methods vary among centers, and some are excessive or inadequate. Therefore, it is desirable to conduct clinical trials and establish adequate care protocols for infection in children with cancer in Japan.
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Affiliation(s)
- Shinya Osone
- grid.272458.e0000 0001 0667 4960Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566 Japan
| | - Kunihiro Shinoda
- grid.415535.3Department of Pediatrics, Gifu Municipal Hospital, 7-1 Kashima-Cho, Gifu, 500-8513 Japan
| | - Nobuyuki Yamamoto
- grid.31432.370000 0001 1092 3077Department of Pediatrics, Kobe University, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017 Japan
| | - Koji Suzuki
- grid.413114.2Department of Pediatrics, Faculty of Medical Science, University of Fukui Hospital, 23-3 Matsuoka-Shimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193 Japan
| | - Michihiro Yano
- grid.411403.30000 0004 0631 7850Department of Pediatrics, Akita University Hospital, 44-2 Hasunuma, Hirozura, Akita 010-8543 Japan
| | - Yuji Ishida
- grid.415797.90000 0004 1774 9501Department of Pediatrics, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Shunto, Shizuoka 411-8777 Japan
| | - Yuya Saito
- grid.417084.e0000 0004 1764 9914Department of Pediatric Hematology and Oncology, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561 Japan
| | - Akihisa Sawada
- grid.416629.e0000 0004 0377 2137Department of Pediatric Hematology/Oncology, Osaka Women’s and Children’s Hospital, 840 Murodo, Izumi, Osaka 594-1101 Japan
| | - Hirozumi Sano
- grid.415262.60000 0004 0642 244XDepartment of Pediatrics, Sapporo Hokuyu Hospital, 6-6-5-1 Higashisapporo, Shiroishi-Ku, Sapporo, Hokkaido 003-0006 Japan
| | - Yoko Kato
- grid.411898.d0000 0001 0661 2073Department of Pediatrics, Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-Ku, Tokyo 105-8471 Japan
| | - Yuichi Shinkoda
- grid.410788.20000 0004 1774 4188Department of Pediatrics, Kagoshima City Hospital, 37-1 Uearatacho, Kagoshima, 890-8760 Japan
| | - Mariko Kakazu
- Pediatric Hematology and Oncology Department, Okinawa Prefectural Medical Center and Children’s Medical Center, 118-1 Shinkawa, Haebaru, Shimajiri, Okinawa 901-1193 Japan
| | - Naoko Mori
- Akabane Zaitaku Clinic, 2-69-6 Akabane, Kita-Ku, Tokyo, 115-0045 Japan
| | - Shuki Mizutani
- grid.265073.50000 0001 1014 9130Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519 Japan
| | - Keitaro Fukushima
- grid.255137.70000 0001 0702 8004Department of Pediatrics, Dokkyo Medical University School of Medicine, 880 Kita-Kobayashi, Mibu, Shimo-Tsuga, Tochigi, 321-0293 Japan
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Tsunoda A. Bidet Toilet Use May Cause Anal Symptoms and Nosocomial Infection. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:335-339. [PMID: 34746497 PMCID: PMC8553346 DOI: 10.23922/jarc.2021-027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
Electric bidet toilets are widely used in Japan and are sanitary devices, that are integral to daily life. Approximately, half of the population washed the anus before or after defecation. Cleaning the anus after defecation using the bidets contributes to hand hygiene and local comfort, and it may be effective against constipation. However, excessive bidet use potentially causes anal pruritus and anal incontinence (AI). Physicians are advised to instruct patients with anal pruritus to avoid excessive cleaning of the anus and those with AI to discontinue bidet use. For the estimation of the inherent severity of AI, physicians should instruct a bidet user with AI to discontinue bidet use and assess the severity of AI later. Additionally, the nozzle surface and splay water of bidet toilets may be contaminated with fecal indicator bacteria, such as Escherichia coli and Pseudomonas aeruginosa, as well as antimicrobial-resistant bacteria, rendering them a potential vehicle for cross-infection. In the hospital setting, compromised patients must be cautious regarding the shared use of bidet toilets to prevent infection by antimicrobial-resistant bacteria. Specifically, they should be provided with bidet toilets exclusive for them or may need to be instructed to not use a bidet.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Itami A, Hori S, Misawa S. Decontamination effect of neutral electrolysed water for spray nozzles of electric warm-water bidet toilet seats in the healthcare setting. Infect Prev Pract 2021; 3:100143. [PMID: 34368750 PMCID: PMC8336319 DOI: 10.1016/j.infpip.2021.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background There has been an increasing demand for more sanitary bidet seats in many healthcare settings because of concerns regarding potential contamination of the spray nozzles of warm-water bidet toilet seats. This contamination is thought to possibly serve as a reservoir for horizontal transmission of drug-resistant bacteria. Aim This study was performed to determine the optimal Pseudomonas aeruginosa decontamination conditions and verify the effectiveness of these decontamination conditions. Methods An in vitro test of rinsing with neutral electrolysed water was performed using seven strains of P. aeruginosa. The decontamination effect of the neutral electrolysed water was verified by a field test involving an analysis of the number of bacteria isolated from samples collected from the spray nozzles and the sprayed water from 10 toilet seats at the internal medicine ward of Juntendo University Hospital. Findings The in vitro test results showed that the decontamination effect of neutral electrolysed water tended to be higher with higher free chlorine concentrations in the nozzle-cleaning water and shorter intervals of rinsing. The field test involving the hospital ward toilets showed that routine physical cleaning was satisfactorily effective. Conclusion The study results suggest that the risk of horizontal transmission of drug-resistant bacteria via the use of bidet toilet seats in hospitals can be reduced by general cleaning and appropriate control of the free chlorine concentration in the nozzle-cleaning water.
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Affiliation(s)
- Aiko Itami
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Research Institute, TOTO Ltd., Chigasaki, Kanagawa, Japan
| | - Satoshi Hori
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
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Tsunoda A, Otsuka Y, Toguchi A, Watanabe K, Nishino R, Takahashi T. Survey on bacterial contamination of bidet toilets and relation to the interval of scrubbing these units. JOURNAL OF WATER AND HEALTH 2019; 17:863-869. [PMID: 31850894 DOI: 10.2166/wh.2019.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Abstract
We conducted a survey to investigate the distribution of bacteria recovered from the bidet toilets at a district hospital. The nozzle surface and spray water of 192 bidet toilets were sampled for contamination. Of the 192 toilets sampled, the nozzle surface of 167 (87%) and the spray water of 181 (94%) were found to be contaminated by one or more of the following organisms: Enterobacteriaceae, Enterococcus spp., Staphylococcus spp., non-glucose-fermenting rods, other Gram-negative bacteria, other Gram-positive bacteria, and Candida spp. An extended spectrum of β-lactamase producing Escherichia coli was found in one nozzle surface and one spray water. The frequency of colonization with 104 or more recovered from the nozzle surface was significantly greater in the toilets scrubbed every week than that in the units scrubbed every day, but that from the spray water was not significantly different between the groups. The nozzle surface and the spray water in the bidet toilets were contaminated with a wide range of bacteria. Because the interval of scrubbing the toilets did not have an influence on the contamination of the spray water, self-cleaning mechanisms of spray water should be developed to prevent patients' possible infections.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan E-mail:
| | - Yoshihito Otsuka
- Department of Clinical Laboratory, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Akihiro Toguchi
- Department of Clinical Laboratory, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Kumiko Watanabe
- Department of Clinical Laboratory, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Ryou Nishino
- Department of Clinical Laboratory, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan E-mail:
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Oie S, Aoshika H, Arita E, Kamiya A. The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model. Jpn J Infect Dis 2018; 71:306-308. [PMID: 29709985 DOI: 10.7883/yoken.jjid.2017.515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A simulation experiment was conducted to examine hand contamination from wiping the buttocks after the use and non-use of an electric toilet seat with water spray. A model of the buttocks was smeared with artificial diarrheal feces containing Serratia marcescens, and wiped by the participants wearing disposable gloves with 4 sheets of toilet paper after the use and non-use of the water spray of an electric toilet seat. Subsequently, the presence of S. marcescens on the surface of the gloves was quantified. After using the water spray, the mean count±standard deviation of S. marcescens was 0.067±0.249 colony-forming units (cfu)/glove, and it was 4,275±6,069 cfu/glove when water spray was not used. The cfu of S. marcescens was significantly lower when the water spray was used (p<0.00001) prior to wiping the artificial diarrheal feces. This result supports the effectiveness of water spray to prevent defecation-related hand contamination.
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Affiliation(s)
| | | | - Emiko Arita
- Department of Nursing, Ube Frontier University
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Kanayama Katsuse A, Takahashi H, Yoshizawa S, Tateda K, Nakanishi Y, Kaneko A, Kobayashi I. Public health and healthcare-associated risk of electric, warm-water bidet toilets. J Hosp Infect 2017; 97:296-300. [PMID: 28756169 DOI: 10.1016/j.jhin.2017.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In recent years, installation of bidet toilets within hospitals in Japan has raised concerns regarding potential for cross-contamination by antimicrobial-resistant bacteria from patients who are hospitalized over an extended period. AIM To investigate the distribution of antimicrobial-resistant bacteria recovered from bidet toilets at a university-affiliated hospital in Japan. METHODS All 292 electric bidet toilets at a university hospital were sampled for contamination. Swabs for culture were used to sample water-jet nozzles and toilet seats. FINDINGS Of the 292 toilet seats sampled, warm-water nozzles of 254 (86.9%) were found to be contaminated by one or more of the following organisms: Staphylococcus aureus, Streptococcus spp., Enterococcus spp., Enterobacteriaceae and non-Enterobacteriaceae Gram-negative bacteria. S. aureus was recovered from one water-jet nozzle and nine toilet seats; of these, meticillin-resistant S. aureus was recovered from the water-jet nozzle and from one toilet seat. Both the water-jet nozzle and seat of the same toilet were contaminated with a CTX-M-9 group extended-spectrum β-lactamase-producing Escherichia coli. Of the Gram-negative isolates recovered from samples, the organism with the highest frequency of isolation was Stenotrophomonas maltophilia, which was recovered from 39 bidet toilets. CONCLUSION Warm-water nozzles of bidet toilets are contaminated with a wide range of bacteria, making them a potential vehicle for cross-infection. In the hospital setting, shared use of bidet toilets must consider the clinical background of patients. Based on these findings, these devices must be part of the risk management programme, and steps should be included for monitoring and disinfection.
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Affiliation(s)
- A Kanayama Katsuse
- Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan
| | - H Takahashi
- Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan
| | - S Yoshizawa
- Clinical Research Centre, Toho University School of Medicine, Tokyo, Japan; Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Y Nakanishi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - A Kaneko
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - I Kobayashi
- Department of Infection Control and Prevention, Toho University Faculty of Nursing, Tokyo, Japan.
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