Biomedical subjects

Kiyoko Makimoto

Publications and source records attributed to Kiyoko Makimoto.

7 recordsLinked to original sources

PubMed2006

Relationship between catheter care and catheter-associated urinary tract infection at Japanese general hospitals: a prospective observational study.

BACKGROUND: The risk factors for catheter-associated urinary tract infections (CAUTIs) that are associated with catheter care have not been examined in detail by prospective studies or randomised clinical trials. OBJECTIVES: To examine the patterns of catheter care and to identify the CAUTI risk factors associated with catheter care. DESIGN: Prospective observational study. METHODS: Between January and December 2004, 555 adult patients who were catheterised for 3 days in five general hospitals in Japan were surveyed. One researcher collected the following data twice a week: catheter insertion method, catheter management, and signs and symptoms of urinary tract infections. The relative risk exceeding 1 by the Poisson regression were selected for Cox proportional hazard analysis in order to calculate adjusted risks. In addition, expected reductions in the incidence of CAUTIs by elimination of the risk factors were estimated using the population attributable risk percent. RESULTS: The mean duration of catheterisation was 25 days. The overall incidence of CAUTIs was 3.9 cases per 1000-device days; the incidence of CAUTIs ranged from 0.6 to 7.2 cases per 1000-device days among the five hospitals. Only fecal incontinent patients were analysed since they accounted for 94% of the CAUTI cases. In the univariate analysis, the silver-alloy catheter, which contains antimicrobial property, emerged as a potential risk. Since silver-alloy catheters were used in only one hospital, silver-alloy catheter care was compared with that of the other types of catheter, and a significantly higher percentage of inappropriate care was observed. In the final Cox model, two variables remained: 'non-pre-connected closed system (standard system)' (RR 2.35, 95%CI 1.20-4.60, p = 0.013) and 'no daily cleansing of the perineal area' (RR 2.49, 95%CI 1.32-4.69, p = 0.005). The population attributable risk percent suggested that the use of a 'pre-connected closed system' and 'daily cleansing of the perineal area' could reduce the incidence of CAUTIs by nearly 50%. CONCLUSIONS: Our investigation identified fecal incontinence as the major risk factor for CAUTIs in the study population. However, attributable risk percent indicates that the implementation of two basic elements of catheter care could reduce CAUTIs by nearly 50%. The hospital using silver-alloy catheters had the highest CAUTI rates, strongly suggesting the hazards of relying on the antimicrobial property of silver and the resultant laxity in care.

Aged↗

PubMed2006

The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison.

BACKGROUND: Catheter care is considered to be important for prevention of catheter-associated bloodstream infections (CABSIs) although epidemiological evidence is sparse. OBJECTIVES: To identify problems associated with catheter care and evaluate the effectiveness of nurse-initiated interventions to reduce CABSIs. DESIGN: An intervention study with before and after comparison. SETTINGS: CABSI surveillance was conducted in a 560-bed acute hospital located in a major urban area in Japan. PARTICIPANTS: Patients were enrolled in this study from April 2000 to December 2002 based on the following criteria: (1) adult inpatients; and (2) those in whom central venous lines or Swan-Ganz catheters were inserted for 2 days or longer. METHODS: In the first year, risk factors for CABSI and problems associated with catheter care were identified by inspection of the infection control nurse (ICN) or four trained link nurses, and the laboratory results. In the subsequent 2 years, the following interventions based on the surveillance results were implemented: (1) enhanced skin preparation by scrubbing with regular bathing soap and tap water; (2) a new method for stabilisation of the catheter inserted into the internal jugular vein, where additional dressing was placed over the sterilised dressing; (3) educating the staff on maximal sterile precautions by teaching staff members at their section meetings and displaying posters; (4) use of a check list and observation of catheter insertion by link nurses to monitor compliance; and (5) selection of a disinfectant that requires shorter contact time and has longer residual effect. RESULTS: After these interventions were implemented, the overall bloodstream infection (BSI) rate declined from 4.0/1000 device-days to 1.1/1000 device-days (p<0.005). CONCLUSIONS: We identified four problems-those related to skin preparation, dressing, sterile precautions and disinfectant. We implemented a series of interventions to reduce CABSIs; the overall CABSI rate decreased significantly.

Adult↗

PubMed2006

Qualitative study of osteoarthritis patients' experience before and after total hip arthroplasty in Japan.

Quantitative studies on the quality of life of patients with osteoarthritis (OA) after total hip arthroplasty (THA) have focused on functional improvement and pain reduction, but patients' perspectives of THA have not been examined in detail. The aim of our study was to investigate, describe, and analyze patients' experience before and after THA by using a qualitative research method. Twenty patients with OA who had undergone primary THA were recruited for this study. The qualitative data obtained were analyzed using content analysis. Participants reported dramatic improvements in pain and disability. However, detailed interviews disclosed problems that the participants faced during the preoperative period, such as an inferiority complex related to abnormal posture. During the postoperative period, some participants suffered from distress over body image related to the artificial joint. This report also suggests possible nursing interventions to deal with these problems.

Activities of Daily Living↗

PubMed2006

The impact of sleep interruptions on vital measurements and chronic fatigue of female caregivers providing home care in Japan.

The purposes of this study were to examine the impact of sleep interruptions on diurnal changes in blood pressure and chronic fatigue in middle-aged and elderly caregivers by using a cross-sectional quantitative method. Thirty-five female caregivers who were not taking antihypertensive and/or sleeping drugs were recruited for this study. Blood pressure was monitored over a 24 h period. Sleeping or waking periods were monitored with an actigraph. Fatigue was determined from a self-administered questionnaire. Participants were classified into four groups by cause of sleep interruption. One-way analysis of variance showed no differences in blood pressure, but hypertension was prevalent (40%). Sleep duration differed significantly, with the longest duration for those scheduled to wake up for care. Substantial variations were identified in the eight subcategories of chronic fatigue, with those without sleep interruption having the worst profile. This suggests that multiple factors in addition to sleep interruption affect the care burden.

Aged↗

PubMed2004

Development of web-based qualitative and quantitative data collection systems: study on daily symptoms and coping strategies among Japanese rheumatoid arthritis patients.

With the sharp rise in Internet access in recent years, the Internet is increasingly being used for research. We have developed two new systems using the Internet for both quantitative and qualitative data collection. One is a dynamic system for creating questionnaires and collecting responses and the other is an individual patient support follow-up system. These systems do not depend on the capacity of computers or servers and enable researchers to interact with participants privately and asynchronously. We have used these systems to collect data on daily symptoms and journal entries from 12 community-dwelling women with rheumatoid arthritis (RA) for a minimum of 1 month. The mean number of data submissions per month was 14.2 +/- 7.8, with the majority recording entries every day, and some submitting several times a day. The combination of two types of data elucidated the changes in coping and coping strategies in conjunction with changes in symptoms, even in a single day, and the coexistence of positive and negative coping. Research participants benefited from web-based symptom management and counseling resulting from 1 month of frequent interactions with the researcher. The use of the Internet for nursing research and interventions thus seems to show promising results.

Adaptation, Psychological↗

PubMed2003

Seroprevalence survey of measles, rubella, varicella, and mumps antibodies in health care workers and evaluation of a vaccination program in a tertiary care hospital in Japan.

Vaccine-preventable viral infections in health care workers (HCWs) have been on the rise for the past 10 years in Japan. To reduce the viral infections and the burden of exposure follow-up surveys at a tertiary care hospital in Osaka, Japan, a seroprevalence survey was conducted, and free vaccinations for measles, rubella, varicella, and mumps were offered to newly hired HCWs (199 physicians and 72 nurses and nursing assistants) who had negative serologic results for antibodies against these viruses. Negative antibody titers were obtained from 7.4% of the newly hired HCWs for measles, 12.5% for rubella, 4.1% for varicella, and 15.9% for mumps. The vaccination program for HCWs improved the vaccine-preventable infection rates and resulted in fewer exposure follow-up surveys, fewer lost work days, and fewer HCWs requiring hospitalization for these viral infections compared with those counted for the previous year. These data indicate that all HCWs should be strongly recommended to be vaccinated against (or have documented immunity to) these viruses in Japan, as is the case in the United States.

Adult↗

PubMed2002

Prospective study of fall risk assessment among institutionalized elderly in Japan.

The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long-term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long-term care facilities and nursing homes was nurses' prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long-term care facilities, history of falls (odds 3.68, 95CI: 1.47-9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48-6.64) showed significance on adjusted-odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.

Accidental Falls↗