1

2023

International

HosCom stands for Hospital Communication.
We aim to provide useful information
to the healthcare professionals involved in Infection Prevention
and Control to promote the sharing of knowledge
and experience globally so that we can improve further together.

World Information
Challenges and Experiences of Handling COVID-19
in Penang Hospital, Malaysia
Dr. Chuan Huan Chuah, Dr. Kar Nim Leong, Dr. Ting Soo Chow, Dr. Peng Shyan Wong
Hospital Pulau Penang

Introduction
Since the first reported COVID-19 case in Malaysia on 25th
January 2020, all public hospitals, including Penang General
Hospital, have been prepared for the outbreak. Confirmed
COVID-19 cases were initially concentrated in Kuala
Lumpur with the arrival of international travellers before
spreading throughout the country, including Penang. Due tothe increasing number of cases, the country was placed undera restrictive movement control order on 18th March 2020.
The country faced the toughest challenge during the period
between July and October 2021, when the number of casesrose above 20,000 per day, with many still not fully vaccinatedagainst the virus.

Our Challenges• Inadequate hospital beds in wards and ICUs
• Lack of manpower• Low oxygen pressure within aging infrastructures• Low PPE supply, particularly N95 masks• Positive COVID-19 cases among healthcare staff• Positive COVID-19 patients diagnosed in non-COVID-19
wards• Vaccine hesitancy among the public and some healthcare staff• New surge due to the Omicron variant

Our Experience and Strategies
Preparation of healthcare facilities and manpower
During the early phase, the hospital director promptly
called for meetings to bring in all relevant clinical and nonclinical departments, as well as infection control, nursing
and engineering representatives. This allowed for unified
decision making on how best to convert existing wards
into COVID-19 wards, expand ICU services and mobilise
manpower. Staff members from other departments were
deployed to join the COVID-19 team. Elective surgeries
and nonurgent procedures were reduced and even stopped tohandle the surge in COVID-19 cases.

1

Briefing to staff members about
expanding beds in the outpatient
department

Repurposed ward for COVID-19
patients

Setting up low-risk centres
In the initial phase, all positive COVID-19 patients wererequired to quarantine in healthcare facilities for monitoring.
Several low-risk centres were set up at the hospital and statelevels. There was also an outbreak of COVID-19 infectionsin the prison, which is located next to the hospital, in
October 2020. Fortunately, most patients suffered only mild
symptoms. Instead of bringing the patients into healthcare
facilities, part of the prison was converted into a low-risk
centre. Medical staff were deployed to monitor these patients
on-site. The majority of the patients recovered withoutcomplications, and only a few needed to be transferred tohospital wards.

Setting up a low-risk centre for more Turning a dental hostel into a lowstable patientsrisk COVID-19 centre

Handling the Delta wave
The most challenging period was from July to October 2021
when the Delta wave hit the country. Many patients wereadmitted with severe disease and required oxygen support andICU care. More than 10 wards were repurposed to manage
the surge in patients. Other intensive units (e.g. cardiology,
cardiothoracic and plastic surgery) were converted into
COVID-19 ICUs to handle severe cases. With the help of thenational armed forces, field hospitals were built in Kepala
Batas Hospital and Penang General Hospital. These field

2023 vol.1

hospitals were fully equipped with oxygen-capable beds andhigh-dependency units. Oxygen pressure was adequate tosustain multiple high-flow nasal cannula machines.

PPE training by infection
control team

Field hospital set up in theparking area of the hospital

Health staff members after transportinga new case into the field hospital

Waves and vaccines
During the peak, the federal government mobilised staff
from the Klang Valley to Penang to assist. These individuals
included specialists, medical doctors and paramedics. The
COVID-19 cases came in waves. When the numbers declined,
the staff members were returned, and the repurposed wards
were converted back to normal wards. This allowed thehospital to resume all essential services. Thanks to the rapid
national immunization program, almost 80% of the population
completed primary vaccination by November 2021. However,the uptake of booster doses was less than 50%. The country
was subsequently hit with the Omicron wave, and the dailycases went back up. Fortunately, due to the high vaccination
rates, the disease severity was mild, and most patients wereallowed to quarantine at home.
Maintaining enough PPE
For PPE, there was no major disruption of supply to our
hospital. The management team monitored the usage andsupply during the peak. Apart from the supply from theministry, we were fortunate to receive numerous donations of
PPE from various channels. Donors included NGOs, privatecompanies and individuals. However, there were times whencertain PPE items, like N95 masks, ran low. To manage thisshortage, the staff members were reminded to avoid wastage.
Infection control in the hospital
Infection control is important not just in COVID-19 wards,
but also in other non-COVID-19 areas. The infection control
team performed regular training and supervision to reduce therisk of transmission in the ward. The hospital adopted a novisitor policy during the pandemic. If caretakers or family
members needed to be in the ward, the number was limited,
and they were required to perform a self-test for COVID-19
whenever they entered the hospital. During the surge in cases,
many healthcare workers were diagnosed with COVID-19.
The majority of them had acquired the infection from thecommunity. This led to manpower shortages and service
disruptions. Measures taken to counter this problem included
restricting the number of people eating together in the pantry,
ensuring compliance with PPE and using virtual platforms to
conduct meetings and conferences.

Regular visits and support to ensure medical
staff members were healthy and motivated

NGO support
We were fortunate and grateful to receive significant support
from NGOs. Donors connected directly with clinicians on
the ground to understand their needs. Medical equipment
and consumables were crucial due to the expansion of wards.
Donated items included PPE, test kits, high-flow nasal cannulamachines, oxygen concentrators, ultrasound machines, X-Ray
machines and laptops. We also received other forms of
support, including food and moral support.

Recommendations• Have a contingency plan for case surges• Recruit more healthcare workers into the COVID-19 workforce• Train more doctors, including specialists in managing severe
and critical COVID-19 patients• Increase surveillance testing in the hospital to diagnose positive
cases earlier• Improve oxygen pressure capacity in facilities• Keep staff updated on the latest evidence in the management
and infection control of COVID-19• Maintain the welfare of frontliners• Increase uptake for adult vaccine booster doses and primary
doses for the paediatric population

日本語要約

マレーシア・ペナン病院におけるCOVID-19対応の課題と経験
マレーシアでは、2020年1月に初めてCOVID-19患者が報告されて以降、全ての公立病院にてアウトブレイクに備えた準備を進めてきました。ペナン病院では、院長の呼びかけにより、初期段階からCOVID-19患者の受け入れ体制を構築。当初、陽性者は全て病院施設での隔離が必要だった為、近隣の刑務所の一部を低リスクセンターに変更するなどし、
患者の受け入れに当たりました。
2021年7月に始まったデルタ株の流行期には重症者が増加し、非常に厳しい局面を迎えました。酸素吸入措置やICUでの治療が必要となり、各科の集中治療室もCOVID-19重症患者のために改修。
さらには、国軍の支援により、酸素吸入が可能な
ベッドと高度治療室を完備した野戦病院が建設されました。
これは複数の高流量式鼻カニュラにも十分対応できる施設です。
ワクチンについては、国の迅速な対応により、2021年11月までに８割程の国民の一次接種が完了。
その後、
オミクロン株の流行により再び感染者数は増加しましたが、接種率が高かった事もあり、重症患者は少なく、多くの患者は自宅療養となりました。
患者の受け入れにあたっては、省庁のみならず、NGO、
民間企業、個人など、様々なルートから必要物資の支援、及び精神的なサポートがあった事に感謝しています。
このような難局を乗り越えるためには、「 緊急時対応計画を定めておくこと」「 十分な
スタッフの確保」「COVID-19重症患者に対応する専門医を含む、より多くの医師の養成」「早期診断のためのサーベイランスの増加」「酸素供給体制の強化」「エビデンスに基づいた最新情報の発信」「最前線で働く従事者への福利厚生の維持」「ワクチンのブースター接種と小児用ワクチンの一次接種率の向上」に取り組む事が推奨されます。

2

World Information
The Development of a Long-term Care Infection Prevention
Compendium During the COVID-19 Pandemic
Elana Kieffer, MBA /Elaine Larson, RN, PhD, FAAN, FIDSA, FSHEA, FAPIC
Carmen Portillo, PhD, RN, FAAN /Mario Rubano, MPH

Introduction
The first recorded COVID-19 death in the United States occurredin a nursing home (NH) in February 2020 1 – a harbinger of thechallenges the long-term care (LTC) sector would face. Since then,over 200,000 residents and staff of long-term care facilities havedied due to the illness. 2 The infection prevention and control (IPC)
literature in NHs and LTC settings has lagged behind that of acutecare hospitals for decades. This dearth of research, coupled with analready-existing staffing crisis, contributed to the outsized burden of
disease experienced in these settings.
At the start of the pandemic, Saraya co., Ltd. communicated with
Dr. Elaine Larson, Senior Scholar in Residence at The New York
Academy of Medicine (NYAM), regarding their interest to work
together examine IPC in NHs for the purpose of identifying strategies
that might help improve practice. As a result, in collaboration with
the Yale School of Nursing (YSN), a project was completed which
included an environmental scan of the infection prevention literature,a series of qualitative interviews of frontline NH staff in New York
City, a two-day virtual summit convening international experts in
NH infection prevention, and the development of an online Infection
Prevention Compendium (Compendium). This paper describes
how the Compendium was created and highlights various resources
which it contains. See [Figure 1] for a concept map of Compendium
contents and structure.

Objectives• To describe the process of developing an Infection Prevention
Compendium• To summarize the contents of the Compendium

Development• The first step was to identify the roles and expertise that would
be needed to complete the project. These included:Project
Coordinators representing NYAM and YSN to oversee theplanning and implementation, to facilitate communication
between the two institutions.
• Nurses with NH experience to inform the selection of resourcesand ensure the practicality and user-friendliness of theCompendium’s design.
• Nurse Educators to inform the didactic elements included in theCompendium.

3• Research Assistants to aide in the collection of resources.
• Web Developer to create and maintain the digital infrastructurethat would host the Compendium.
Secondly, we created a shared workplan that considered the scope ofthe entire project and plotted key checkpoints and deadlines. Team
members met on a bi-weekly basis. Areas of focus were assigned
to individuals with expertise and experience in specific areas of
the NH system. For example, a Nurse Practitioner and Director of
Nursing with pharmacy and administrative experience searched formaterials in the Direct Care Providers and Administrator & Manager
categories while a team member with experience in building
didactic instruments assembled the educational PowerPoint tools.
Team members with real-time clinical experience were important toensure the relevance and practicality of the selected resources. The
resource identification process included combing through the online
resources of reliable public health institutions and agencies including
the Centers for Disease Control and Prevention (CDC), the World
Health Organization, and Institute for Healthcare Improvement, as
well as other sources such as peer reviewed journals (e.g., American
Journal of Infection Control and Infection Control and Hospital
Epidemiology), as well as internet searches.
The third step included the review of resources and the compilationof final selections. Once the resources were identified, the teamcollectively reviewed the findings for relevance, usefulness,timeliness, validity, and accuracy of hyperlinks. The aim was tocreate a “one-stop” resource with which NH professionals could
locate reliable tools in a timely manner and maximize the amount oftime spent addressing the needs of residents.
After deliberation, the final items were organized by category and thetitle and accompanying hyperlinks were sent to the Web Developer
who added the materials to the website in a series of interactive
drop-down menus. The final product was reviewed by the internal
communications teams of The New York Academy of Medicine,
Yale School of Nursing, and Saraya co., LTD. See [Figure 2] for ascreenshot of the Compendium homepage.

Dissemination
The efforts of this project culminated in multiple deliverables thatwere disseminated across a range of formats. A report published on
the NYAM website (https://www.nyam.org/center-healthy-aging/
resources/infection-prevention-resources/) , “Infection Prevention andControl in Nursing Homes in the COVID Era: Research, Stakeholder
Perspectives, and Best Practices”, summarized the project including
a literature review, qualitative interviews with New York City-based
direct care providers, and summaries of regulatory and policy

2023 vol.1

examples from around the globe. Findings were also disseminatedthrough publication in peer-reviewed journals and presentations atconferences:
Geriatric Nursing:• Rubano, M., Kieffer, E., Larson, E. “Infection prevention andcontrol in nursing homes during COVID-19: An environmental
scan.” Geriatric Nursing 43 (November 2021): 51-57. https://doi.
org/10.1016/j.gerinurse.2021.10.023• Fisher, E., Cárdenas, L., Kieffer, E., and Larson, E. “Reflections
from the ‘Forgotten Front Line’: A qualitative study of factors
affecting wellbeing among long-term care workers in New York
City during the COVID-19 pandemic.” Geriatric Nursing 42, no. 6,(November-December 2021): 1408-1414. https://doi.org/10.1016/
j.gerinurse.2021.09.002
American Journal of Infection Control• R ubano, M., Kieffer, E., Larson, E. “Long-term care and
COVID-19: An equitable recovery”. American Journal of Infection
Control 50, no. 3, (March 2022): 364-365. https://doi.org/10.1016/
j.ajic.2021.11.010
Academy Health Annual Research Meeting 2021
• Fisher, E., Cárdenas, L., Kieffer, E., Larson, E. “Long-term carestaff experiences during the COVID-19 pandemic: A qualitative
study.” AcademyHealth Annual Research Meeting (June 2021).
Additionally, NYAM and YSN hosted two international virtual
summits (December 2nd and December 8th, 2020) featuring experts in
IPC and public health policy. The goals of the summit were to:• Critically examine evidence-based practice guidelines for infection
prevention and control in skilled nursing and assisted living facilities,• U nderstand key barriers to implementing these best practices, and• P ropose sustainable regional and global solutions.

Tools for
Direct Care
Providers

Infection
Prevention
Tools &
Resources

Tools for
Administrators &Managers

Tools for
Support Staff

Infection
ControlCompendium
for Long-TermCare Facilities

International& U.S.
Infection
ControlResources

Summary of
NYAM
Reports

Teaching
Tools(PowerPoint)

International
Resources

U.S.
Resources

Nurses &Nursing Assistants

Pharmacy

Medical Providers
Infection
Preventionist

Administration

Specialized Providers
MDS Coordinator /Insurance Liaison

Admitting
Department Staff

Therapist

Kitchen Staff

Recreation Staff

Receptionist

Scheduler

Family / Friends /Resident

The featured presenters included:
Anucha Apisarnthanarak, MD
Associate Professor
Thammasat University Hospital, Thailand
Lisa Hall, PhD, SFHEA
Associate Professor in Epidemiology
University of Queensland, Australia

Donald Macaskill, PhD
Chief Executive
Scottish Care, Scotland

Steven Schweon, RN, MPH, MSN, CIC,FSHEA, FAPICInfection Preventionist
Steven J. Schweon LLC, United States
Nimalie Stone, MD, MS
Medical Epidemiologist for Long-term Care,
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention,
United States

Evelyn Cook, RN, CIC
Associate Director, Statewide Program for
Infection Control and Epidemiology
University of North Carolina at Chapel Hill
United States

Karen Hoffmann, RN, MS, CIC, FAPIC,FSHEA
Clinical Instructor in the Division of Infectious
Diseases
University of North Carolina at Chapel Hill,
United States
Judith A. Salerno, MD, MS
President
NYAM, United States

Ann Spenard, DNP, RN-BC
Chief Clinical Officer
National Health Care Associates, UnitedStatesPatricia W. Stone, PhD, RN, FAAN
Centennial Professor in Health Policy andDirector, Center for Health Policy
Columbia School of Nursing, United States

Michael Wasserman, MD
Past President
California Association of Long-term Care
Medicine, United States

Utilization

The Compendium was launched in August 2021. To date, the Compendium has beenaccessed approximately 3,500 times. The compendium has recorded visitors from thefollowing nations (in order of highest to lowest number of visitors):•United States •Japan •Canada •New Zealand •China •South Korea •Portugal •Nigeria•Australia •United Kingdom •Germany •Egypt •France •Hong Kong •Malaysia•Philippines •Vietnam •Cambodia •Russia •Taiwan •South Africa •Uganda •Rwanda
1. Soucheray, S. Coroner: First US COVID-19 death occurred in early February. Center for Infectious
Disease Research and Policy. April 22, 2020. Accessed July 22, 2022.
2. Chidambaram P. Over 200,000 residents and staff in long-term care facilities have died fromcovid-19. KFF. February 3, 2022. Accessed July 22, 2022. https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19/

Housekeeping-Laundry-Environmental Services-Maintenance

Africa

日本語要約

Asia

Australia

Quality of Life

COVID-19流行期の長期療養施設で活用できる
感染対策ツールの開発プロジェクト

EuropeExternal Influences &Regulations
Staffing &PPE Resources

Training &Knowledge

Organizational
CultureGeneralResources

Summary Report &Journal Publications
International VirtualSummit Materials
Qualitative Study &Journal Publications

Administrator

Figure 2: Compendium Homepage

FamilySpecialized Contract Provider

Resident
Nurse

Figure 1: Structure of online Infection Control 		Compendium for Long-Term Care Facilities

米国における最初のCOVID-19罹患報告は、2020年2月の高齢者施設からであった。
それ以降、20万人以上の長期療養施設の利用者やスタッフが同感染症に関連して亡くなった。
高齢者施設や長期療養施設の感染対策に関する研究は急性期病院での研究に比べて少なく、このことも長期療養施設におけるCOVID-19による経験に影響を与えたのではないかと考えられる。
そのような中、New York Academy of MedicineとYale School of Nursing、
サラヤが共同で、長期療養施設における感染対策に関するプロジェクトを実施した。
まずはプロジェクトメンバーの役割と専門性を明確にし、プロジェクトの全体計画を作成した。隔週でミーティングを開催し、情報収集、教育ツールの作成などを進め、チームメンバーで集められた情報のレビューを行った。熟考の後、活用する情報をカテゴリ別に整理し、Figure 1に示すようにウェブ上に掲載した。
（ウェブサイト：https://www.nyam.org/center-healthyaging/resources/infection-prevention-resources/）
本プロジェクトにより、「コロナ禍における高齢者施設の感染対策の報告」
といった様々な成果物が生み出され、プロジェクトウェブサイトに掲載、
あるいは論文として投稿した。2020年12月にはバーチャルサミットを開催し、感染対策のガイドラインの確認、現状課題の把握、課題解決策に関するディスカッションを行った。プロジェクトの成果物は2021年8月から公開が開始され、2022年7月時点で23カ国から約3,500回のアクセスがあった。

4World Information
The main risk factors for patient infection
associated with endoscopic examinations in Russia
T.A. Grenkova, M.D., Ph.D., Associate Professor, Leading Researcher
E.P. Selkova, M.D., Ph.D., Professor, Chief Researcher
Department of Education, Laboratory of Infectious Diseases, G.N. Gabrichevsky Moscow Research Institute for Epidemiology
and Microbiology, Russia

Introduction
About 14 million endoscopic interventions are carried out in Russia
annually, and a few scores of related healthcare-associated infection(HAI) cases are officially registered. The Epidemiological Safety
System (ESS) for endoscopic interventions and the method ofsafety level detection in a particular medical organization have been
determined in the country.
Since September 1, 2021, the third version of the national guidelines
for ensuring the epidemiological safety of endoscopic examinations[1] (hereinafter referred to as the Guidelines) has been in effect inRussia. The release of this document was preceded by a recurrent
survey conducted in 2019, which was completed by 460 doctors andnurses representing endoscopy hospital departments from 80 regionsof Russia. The survey contained 47 questions, some of which were
not answered by all respondents.
We set ourselves the task of assessing the main risk factors for patient
infection during endoscopic examinations to correct the requirements
for individual components of the ESS for endoscopic interventions
and to control the quality of flexible endoscope reprocessing.

Survey Results
A comparison of the results of questionnaires from 2006, 2014,
and 2019 revealed an increase in the annual number of endoscopic
interventions, including surgical ones. In 2006, in endoscopy
departments, endoscopy examinations were performed an averageof 7 times per day. In 2014, there were 15 examinations per day. In
2019, more than 15 examinations per day were carried out by 70% of
the surveyed hospitals. Surgical interventions in 2019 were performedin 303 (66.3%) endoscopy departments.
The infectious safety of endoscopes is ensured by the correct
operation of reprocessing and compliance with the requirementsof the Guidelines. The analysis of the materials obtained fromthe period 2006-2019 indicates that the system of reprocessing,including technical equipment and material support, is steadily
improving. Of the 460 endoscopy departments, 385 (73.7%) havereprocessing rooms. The area for manual cleaning is organizedcorrectly. Reprocessors (EWDs) are used by 300 (65.2%) out of 460
hospitals that were surveyed. In 2014, the use of EWD equipment was

5extremely low, amounting to only
22.6% of hospitals.
Disinfectant solutions for manual
cleaning of endoscopes preparedon a daily basis are used by 47.4%
of hospitals. Single-use detergentsbased on surfactants are used in
8.7% of endoscopy departments, andwith an enzymatic booster, 27.0% ofendoscopy departments. The shareof ineffective detergents or disinfectants for endoscope cleaning fell
from 26% in 2014 to 16.9% in 2019.
Among the high-level disinfection (HLD) chemicals applied, thealdehyde share is 47.9%, 38.7% use peracetic acid (PAA), and theremaining 13.4% use HLD solutions not recommended for such a
purpose. There is a tendency to replace detergent and HLD solutions
for EWD with cheaper counterparts without their validation in EWDs.
More than a third of endoscopy departments do not check theminimum effective concentration of HLD solutions. The main
reasons why test strips are not used are that chemical indicators are
not developed for the product (10.5% of hospitals) or that they are notpurchased (23.7% of hospitals).
Two-stage cleaning (pre-cleaning and manual cleaning) of endoscopes
is extremely important to ensure the effectiveness of the subsequent
HLD procedure. Among 442 surveyed endoscopy departments,
325 (73.5%) never violate the guidelines for manual cleaning. The
analysis showed a low incidence of critical errors during pre-cleaning
and manual cleaning (Table 1).
Analysis of the received materials showed that the reduction in thevolume of pre-cleaning in 8.9% of endoscopy departments is always
associated with time pressure. Refusal to perform a leakage test during
manual cleaning is tolerated in nearly a third of EWD-equipped-endoscopy departments and is associated with an underestimation of
the importance of this step for endoscope damage prevention. Errors#numbered 5- 7 in table 1
also occur predominantly
in endoscopy departments
equipped with EWDs andare associated with thefalse belief that the EWD
can completely replace
manual cleaning.

2023 vol.1

Table 1 The occurrence of critical errors during pre-cleaning and manual cleaningNo.

Occurrence ＊Error description

1

Refusal to flush the system of air or water channels and additional channels during pre-cleaning

8.9%

2

Refusal to perform a leakage test during manual cleaning

29.9%

3

Refusal to carry out manual cleaning before the reprocessing cycle in EWD

1.7%

4

Skipping or reducing of the number of brushing passes

6.2%

5

Reducing the duration of the endoscope soaking in the detergent solution

7.9%

6

Flushing with detergent solution can be skipped before the reprocessing cycle in EWD

2.0%

7

Refusal to using alcohol for additional drying of endoscope channels before the reprocessing cycle in EWD

7.2%＊ Respondents answered several different questions regarding endoscope reprocessing, therefore, the table only shows the occurrence of the error.

It is this false belief that sometimes
allows brushing to be skipped or
the number of brushing passes tobe reduced. There is insufficient
provision of disposable brushes forreprocessing in most endoscopy
departments, therefore, reusable
brushes are used in 72.0% of thesurveyed hospitals.
Manual final rinsing of gastrointestinal (GI) endoscopes is carried out
with tap water in all questioned endoscopy departments. Antibacterial
tap water treatment systems (0.2 micron water filters) are not used in
11.7% of EWDs.
In Russia, 70% alcohol is used for additional drying of endoscopecanals. This requirement is fulfilled by 92.8% of endoscopy
departments. At the moment, this measure cannot be refused dueto the low provision of storage cabinets with a drying function(25.4%), insufficient provision of EWDs, and the use of EWDs with
unvalidated detergents and HLD solutions.
Quality control of endoscope reprocessing is carried out by visual,
instrumental, and microbiological methods with the frequency
established by the Guidelines. Among 460 respondents who answered
relevant set of questions, 104 (22.6%) do not carry out quality controlof manual cleaning, and 8 (1.7%) carry it out with a lower frequency.
Among the main reasons for not fulfilling this requirement, therespondents named a lack of effective tests or insufficient information
about them (57.6%), as well as a lack of time (29.6%).
Microbiological control of the effectiveness of the endoscope
reprocessing cycles is not arranged in 56 (12.7%), and is arranged
at a frequency of less than four times a year in 82 (17.9%), of
460 surveyed departments. The main reasons are the high cost of
microbiological research (70.5%) and the lack of skills in sampling(29.5%). Of the samples taken, 4.4% do not meet the efficiency
criteria. Microbiological control of the efficiency of the EWD self
disinfection cycle was arranged in 223 (74.3%) of 300 medical
facilities equipped with EWDs. The reasons for the rejection of
microbiological monitoring of the effectiveness of self disinfection
EWDs are similar to the reasons for the rejection of microbiologicalmonitoring of the effectiveness of the endoscope reprocessing cycle.
In 84.4% of the endoscopy departments surveyed, all or some of thenurses completed advanced training in endoscope reprocessing and
HAI prevention.

Conclusion
The 2019 survey allowed the identification of the main risk factors
for patient infection associated with the reprocessing of flexible
endoscopes and the development of corrective measures that were
included in the new Guidelines and a draft of new practical policies.
It should be added that respondents representing the endoscopy
departments of leading clinics, in response to a question about
the main routes toward increasing the epidemiological safety ofendoscopic examinations, gave the following answers:
1.Improvement of equipment for endoscopy departments, such as
EWDs and drying cabinets (76.7%)
2.Continuing education of medical personnel on epidemiologicalsafety issues (68.2%)
3.Increasing in the number and renewal of endoscopes, and providing
a sufficient number of disposable instruments and personal protective
equipment (PPE) (46.4%)

Reference

1. Hygiene guidelines: Sanitary rules and norms (SanPiN) 3.3686-21 "Sanitary andepidemiological guidelines for the prevention of infectious diseases", approvedby the Resolution of the Chief Public Health Officer of the Russian Federation
No. 4 dated 01.28.2021 (https://www.rospotrebnadzor.ru/about/info/news/
news_details.php?ELEMENT_ID=18781)

日本語要約

ロシアにおける内視鏡診療による感染の主なリスク要因
ロシアでは年間約1400万件もの内視鏡診療が行われ、数件の医療関連感染（HAI）が報告されている。安全性向上のため、2019年に国内80地域の医療施設の内視鏡診療に携わる460人の医療従事者から、内視鏡再生処理の実情調査を実施した。
その結果を基に、我々は内視鏡検査の安全性に関わる国内ガイドラインの見直しを行った。以下に当時の調査結果を一部紹介する。
内視鏡の使用件数は年々増加しており、調査対象のうち７割の病院で内視鏡診療数の1日平均が15件以上にのぼると回答した。
ところが調査結果によると、用手洗浄におけるブラッシング工程を省略・短縮、内視鏡漏水テストや洗浄機使用前の用手洗浄の省略、非推奨薬剤の使用やケミカルインジケータの不使用等、不適切な運用の認められる病院があった。
またガイドラインでは定期的に洗浄方法のバリデーションを行うよう定められているが、その頻度が低い、
またそもそも実施されていない病院も一部あることが分かった。
内視鏡の感染対策は、
ガイドラインの遵守で確保されるものである。
しかし手間やコストがかかるという理由に加え、洗浄機使用時は事前の用手洗浄が省略できるといった誤解、
内視鏡の不具合確認を目的とした漏水テストの意味を理解していない等、知識不足が原因となり、一部の病院では適切な運用がなされていなかった。
こうした調査結果を踏まえ、我々は軟性内視鏡の再生処理に関連する感染の主要危険因子を分析した。結果、ロシア国内の内視鏡検査の疫学的安全性を確保するための国内ガイドラインに是正策と新たな実践方針を追加した。このガイドラインは2021年9月1日から第三版としてロシアで施行されている。

6

SARAYA Healthcare Hygiene News
Living with the Covid-19 Pandemic in the European
Union (EU) and the European Economic Area (EEA)
Countries and Countries Opening Up.
Dr. Bonnie OKEKE, Saraya Co., Ltd. Europe, BelgiumCountries across Europe
have almost completely
eased up on preventive,
control and restrictive
measures put in place
to check the spread of
Covid-19 since the inception of the catastrophic pandemic
in late 2019 and inflicting over 100 million cases in the
EU/EEA countries alone.
After nearly two years of national lockdowns to control the
pandemic, countries understandably and excitedly embraced
opening up.
Previously restrained life activities have rapidly moved
from what was referred to as a new normal to the real
normal, including major large sporting events, such as therecently ended 2022 UEFA European Women’s FootballChampionship and the Qatar 2022 FIFA World Cup, musicalconcerts, travels, and so on.
Picture showing passengers
rushing to board trains at amajor train station in Paris,
France, after the relaxation of
Covid-19 rules in France.
Qatar 2022 FIFA WorldCup has fully regained its
pre-pandemic vibrancy.
Spectators enjoying andcheering at the World
Cup finals between the
French and Argentinean national men’s football teams. The
usual social distancing seemed no longer of any concern inthese public gatherings.

What are the infection prevention and control (IPC)
consequences of this apparently rapid normalcy?

Although reliable data remain scarce, scientists andepidemiologists have modelled a positive upward trend
in the spread of Covid-19 infection in several European
countries following the rapid opening of socio-economic
activities.
The wearing of masks in public places, social distancing,handwashing and the use of alcohol hand rubs are now

7

only encouraged or voluntary. Legal enforcement looks
like a distant past across Europe.
Some countries have completely opened up, leaving every
aspect of the IPC precautionary measures as voluntary. The
danger of the spread of disease is that when the preventive
and control actions are voluntary and not enforced by law,regulations or even by an active campaign, only a small
minority of the population tends to adhere, usually among
the medically vulnerable individuals with other underlying
conditions. New infections have been observed to be
driven by the emerging Covid-19 virus variants.
Reasons for continuing adhesion to preventive andcontrol measures often vary among individuals and may
be due to the need to continue protection as a result ofother underlying health problems to characteristicallybehavioural personal choices and self-enforced social
discipline and/or norms.

What are the symptoms of infection withemerging virus variants?
Although new Covid-19 variants have emerged, thesymptoms are still the same or very close to the familiar
ones, with different degrees of variation, and include:• Fever• Cough• Sore throat• General weakness, fatigue and muscle pain
• Loss of smell and taste
Some individuals may still be asymptomatic, that is,showing no signs of the disease while carrying and, inother cases, spreading the virus.
Data from some European countries also suggest thatan infection by the new variants is less likely to lead tohospitalisation, particularly among persons classed as
fully vaccinated members of the population. Hence, somecountries allow only fully vaccinated as part of the entry
requirements, although this seems increasingly unenforced
in many parts.
It is also critical to avoid what has been referred to in
IPC circles as campaign or enforcement fatigue, where
indifference sets in or even outright oppositions to IPC
measures and/or campaigns. Human behavioural impact
must be assessed and considered to maintain a good andconsistent outcome.

2023 vol.1

What are the observed case situations inparts of Europe?

How many SARS-CoV-2 variants or the
Omicron virus are recognised in Europe?

As a part of ongoing European health policy measures, ajoint European Centre for Disease Prevention and Control(ECDC, an agency of the European Union) and World
Health Organisation (WHO) report on the new Covid-19
infections in the European Region in week 47/2022
showed a decrease of 3.5% (871,728) in newly confirmed
Covid-19 cases and a reduction of 35.2% (2,238) of new
deaths reported by national authorities. Although this is asignificant reduction from the previous situation, it showsthat Covid-19 is still very much around, and preventive
measures should be encouraged.
There is a wide ongoing variation in infection levels among
European countries. Some of the variations have been
attributed to a lack of or inadequate surveillance and realtime data reporting. There is also the emerging challengeof separating the high annual winter flu and Covid-19
infection mixtures.
Among eight countries that reported test positivity rates
weekly, the highest observed level was >20%, four
countries (Finland, France, Hungary and Sweden) had
increased test positivity compared to the previous week,
one country had a decrease (Iceland) and three remained
stable (Germany, Luxembourg and Netherlands). Morerecent data still indicate high variability in infection andhospitalisation in various countries.
Although increases are being recorded with a mixture ofhigh flu levels, the overall picture is still highly variable
among European countries.

Virus sequencing and identification are ongoing exercises
among EU and EEA member states, and new variants arestill being added to the existing list. So far, the following
six viral variants have been actively monitored andreported to the ECDC database:• Omicron BA.2
• Omicron BA.2.75• Omicron BA.4
• Omicron BA.5
• Omicron BQ.1
• Omicron XBB
The disease manifestation in infected patients may appear
similar, despite their inherent structural differences.
The viral sequencing work is regularly ongoing in various
countries, so new ones are likely to continue to be added as
the virus fights back control measures through its built-in
genetic mutation mechanisms.
This is a main reason to have continuous, not continual,effective IPC measures in place, including the applicationof alcohol, handwashing, rubbing with alcohol-based
products, social distancing where appropriate, intelligent
use of masks in crowded and enclosed places and surface
disinfection with appropriate agents.

What is the situation in hospitals andintensive care units (ICUs)?
High variability also exists in data from various ICUs. Data
from eighteen countries in the last two weeks under review
were mixed. New hospital admissions due to Covid-19
increased compared to the previous week. Infection
decreased in ten countries and remained stable in four
(Estonia, France, Greece and Netherlands).
In the 12 countries reporting over the same two weeks,
new ICU admissions due to Covid-19 had increased in four
countries compared to the previous week (Estonia, France,
Latvia and the Netherlands), decreased in five (Greece,
Lithuania, Luxembourg, Spain and Ukraine) and remained
stable in one (Ireland).

What does the future hold in the IPC?
The key question some have asked is, “Are countries
over relaxing rules too quickly?” This suggests an
epidemiologically arguable gradual opening with active
encouragement and support of testing and precautionary
hygiene measures, including regular handwashingwith soap and water, use of alcohol hand rubs, such as
SARAYA’s Alsoft VB with broad spectrum antiviralefficacy, maintaining the practice of social distancing, andwearing appropriate face masks, particularly in crowded
places or rooms when with people outside our social
bubbles.
Evidence from several countries continues to show
an upward trend in key statistical measures, such as
new infections, infection rates and hospitalisation. A
compounding effect from a severe seasonal winter flu isalso recognised in some EU countries, including the UK.
Hence, there is a need to maintain and enhance existing
multimodal hygiene to continue protecting the entire
population.

References
https://worldhealthorg.shinyapps.io/euro-covid19/• ECDC - Joint ECDC-WHO Regional Office for Europe Weekly COVID-19 Surveillance Bulletin
https://www.gov.uk/government/news/back-to-school-advice-issued-amid-high-levels-of-flu-covid-19-and-scarlet-fever• UK Health Security Agencyn8Dry and rough skinbothering you?
Tips to prevent rough hands for healthcare wokers
Select hand hygiene products that are less likely to cause rough hand
Use a hand disinfectant that contains a moisturizer that is appropriate for you
Use soap that is gentle on skin

Reduce irritating hand hygiene practices

Rinse thoroughly after hand washing with soap and running water
When wiping hands, use a paper towel and gently press against the towel

Use hand care products
Hand Care
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When you hold out your hand,the sensor automatically detects
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Functionality

Transparent front makes it easy
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Put a small amount ofhand care product on
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Bend your fingers, wrap
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Apply by stretching the joints and crease.
Massage between fingers.

Spread on both palms
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Spread from the back ofyour hand to fingertips.

Apply while massaging
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Spread over hands
until dry.

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Fragrance-free antibacterial soap

・Emollients keep skin moisturized・Natural potassium soap based

Alsoft Foaming Hand Soap G

Antibacterial soap with green apple fragrance

・Emollients keep skin moisturized・Natural potassium soap based

Hand Disinfection
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Hygienic and surgical hand disinfectant

・Contains moisturizers with excellent skin feel (clean and smooth)・Formulation containing two kinds of alcohol and Phosphoric Acid,
resulting in excellent bactericidal and virucidal eﬀect10Saraya Co., Ltd.

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