Japanese experience of hydrogen sulfide: the suicide craze in 2008

Most of hydrogen sulfide poisoning has been reported as industrial accidents in Japan. However, since January 2008, a burgeoning of suicide attempts using homemade hydrogen sulfide gas has become evident. By April 2008, the fad escalated into a chain reaction nationwide. Mortality of the poisoning was very high. There were 220 cases of attempted gas suicides during the period of March 27 to June 15, killing 208. An introduction of new method of making the gas, transmitted through message boards on the internet, was blamed for this "outbreak". The new method entailed mixing bath additive and toilet detergent. The National Police Agency instructed internet providers to remove information that could be harmful. Of the victims of the fad in 2008, several cases were serious enough that family members were involved and died. Paramedics and caregivers were also injured secondarily by the gas. This fad has rapidly spread by internet communication, and can happen anywhere in the world

ニホン ニ オケル タンカイ シヨウ イリョウ キキ モンダイ セイフ シジョウ ソシテ リンリ

論文Article医療現場には，医療機器に付される添付文書によって，一度使用されたら廃棄されなければならないとする単回使用医療機器というものがある。日本では，この医療機器の再使用が長らく問題となってきた。しかし，このような規制は実は法的な根拠がない。再使用は違法ではないが，患者は単回使用が遵守されていると信頼しており，その信頼が覆される事態が露見すると，医療機関は社会的非難を浴びる。そして，有害事象が起こった場合には，医師の過失が推定されるという判例法理がある。また，添付文書の法的性質は，製造販売業者からエンドユーザーたる医療者への情報提供書であり，その記載内容に関しては，製造販売業者の裁量にゆだねられている。そのため，その記載内容に政府は法的責任を負わず，医療者の意見を聞くことも課されていない。このような中で，「一度使った機器は，再使用してはならない」というルールが，社会的な規範として，極めてあいまいな形で実効性を持つに至っている。本稿では，単回使用医療機器の実態と，法制度，それに対する社会的反応，医療側の行動等を解説した上で，政府の関わりや，規制のあるべき姿について考察する。In the medical practice, there is medical devices called single use device (SUD), which has to be discarded after being used once according to the attached documents. Reuse of this medical device has long been a problem in Japan. However, such regulations have no legal basis. Reuse is not illegal, but patients trust that single use is being adhered to, and medical institutions face social criticism when this trust is compromised. And there is a judicial doctrine that physician negligence is presumed when an adverse event occurs. In addition, the legal nature of attached documents is that they provide information from marketing authorization holders to end-users (medical professionals), and the content of such information is left to the discretion of marketing authorization holders. Therefore, the government is not legally responsible for the contents of the report, nor is it required to consult medical professionals. Under these circumstances, the rule that “a device that has been used once must not be reused” has become effective as a social norm in an extremely ambiguous way. In this paper, after explaining the actual situation of SUD, the legal system, the social reaction to it, and the behavior of the healthcare providers, I will consider the government's involvement and the ideal form of regulation

Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals

[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

PCR-Dipstick-Oriented Surveillance and Characterization of mcr-1- and Carbapenemase-Carrying Enterobacteriaceae in a Thai Hospital

Colistin is used as an alternative therapeutic for carbapenemase-producing Enterobacteriaceae (CPE) infections which are spreading at a very high rate due to the transfer of carbapenemase genes through mobile genetic elements. Due to the emergence of mcr-1, the plasmid-mediated colistin resistance gene, mcr-1-positive Enterobacteriaceae (MCRPEn) pose a high risk for the transfer of mcr-1-carrying plasmid to CPE, leading to a situation with no treatment alternatives for infections caused by Enterobacteriaceae possessing both mcr-1 and carbapenemase genes. Here, we report the application of PCR-dipstick-oriented surveillance strategy to control MCRPEn and CPE by conducting the PCR-dipstick technique for the detection of MCRPEn and CPE in a tertiary care hospital in Thailand and comparing its efficacy with conventional surveillance method. Our surveillance results showed a high MCRPEn (5.9%) and CPE (8.7%) carriage rate among the 219 rectal swab specimens examined. Three different CPE clones were determined by pulsed-field gel electrophoresis (PFGE) whereas only two MCRPEn isolates were found to be closely related as shown by single nucleotide polymorphism-based phylogenetic analysis. Whole genome sequencing (WGS) and plasmid analysis showed that MCRPEn carried mcr-1 in two plasmids types—IncX4 and IncI2 with ~99% identity to the previously reported mcr-1-carrying plasmids. The identification of both MCRPEn and CPE in the same specimen indicates the plausibility of plasmid-mediated transfer of mcr-1 genes leading to the emergence of colistin- and carbapenem-resistant Enterobacteriaceae. The rapidity (<2 h) and robust sensitivity (100%)/specificity (~99%) of PCR-dipstick show that this specimen-direct screening method could aid in implementing infection control measures at the earliest to control the dissemination of MCRPEn and CPE