Proper hand scrubbing is very important for the prevention of food poisoning. The scrubbing checker is a method for determining the level of cleanliness based on light emitted from the hands after washing with a lotion containing fluorescence. In March 2008, we examined the hands of 33 individuals on the staff of the Department of Dietetics, Konan Kosei Hospital, using the ATP wipe test and the scrubbing checker. We also investigated the effectiveness of sanitary education using both methods. The ATP wipe test was conducted twice. The first test was done after normal scrubbing, and scrubbing education was given later. In order to evaluate the effectiveness of sanitary education, the second test was done approximately one week after the first test and the ATP levels obtained before and after sanitary education were compared. The measurements were evaluated in three stages:grade A (satisfactory), B (borderline) and C (unsatisfactory). For sanitary education, hand cleanliness was confirmed by each of the participants themselves using the scrubbing checker. In the first test, 58% of those tested were evaluated as grade A. Sanitary education using the scrubbing checker showed that scrubbing of the nails was inadequate in 64% of the examinees. Therefore, education was given about scrubbing the nails against the palm of the other hand. In the second test after scrubbing education, the percentage of those evaluated as gradeA increased to 91%. As a result of these findings, it was concluded that sanitary education using the ATP wipe test and the scrubbing checker is effective. We plan to prevent food poisoning by conducting both tests periodically hereafter.
educational ; Azathioprine ; Hand ; Grade ; Educational Background

In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.

In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.
Solutions ; Disinfectants ; Hand ; Detergents ; Desiccation

　　There is a need for measures to prevent accidental ingestion at hospitals that provide food for children with food allergies. The dietetics department of our hospital attempts to prevent accidental ingestion by providing meal tags that clearly indicate the dishes prepared without allergens (“allergen-free meal”), which are attached in the designated area by a licensed cook in charge of food preparation. During the 1-year period between January and December 2014, 258 children with food allergy were treated in our hospital and received allergen-free meals. There were 3 cases in which dishes containing allergens were served by mistake, and accidental ingestion by the patient occurred in 2 cases. Regarding the cause of these serving errors, it is likely that they occurred because allergen-free dishes were served using tableware with the same color as that used for allergen-containing dishes. Accordingly, we have revised our preventive measures against accidental ingestion so that all of the tableware and trays used for allergen-free dishes are yellow in color, in order to distinguish them from other dishes. Furthermore, we have provided a dedicated shelf for allergen-free dishes, and have also made it a requirement for final confirmation to be performed by 2 responsible cooks who double-check the food before serving. We will continue to monitor and improve our measures to prevent accidental ingestion as necessary.

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

From April 1, 2002 through March 31, 2003, 158 accident reports were submitted from 35 staffers of the nutrient Department in Showa Hospital. We analysed the causes of accidents with the aim of preventing future accidents. It was found 90 cases were attributable to errors in paperwork (57%), 56 cases dul to waiting errors (35%), eight cases to foreign body contamination (5%), and four cases to other resons (3%). Most accidents occurred by lack of confirmation, and it seemed that thoroughness of affirmation such as repetitive affirmation by a plural number of staffers prevent accidents. We should feed back both contents and causes of these accidents to all the employees, and should make a new guideline for accident prevention.
Hospitals ; Accidents ; Analysis ; Staff ; etiology

To prevent protein-energy malnutrition in elderly inpatients with dysphagia, weexamined the current meals for them in detail. The thickeners seemed to be a ploblem. Changes of viscosity over time and temperature were reduced when a starch thickener was changed to a xanthan gum thickener. When a gelatinizer was added to soft meals to allow cutting into shape, etc., the meals looked better were less sticky, more cohesive, and easier to eat. Thus, the smooth texture required of meals for dysphagia patients was obtained. When conventional mixed meals were changed to soft meals, there was an improvement of appearance and the meals became more palatable.The change of food intake after these improvements was investigated in five inpatients who had difficulty in swallowing. Food intake was increased in four of these five patients after these improvements, suggesting that their appetite might have been increased by improvement of the appearance and palatability of their meals. We will continue making improvements of these meals in hopes that patients can eat solid food again as early as possible.
Deglutition Disorders ; Eating ; Energy, Physics ; Solid ; Malnutrition

  The incidence of fever in children admitted to general hospitals is very high. Provision of adequate nutrition and fluid supplements to febrile children is very important, but with some children it is difficult to maintain an adequate intake. To address this problem, we devised a new ‘febrile children's menu’, utilizing preparation methods and foods to produce a palatable menu for patients with fever.
  We introduced this ‘febrile children's menu‘ on January 6, 2011, providing it to 109 patients (age range: 1 to 8 years, average age: 3.3±1.9 years) over the ensuing 3-month period. We provided a mean 4.0±2.9 meals per day to each patient during their febrile stage (≥37.5°C). To evaluate the usefulness of the ‘febrile children's menu’, we investigated eating rates during the febrile period in all patients who had been provided with the menu, and performed a questiomaire survey on their parents/guardians. The mean eating rates during the febrile period were 39±30% for main meals, and 28±22% for side dishes. No significant difference was seen in the eating rates during the febrile period recorded over the 2-month period prior to introduction of the new menu to 112 febrile children (age range: 1 to 8 years, average age: 3.3±2.1 years), 39±30% for main meals, and 29±22% for side dishes. The questionnaire survey was responded by 43 parents/guardians (a recovery rate of 39%). The ‘febrile children's menu’ was assessed as ‘good’ by 67% of respondents, representing an overall favourable impression from the parents/guardians. With reference to the survey results, we will attempt to further improve the ‘febrile children's menu’ with the aim of increasing eating rates during the febrile period.

In 2010, we at Konan Kosei Hospital introduced a menu with 8 days set as a cycle for inpatients undergoing chemotherapy. We have thus far used it for 258 patients. Over the 6-month period extending from October 2011 and March 2012, we performed a questionnaire survey on 23 patients (8 with lung cancer, 5 with acute myeloid leukemia and 3 with lymphoma) about their meals. On the basis of the findings, we have made a number of improvements in the menu.　　To the question of ease with which to eat, 96% of patients responded the meals were “easy to eat.” When it came to the volume of meals, 29% replied that breakfast was “small,” whereas 83% said lunch and dinner were “just right.” Cold chawan-mushi (custard-like egg and vegetable dish steamed in a cup) was difficult to eat for 7 patients, whereas there were indications that fish meals were also hard to eat.　　Based on this survey, we have increased the volume of breakfast, and replaced cold chawan- mushi with hot chawan-mushi. Furthermore, in order to reduce the smell peculiar to fish, we substituted kaba-yaki (spitchcocks) and ankake (food dressed with a thick, starchy sauce) fish- cooking styles for nitsuke (fish boiled and seasoned with sugar and soy sauce) and mushizakana (steamed fish) styles. Further surveys are necessary to produce a menu suitable for as many patients undergoing chemotherapy as possible.

  Dietary management during chemotherapy for cancer can improve a patient's nutritional status through an adequate dietary intake, and increase the therapeutic effect.  In this study, we performed a questionnaire survey of inpatients in chemotherapy about their dietary preferences and changes in their senses of taste and smell, with the aim of producing a ‘chemotherapy menu’, utilizing recipes and foodstuffs to produce a palatable menu for those patients with their appetite diminished. We received responses from 102 out of 109 in patients surveyed (94%). Of the respondents, 66% rerealed that they had a decrease in appetite during chemotherapy, of whom 85% complained of extremely poor appetite. The smell of fish dishes disturbed 29% of the respondents, of whom 62% reported a stronger aversion to hot dishes. The foods easy to eat were found to be fruits, noodles, and soups. Meat and fish dishes, white rice, and stews were difficult to eat. Seasoning with tomato sauce made food difficult to eat for 44% of the respondents, whereas soy sauce was shunned by only 6%. The survey also found that 38% liked the use of Furikake (dried seasoning sprinkles), because it could make the meals palatable.  Based on the survey results, we devised an 8-day ‘chemotherapy menu’. It includes a Japanese style breakfast, with bread as an option, and many foods easy to eat, such as flavoured rice, sushi, noodles, sandwiches, and fruits. We have offered this menu to 47 inpatients, with average eating rates of greater than 70% for both rice and dishes. We will further conduct surveys with a view to producing a ‘chemotherapy menu’ palatable for as many patients as possible.