title: Health care-associated infection prevention in Japan: the role of safety culture.
abstract: BACKGROUND
  Limited data exist on the use of infection prevention practices in Japan. We conducted a nationwide survey to examine the use of recommended infection prevention strategies and factors affecting their use in Japanese hospitals.
  
  
  METHODS
  Between April 1, 2012, and January 31, 2013, we surveyed 971 hospitals in Japan. The survey instrument assessed general hospital and infection prevention program characteristics and use of infection prevention practices, including practices specific to preventing catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Logistic regression models were used to examine multivariable associations between hospital characteristics and the use of the various prevention practices.
  
  
  RESULTS
  A total of 685 hospitals (71%) responded to the survey. Maintaining aseptic technique during catheter insertion and maintenance, avoiding routine central line changes, and using maximum sterile barrier precautions and semirecumbent positioning were the only practices regularly used by more than one-half of the hospitals to prevent CAUTI, CLABSI, and VAP, respectively. Higher safety-centeredness was associated with regular use of prevention practices across all infection types.
  
  
  CONCLUSIONS
  Although certain practices were used commonly, the rate of regular use of many evidence-based prevention practices was low in Japanese hospitals. Our findings highlight the importance of fostering an organization-wide atmosphere that prioritizes patient safety. Such a commitment to patient safety should in turn promote the use of effective measures to reduce health care-associated infections in Japan.
authors.affiliation: Center for Quality Improvement, St Luke's International Medical Center, Tokyo, Japan. Electronic address: fumienum@luke.ac.jp.
authors.forename: Fumie
authors.initials: F
authors.lastname: Sakamoto
authors.affiliation: Division of Infection Control and Prevention, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sakihama
authors.affiliation: Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.affiliation: Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan.
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.affiliation: Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan; Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.affiliation: Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D019983:Guideline Adherence; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D007564:Japan; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D018805:Sepsis / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000517:prevention & control
keywords: Health care–associated infection; Infection prevention; Japanese hospitals; Nosocomial; Safety culture