The activities of Certified Nurse in Infection Control in Japan
In the face of COVID-19 pandemic globally, nurses in Japan are also dealing with infection prevention and care for patients at various settings in Japan. The Certified Nurses (CNs) in Infection Control, who received credentials from Japanese Nursing Association (JNA), provided their skilled expertise and knowledge in infection control at the settings including the Government, hospitals and call centers. There are 2,923 CNs in Infection Control as of December, 2019.
These are stories of four CNs in Infection Control who tackled the COVID-19.
Leading the frontline infection control as a member of the Government’s Cluster Intervention Group
Hitomi Kurosu, RN, CNIC, MS, PH.D, Researcher, AMR Center at National Institute of Infectious Diseases
Since early April, she works as a member of the Cluster Intervention Group within the Novel Coronavirus Response Headquarters, the Ministry of Health, Labour and Welfare. The main tasks of the Cluster Intervention Group are to visit the site and provide support for epidemiological study, infection control and work continuation on the request of local governments where the cluster occured. Within the Group, physicians take the role of epidemiological study and nurses take the role of on-site infection control and provision of lectures and advices. There is only one CN on Infection Control in the Group.
She has visited and stayed at Hokkaido, where the hotspot of COIVD-19 in Japan, and dealt with COVID-19 clusters. Principally, she visited long-term care facilities in the event of the one or two people become COVID-19 positives and provided guidance including how to clean up after COVID-19 positive patients transferred to hospital, zoning, infection control practice for staff, and the procedure for putting on and removing PPE. There was no CNs at the long-term care facilities as well as nurse staffing was low. In addition, long-term care workers were not adequately educated with infection control. Many of them had anxiety without knowing how to handle the situation. She provided follow-up through SNS so that the staff could ask questions as required. She also re-visited the site and made confirmation a few days after her visit so as to ensure infection control practice takes root in the settings. She also worked in collaboration with public health center staff. She looks forward that staff she worked with are able to work more autonomously thorough her nursing intervention.
Leading patient care with lack of PPEs at the core hospital of the regional health care
Yumiko Zamma, RN, CNIC, MSN, Infection Control Unit, Saka General Hospital
As a position in charge of infection control in the hospital, she started to prepare manual and build stockpile of PPE at the time first COVID-19 case was confirmed in Japan in mid-January. Although she centralized the management of PPE to prepare for pandemic, the PPE ran out. This was the toughest challenge she faced as a position in charge of infection control. The hospital managed to purchase and received donation of face masks and PPEs, however, these quality were varied. In addition, during the shortage of PPE, staff had to use these for exceptional way, which is using single-use PPEs for several times. Under these circumstances, she guided staff for proper and safe way of using PPEs.
As people need to live with uncontrolled infection, she would continue to keep stock control and takes appropriate infection control so as to settle the new way of life within work environment.
Contributing to the detection of the first case in the hospital and control of the spread by leading infection control
Tomoko Yukita, RN, CNIC, Nursing Deputy Director, Takarazuka-daiichi Hospital
Her hospital confirmed 5 cases for patients and 3 cases for staff. She responded to the situation as a member of infection control team (ICT) at the hospital. The first confirmed case of her hospital was not considered as infected case in the first place. Because the patient was emergently admitted due to pyelonephritis and although patient had clinical findings of pneumonia, there was no respiratory symptom. She originally received information of this case through conference at Antimicrobial Stewardship Team (AST). She suspected the patient was infected to COVID-19 when receiving the information from the ward nurse 10 days after admission that the patient used to go to the day care facility where mass outbreak of infection occurred. Immediately, she asked pulmonologist to recheck the computed tomography image. With diagnose of “strong possibility of suspected infection”, she started to take measures including consideration of implementing PCR tests, contacting Public Health Center for the tests, calling for emergency meetings at the hospital and limiting admission and discharge. Working closely with each department through cross-sectoral work of ICT and AST as a Certified Nurse on Infection Control on a regular basis resulted in the quick integration of information and detection of the infected patient.
Although it took 10 days to confirm the case, the spread of infection among ward nurses as well as healthcare related infection were controlled to minimum level. This may be the result of infection management among staff in normal times. In addition, after they found out the first case, she always thought about what would happen and took measures for staffing, ward cleaning and infection control among staff. Although 49 staff including 30 nursing staff were restricted on work due to close contact with infected cases, immediate action resulted to gain collaboration throughout the hospital.
Utilizing expertise to prevent panic by responding to anxiety and inquiries of public
Sanae Matsunaga, RN, CNIC, MSN, Program-Specific Senior Lecture(Infection Control), Miyagi University
She had an opportunity to join the operation of the Expert Meeting on Control of the Novel Coronavirus Disease Control, the Ministry of Health, Labour and Welfare, where she did negotiation to establish the policies and direction utilizing her expertise. She also had an opportunity to respond health consultation from population.
At the call center on COVID-19, she worked for health consultation from population. In many cases, those who called were in a panic as they had some kind of issues in their health. Some people shouted angrily, and others called repeatedly from anxiety. Most of the cases were in ill health due to hay fever or pre-existing condition with mild conditions. However, there were cases that people had close contact with infected person or people having diseases which requires immediate response. Although, those who called wanted to be heard their story, the consultation time was limited to 15 minutes. She had to make painful decision to finish the call in this time frame.
She worked with a sense of responsibility as a professional, however, there was a feeling of fear that she had to consult and make decision without seeing people through phone. She also felt fear that she might have missed the suspected cases. Some of the call center staff had difficulty sleeping at night because they felt like hearing the phone keep ringing.
Through these experiences, she was convinced that nurses, who are skilled at taking holistic approach, and Certified Nurses on Infection Control, who have expertise of infection control, were in the best position to take the important role at the government and community.
About Certified Nurse
In order to offer quality healthcare to public, the credentialing system by JNA certificates Certified Nurse Specialists, Certified Nurses and Certified Nurse Administrators.
Certified Nurse (CN) system is designated to diffuse quality nursing care by forwarding CNs who can provide high-level nursing practice, using skilled nursing expertise in specific nursing fields at every nursing settings, into society.
The role of CNs are to practice high-level nursing care, to provide guidance to nurses, and to provide consultation to nurses and others.
There are 21,048 CNs in 21 fields as of December, 2019.