A Historical Review of Infection Prevention and Control (IPC) in Japan

• About 10,000 cases of Escherichia coli O157 infection were reported in Japan between May and August 1996, with school-age children being the majority of those affected. Radish sprouts are suspected to be the cause of a significant outbreak that afflicted over 6,000 elementary school students in Sakai City, Osaka Prefecture. An epidemiologic study was prompted by another incident that happened in a Kyoto workplace, when three employees experienced severe symptoms following their meal at the cafeteria.
• Following two significant outbreaks in 2010, criteria for multi-drug-resistant Acinetobacter baumannii (MDRA) were defined in Japan. A. baumannii can endure for a very long time in dry settings and carriers, frequently remaining undiagnosed because of mixed infections. This further postpones the identification of multi-drug-resistant Pseudomonas aeruginosa (MDRP).
• It frequently takes more than a year to contain an outbreak since effective control involves establishing release criteria, quarantine times, and clean-up procedures.

From 1990 to 2010, various training and certification programs were part of IPC capacity-building initiatives, producing competent infectious disease experts.

In 1999, six societies jointly launched the Infection Control Doctor Council. The Infection Control Doctor Council describes the duties of Infection Control Doctors (ICDs), which include:

• managing hospital-acquired infection outbreaks
  
•  educating healthcare professionals
•  planning and carrying out infection control measures
•  evaluating and reviewing these measures
• and looking into hospital infection conditions (surveillance)

Infection control certification for certified nurses (CN) was introduced in 2001. This certification means that nurses must create IPC systems, conduct assessments, and put healthcare-associated infections (HAI) surveillance into place for every facility.

A certification program for infectious disease specialists—previously referred to as infectious disease doctors—was established in 1995 by the Japanese Association for Infectious Diseases. Physicians with exceptional proficiency in infectious illnesses are trained and certified under this method, which does not require IPC-related knowledge or abilities in order to be certified.

A two-year practical training program for epidemiologists, the Field Epidemiology Training Program (FETP) was introduced by the National Institute of Infectious Diseases in 1999. It was created with technical support from the United States Centers for Disease Control and Prevention, taking inspiration from their post-doctoral training program for the Epidemic Intelligence Service. Under the Infectious Diseases Control Law (IDCL), the FETP was created to assist prefectures in putting IPC measures into practice.

Ministerial reports and the organization of liaison councils and meetings were two ways the Ministry of Health, Labour and Welfare (MHLW) responded to the growing need for nosocomial infection control in hospital settings in the early 1990s.

Since 1993, the MHLW has held an annual Nosocomial Infection Seminar with the goal of providing healthcare personnel around the country with up-to-date scientific knowledge to improve IPC. The lecture was originally intended for physicians and nurses, but since 1999, pharmacists and clinical laboratory technicians have also attended.

Aside from those, different surveillances systems have surfaced, such as the major HAI surveillance systems and National Epidemiological Surveillance of Infectious Diseases (NESID) system. The MHLW also oversees the national surveillance program Japan Nosocomial Infections Surveillance (JANIS), which collects information on nosocomial infections and antimicrobial-resistant bacteria in healthcare settings.

Increased reimbursements for countermeasures and regional cooperation were implemented in 2012, along with an independent assessment system for infection prevention under the health-care reimbursement program. The fact that these reimbursements for infection prevention have continuously increased since the first one was made in 1996 suggests that the significance of IPC is now more widely acknowledged.

Also, cooperation between organizations, communities, and facilities improves the quality of IPC by gathering and using data, adding to epidemiological understanding, and serving as the foundation for inter-facility emergency protocols.

As per World Health Organization Western Pacific Region’s study in IPC on the present IPC state, there are also advancement strategies such as the following:

•  Improving IPC in healthcare settings using specialized infection control teams
•  Connecting facilities and communities to create interconnected networks
•  Preventing and managing infections in long-term care settings
•  Countermeasures against antimicrobial resistance
• Leveraging international events to improve the IPC system
• Conducting surveillance based on specific events

To ensure public health and safety in the future, IPC advancement is essential. The development of IPC procedures, such as the creation of specialized teams, inter-facility networks, and focused actions, highlights the necessity of taking preventative action in order to handle new and developing infectious risks.

Sustaining IPC systems calls for constant work in the face of issues like antibiotic resistance and managing global health crises. Communities and healthcare institutions can be protected in the future by developing a robust and efficient IPC framework through collaboration, innovative implementation, and constant surveillance.