Effect of Revised Medical Care Law to Infection Control in Small-Scale Hospitals and Clinics

The Medical Care Act was amended partially to require the establishment of infection control systems in all health care facilities (HCFs) including hospitals, clinics with or without beds, and health care facilities for the elderly in 2007. To clarify how HCFs have responded to this amendment, we surveyed a total of 211 HCFs in Toyama Prefecture. Analysis of the responses to our questionnaire showed that as many as 84% and 72% of HCFs have established their own infection control guidelines and infection-surveillance systems, respectively. In almost half of HCFs, 100% of the health care personnel attended the infection control-training programs. However, attendance rates were no more than 30% in the most clinics. Improved infection control practices were reported in 68% of HCFs, but t many clinics reported no improvement because of the uncooperative attitude of facility managers or low concern and interest of personnel in this issue. In most of HCFs, hand-washing spaces and personal protective equipments were well organized, and ready to use at a moment's notice. However, masks and aprons were not always used adequately in certain HCFs. Surprisingly, in as many as 25% of HCFs, glass injectors were still used repeatedly after sterilization. Alcohol cotton swabs were prepared in utility containers in 51% of HCFs. Management of the container was different in HCFs and not adequate. Such differences in infection control systems and practices among the HCFs require careful checking of provisions and improvement of complete infection control systems and practices.