Development and Application of an Infection Control Education Program in Long-Term Care Hospitals / 재활간호학회지

Purpose@#The purpose of this study was to develop an infection control education program (ICEP) for infection control practitioners (ICPs) in long-term care hospitals (LTCH) and to test the effectiveness of the program. @*Methods@#The ICEP was developed based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. Focus group interviews, Borich needs assessment, and location of focus models were used to assess educational needs. To test the effectiveness of the developed ICEP program, one-group pretest-posttest design was used. Participants were 269 ICPs working at LTCH. Knowledge, skills, awareness, self-efficacy, and teaching efficacy on infection control were measured before and after the program using questionnaires. A paired t-test was performed to analyze the data. @*Results@#Compared to pre-test, there was a significant improvement in knowledge (47.07±10.22 vs, 76.99±0.88, p<.001) and skills (32.11±12.48 vs. 62.11±14.08, p<.001). Awareness of infection control, self-efficacy, and teaching efficacy were also significantly improved. @*Conclusion@#We developed an ICEP for ICPs working at LTCH. Based on the results of this study, the ICEP is effective in improving infection control knowledge, skills, self-efficacy, and teaching efficacy for the ICPs. It is suggestive to provide an ICEP to improve hospital infection control activities.

Status of Infection Control and Educational Needs of Nurses in Long Term Care Facilities in Korea / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the status of infection control in long-term care facilities in Korea and educational needs of nurses in charge of infection control. METHODS: This was a descriptive study. A self-reported questionnaire was provided to the nurses in charge of infection control in 250 hospitals with long-term care. 209 nurses answered to the questionnaire. Data were collected from September 30 to November 7, 2016. Data were analyzed using SPSS/WIN 18.0, and the educational needs were analyzed by applying the Borich Needs Assessment Model. RESULTS: Only 17.4% of the hospitals had infection control departments, and only 1.0% of the hospitals had nurses who were fully-in-charge of infection control. Regarding the educational needs on infection control, level of knowledge was statistically significantly lower in all 50 items compared to the importance. Specifically, educational demand on air and water quality management, construction and infection control, indicator management, and infectious disease management were also high. CONCLUSION: The results of this study showed that organization and manpower were needed for effective infection control of long-term care facilities in Korea. In addition, it was deemed necessary to develop and applicate infection control education programs as reflected on the scores obtained in the educational needs on infection control.

The Status of Infection Control Nurses and Factors Affecting Infection Control Activities in Healthcare Facilities with more than 150 Beds in 2016 in KOREA / 임상간호연구

PURPOSE: The purpose of this study was to describe the status of infection control nurses (ICNs) and their activities, and to identify the factors affecting the level of infection control activities. Methods: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. METHODS: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. RESULTS: Most participating hospital were advanced general hospital (20.1%) and general hospital (67.8%). Among the hospitals, 86.4% had an infection control department (ICD). The average hospital work experience of ICNs was 14.62 years, and their average infection control career was for 4.94 years. Among the ICNs, 85.6% worked in full time and the average number of beds per ICN was 311.21. There were significant differences in the existence of ICD, infection control activities including surveillance, outbreak investigation, negative pressure room, hand hygiene monitoring, disinfection, and sterilization according to hospital size. The level of infection control activities was higher with more number of ICNs, ICN employment as full time, and healthcare institution accreditation status. The explanatory power was 37.5%. CONCLUSION: These results of this study which reflect infection control status of healthcare facilities with more than 150 beds in 2016 will provide baseline data to establish infection control system in small to medium sized hospitals after the Middle East Respiratory Syndrome outbreak in 2015.

Comparison of the Incidence Rate of Influenza-like Illness between an Influenza-Vaccinated Group and Unvaccinated Group

PURPOSE: This study was conducted to compare the incidence rate of influenza-like illnesses between an influenza-vaccinated group and a non-vaccinated group of adults. METHODS: From July 1, 2015 to July 30, 2015, self-reporting questionnaires were given to 300 adults living in the Seoul and Gyeonggi-do, Korea. 265 survey questionnaires that had an earnest response were used for data analysis. The collected data were analyzed using the statistical software SPSS Win 18.0 version. RESULTS: 52.1% of the participants were vaccinated. The incidence rate of influenza-like illnesses was 11.3%. Within the influenza-vaccinated group, 12.3% experienced an influenza-like illness. On the other hand, in the non-vaccinated group, 10.2% experienced an influenza-like illness. There was no statistically significant difference in the incidence of influenza-like illness depending on vaccination status. CONCLUSION: During the influenza season from Fall 2014 to Spring 2015, there was no significant difference on the prevalence of influenza-like illness between the study participants whether they were vaccinated or not. Thus, future studies should confirm and closely examine this fact, whether it was a matter of pandemic strain selection or whether there were differences in the effects of adult influenza vaccination as reported in previous studies.

Development and Implementation of an Education Program for Novice Infection Control Nurses / 병원감염관리

BACKGROUND: This study was performed to improve the working competencies of novice infection control nurses (ICNs) and thereby prevent healthcare associated infection. We developed and implemented an education program and then evaluated its effectiveness. METHODS: The education program was developed by conducting a literature review and four expert group discussions. The program was implemented twice, and included 3 days of lectures and 1 day of practice in Seoul and Pusan, for 157 ICNs with less than 3 years of experience. The knowledge of the participants before and after the educational program and overall satisfaction were measured. Data were analyzed using the SPSS WIN 18.0 program. RESULTS: The education program consisted of 12 lectures and 2 practices in total. The post-program knowledge score increased to 77.99 compared to 45.91 prior to participating in the program (P<.001). The scores for overall satisfaction, knowledge acquirement, and usefulness in field practice were 9.05, 8.97, and 9.01, respectively. The overall satisfaction was higher for the practice component (9.37) than the lectures (9.00). There were significant differences in surveillance knowledge according to age (F=3.94, P=.021), hospital career (F=3.71, P=.027), hospital type (F=5.36, P=.006), and hospital size (F=6.19, P=.003); and there were significant differences in hand hygiene knowledge according to age (F=4.14, P=.018) and hospital type (F=4.84, P=.009). However, there was no difference in overall satisfaction with the program. CONCLUSION: To enhance working competencies and professionalism, education programs considering the characteristics and needs of the ICNs must be developed. Moreover, professional training courses are needed to nurture ICNs in small hospitals.

Knowledge and Compliance with Prevention of Respiratory Tract Infection Among Workers in Geriatric Facilities / 병원감염관리

BACKGROUND: Prevention of respiratory infection among workers in geriatric facilities is important because the workers can transmit these infections to the elderly. Therefore, this study intended to assess the knowledge and compliance of preventive behavior against respiratory tract infection among these workers. METHODS: Data were collected from 202 workers in geriatric facilities via a questionnaire-based survey from July 19 to August 8, 2014. Data were analyzed using the SPSS 21.0 program. RESULTS: Among the workers, 44.6% experienced respiratory tract infection in the last 1 year. The score for knowledge of respiratory tract infection prevention among the workers was 10.6 points out of 12. The average score for compliance of the preventive behavior against respiratory tract infection was 34.6 points out of 48. The correlation between preventive knowledge and compliance of the preventive behavior against respiratory tract infection was not verified (r=0.00, P=0.967). CONCLUSION: In this study, the level of knowledge of respiratory infection prevention among the workers in the elderly care facility was high. However, the level of compliance was not sufficiently high. In addition, no correlation was found between their preventive knowledge and compliance. Therefore, a preventive program that focuses on the compliance of respiratory infection prevention rather than on its knowledge needs to be developed.

Current State of Influenza Vaccination and Factors Affecting Vaccination Rate among Pregnant Women

PURPOSE: This study was done to examine the actual state of influenza vaccination among pregnant women and factors affecting vaccination rate. METHODS: Data were collected using self-report questionnaires. Participants were pregnant women who participated in a prenatal education program at an acute care hospital in 2013. Data collected from 218 pregnant women were analyzed using the SPSS 18.0 Program. RESULTS: Only 48.6% of the pregnant women had received vaccination when the influenza was prevalent. Statistically significant factors affecting the influenza vaccination rate among pregnant women were vaccination experience in the previous year, knowledge and attitude about vaccination, and gestation period. CONCLUSION: Results indicate that the influenza vaccination rate among pregnant women is lower than that of elders, healthcare workers, and patients with chronic diseases, who have been considered to be the mandatory vaccination recipients. Therefore, it is necessary to develop programs and policies which provide information including safety of vaccines for pregnant women and to induce positive attitudes towards vaccination for these women, in order to ultimately improve the vaccination rate.

Actual Disinfection and Sterilization Control in Korean Healthcare Facilities / 기본간호학회지

PURPOSE: This study was done to investigate the status of disinfection and sterilization in healthcare facilities. METHOD: A survey of 193 Korean healthcare facilities was conducted from February 8 to March 7, 2013. Data were analyzed using descriptive statistics, chi2 test, Fisher's exact test, one-way ANOVA, Scheffe with SPSS WIN 18.0. RESULTS: Of the healthcare facilities 93.2% had specific guidelines for disinfection/sterilization, but only 47.9% had a committee on disinfection/sterilization for decision-making, less than half (42.7%) conducted regular monitoring of actual practices, while 83.9% had established procedures for recovery in case of problems with the disinfection process and 89.0% kept records and archives of disinfection practices. Cleaning process, selection of chemical disinfectants and process of disinfection and sterilization were found to be inadequate in some healthcare facilities. Perception score for adequacy of medical instruments was 8.10, environmental disinfection was 7.20, and sterilizer management was 8.45 out of a possible 10. CONCLUSION: Compared to larger institutions, smaller healthcare facilities had less effective disinfection and sterilization management systems, while some facilities showed inadequate practices for medical equipment and general sterilization. Better academic and state-level support is recommended for smaller facilities in order to establish a better system-wide management system.

Pregnant Women's Knowledge and Compliance about Prevention of Respiratory Infection / 병원감염관리

BACKGROUND: Respiratory infection in pregnancy can cause various side effects and affect the fetus. Therefore, efforts to prevent infection during pregnancy are essential. This study investigated knowledge and compliance regarding the prevention of respiratory infection among pregnant women. METHODS: A survey was conducted on May 10, 2012 on 300 pregnant women who attended a maternity school education program in a tertiary care hospital. The responses of 259 women were collected and analyzed. RESULTS: Only 2 women (0.8%) had been educated about respiratory infection prevention methods, while 106 (40.9%) experienced respiratory infection during pregnancy. The mean score of respiratory infection prevention knowledge was 11.63 out of 15 points (percentage of correct answers: 77.5%). The mean score for compliance to respiratory infection prevention was 32.34 out of 52 points (percentage of practice: 62.19%). Knowledge and compliance were found to be positively correlated. CONCLUSION: Although many pregnant women experience respiratory infection during pregnancy, few have opportunities to be educated about prevention. Thus, the positive correlation between knowledge and compliance highlights the need for respiratory infection prevention education programs.

Knowledge of and Compliance with Cough Etiquette among Nursing and Allied Health College Students / 병원감염관리

BACKGROUND: This study aims to examine the knowledge of nursing and allied health-college students on cough etiquette and their actual compliance to it. METHODS: For data collection, a structured questionnaire was created and handed out to students from 3 colleges from November 9 to November 18, 2011. The questionnaires were distributed to 300 students, and responses from 253 students were used for data analysis. RESULTS: In total, 54.85% students provided correct answers to questions regarding their knowledge on cough etiquette. The compliance score was 34.39 (compliance rate: 61.41%). There was a positive association between knowledge of proper cough etiquette and compliance with those procedures. CONCLUSION: It can be concluded that college student's knowledge of cough etiquette is low, and subsequently that their compliance with the proper procedures of cough etiquette was low. Therefore, it is necessary to develop a program to build knowledge of proper cough etiquette amongst these students.

Underreporting Rate and Related Factors after Needlestick Injuries among Healthcare Workers in Small- or Medium-Sized Hospitals / 병원감염관리

BACKGROUND: This study aimed to examine the underreporting rate and related factors after needlestick injuries among healthcare workers (HCWs) in small- or medium-sized hospitals. METHODS: Convenience sampling was conducted for 1,100 HCWs in 12 small- or medium-sized hospitals with less than 500 beds. From October 1 to November 30, 2010, data were collected using self-report questionnaire that was developed by researcher. The response rate for the study was 98.3% (982 HCWs). Data were analyzed using Statistical Package for the Social Sciences (SPSS) Win 12.0. RESULTS: The reports showed that 239 HCWs (24.3%) sustained needlestick injuries within the last year. The under-reporting rate after a needlestick injury was 67.4% (161/239), and underreporting rates varied across the hospitals and ranged from 46.2% to 85.7%. The major reasons for underreporting after needlestick injuries were the assumption that no blood-borne pathogens existed in the source patient (62.8%), annoyance (17.9%), and no knowledge about the reporting procedure (6.0%). Multiple logistic regression analysis showed that the suggestion by colleagues to report the injury, the number of needlestick injuries, and the needle type were independently related to the underreporting of needlestick injuries. CONCLUSION: The underreporting rate of needlestick injuries in small- or medium-sized hospitals was similar to that in large-sized hospitals, and this finding confirmed that the suggestion by colleagues to report the injury was the most significant factor influencing the injury-report rate. Thus, creating an environment that encourages HCWs to report injuries is considered the most important method to decrease the underreporting rate of needlestick injuries in small- and medium-sized hospitals.

Status of and Factors Influencing Vaccination against the Pandemic (H1N1) 2009 Virus among University Students from the Fields of Nursing and Allied Health

PURPOSE: This study was to identify the current status of vaccination against the pandemic (H1N1) 2009 virus among university students from the fields of nursing and allied health from a local community and verify factors influencing vaccination. METHODS: The study included 227 students in the fields of nursing and allied health from a provincial university. Data were obtained from these participants between May 31 and June 11, 2010 by using self-report questionnaires. RESULTS: The rate of vaccination against the pandemic (H1N1) 2009 virus for these participants was 14.5%. No difference was observed in this regard between majors and school year. Factors that influence vaccination against this virus included previous vaccination against seasonal influenza and participants' attitudes toward general vaccination. CONCLUSION: The results suggest that for effective pandemic (H1N1) 2009 vaccination of university students from the fields of nursing and allied health, students who have not been vaccinated should be intensively managed. Developing a vaccination program that encourages a positive attitude toward vaccination is recommended.

Survey of Under-Reporting Rate and Related Factors after Blood and Body Fluid Exposure among Hospital Employees / 성인간호학회지

PURPOSE: The purpose of this study was to examine the under-reporting rate and related factors after blood and body fluid (BBF) exposure among hospital employees. METHODS: Fifteen hundred employees were conveniently sampled from ten university and acute care hospitals. The survey questionnaire consisted of 37 items. Data were collected from September 10 to November 30, 2008. RESULTS: The survey response rate was 88.7%. The 47.9% (638/1,331) of hospital employees were exposed to BBF and the mean number of exposure was 4.7+/-5.942 within the previous year. Under-reporting rate after BBF exposure was 69.4% (443/638). By multi-variate logistic regression analysis, the exposure number, exposure type, infectious disease and hospital were independently related to the under-reporting of BBF among hospital employees. CONCLUSION: The Under-reporting Rate After Being Exposed To Blood And Body Fluids Was Relatively High. To Address This Problem, Educational Programs Are Needed To Decrease The Under-reporting Rate For Healthcare Workers. Further, It Might Be Helpful If Other Factors Related To Under-reporting Be Investigated In Future Studies.

Survey of Knowledge and Preventive Measures against Novel Influenza during the National Novel Influenza Pandemic Outbreak / 병원감염관리

BACKGROUND: This study aimed at assessing the knowledge of the general public about novel influenza and the extent of preventive measures undertaken when information on novel influenza and its preventive measures was extensively broadcasted during the novel influenza outbreak. METHODS: Between September 21 and October 31, self-report questionnaires were distributed to 1,200 persons. The completed questionnaires were collected from 1,025 persons. The collected data was used to determine the frequency and percentage as well as to conduct analyses such as t-test, ANOVA, and logistic regression by using SPSS WIN 12.0. RESULTS: The knowledge on novel influenza and the performance of preventive measures were scored at 6.58 and 5.10, respectively, on a scale of 12. This finding suggested that the knowledge on novel influenza and the performance of preventive measures were low. The significant factors influencing the participants' knowledge on novel influenza were age and the experience of watching relevant educational programs on television, whereas the factors influencing the performance of preventive measures were academic career, working status, and the experience of watching relevant educational programs on television. Between knowledge and implementation of preventive measures, there was positive correlation at low level (r=0.112, P<0.001). CONCLUSION: In conclusion, this study demonstrated that factors influencing the knowledge on and the performance of preventive measures against a disease should be considered when developing prevention strategies, such as broadcast of educational programs on television, against influenza or similar infectious diseases during an outbreak.

Rate of Nasal Colonization of Methicillin-Resistant Staphylococcus aureus at Admission to a Medical Intensive Care Unit / 병원감염관리

BACKGROUND: The purpose of this study was to survey the nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) among the patients admitted in a medical intensive care unit (MICU) and analyze risk factors associated with the colonization. METHODS: The study was carried out on patients admitted into the MICU in a 1,250-bed tertiary care university hospital from January through December 2006. Nasal surveillance cultures were obtained from patients within 24 hours of admission to the unit. Data were analyzed retrospectively by the review of medical records. RESULTS: A total of 312 patients were screened with active nasal cultures; 36 patients (11.6%) were positive for MRSA. Of these, 22 (7.1%) were positive in the nasal cultures only and 14 (4.5%) were positive in the cultures of other specimens (13, sputum; 1, joint fluid) in addition to the nasal swabs. Among the risk factors for MRSA nasal colonization were sex (man), route of admission (from other ICUs or wards), a history of ICU admission during the recent 12 months, and prolonged hospital days in ICU. CONCLUSION: MRSA nasal carrier rate was found higher in this study than in those reported in the literature. Most of the patients colonized with MRSA in the nostril were not colonized with the organism elsewhere in the body. Whether or not active surveillance for MRSA should be performed would depend on the nasal colonization rate of the patients at the time of admission to the ICU.

A Study on the Costs of Hospital Infection Control and Prevention / 병원감염관리

BACKGROUND: Cost-benefit studies for hospital infection control and prevention (HICP) are often applied to improve the investment for infection control; however, an accurate cost measurement for HICP would be necessary before a cost benefit analysis and establishing a proper policy for HICP. The purpose of this study is to analyze the costs of HICP for the hospital in Korea. METHOD: The costs associated with HICP in the year 2004 were surveyed for 8 university-affiliated teaching hospitals in Seoul and Kyounggi province. The collected data included the costs for standard precaution materials including hand hygiene and personal protective equipments, hospital employee health service, maintenance of hospital facility and environmental control, and operating infection control office. RESULT: The average costs for HICP were estimated to be 785,115 won per one bed per year. Among the contributing factors to the total costs were the cost for patient isolation in private rooms (310,458 won), disinfectants (125,533), hand hygiene materials (99,007), maintenance of hospital environmental hygiene (90,773), operation of infection control office (65,811), personal protective equipment (58,099), and employee health care (35,434). CONCLUSION: We estimated the annual cost of HICP at a minimum of 96,723,000 won for a 100-bed hospital. This study contributes to establishing the basic and necessary data for a proper HICP compensation system by providing various HICP costs for the university hospital.

Comparison of Handwashing Perception and Compliance between Direct Patient Contact and Indirect Contact Groups among Hospital Employees / 병원감염관리

Backgound: The aim of this study was to compare the levels of perception of and compliance with handwashing between the groups of direct patient contact and indirect contact in a tertiary-care university hospital. METHODS: A cross-sectional study was conducted in a university hospital with 4,500 employees. A questionnaire, containing questions on demographic data and the perception of and compliance with handwashing, was distributed to and collected from a total of 1,087 employees from June 25 to July 10, 2005. RESULTS: The study subjects washed their hands an average of 11.2 times (range, 1-100) per day: nurses washed their hands more frequently than others. The average duration of handwashing by employees was 18.8 seconds. Those in the direct patient contact group scored significantly higher points than did those in the indirect contact group in both perception (P<.021) of and compliance (P<.001) with handwashing. CONCLUSION: Education for handwashing is needed direction employees who have indirect contact with patients to improve their compliance with handwashing.

Descriptive Study on the Current Usage of Disinfectants in Korea / 병원감염관리

BACKGROUND: The proper use of disinfectants has been a major issue in infection control programs. We performed a survey to evaluate the current usage of disinfectants in Korea. METHODS: A questionnaire was e-mailed to 95 hospitals that had infection control programs and data were collected between 10 and 28 October 2005. The questionnaire included questions about whether the hospital had official procedures for selection and use of disinfectants and an education program for proper use; also included were questions about the general characteristics of the hospitals. The types of disinfectants consisted of antiseptics and disinfectants for medical devices, endoscopes, and environments. The questionnaire was analyzed using SPSS 12.0 program. RESULTS: Thirty-nine (41.1%) of the 95 hospitals responded to the questionnaire. Thirty-six hospitals (84.6%) had an official decision making process in selecting disinfectants in their hospitals. Ten percent povidone iodine (PVI) (94.9% for central line) and alcohol (92.3% for peripheral line) were commonly used for skin preparation for intravenous catheterization. Most hospitals used 10% PVI for clean wound (97.4%), dirty/infected wound (94.8%) and sore wound (61.5%); 3% H2O2 (43.6%) for dirty/infected wound; and saline (25.6%) for sore wound. Waterless alcohol handrubs were used in general ward (92.3%), ICU (97.4%), and OR (43.6%). Over the 60% of the hospitals used sodium hypochlorites for cleansing the floors and bathrooms of patients' rooms. As a disinfectant for endoscopes, peracetic acid (40-60%) was used the most frequently, followed by orth-pthalaldehyde (25-36%), and superoxidized water (8-23%). Most hospital followed the manufactures' guidelines on the exposure time of gastroscopes to disinfectants such as orth-pthalaldehyde (100%) and peracetic acid (96%). But, some hospitals re-used peracetic acid (12.0%) and superoxidized water (28.6%) for a longer duration than was recommended by the manufacturers. Fifty to eighty percents of the hospitals used tap water for rinsing endoscopes after disinfection, and only about 80% of these dried with alcohol after rinsing. Most hospitals (84.6%) had teaching sessions for the proper use of disinfectants more than once a year. CONCLUSION: The current use of disinfectants has been improved since 1999 in its suitability and appropriateness Proper use of disinfectants ensures the safety of invasive and non-invasive medical processes; therefore, the current guidelines for disinfection should be strictly followed by the hospital. And continuous staff education will facilitate the correct use of disinfectants.

Comparison of Two Surveillance Methods for Detecting Nosocomial Infections in a Neonatal Intensive Care Unit / 병원감염관리

BACKGROUND: The aim of this study was to evaluate the sensitivity of a clinicians' self-report method for the detection of nosocomial infections (NIs) in comparison with a total surveillance method in a neonatal intensive care unit (NICU). METHODS: Two surveillance methods were concurrently performed in the NICU of a university hospital during 5 months in 2003. Clinicians' self-report surveillance (CSRS) was based on the retrospective verification of monthly reports of positive bacteriologic results by NICU clinicians. Total surveillance (TS) was done prospectively by an infection control nurse based on chart review and laboratory data. RESULTS: One hundred fifty nine patients accounting to 2759 patient-days were included in the study. Twenty-seven NIs among 26 patients were identified by TS. The sensitivity of CSRS compared to TS was 14.8% (4 of 27 NIs). The specificity was 98.5% (131 of 133 non-NIs). Kappa measures of agreement were -0.309. CONCLUSIONS: Our results confirm that the retrospective review of charts and laboratory data by clinicians lacks sensitivity and agreement for the surveillance of nosocomial infections.

A Pseudoepidemic of Alcaligenes xylosoxidans Due to Contaminated Buffer Solution / 병원감염관리

Background: A clinician reported unusually high incidence of A. xylosoxidans isolation from aspirated tissues in outpatient clinic. Methods: A. xylosoxidans isolates from January 2002 to June 2002 were investigated. The infection control nurse reviewed medical records and observed the procedures of tissue aspiration and culture at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from dye, aspiration gun, slide alcohol sponge, tray, sink. water of sink, buffer solution, microscope, computer, and telephone. Results: A. xyloxosidans was isolated from twenty-four patients during 6 months. None of 24 cases had any typical signs or symptoms of infections by A. xylosoxidans. Observation of tissue aspiration and culture procedure revealed that buffer solution was used for prevention of specimen drying after tissue aspiration. Culture of the buffer solution yielded a heavy growth of A. xylosoxidans from four out of ten specimens. A. xylosoxidans was not isolated from any other investigational specimens. Conclusions: This was supposed to represent pseudoepidemic. Contaminated buffer solution was documented as the cause of this pseudoepidemic. The usage of buffer solution was stopped. During the follow-up period of 2 months, no additional A. Xylosoxidans was cultured from aspirated tissues.