[Routine written intervention asserting the advantages of multiple blood cultures increases their order rate among doctors].

PURPOSE: Obtaining two or more blood culture sets is important for achieving good sensitivity and for detecting contamination. However, many doctors still only order one set for their laboratory testing. We wished to determine if routine written intervention to these doctors could increase the number of multiple blood cultures they ordered. MATERIALS AND METHODS: On November 11, 2011 at Tokyo Teishin Hospital, we began sending letters asserting the advantages of using multiple blood culture sets to doctors who only ordered solitary blood cultures. The effect of the intervention was determined by measuring the order rate of multiple blood culture sets at the hospital. We compared the order rate one year before intervention with that of one year after. We used a chi-square test (without Yates correction) to analyze the data, and p values less than 0.05 were considered to be statistically significant; all tests were two-tailed. RESULTS: Before written intervention, the order rate of multiple blood cultures was 41%. This increased significantly to 68% after intervention (p < 0.001). The latter figure was 1.7 times greater than the former (relative risk, 1.7; 95% confidence interval, 1.5-1.8). CONCLUSION: Routine written educational intervention asserting the advantage of multiple blood cultures led to an increase in their order rate by doctors. While this is a significant increase, it is still insufficient. Therefore, we propose the need for internal policies requiring at least two blood culture sets to ensure better sensitivity and detection of contamination. To enforce these policies, hospital personnel should be allowed to routinely intervene by either sending warning letters to the doctors or displaying this information on the patient's electronic chart.

[Effect of admixture of betamethasone butyrate propionate ointment on preservative efficacy].

Twenty percent of dermatologists have experienced a separation of water or deterioration of topical corticosteroids mixed with commercially available ointments and/or creams. However, few investigations of this deterioration of admixtures have been reported. To assess the effects of preservatives in preventing microbial contamination of these admixtures, we attempted to investigate the concentration of preservative agents in admixtures and the microbial contamination of these admixtures with a topical corticosteroid ointment (Antebate). The concentration of parabens was reduced by half using an admixture of corticosteroid ointment with four types of moisturizing creams, Urepearl, Pastaronsoft, Hirudoid, and Hirudoidsoft. After a further 3 months, no decrease in parabens was seen. No microbial contamination was found in any admixture stored at room temperature for 1 week and touched two times daily with a finger. The concentration and ratio of the parabens in the aqueous phase and oil phase were entirely different in the admixtures before being centrifuged. The aqueous phase of the admixtures of the oil/water (O/W)-type emulsions of Urepearl and Hirudoid was not found to have microbial contamination immediately after being centrifuged. All aqueous phases stored at room temperature or in a refrigerator for 1 week and touched with a finger twice daily exhibited microbial contamination. These experiments demonstrated that O/W-type emulsions, in which the water easily separates from the bases, should be thoroughly mixed to prevent microbial contamination.