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NosoVeille – Bulletin de veille Avril 2015 NosoVeille n°4 Avril 2015 Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve Secrétariat de rédaction : Nathalie Vincent Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé. Il est disponible sur le site de NosoBase à l’adresse suivante : http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Désabonnement Sommaire de ce numéro : Acinetobacter baumannii Antibiotique / Antibiorésistance Antiseptique Bactériémie Chirurgie Clostridium difficile Ebola EHPAD Environnement Epidémie Grippe Hépatite Hygiène des mains Infection fongique Infection urinaire Légionellose Néonatologie Norovirus Personnel Pneumonie 1 / 40

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NosoVeille – Bulletin de veille Avril 2015

NosoVeille n°4

Avril 2015Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie TreyveSecrétariat de rédaction : Nathalie Vincent

Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé.

Il est disponible sur le site de NosoBase à l’adresse suivante :

http://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html

Pour recevoir, tous les mois, NosoVeille dans votre messagerie :Abonnement / Désabonnement

Sommaire de ce numéro :

Acinetobacter baumanniiAntibiotique / AntibiorésistanceAntiseptiqueBactériémieChirurgieClostridium difficileEbolaEHPADEnvironnementEpidémieGrippeHépatiteHygiène des mainsInfection fongiqueInfection urinaireLégionelloseNéonatologieNorovirusPersonnelPneumoniePréventionPseudomonas aeruginosaRéglementationStaphylococcus aureusStérilisationSurveillanceTuberculoseVaccination

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Acinetobacter baumannii

NosoBase ID notice : 393743Acinetobacter baumannii producteurs de biofilm multirésistant aux antibiotiques : un défi émergent

Badave GK; Dhananjay K. Biofilm producing multidrug resistant Acinetobacter baumannii: an emerging challenge. Journal of clinical and diagnostic research 2015/01; 9(1): 8-10.

Mots-clés : ACINETOBACTER BAUMANNII; MULTIRESISTANCE; BIOFILM

Aim: To study the quantitative method for biofilm formation and examine the correlation between biofilm formation and antibiotic resistance among the clinical isolates of Acinetobacter baumannii.Materials and methods: A total of 72 A. baumannii isolates from different clinical specimens were processed and confirmed by conventional microbiological methods. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method using six antibiotics. Biofilm formation was studied by microtitre plate assay.Results: Forty five (62.5%) of 72 isolates produced biofilm. Resistance to ampicillin-sulbactam was least. 36.1% isolates were resistant to imipenem, 66.6% to ceftazidime, 72.2% to ciprofloxacin, 80.5% to amikacin and 84.7% to piperacillin. Biofilm formers showed greater resistance to ampicillin- sulbactam, amikacin, ciprofloxacin and ceftazidime as compared to imipenem and piperacillin. In all 65 (90.3%) isolates showed multiple drug resistance. Correlation between multidrug resistance and biofilm formation was analysed statistically and p-value was found to be significant (p-value =0.0004; p-value <0.05 is significant by Chi - Square Test).Conclusion: The study concludes that there a positive correlation between biofilm formation and multiple drug resistance in A. baumannii.

Antibiotique / Antibiorésistance

NosoBase ID notice : 393272La procalcitonine est-elle un marqueur efficace en termes de coût-efficacité pour mettre en place et réévaluer l’antibiothérapie de patients adultes suspectés d’infection bactérienne et de sepsis ?

Harrison M; Collins CD. Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis? Infection control and hospital epidemiology 2015/03; 36(3): 265-272.

Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; PROCALCITONINE; SOIN INTENSIF; COUT-EFFICACITE; COUT; COHORTE; INFECTION; SYNDROME SEPTIQUE

Objective: Procalcitonin has emerged as a promising biomarker of bacterial infection. Published literature demonstrates that use of procalcitonin testing and an associated treatment pathway reduces duration of antibiotic therapy without impacting mortality. The objective of this study was to determine the financial impact of utilizing a procalcitonin-guided treatment algorithm in hospitalized patients with sepsis. Design: Cost-minimization and cost-utility analysis. Patients: Hypothetical cohort of adult ICU patients with suspected bacterial infection and sepsis. Methods: Utilizing published clinical and economic data, a decision analytic model was developed from the U.S. hospital perspective. Effectiveness and utility measures were defined using cost-per-clinical episode and cost per quality-adjusted life years (QALYs). Upper and lower sensitivity ranges were determined for all inputs. Univariate and probabilistic sensitivity analyses assessed the robustness of our model and variables. Incremental cost-effectiveness ratios (ICERs) were calculated and compared to predetermined willingness-to-pay thresholds. Results: Base-case results predicted the use of a procalcitonin-guided treatment algorithm dominated standard care with improved quality (0.0002 QALYs) and decreased overall treatment costs ($65). The model was sensitive to a number of key variables that had the potential to impact results, including algorithm adherence (<42.3%), number and cost of procalcitonin tests ordered (≥9 and >$46), days of antimicrobial reduction (<1.6 d), incidence of nephrotoxicity and rate of nephrotoxicity reduction. Conclusion: The combination of procalcitonin testing with an evidence-based treatment algorithm may improve patients' quality of life while decreasing costs in ICU patients with suspected bacterial infection and sepsis; however, results were highly dependent on a number of variables and assumptions.

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NosoBase ID notice : 393269Mise en place de politiques de gestion des antibiotiques dans les hôpitaux américains : résultats d’une enquête nationale

Pogorzelska-Maziarz M; Herzig CT; Larson EL; Furuya EY; Perencevich EN; Stone PW. Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey. Infection control and hospital epidemiology 2015/03; 36(3): 261-264.

Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; CONSOMMATION; ENQUETE; RESEAU

Objective: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals. Design: Cross-sectional survey. Participants: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN). Methods: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data. Results: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P<.01). Hospitals located in California were more likely to have policy in place than in hospitals located in other states (P=.014). Conclusion: This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies.

NosoBase ID notice : 395061Endocardite infectieuse sur pacemaker à Stenotrophomonas maltophilia

Reynaud Q; Weber E; Gagneux-Brunon A; Suy F; Lucht F; Botelho-Nevers E. Late Stenotrophomonas maltophilia pacemaker infective endocarditis. Médecine et maladies infectieuses 2015/03; 45 (3): 95-97.

Mots-clés : ENDOCARDE; INFECTION; STIMULATEUR CARDIAQUE; ANTIBIORESISTANCE; MORTALITE; STENOTROPHOMONAS MALTOPHILIA

Antiseptique

NosoBase ID notice : 395020Evaluation de l’activité bactéricide de 3 antiseptiques cutanéomuqueux en présence de substances interférentes : peut-on compléter la norme NF EN 13727 ?

Salvatico S; Feuillolay C; Mas Y; Verrière F; Roques C. Bactericidal activity of 3 cutaneous/mucosal antiseptic solutions in the presence of interfering substances: Improvement of the NF EN 13727 European Standard? Médecine et maladies infectieuses 2015/03; 45(3): 89-94.

Mots-clés : ANTISEPTIQUE; BACTERICIDIE; TEST; PEAU; CONTACT MUQUEUX; NORME; CHLORHEXIDINE; POLYVIDONE IODEE; GYNECOLOGIE; DERMATOLOGIE

Objectifs : L’évaluation des antiseptiques à visée cutanéomuqueuse, en présence de substances interférentes, ne fait l’objet d’aucun protocole normatif. Notre objectif était de proposer des conditions d’essai adaptées de la norme NF EN 13727 pour l’évaluation d’antiseptiques utilisés en gynécologie et dermatologie.Méthode : Trois antiseptiques : une association chlorhexidine-benzalkonium (CB), une association hexamidine-chlorhexidine-chlorocrésol (HCC) et la povidone iodée (P) ont été testés in vitro. L’adaptation des conditions d’essai de la norme a concerné le choix des dilutions, du diluant et des substances interférentes. L’activité des produits a été évaluée sur les souches de la norme aux concentrations de 97 % (utilisation pure), de 50 % et 10 % (utilisation diluée) et de 1 %. Pour répondre aux exigences de bactéricidie, une réduction logarithmique ≥ 5 était attendue pour 60 secondes de contact.Résultats : HCC n’avait pas d’activité bactéricide à l’exception de la concentration à 97 % sur P. aeruginosa . P n’avait pas d’activité bactéricide sur E. hirae , quelle que soit la concentration testée, ni sur S. aureus à 97

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%. CB avait l’activité bactéricide la plus homogène avec réduction>5 log sur les 4 souches bactériennes à 97 %, 50 % et 10 %.Conclusion : L’adaptation de la norme NF EN 13727 permet de discriminer les 3 produits testés : seul CB était bactéricide en conditions de saleté. Ce travail souligne la possibilité de valider le choix des antiseptiques in vitro dans des conditions représentatives de la pratique, dans le traitement d’appoint des affections cutanéomuqueuses primitivement bactériennes ou susceptibles de se surinfecter.

Bactériémie

NosoBase ID notice : 395001Les bactériémies associées aux soins à Staphylococcus aureus : un indicateur des infections associées aux cathéters

Bonnal C; Birgand G; Lolom I; Diamantis S; Dumortier C; L'Hériteau F; et al. Staphylococcus aureus healthcare associated bacteraemia: An indicator of catheter related infections. Médecine et maladies infectieuses 2015/03; 45(3): 84-88.

Mots-clés : INFECTION NOSOCOMIALE; CATHETER VEINEUX; STAPHYLOCOCCUS AUREUS; BACTERIEMIE; INDICATEUR; CATHETER VEINEUX PERIPHERIQUE; CATHETER VEINEUX CENTRAL; METICILLINO-RESISTANCE; SARM; SURVEILLANCE; INCIDENCE; ETUDE PROSPECTIVE

Objectifs : Les établissements de santé doivent disposer d’indicateurs pertinents permettant d’évaluer et de surveiller les infections associées aux soins dites évitables et en particulier celles liées aux cathéters. Le but de ce travail était de montrer que la surveillance des bactériémies nosocomiales à Staphylococcus aureus pouvait être un de ces indicateurs.Patients et méthode : Nous avons réalisé une surveillance prospective sur 10 ans des bactériémies associées aux soins à S. aureus dans notre hôpital de 940 lits en nous basant sur les définitions standard.Résultats : Entre 2002 et 2012, 2784 bactériémies associées aux soins ont été identifiées, dont 573 (18 %) étaient dues à S. aureus. Parmi ces 573 bactériémies, 189 (32,8 %) avaient pour origine un cathéter vasculaire et 84 % (158/189) survenaient en dehors des services de réanimation. S. aureus était associé à 56 % (61/109) des bactériémies liées à un cathéter veineux périphérique (CVP) et à 34 % (103/301) de celles dues à un cathéter veineux central (CVC). Les souches de S. aureus résistantes à la méticilline isolées des bactériémies ont diminué de 50,3 % à 18,4 % entre 2002 et 2012. Les bactériémies sur CVP ont baissé de 20 à 7 par an pendant l’étude.Conclusion : Dans notre expérience, la surveillance des bactériémies associées aux soins à S. aureus serait donc un indicateur simple et efficace des infections sur cathéter et donc de la qualité des soins, en particulier dans des secteurs non couverts habituellement par d’autres types de surveillance.

NosoBase ID notice : 393276Comparaison entre connecteurs sans aiguille imprégnés d'argent et connecteurs sans aiguille standard dans la prévention des bactériémies sur voie centrale

Jacob JT; Tejedor SC; Reyes MD; Lu X; Easley KA; Aurand WL; et al. Comparison of a silver-coated needleless connector and a standard needleless connector for the prevention of central line-associated bloodstream infections. Infection control and hospital epidemiology 2015/03; 36(3): 294-301.

Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; MATERIEL MEDICO-CHIRURGICAL; TAUX; ETUDE PROSPECTIVE; CONNECTEUR

Objective: To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating. Design: Prospective longitudinal observation study Setting: Two 500-bed university hospitals Patients: All hospitalized adults from November 2009 to June 2011 with non-hemodialysis central linesInterventions: Hospital A started with silver-coated NCs and switched to standard NCs in September 2010; hospital B started with standard NCs and switched to silver-coated NCs. The primary outcome was the difference revealed by Poisson multivariate regression in CLABSI rate using standard Centers for Disease Control and Prevention surveillance definitions. The secondary outcome was a comparison of organism-specific CLABSI rates by NC type.

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Results: Among 15,845 hospital admissions, 140,186 central-line days and 221 CLABSIs were recorded during the study period. In a multivariate model, the CLABSI rate per 1,000 central-line days was lower with silver-coated NCs than with standard NCs (1.21 vs 1.79; incidence rate ratio=0.68 [95% CI: 0.52-0.89], P=.005). A lower CLABSI rate per 1,000 central-line days for the silver-coated NCs versus the standard NCs was observed with S. aureus (0.11 vs 0.30, P=.02), enterococci (0.10 vs 0.27, P=.03), and Gram-negative organisms (0.28 vs 0.63, P=.003) but not with coagulase-negative staphylococci (0.31 vs 0.36) or Candida spp. (0.42 vs 0.40). Conclusions: The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs.

NosoBase ID notice : 393741Comparaison des bactériémies à Acinetobacter pittii et à Acinetobacter nosocomialis

Liu YM; Lee YT; Kuo SC; Chen TL; Liu CP; Liu CE. Comparison between bacteremia caused by Acinetobacter pittii and Acinetobacter nosocomialis. Journal of microbiology, immunology and infection 2015/01/30; in press: 1-6.

Mots-clés : BACTERIEMIE; ACINETOBACTER; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; APPARIEMENT; MORTALITE; ACINETOBACTER PITTII; ACINETOBACTER NOSOCOMIALIS

Background/Purpose: Patients with Acinetobacter pittii and Acinetobacter nosocomialis bacteremia have lower mortality rates than those with Acinetobacter baumannii bacteremia. However, it is unknown whether these organisms differ in outcomes of bacteremic patients. We conducted this study to answer this question.Methods: In this retrospective study conducted at a teaching hospital in Taiwan, we enrolled all 86 patients who had developed A. pittii bacteremia and those with A. nosocomialis bacteremia from 2000 to 2008 while matching for age, sex, Acute Physiology and Chronic Health Evaluation II score, and appropriate antimicrobial therapy. After adjustment, we accessed the clinical characteristics and 14- and 28-day mortalities.Results: We found that the patients with A. pittii bacteremia had multiple comorbidities less often and received invasive procedures less frequently. The 14-day mortality rate of patients with A. pittii or A. nosocomialis bacteremia was 14% and 7%, respectively, whereas their 28-day mortality rate was 17% and 9%, respectively. Using the mortality rate in patients with A. nosocomialis bacteremia as a reference, the odds ratios for the 14- and 28-day crude morality in those with A . pittii were 2.16 [95% confidence interval (CI), 0.77-6.05] and 2.06 (95% CI, 0.82-5.15), respectively, whereas the adjusted odds ratios for 14- and 28-day mortality were 1.89 (95% CI, 0.56-6.14) and 1.67 (95% CI, 0.59-4.78) respectively.Conclusion: Our 8-year study showed that the mortality rate of A. pittii bacteremia was higher but the difference was not statistically significant.

NosoBase ID notice : 394304Impact d’interventions de lutte contre le risque infectieux sur les taux de bactériémies à Staphylococcus aureus dans des hôpitaux pour soins aigus du NHS, Est des Midlands, Royaume-Uni, à l’aide d’une analyse de series temporelles interrompues

Newitt S; Myles PR; Birkin JA; Maskell V; Slack RC; Nguyen-Van-Tam JS; et al. Impact of infection control interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East Midlands, UK, using interrupted time-series analysis. The journal of hospital infection 2015/01/15; in press: 1-10.

Mots-clés : ANALYSE; TAUX; BACTERIEMIE; STAPHYLOCOCCUS AUREUS; PREVENTION; EFFICACITE; ETUDE MULTICENTRIQUE

Background: Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and regional interventions aimed at reduction have been implemented in National Health Service acute hospitals, but assessment of their effectiveness is methodologically challenging.Aim: To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008 on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis.Methods: We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the pre-intervention, implementation, and post-intervention phases for combined intervention packages in eight acute hospitals.

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Findings: Most of the change in MSSA and MRSA rates occurred during the implementation phase. During this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation or post-intervention periods.Conclusion: The impact of interventions varied by hospital group but the overall results suggest that national and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands.

NosoBase ID notice : 393699Mortalité attribuable aux bactériémies associées aux voies centrales : revue systématique et méta-analyse

Ziegler MJ; Pellegrini DC; Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2015/02; 43(1): 29-36.

Mots-clés : MORTALITE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; META-ANALYSE

Purpose: To identify the attributable mortality of central line associated blood stream infections (CLABSI) through meta-analysis.Methods: Meta-analysis of case control and cohort studies, matched and unmatched, that reported on mortality of patients with and without CLABSI was performed. MEDLINE, CENTRAL, CINAHL were searched. Non-interventional studies of all languages that reported mortality in patients with CLABSI were included. Data were extracted on patient population, study setting, design, diagnostic criteria for CLABSI, and mortality. Results from studies comparing mortality due to CLABSI were pooled using a random effects model with assessment of heterogeneity. Heterogeneity of studies was assessed with an I (2) statistic and a funnel plot was generated to assess for publication bias.Results: Eighteen studies were included with 1,976 CLABSI cases. Of the included studies, 17 took place in intensive care unit settings, most involved a mixed population of medical and surgical patients, and ten were matched using an illness severity index. Our findings show an odds ratio of in hospital death associated with CLABSI as 2.75 (CI 1.86-4.07) and 1.51 (CI 1.08-2.09) in the subgroup of the ten matched studies. Those studies where greater than 30 % of CLABSI were attributed to coagulase-negative Staphylococcus had an odds ratio of death of 1.64 (95 % CI 1.02-2.65) compared with 4.71 (95 % CI 1.54-14.39).Conclusions: CLABSI is associated with a significantly increased risk of death supporting the use of extensive efforts to reduce these infections.

Chirurgie

NosoBase ID notice : 393761Actualisation des preuves sur la prévention des infections du site opératoire

Leaper D; Ousey K. Evidence update on prevention of surgical site infection. Current opinion in infectious diseases 2015/04; 28(2): 158-163.

Mots-clés : REVUE DE LA LITTERATURE; PREVENTION; ANTISEPTIQUE; ANTIBIOPROPHYLAXIE; CHIRURGIE; PANSEMENT; EFFICACITE; PREUVE; MEDECINE FACTUELLE

Purpose of review: Surgical site infection (SSI) is a common healthcare-associated infection and complicates up to 10-20% of operations with considerable strain on healthcare resources. Apart from the widely adopted use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and perioperative glycaemic control to reduce SSIs, this review has considered new research and systematic reviews, and whether their findings should be included in guidelines.Recent findings: The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and perioperative oxygen supplementation to reduce the risk of SSI is still in doubt. By contrast, the use of 2% chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic surgical dressings do show promise. Antimicrobial sutures in independent meta-analyses were found to reduce the risk of SSI after all classes of surgery (except dirty) whereas the use of wound guards, or diathermy skin incision (compared with scalpel incision), did not.

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Summary: The incidence of SSI after surgery is not falling. Based on this review of published trials and evidence-based systematic reviews some advances might be included into these care bundles. More research is needed together with improved compliance with care bundles.

NosoBase ID notice : 393282Stratification du risque d’infections du site opératoire en fonction des facteurs de risque liés à l’intervention et comparaison des taux d’infections après réparation chirurgicale de hernie

Olsen MA; Nickel KB; Wallace AE; Mines D; Fraser VJ; Warren DK. Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair. Infection control and hospital epidemiology 2015/03; 36(3): 329-335.

Mots-clés : CHIRURGIE; CHIRURGIE DIGESTIVE; INFECTION NOSOCOMIALE; TAUX; INCIDENCE; FACTEUR DE RISQUE; ETUDE RETROSPECTIVE

Objective: To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair.Design: Retrospective cohort study. Patients Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010.Methods: SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors.Results: A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645).Conclusions: The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.

Clostridium difficile

NosoBase ID notice : 393710Prévalence des infections à Clostridium difficile chez les patients hospitalisés avec une diarrhée : résultats d'une étude française prospective multicentrique

Barbut F; Ramé L; Petit A; Suzon L; de Chevigny A; Eckert C. Prévalence des infections à Clostridium difficile chez les patients hospitalisés avec une diarrhée : résultats d'une étude française prospective multicentrique. La Presse médicale 2015/02/27; in press: e1-e9.

Mots-clés : CLOSTRIDIUM DIFFICILE; DIARRHEE; ANALYSE MULTICENTRIQUE; PREVALENCE; SELLES; INCIDENCE

Introduction : Les infections digestives à Clostridium difficile (CD) représentent la principale cause de diarrhées associées aux soins chez l'adulte. L'objectif de l'étude était de déterminer l'incidence des infections à C. difficile (ICD) en 2012 et d'évaluer l'ampleur du sous-diagnostic en France. Méthodes : Soixante-dix établissements de santé (ES) répartis sur l'ensemble du territoire ont participé à une étude de prévalence bi-annuelle. Chaque ES a systématiquement adressé au centre national de référence (CNR) C. difficile, toutes les selles diarrhéiques de patients hospitalisés reçues au laboratoire au cours de 2 journées (un jour en décembre 2012 et un jour en juillet 2013), indépendamment de la prescription médicale de la recherche de CD. L'analyse des selles au CNR a été réalisée par le test Quik Chek Complete ® (Alere). Les selles positives en Glutamate déshydrogénase (GDH) ou en toxines ont été cultivées sur milieu sélectif Taurocholate, Cyclosérine, Céfoxitine, Agar (TCCA) et les souches isolées ont été caractérisées par PCR vis-à-vis des toxines A et B. Les résultats obtenus par le CNR ont été confrontés à ceux obtenus par chaque

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laboratoire participant. Un questionnaire a permis de recueillir les données d'incidence des ICD en 2012 de chaque ES.Résultats : L'incidence moyenne des ICD rapportées en 2012 par les ES participants était de 3,6 ± 2,9 pour 10000 patients-jours; l'incidence était positivement corrélée à la densité de prescription (nombre de tests réalisés pour 10000 patients-jours) qui variait largement d'un ES à l'autre (médiane 29 pour 10000 patients-jours;IQR19-50). Lors de l'enquête de prévalence bi-annuelle, 651 selles ont été analysées et 90 se sont révélées positives à CD en culture. La prévalence globale des patients infectés par CD toxinogène était de 9,7 % (63/651) et celle des patients colonisés à CD non toxinogène était de 4,2 % (27/651). Parmi les ICD diagnostiquées par le CNR, 35/63 (55,6 %) ne l'ont pas été par les laboratoires participants, soit par manque de sensibilité des méthodes utilisées (16/63, 25,4 %) soit par manque de suspicion clinique (19/63, 30,2 %). Conclusion : L'incidence des ICD en France en 2012 est en augmentation par rapport à 2009 mais reste largement sous-estimée par un défaut de sensibilité des tests utilisés et par un manque de suspicion clinique.

NosoBase ID notice : 394259Comment éradiquer Clostridium difficile de l’environnement

Barbut F. How to eradicate Clostridium difficile from the environment. The journal of hospital infection 2015/04; 89(4): 287-295.

Mots-clés : CLOSTRIDIUM DIFFICILE; ERADICATION; ENVIRONNEMENT; TRANSMISSION; RECOMMANDATIONS DE BONNE PRATIQUE; DESINFECTION; ULTRA-VIOLET; PEROXYDE D'HYDROGENE

During the last decade, Clostridium difficile has emerged as a major cause of healthcare-associated diarrhoea and death. Transmission of this spore-forming bacterium is thought to occur via the hands of healthcare providers or via the contaminated environment. Therefore, enhanced environmental cleaning/disinfection of the rooms housing C. difficile-infected patients is warranted. Guidelines from various scientific bodies have been published. They recommend performing environmental decontamination of rooms of patients with C. difficile infection (CDI) using hypochlorite (diluted 1/10) or a sporicidal product. Compliance with cleaning and disinfection is a critical point and is often suboptimal. Novel 'no-touch' methods for room disinfection have recently been introduced. Ultraviolet (UV) light or hydrogen peroxide systems are most widely used. In-vitro studies suggest that hydrogen peroxide vapour (from 30% hydrogen peroxide) methods achieve a >6 log10 reduction in C. difficile spores placed on carriers, and that aerosolized hydrogen peroxide systems (from 5% to 6% hydrogen peroxide) achieve ~4 log10 reduction, whereas UV-based methods achieve ~2 log10 reduction. Very few studies have assessed the impact of these devices on the transmission of C. difficile. Major limitations of these devices include the fact that they can only be used after the patient's discharge, because patients and staff must be removed from the room. The new no-touch methods for room disinfection supplement, but do not replace, daily cleaning.

NosoBase ID notice : 394302 Réduction de la contamination environnementale à Clostridium difficile par des patients traités par fidaxomicine

Biswas J; Patel S; Otter A; Wade JA; Newsholme P; van Kleef W; et al. Reduction in Clostridium difficile environmental contamination by hospitalized patients treated with fidaxomicin. The journal of hospital infection 2015/02/09; in pres: 1-4.

Mots-clés : CLOSTRIDIUM DIFFICILE; PREVENTION; ENVIRONNEMENT; CONTAMINATION; ANTIBIOTIQUE; SPORICIDIE; SURFACE

Fidaxomicin is sporicidal and may be associated with a reduced time to resolution of diarrhoea when used to treat patients with Clostridium difficile infection (CDI). This study investigated whether fidaxomicin for treatment of all patients with CDI reduced C. difficile environmental contamination. Surfaces in the rooms of 66 hospitalized patients treated with metronidazole and/or vancomycin and 68 hospitalized patients treated with fidaxomicin were sampled. Patients treated with fidaxomicin were less likely to contaminate their environment (25/68, 36.8%) than patients treated with metronidazole and/or vancomycin (38/66 57.6%) (P=0.02). Treatment with fidaxomicin was associated with reduced environmental contamination with C. difficile.

NosoBase ID notice : 393274

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Gravité des infections à Clostridium difficile et évolution clinique des patients infectés par la souche NAP1/BI/027 hors cadre épidémique

Scardina T; Labuszewski L; Pacheco SM; Adams W; Schreckenberger P; Johnson S. Clostridium difficile infection (CDI) severity and outcome among patients infected with the NAP1/BI/027 strain in a non-epidemic setting. Infection control and hospital epidemiology 2015/03; 36(3): 280-286.

Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION; GRAVITE; PCR; AGE; GERIATRIE; FACTEUR DE RISQUE; TRAITEMENT

Objective: Determine whether the NAP1 strain identified by polymerase chain reaction (PCR)-based stool assay is correlated with CDI severity and clinical outcomes. Methods: Medical records of adult patients with positive stool Xpert® Clostridium difficile PCR assay for an initial episode of CDI between January 2012 and January 2013 at a tertiary care hospital in Chicago were reviewed. Two patients diagnosed with CDI caused by a non-NAP1 strain (positive Xpert® C. difficile assay but negative Xpert® C. difficile Epi assay) were included for each patient diagnosed with CDI caused by a NAP1 strain (positive Epi assay). Patient charts were reviewed for markers of severity, risk factors, treatment regimens, and outcomes. Results: Of 494 stool specimens, 90 (18%) that were positive for C. difficile by PCR were positive for NAP1 strain. In total, 37 patients with CDI due to NAP1 were matched with 74 patients with CDI due to non-NAP1 strains. Multivariable model revealed individuals ≥65 years old were 3 times more likely to have NAP1 strain than individuals <65 (P=.02). Residents of a nursing home prior to hospitalization were 10 times more likely to have NAP1 strain than patients residing in their homes (P=.001). More NAP1 cases had a change in treatment from metronidazole to oral vancomycin plus intravenous metronidazole (P=.01). The severity of CDI, incidence of mortality and recurrent CDI were similar between groups. Conclusions: In a nonepidemic setting, NAP1 strains were more common in older patients and individuals admitted from nursing homes. Identification of NAP1 by PCR of stool specimens was associated in a change of therapy but did not predict worse outcomes. Reporting strain results may not be clinically useful in routine settings.

NosoBase ID notice : 393273La récurrence d’une infection à Clostridium difficile chez des patients en soins intensifs est un facteur prédictif fort d’une ré-hospitalisation dans les 30 jours

Zilberberg M; Shorr AF; Micek ST; Kollef MH. Clostridium difficile recurrence is a strong predictor of 30-day rehospitalization among patients in intensive care. Infection control and hospital epidemiology 2015/03; 36(3): 273-279.

Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION; FACTEUR DE RISQUE; ADMISSION; SOIN INTENSIF; ETUDE RETROSPECTIVE; COHORTE

Objective: While incidence, mortality, morbidity, and recurrence rates of C. difficile infection (CDI) among the critically ill have been investigated, the impact of its recurrence on 30-day rehospitalization (ReAd), an important policy focus, has not been examined.Design: Secondary analysis of a multicenter retrospective cohort study Patients Adult critically ill patients who survived their index hospitalization complicated by CDI METHODS: CDI was defined by diarrhea or pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. CDI recurrence (rCDI) was defined as diarrhea, positive C. difficile toxin and need for retreatment after cessation of therapy. Descriptive statistics and a logistic regression examined ReAd rates and characteristics, and factors that impact it.Results: Among 287 hospital survivors, 76 (26.5%) required ReAd (ReAd+). At baseline, the ReAd+ group did not differ significantly from the ReAd- group based on demographics, comorbidities, APACHE II scores, or ICU type. ReAd+ patients were more likely to have hypotension at CDI onset (48.7% vs 34.1%, P=.025) and to require vasopressors (40.0% vs 27.1%, P=.038); they were less likely to require mechanical ventilation (56.0% vs 77.3%, P<.001). A far greater proportion of ReAd+ than ReAd- had developed a recurrence either during the index hospitalization or within 30 days after discharge (32.89% vs 2.84%, P<.001). In a logistic regression, rCDI was a strong predictor of ReAd+ (adjusted odd ratio, 15.33, 95% confidence interval, 5.68-41.40).Conclusions: Greater than 25% of all survivors of critical illness complicated by CDI require readmission within 30 days of discharge. CDI recurrence is a strong predictor of such rehospitalizations.

Ebola

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NosoBase ID notice : 393749Vaccination post-exposition en urgence après exposition au sang à l’aide d’un vaccin contre Ebola utilisant des virus de la stomatite vésiculaire

Lai L; Davey R; Beck A; Xu Y; Suffredini AF; Palmore T; et al. Emergency postexposure vaccination with vesicular stomatitis virus-vectored Ebola vaccine after needlestick. JAMA, the journal of the American Medical Association 2015/03/24; 313(12): 1249-1255.

Mots-clés : URGENCES HOSPITALIERES; VACCIN; ACCIDENT D'EXPOSITION AU SANG; FIEVRE HEMORRAGIQUE; EBOLA

NosoBase ID notice : 394305Infections aux virus Ebola en Afrique : épidémiologie et transmission nosocomiale

Shears P; O'Dempsey TD. Ebola virus disease in Africa: epidemiology and nosocomial transmission. The journal of hospital infection 2015/01/20; in press: 1-9.

Mots-clés : EPIDEMIOLOGIE; TRANSMISSION; VIRUS; FIEVRE HEMORRAGIQUE; EPIDEMIE; MORTALITE; RISQUE; REVUE DE LA LITTERATURE; PREVENTION; EBOLA

The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, has exceeded all previous Ebola outbreaks in the number of cases and in international response. There have been 20 significant outbreaks of Ebola virus disease in Sub-Saharan Africa prior to the 2014 outbreak, the largest being that in Uganda in 2000, with 425 cases and a mortality of 53%. Since the first outbreaks in Sudan and Zaire in 1976, transmission within health facilities has been of major concern, affecting healthcare workers and acting as amplifiers of spread into the community. The lack of resources for infection control and personal protective equipment are the main reasons for nosocomial transmission. Local strategies to improve infection control, and a greater understanding of local community views on the disease, have helped to bring outbreaks under control. Recommendations from previous outbreaks include improved disease surveillance to enable more rapid health responses, the wider availability of personal protective equipment, and greater international preparedness.

EHPAD

NosoBase ID notice : 394320Qualité de l’air intérieur, ventilation et santé sur le plan respiratoire de residents âgés vivant en EHPAD en Europe

Bentayeb M; Norback D; Bednarek M; Bernard A; Cai G; Cerrai S; et al. Indoor air quality, ventilation and respiratory health in elderly residents living in nursing homes in Europe. The European respiratory journal 2015/03/11; in press: 1-11.

Mots-clés : ETUDE MULTICENTRIQUE; EHPAD; PERSONNE AGEE; AIR; QUALITE; GERIATRIE; APPAREIL RESPIRATOIRE; ENVIRONNEMENT; TAUX

Few data exist on respiratory effects of indoor air quality and comfort parameters in the elderly. In the context of the GERIE study, we investigated for the first time the relationships of these factors to respiratory morbidity among elderly people permanently living in nursing homes in seven European countries. 600 elderly people from 50 nursing homes underwent a medical examination and completed a standardised questionnaire. Air quality and comfort parameters were objectively assessed in situ in the nursing home. Mean concentrations of air pollutants did not exceed the existing standards. Forced expiratory volume in 1 s/forced vital capacity ratio was highly significantly related to elevated levels of particles with a 50% cut-off aerodynamic diameter of <0.1 µm (PM0.1) (adjusted OR 8.16, 95% CI 2.24-29.3) and nitrogen dioxide (aOR 3.74, 95% CI 1.06-13.1). Excess risks for usual breathlessness and cough were found with elevated PM10 (aOR 1.53 (95% CI 1.15-2.07) and aOR 1.73 (95% CI 1.17-10.3), respectively) and nitrogen dioxide (aOR 1.58 (95% CI 1.15-2.20) and aOR 1.56 (95% CI 1.03-2.41), respectively). Excess risks for wheeze in the past year were found with PM0.1 (aOR 2.82, 95% CI 1.15-7.02) and for chronic obstructive pulmonary disease and exhaled carbon monoxide with formaldehyde (aOR 3.49 (95% CI 1.17-10.3) and aOR 1.25 (95% CI 1.02-1.55), respectively). Breathlessness and cough were associated with higher carbon dioxide. Relative humidity was inversely related to wheeze in the past year and usual cough. Elderly subjects aged ⩾80 years were at higher risk.

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Pollutant effects were more pronounced in the case of poor ventilation. Even at low levels, indoor air quality affected respiratory health in elderly people permanently living in nursing homes, with frailty increasing with age. The effects were modulated by ventilation.

NosoBase ID notice : 393646Porteurs asymptomatiques de Clostridium difficile toxinogène dans des EHPAD : méta-analyse de la prévalence et des facteurs de risque

Ziakas PD; Zacharioudakis IM; Zervou FN; Grigoras C; Pliakos EE; Mylonakis E. Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors. PLoS One 2015/02/23; 10(2): 1-14.

Mots-clés : CLOSTRIDIUM DIFFICILE; COLONISATION; PREVALENCE; FACTEUR DE RISQUE; META-ANALYSE; EPIDEMIOLOGIE; EHPAD; PERSONNE AGEE

Background: The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown.Purpose: To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.Data sources: PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.Study selection: All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.Data extraction: Two authors extracted data independently.Statistical methods: The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.Results: Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p=0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.Conclusion: Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs.

Environnement

NosoBase ID notice : 394221Evaluation du contact manuel des surfaces fréquemment touchées et des surfaces mutuellement touchées par le personnel de santé, les patients et les visiteurs

Cheng VC; Chau PH; Lee WM; Ho SK; Lee DW; So SY; et al. Hand-touch contact assessment of high-touch and mutual-touch surfaces among healthcare workers, patients, and visitors. The journal of hospital infection 2015/03/06; in press: 1-18.

Mots-clés : SURFACE; PERSONNEL; USAGER DE LA SANTE; ENVIRONNEMENT; TRANSMISSION; CENTRE HOSPITALIER UNIVERSITAIRE; LIT; CHAMBRE DU MALADE; VISITE AUX HOSPITALISES; ETUDE D'OBSERVATION

Background: Unlike direct contact with patients’ body, hand hygiene practice is often neglected by healthcare workers (HCWs) and visitors after contact with patients’ environment. Contact with hospital environmental items may increase risk of pathogen transmission. Aim: To enumerate the number of hand-touch contacts by patients, HCWs and visitors with any hospital environmental items.

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Methods: All contact-episodes between person and item were recorded by direct observation in a six-bed cubicle of acute wards for 33 working days. High-touch and mutual-touch items with high contact frequencies by HCWs, patients, and visitors were analysed. Findings: In total, 1107 person-episodes with 6144 contact-episodes were observed in 66 observation hours (average: 16.8 person-episodes and 93.1 contact-episodes per hour). Eight of the top 10 high-touch items, including bedside rail, bedside table, patients’ bodies, patients’ files, linen, bed curtain, bed frame, and locker were mutually touched by HCWs, patients, and visitors. Bedside rail topped the list with 13.6 contact-episodes per hour (mean), followed by bedside table (12.3 contact-episodes per hour). Using patients’ body contacts as a reference, it was found that medical staff and nursing staff contacted bedside table [rate ratio (RR): 1.741, 1.427, respectively] and patients’ file (RR: 1.358, 1.324, respectively) more than patients’ bodies, and nursing staff also contacted bedside rails (RR: 1.490) more than patients’ body. Conclusion: Patients’ surroundings may be links in the transmission of nosocomial infections because many are frequently touched and mutually contacted by HCWs, patients, and visitors. Therefore, the focus of hand hygiene education, environmental disinfection, and other system changes should be enhanced with respect to high-touch and mutual-touch items.

Epidémie

NosoBase ID notice : 394478Emergence d’une souche clonale de Providencia stuartii productrice de VIM-1 panrésistante aux antibiotiques responsable d’une épidémie dans une unite de reanimation en Grèce

Douka E; Perivolioti E; Kraniotaki E; Fountoulis K; Economidou F; Tsakris A; et al. Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care unit. International journal of antimicrobial agents 2015/02/16; in press: 1-4.

Mots-clés : SOIN INTENSIF; BACILLE GRAM NEGATIF; PROVIDENCIA; EPIDEMIE; PFGE; TRANSMISSION; CONTROLE; CENTRE HOSPITALIER UNIVERSITAIRE; ANTIBIORESISTANCE; TYPAGE; BIOLOGIE MOLECULAIRE; MULTIRESISTANCE; PROVIDENCIA STUARTII|

Here we describe an outbreak caused by a pandrug-resistant Providencia stuartii strain involving 15 critically ill patients in a Greek intensive care unit (ICU) during September-November 2011. All isolates harboured the blaVIM-1 gene and a class 1 integron structure of 1913 bp as well as blaSHV-5 and blaTEM-1. Pulsed-field gel electrophoresis (PFGE) demonstrated that isolates from all 15 patients belonged to a single P. stuartii clonal type. As all of the infected patients were hospitalised during overlapping time periods, horizontal intra-ICU transmission was considered as the main route for the dissemination of the outbreak strain. The outbreak ended following reinforcement of infection control measures, including implementation of additional barrier precautions for infected patients.

NosoBase ID notice : 394289Défis pour le contrôle d’une vaste épidémie à Klebsiella pneumonia productrices de carbapénèmase type OXA-48 dans un centre hospitalier universitaire en France

Semin-Pelletier B; Cazet L; Bourigault C; Juvin ME; Boutoille D; Raffi F; et al. Challenges of controlling a large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a French university hospital. The journal of hospital infection 2015/04; 89(4): 248-253.

Mots-clés : KLEBSIELLA PNEUMONIAE; CONTROLE; EPIDEMIE; ANTIBIORESISTANCE; CARBAPENEME; CENTRE HOSPITALIER UNIVERSITAIRE; DEPISTAGE; COLONISATION DIGESTIVE; INFECTIOLOGIE; MEDECINE INTERNE; PERSONNEL; ENQUETE; NEPHROLOGIE; TRANSPLANTATION; PRECAUTION STANDARD; CARBAPENEMASE

A large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae at Nantes University Hospital was investigated. The index case had no history of travel or hospitalization abroad and had been hospitalized in the internal medicine department for more than one month when the epidemic strain was isolated from a urine sample in June 2013. Seventy-two secondary cases were detected by weekly screening for gastrointestinal colonization during the two phases of the outbreak from June to October 2013 (33 cases) and from November 2013 to August 2014 (39 cases). Spread of the epidemic strain was attributed to the proximity of, and staff movement between, the infectious diseases (32 cases) and the internal medicine (26 cases) departments; 14 secondary cases were also observed in the renal transplant department following the transfer of an exposed patient from the infectious diseases department. Most of the patients (90%) were

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colonized and no death was linked to the epidemic strain. More than 3000 contact patients were reviewed and 6000 rectal swabs were performed. Initial control measures failed to control the outbreak owing to the late detection of the index case. The late implementation of three successive cohort units, the large number of transfers between wards, and the frequent readmission of cases contributed to the incomplete success of control measures.

Grippe

NosoBase ID notice : 394306Tests rapides au lit du patient pour le diagnostic, la prise en charge et la prévention de la grippe nosocomiale

Bouscambert M; Valette M; Lina B. Rapid bedside tests for diagnosis, management, and prevention of nosocomial influenza. The journal of hospital infection 2015/04; 89(4): 314-318.

Mots-clés : GRIPPE; DIAGNOSTIC BIOLOGIQUE; PREVENTION; EPIDEMIOLOGIE; VIRUS; ANTIVIRAL; TRANSMISSION

Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for influenza can be of real value; they enable early introduction of measures to prevent spread and early specific antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment, especially of very young children or immunocompromised patients. In the latter, the shedding of resistant influenza virus can last several weeks. Sporadic instances of nosocomial transmission among immunocompromised patients have been reported. The limitations of bedside tests for influenza make them unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and cost-effective. Recent developments in these tests look promising, offering prospects of increased sensitivity, increased specificity, and screening for antiviral susceptibility.

NosoBase ID notice : 393265Facteurs cliniques prédictifs des infections au virus de la grippe confirmées par le laboratoire : évaluer les définitions de cas des syndromes pseudo-grippaux

Shah SC; Rumoro DP; Hallock M; Trenholme GM; Gibbs GS; Silva JC; et al. Clinical predictors for laboratory-confirmed influenza infections: exploring case definitions for influenza-like illness. Infection control and hospital epidemiology 2015/03; 36(3): 241-248.

Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; LABORATOIRE; URGENCES HOSPITALIERES; DEFINITION; HYPERTHERMIE; TOUX; MYALGIE; NEZ; AGE; PRELEVEMENT; ETUDE RETROSPECTIVE

Objective: To identify clinical signs and symptoms (ie, "terms") that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza. Design: Retrospective, cross-sectional study. Setting: Large urban academic medical center hospital. Participants: A total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011. Methods: An electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity. Results: The best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%-92% and specificity=38%-44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough

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ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data. Conclusions: A simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0-4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.

NosoBase ID notice : 393266Comparer la réponse immunitaire au vaccin contre la grippe du personnel soignant obèse à celle du personnel soignant non-obèse

Sweet MA; McCullers JA; Lasala PR; Briggs FE; Smithmyer A; Khakoo RA. Comparison of immune response to the influenza vaccine in obese and nonobese healthcare workers. Infection control and hospital epidemiology 2015/03; 36(3): 249-253.

Mots-clés : GRIPPE; VIRUS INFLUENZA TYPE A; PERSONNEL; VACCIN; IMMUNITE; OBESITE

Objective: To determine whether there is a difference in antibody titers and functionality after receipt of the influenza vaccine for obese versus nonobese healthcare workers (HCW). Design: Prospective observational study. Setting: Tertiary medical center. Participants: Healthcare workers. Methods: Baseline influenza antibody titers for obese and nonobese HCW were recorded during the hospital's 2011 annual influenza vaccination day and follow-up antibody titers were measured 4 weeks later. Antibodies were measured using the hemagglutination inhibition assay and functionality was measured using the micro-neutralization method. Results: Of 200 initial HCWs, 190 completed the study (97 obese and 93 nonobese). Seroprotection after immunization was not significantly different for nonobese compared with obese HCW for each strain (influenza A [H1N1], 99% and 99%; influenza A [H3N2], 100% and 99%; and influenza B, 67% and 71%, respectively) All geometric mean titers measured by micro-neutralization showed statistically significant increases in activity. In comparison, there was no difference in the 4-fold increase in H1N1 or B titers. There was a significant difference in the 4-fold increase of H3N2 titers between the nonobese and obese HCWs (82/93 [88%] vs 64/97 [66%], P=.003) In an ad hoc analysis we found that obese HCWs had a statistically greater number of 4-fold decreases in titers with H1N1 and H3N2. Conclusions: There was no significant difference in protection from influenza between obese and nonobese HCWs after immunization.

NosoBase ID notice : 394472Immunisation contre la grippe par le vaccin ou politique du masque pour le personnel de santé : strategies pour une mise en place coût-efficace et reductions subséquentes de l’abstentéisme du personnel pour maladie

Van Buynder PG; Konrad S; Kersteins F; Preston E; Brown PD; Keen D; et al. Healthcare worker influenza immunization vaccinate or mask policy: Strategies for cost effective implementation and subsequent reductions in staff absenteeism due to illness. Vaccine 2015/03/24; 33(13): 1625-1628.

Mots-clés : PERSONNEL; GRIPPE; ETAT IMMUNITAIRE; VACCIN; MASQUE; COUT-EFFICACITE; PREVENTION; COHORTE; ETUDE RETROSPECTIVE

Background: A new policy requiring staff in clinical areas to vaccinate or wear a mask was implemented in British Columbia (BC) in the 2012/13 winter. This review assessed the impact of the policy on absenteeism in health care workers.Methods: A retrospective cohort study of full-time HCW that worked prior to and during the 2012/13 influenza season in a health authority in BC. The rate of absenteeism due to all cause illness was compared between vaccinated and unvaccinated staff controlling for behaviors outside influenza season.Results: Of the 10079 HCW, 77% were vaccinated. By comparison to absenteeism rates in the pre-influenza season, unvaccinated staff in winter had twice the increase in absenteeism due to all-cause illness than vaccinated staff.Conclusion: After controlling for baseline differences between those vaccinated and unvaccinated, influenza vaccination was associated with reduced absenteeism, saving the Health Authority substantial money. Having regular staff in attendance increases the quality of care.

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NosoBase ID notice : 393268Utilisation combinée de données détaillées de contacts et de données virologiques pour étudier la transmission de la grippe dans un centre hospitalo-universitaire

Voirin N; Payet C; Barrat A; Cattuto C; Khanafer N; Régis C; et al. Combining high-resolution contact data with virological data to investigate influenza transmission in a tertiary care hospital. Infection control and hospital epidemiology 2015/03; 36(3): 254-260.

Mots-clés : TRANSMISSION; GRIPPE; VIRUS INFLUENZA TYPE A; SUJET CONTACT; PRELEVEMENT; PCR; BIOLOGIE MOLECULAIRE; TYPE DE DONNEE; PERSONNE AGEE; INFIRMIER; MEDECIN; GERIATRIE; CENTRE HOSPITALIER UNIVERSITAIRE; VIRUS INFLUENZA TYPE B

Objective: Contact patterns and microbiological data contribute to a detailed understanding of infectious disease transmission. We explored the automated collection of high-resolution contact data by wearable sensors combined with virological data to investigate influenza transmission among patients and healthcare workers in a geriatric unit. Design: Proof-of-concept observational study. Detailed information on contact patterns were collected by wearable sensors over 12 days. Systematic nasopharyngeal swabs were taken, analyzed for influenza A and B viruses by real-time polymerase chain reaction, and cultured for phylogenetic analysis. Setting: An acute-care geriatric unit in a tertiary care hospital. Participants: Patients, nurses, and medical doctors. Results: A total of 18,765 contacts were recorded among 37 patients, 32 nurses, and 15 medical doctors. Most contacts occurred between nurses or between a nurse and a patient. Fifteen individuals had influenza A (H3N2). Among these, 11 study participants were positive at the beginning of the study or at admission, and 3 patients and 1 nurse acquired laboratory-confirmed influenza during the study. Infectious medical doctors and nurses were identified as potential sources of hospital-acquired influenza (HA-Flu) for patients, and infectious patients were identified as likely sources for nurses. Only 1 potential transmission between nurses was observed. Conclusions: Combining high-resolution contact data and virological data allowed us to identify a potential transmission route in each possible case of HA-Flu. This promising method should be applied for longer periods in larger populations, with more complete use of phylogenetic analyses, for a better understanding of influenza transmission dynamics in a hospital setting.

Hépatite

NosoBase ID notice : 393653Identification, enquête de gestion de la transmission patient-patient d’hépatite B dans un service d’hospitalisation en néphrologie du nord-ouest de l’Angleterre

Kliner M; Dardamissis E; Abraham KA; Sen R; Lal P; Pandya B; et al. Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England. Clinical kidney journal 2015/02; 8(1): 102-106.

Mots-clés : HEPATITE B; TRANSMISSION; TRANSMISSION SOIGNE-SOIGNE; NEPHROLOGIE; ENQUETE; CONTAMINATION; ENVIRONNEMENT; DISPOSITIF MEDICAL; VACCIN

Background: Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward.Methods: The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken.Results: Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission.Conclusions: Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and

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decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.

Hygiène des mains

NosoBase ID notice : 393278Facteurs modifiant l’évaluation des produits de friction hydro-alcoolique dans les essais de terrain

Girard R; Carré E; Mermet V; Adjidé CC; Blaise S; Dagain M; et al. Factors influencing field testing of alcohol-based hand rubs. Infection control and hospital epidemiology 2015/03; 36(3): 302-310.

Mots-clés : HYGIENE DES MAINS; PRODUIT HYDROALCOOLIQUE; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION; PRATIQUE; PERSONNEL; TOLERANCE; PEAU; MAIN

Background: According to the World Health Organization guidelines, field tests, in the context of a bid for the supply of alcohol-based hand rubs, should take into account climatic region, test period, products already in use, and type of use (hygienic or surgical) when assessing tolerance. This laborious method is often contested. Objective: To conduct a post hoc analysis of the data of a large bid, including 5 factors, to validate the relevance of their inclusion. Methods: For the purposes of the bid, products were compared in terms of the 4 World Health Organization tolerance criteria (appearance, intactness, moisture content, sensation) during product testing and were separated into groups on the basis of the studied factors. The post hoc analysis method included (1) comparison of the mean before-and-after difference based on the self-evaluation of the skin with the 4 World Health Organization tolerance criteria, between climatic regions, periods, products in use, test product, and the type of use; (2) generalized linear models, taking into account all studied factors.Results: The analysis included data for 1,925 pairs of professionals. The means of the differences observed were independently and significantly associated with the test period (P<.001), the hygienic or surgical use (P=.010 to .041, not significant for appearance), the product already in use (significant for appearance P=.021), and the test product (P<.001). The association with climatic region was found to be significant only in the nonadjusted analysis. Conclusion: The type of use, the test period, and the product in use should be taken into account when designing field tests of alcohol-based hand rubs.

NosoBase ID notice : 393630Erreurs dans les pratiques de l’hygiène des mains en Ukraine : détection, conséquences et voies d’élimination

Klymenko I; Kampf G. Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and ways of elimination. GMS Hygiene and infection control 2015/01/14; 10: 1-9.

Mots-clés : HYGIENE DES MAINS; PRATIQUE; OBSERVANCE; ATTITUDE; TRAVAIL; PERSONNEL; ETUDE D'OBSERVATION

Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine.Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice.Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various

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hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers.Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training.

Infection fongique

NosoBase ID notice : 393281Les transferts intra-hospitaliers sont des facteurs de risque d’infection fongique filamenteuse invasive pour les patients atteints de cancers hématologiques : une étude cas-témoin appariée

Gayet-Ageron A; Iten A; van Delden C; Farquet N; Masouridi-Levrat S; Von Dach E; et al. In-hospital transfer is a risk factor for invasive filamentous fungal infection among hospitalized patients with hematological malignancies: a matched case-control study. Infection control and hospital epidemiology 2015/03; 36(3): 320-328.

Mots-clés : DEFICIT IMMUNITAIRE; CANCER; HEMATOLOGIE; INFECTION NOSOCOMIALE; MYCOLOGIE; CHAMPIGNON FILAMENTEUX; TRANSFERT; COULOIR; ETUDE RETROSPECTIVE; EPIDEMIE; MORTALITE

Objective: Immunocompromised patients now benefit from a longer life expectancy due to advanced medical techniques, but they are also weakened by aggressive treatment approaches and are at high risk for invasive fungal disease. We determined risk factors associated with an outbreak of invasive filamentous fungal infection (IFFI) among hospitalized hemato-oncological patients. Methods: A retrospective, matched, case-control study was conducted between January 1, 2009, and April 31, 2011, including 29 cases (6 proven, 8 probable, and 15 possible) of IFFI and 102 matched control patients hospitalized during the same time period. Control patients were identified from the hospital electronic database. Conditional logistic regression was performed to identify independent risk factors for IFFI. Results: Overall mortality associated with IFFI was 20.7% (8.0%-39.7%). Myelodysplastic syndrome was associated with a higher risk for IFFI compared to chronic hematological malignancies. After adjustment for major risk factors and confounders, >5 patient transfers outside the protected environment of the hematology ward increased the IFFI risk by 6.1-fold. The risk increased by 6.7-fold when transfers were performed during neutropenia. Conclusion: This IFFI outbreak was characterized by a strong association with exposure to the unprotected environment outside the hematology ward during patient transfer. The independent associations of a high number of transfers with the presence of neutropenia suggest that affected patients were probably not sufficiently protected during transport in the corridors. Our study highlights that a heightened awareness of the need for preventive measures during the entire care process of at-risk patients should be promoted among healthcare workers.

Infection urinaire

NosoBase ID notice : 394206Contrôle des infections urinaires associées au cathétérisme vésical intermittent dans des centres hospitaliers gériatriques

Girard R; Gaujard S; Pergay V; Pornon P; Martin Gaujard G; Vieux C; et al. Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals. The journal of hospital infection 2015/03/05; in press: 1-26.

Mots-clés : INFECTION URINAIRE; GERIATRIE; PERSONNE AGEE; SONDAGE URINAIRE; SONDAGE EVACUATEUR; CONTROLE; EPIDEMIOLOGIE; ETUDE PROSPECTIVE; CATHETER; ETUDE MULTICENTRIQUE; PERSONNEL; INCIDENCE; CONNAISSANCE; PRATIQUE; COHORTE

Background: Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients. Aim: After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures. Methods: In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was

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administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme. Findings: Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P=0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature. Conclusion: Multi-modal programmes are an effective means to control UTI.

Légionellose

NosoBase ID notice : 395009Légionellose en France

Campese C; Descours G; Lepoutre A; Beraud L; Maine C; Che D; et al. Legionnaires’ disease in France. Médecine et maladies infectieuses 2015/03; 45(3): 65-71.

Mots-clés : LEGIONELLA; CONNAISSANCE; EPIDEMIOLOGIE; DIAGNOSTIC BIOLOGIQUE; CONTAMINATION; CONTROLE; PREVENTION

Cet article avait pour objectif d’effectuer une synthèse sur les connaissances actuelles de la légionellose illustrées par le bilan épidémiologique en France en 2013. La légionellose est une pneumopathie souvent sévère due en majorité aux bactéries Legionella pneumophila sérogroupe 1. Le diagnostic repose essentiellement sur la détection de l’antigène dans les urines, méthode permettant d’écourter le délai entre la suspicion clinique et la mise en route d’un traitement adapté. Cependant, la disponibilité d’une souche clinique est primordiale car elle permet d’améliorer les connaissances sur les bactéries, de documenter les cas groupés et de préciser les sources de contamination. Pour la majorité des cas, la source de contamination demeure inconnue. Les principales installations susceptibles d’être à l’origine des cas sont les réseaux d’eaux sanitaires et les tours aéroréfrigérantes. Grâce au renforcement de la surveillance et à la diffusion de nombreuses règlementations visant l’amélioration des mesures de contrôles et de prévention, aucune épidémie n’a été identifiée en France depuis 2006. Malgré ces efforts, le nombre de cas de légionellose ne diminue pas ces dernières années. Pour mieux comprendre la dynamique temporospatiale de la légionellose et l’ensemble des déterminants de la maladie (impact des facteurs environnementaux, caractéristiques des sources d’exposition, des souches et de l’hôte…), il est essentiel que les recherches appliquées se poursuivent. Parallèlement, les connaissances fondamentales ont largement progressé. Ces recherches contribueront à terme à la définition de nouvelles stratégies de diagnostic, de contrôle et de prévention et à faire régresser le nombre de cas de légionellose diagnostiqués chaque année.

NosoBase ID notice : 394473Caractéristiques épidémiologiques associées aux clones ST23 par comparaison à celles des clones STI et ST47 des cas de légionellose en France

Cassier P; Campese C; Le Strat Y; Che D; Ginevra C; Etienne J; et al. Epidemiologic characteristics associated with ST23 clones compared to ST1 and ST47 clones of Legionnaires disease cases in France. New microbes and new infections 2015/01; 3(C): 29-33.

Mots-clés : EPIDEMIOLOGIE; LEGIONELLA; LEGIONELLOSE; TYPAGE; LEGIONELLA PNEUMOPHILA; INCIDENCE; TRAITEMENT; FACTEUR DE RISQUE

In France, approximately 1200 cases of Legionnaires disease (LD) are reported annually, and isolates are available for approximately 20% of cases identified since 2000. All Legionella pneumophila serogroup 1 (sg1) isolates are characterized by sequence-based typing at the National Reference Centre. LD cases caused by L. pneumophila sg1 reported from 2008 through 2012 were considered for the study. Our study objective was to describe cases according to their sequence type (ST). We also constructed multivariable modified Poisson regression models to estimate the incidence rate ratio (IRR) and to identify characteristics potentially associated with ST23 clones compared to ST1 and ST47 clones. We studied 1192 patients infected by ST1

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(n=109), ST23 (n=236), ST47 (n=123) or other STs (n=724). The geographic distribution of the ST23 cases across the country was significantly different compared to other ST groups. This genotype was significantly associated with the absence of corticosteroid therapy compared to ST1 (IRR=0.56; p 0.016). Concerning exposure, the ST23 genotype was significantly less associated with hospital-acquired infections compared to ST1 (IRR=0.32; p 0.001), but it was more associated with infections acquired in hospitals and elderly settings compared with ST47. Finally, the ST23 genotype was less frequently associated with travel than other STs. Despite the large number of cases of ST23 infection, we did not identify any characteristics specific to this ST. However, we identified independent associations between ST1 and nosocomial transmission and steroid therapy. These findings should encourage further exploration, especially in terms of environmental diffusion, strain virulence and host factors.

Néonatologie

NosoBase ID notice : 393275Changement du circuit d’assistance respiratoire une fois par semaine versus tous les deux jours en cas de ventilation assistée prolongée chez le nouveau-né : coût-efficacité et impact sur les pneumonies acquises sous ventilation

Chu SM; Yang MC; Hsiao HF; Hsu JF; Lien R; Chiang MC; et al. One-week versus 2-day ventilator circuit change in neonates with prolonged ventilation: cost-effectiveness and impact on ventilator-associated pneumonia. Infection control and hospital epidemiology 2015/03; 36(3): 287-293.

Mots-clés : PNEUMONIE; SOIN INTENSIF; NEONATOLOGIE; VENTILATION ASSISTEE; CIRCUIT; MATERIEL MEDICO-CHIRURGICAL; INTUBATION; COUT-EFFICACITE; INFECTION NOSOCOMIALE; TAUX; BACTERIEMIE

NosoBase ID notice : 394283Prévention des infections associées aux soins parmi des nouveau-nés : place à l’amélioration

Legeay C; Bourigault C; Lepelletier D; Zahar JR. Prevention of healthcare-associated infections in neonates: room for improvement. The journal of hospital infection 2015/04; 89(4): 319-323.

Mots-clés : PREVENTION; NOUVEAU-NE; CONTROLE; SOIN INTENSIF; EPIDEMIOLOGIE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; PNEUMONIE; CANDIDEMIE; STAPHYLOCOCCUS AUREUS; PEAU; VIRUS; SURFACE; INCUBATEUR; ENTEROCOLITE; INFECTION ASSOCIEE AUX SOINS; JOUET

Infants in neonatal intensive care units (NICUs) are highly susceptible to infection due to the immaturity of their immune systems. Healthcare-associated infections (HCAIs) are associated with prolonged hospital stay, and represent a significant risk factor for neurological development problems and death. Improving HCAI control is a priority for NICUs. Many factors contribute to the occurrence of HCAIs in neonates such as poor hand hygiene, low nurse-infant ratios, environmental contamination and unnecessary use of antibiotics. Prevention is based on improving neonatal management, avoiding unnecessary use of central venous catheters, restricting use of antibiotics and H2 blockers, and introducing antifungal prophylaxis if necessary. Quality improvement interventions to reduce HCAIs in neonates seem to be the cornerstone of infection control.

Norovirus

NosoBase ID notice : 394285Poids des norovirus dans les établissements de santé et stratégies pour le contrôle des épidémies

Kambhampati A; Koopmans M; Lopman BA. Burden of norovirus in healthcare facilities and strategies for outbreak control. The journal of hospital infection 2015/04; 89(4): 296-301.

Mots-clés : VIRUS; NOROVIRUS; EPIDEMIE; CONTROLE; GASTRO-ENTERITE; TRANSMISSION; COUT; TRAITEMENT; VACCIN

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Norovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term care facilities and acute care hospitals. Whereas norovirus gastroenteritis is typically mild and resolves without medical attention, healthcare-associated infections often affect vulnerable populations, resulting in severe infections and disruption of healthcare services. Globally, most norovirus outbreaks in hospitals and residential care institutions are associated with genogroup II type 4 (GII.4) strains. Recent data demonstrate that excess mortality occurs during outbreak periods in healthcare facilities. Nosocomial outbreaks can result in large economic and societal costs. Current control measures for norovirus are largely based on general infection control principles, and treatment is mainly supportive and non-specific. While neither vaccines nor antiviral agents are currently available, both are being developed with encouraging results.

Personnel

NosoBase ID notice : 392903Les bonnes pratiques aides-soignantes dans le cadre des infections nosocomiales

Beuzit L; Randriamalala MJ. Les bonnes pratiques aides-soignantes dans le cadre des infections nosocomiales. Soins aides soignantes 2015/01; 62: 24-25.

Mots-clés : INFECTION NOSOCOMIALE; PREVENTION; AIDE-SOIGNANT; HYGIENE; GANT; TRANSMISSION; EXOGENE; ENDOGENE; HYGIENE DES MAINS; MASQUE; TENUE VESTIMENTAIRE

Les infections nosocomiales sont aujourd’hui reconnues comme des problèmes majeurs en santé publique de par leur fréquence, leur gravité et leur coût. L’aide-soignante, amenée quotidiennement à effectuer de nombreux soins de nursing auprès du patient, joue un role majeur de prévention.

NosoBase ID notice : 393283Protéger le personnel en première ligne : concevoir une plateforme de prévention du risque infectieux pour protéger le personnel soignant des infections respiratoires à virus émergent

Branch-Elliman W; Savor Price C; McGeer A; Perl TM. Protecting the frontline: designing an infection prevention platform for preventing emerging respiratory viral illnesses in healthcare personnel . Infection control and hospital epidemiology 2015/03; 36(3): 336-345.

Mots-clés : PERSONNEL; APPAREIL RESPIRATOIRE; FORMATION; VIRUS; GRIPPE; HYGIENE HOSPITALIERE; PRECAUTION COMPLEMENTAIRE; MERS-CoV; SARS-CoV

Healthcare personnel often find themselves on the frontlines of any epidemic, and may be at particularly high risk of acquiring respiratory viral illnesses when compared to the general population. Many aspects dictate how respiratory viruses spread both inside the hospital and out: Elements to consider include the specific type of virus being targeted for prevention, as well as environmental conditions and host factors, such as age and immune status. Due to the diverse nature of these agents, multiple modes of transmission, including contact, droplet, aerosol, and transocular, must be considered when designing an effective infection prevention program. In this review, we examine the data behind current theories of respiratory virus transmission and key elements of any respiratory illness prevention program. We also highlight other influences that may come into play, such as the cost-effectiveness of choosing one respiratory protection strategy over another.

NosoBase ID notice : 394300Harmoniser et soutenir la formation en hygiène hospitalière en Europe

Brusaferro S; Arnoldo L; Cattani G; Fabbro E; Cookson B; Gallagher R; et al. Harmonizing and supporting infection control training in Europe. The journal of hospital infection 2015/04; 89(4): 351-356.

Mots-clés : FORMATION; PERSONNEL; SECURITE SANITAIRE; PREVENTION; EOH; INFIRMIER HYGIENISTE; QUESTIONNAIRE; ECDC

Healthcare-associated infection (HCAI), patient safety, and the harmonization of related policies and programmes are the focus of increasing attention and activity in Europe. Infection control training for healthcare workers (HCWs) is a cornerstone of all patient safety and HCAI prevention and control

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programmes. In 2009 the European Centre for Disease Prevention and Control (ECDC) commissioned an assessment of needs for training in infection control in Europe (TRICE), which showed a substantial increase in commitment to HCAI prevention. On the other hand, it also identified obstacles to the harmonization and promotion of training in infection control and hospital hygiene (IC/HH), mostly due to differences between countries in: (i) the required qualifications of HCWs, particularly nurses; (ii) the available resources; and (iii) the sustainability of IC/HH programmes. In 2013, ECDC published core competencies for infection control and hospital hygiene professionals in the European Union and a new project was launched ['Implementation of a training strategy for infection control in the European Union' (TRICE-IS)] that aimed to: define an agreed methodology and standards for the evaluation of IC/HH courses and training programmes; develop a flexible IC/HH taxonomy; and implement an easily accessible web tool in 'Wiki' format for IC/HH professionals. This paper reviews several aspects of the TRICE and the TRICE-IS projects.

NosoBase ID notice : 395263Evaluation du risque pour les personnels de santé après un cas de rage et revue de la littérature

Kan VL; Joyce P; Benator D; Agnes K; Gill J; Irmler M; et al. Risk assessment for healthcare workers after a sentinel case of rabies and review of the literature. Clinical infectious diseases 2015/02/01; 60(3): 341-348.

Mots-clés : ANALYSE DES RISQUES; RAGE; INVESTIGATION; PERSONNEL; REVUE DE LA LITTERATURE; TRAITEMENT

After a case of rabies, healthcare workers (HCWs) had fear of contagion from the infected patient. Although transmission of rabies to HCWs has never been documented, high-risk exposures theoretically include direct contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, cerebrospinal fluid, and neural tissue. Urine/kidney exposure posed a concern, as our patient's renal transplant was identified as the infection source.Methods: Our risk assessment included (1) identification of exposed HCWs; (2) notification of HCWs; (3) risk assessment using a tool from the local health department; (4) supplemental screening for urine/kidney exposure; and (5) postexposure prophylaxis (PEP) when indicated.Results: A total of 222 HCWs including diverse hospital staff and medical trainees from university affiliates were evaluated. Risk screening was initiated within 2 hours of rabies confirmation, and 95% of HCWs were assessed within the first 8 days. There were 8 high-risk exposures related to broken skin contact or mucosal splash with the patient's secretions, and 1 person without high-risk contact sought and received PEP outside our hospital. Nine HCWs (4%) received PEP with good tolerance. Due to fear of rabies transmission, additional HCWs without direct patient contact required counseling. There have been no secondary cases after our sentinel rabies patient.Conclusions: Rabies exposure represents a major concern for HCWs and requires rapid, comprehensive risk screening and counseling of staff and timely PEP. Given the lack of human-to-human rabies transmission from our own experience and the literature, a conservative approach seems appropriate for providing PEP to HCWs.

NosoBase ID notice : 394218Vers un changement de comportement du personnel de santé : étude qualitative explorant la non-observance à travers l’évaluation des pratiques de contrôle et de prévention du risque infectieux

Shah N; Castro-Sánchez E; Charani E; Drumright LN; Holmes AH. Towards changing healthcare workers’ behaviour: a qualitative study exploring noncompliance through appraisals of infection prevention and control practices. The journal of hospital infection 2015/02/26; in press: 1-26.

Mots-clés : TRAVAIL; ATTITUDE; PERSONNEL; OBSERVANCE; PREVENTION; RISQUE; PRATIQUE; PROTOCOLE; ETUDE MULTICENTRIQUE; QUESTIONNAIRE; ANTIBIOTIQUE; PRESCRIPTION

Background: Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers’ (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. Aim: To identify behaviours of HCWs that facilitated non-compliance of IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices.

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Methods: Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. Findings: Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. Conclusions: Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation.

Pneumonie

NosoBase ID notice : 393647Prophylaxie par des probiotiques pour la prévention des pneumonies acquises sous ventilation (VAP) parmi des enfants sous ventilation assistée : essai ouvert contrôlé randomisé

Banupriya B; Biswal N; Srinivasaraghavan R; Narayanan P; Mandal J. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive care medicine 2015/02/24; in press: 9 pages.

Mots-clés : PNEUMONIE; PREVENTION; VENTILATION ASSISTEE; PEDIATRIE; RANDOMISATION; SOIN INTENSIF; INCIDENCE; PROBIOTIQUE

Purpose: Ventilator associated pneumonia (VAP) is one of the most common nosocomial infections in the pediatric intensive care unit (PICU). It is associated with increased mortality and prolonged hospital stay. Several preventive strategies have been introduced to reduce VAP. One novel intervention is prophylactic administration of probiotics. Studies on the effect of probiotics on VAP in pediatric populations are lacking.Methods: This was an open-label randomized controlled trial. A total of 150 children no older than 12 years admitted to the PICU were recruited from November 2011 to July 2013. Children who were likely to require ventilation for more than 48 h were eligible for inclusion in the study. Patients were randomized into two groups after stratification based on age groups. Children in the intervention group received probiotic preparation twice a day beginning from the day of ICU admission till 7 days or discharge from ICU, whichever was earlier. The control group did not receive any placebo. Children were examined daily for evidence of VAP and were followed up till discharge from hospital. Incidence of VAP, duration of hospital stay, and mortality were compared.Results: Children who received prophylactic probiotics had a lower incidence of VAP compared to the control group (17.1% in the probiotics group vs 48.6% in the control group, p<0.001; 22 per 1,000 ventilated days vs 39 per 1,000 ventilated days, p=0.02). On multiple logistic regression analysis, use of prophylactic probiotics decreased the incidence of VAP by 77% and reduced the duration of ICU and hospital stays by an average of 2.1 and 3.3 days, respectively, after adjusting for the other confounders. No complications due to administration of probiotics were observed in the study.Conclusion: Prophylactic probiotics administration resulted in reduction of the incidence of VAP in critically ill children in a setting where baseline VAP rates are high. The intervention was found to be safe.

Prévention

NosoBase ID notice : 393685Recommandations de l’OMS sur l’usage de seringues de sécurité pour des injections intramusculaires, intradermiques et sous-cutanées dans des établissements de soins

Organisation mondiale de la santé (OMS). WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health-care settings. OMS 2015/02/23: 1-31.

Mots-clés : ORGANISATION MONDIALE DE LA SANTE; RECOMMANDATIONS DE BONNE PRATIQUE; MATERIEL DE SECURITE; INJECTION; VOIE INTRADERMIQUE; VOIE INTRAMUSCULAIRE; VOIE SOUS-CUTANEE; REUTILISABLE; ACCIDENT D'EXPOSITION AU SANG; DECHET; SECURITE SANITAIRE; DISPOSITIF MEDICAL; QUALITE; PREUVE; NIVEAU DE PREUVE

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NosoBase ID notice : 394771Comment les pathogènes bactériens colonisent leurs hôtes et envahissent les tissus profonds

Ribet D; Cossart P. How bacterial pathogens colonize their hosts and invade deeper tissues. Microbes and infection 2015/03; 17(3): 173-183.

Mots-clés : COLONISATION; BACTERIE; HELICOBACTER PYLORI; ESCHERICHIA COLI; LEGIONELLA; MYCOBACTERIUM TUBERCULOSIS; SALMONELLA; REVUE DE LA LITTERATURE; MICROBIOTE

Bacterial pathogens have evolved a wide range of strategies to colonize and invade human organs, despite the presence of multiple host defense mechanisms. In this review, we will describe how pathogenic bacteria can adhere and multiply at the surface of host cells, how some bacteria can enter and proliferate inside these cells, and finally how pathogens may cross epithelial or endothelial host barriers and get access to internal tissues, leading to severe diseases in humans.

NosoBase ID notice : 393854Organisation hospitalière, management, et structuration pour la prévention des infections associées aux soins : revue systématique et consensus d'expert

Zingg W; Holmes A; Dettenkofer M; Goetting T; Secci F; Clack L; et al. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet infectious diseases 2015/02; 15(2): 212-224.

Mots-clés : PREVENTION; REVUE DE LA LITTERATURE; ORGANISATION; INDICATEUR; CHARGE DE TRAVAIL; EFFECTIF

Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37 000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.

Pseudomonas aeruginosa

NosoBase ID notice : 393279Robinets électroniques et qualité de l’eau, leur impact sur la présence de Pseudomonas aeruginosa dans les circuits d’eau : une étude sur plusieurs hôpitaux

Charron D; Bédard E; Lalancette C; Laferrière C; Prévost M. Impact of electronic faucets and water quality on the occurrence of Pseudomonas aeruginosa in water: a multi-hospital study. Infection control and hospital epidemiology 2015/03; 36(3): 311-319.

Mots-clés : PSEUDOMONAS AERUGINOSA; EAU; ROBINET D'EAU; QUALITE; CONTAMINATION; PREVALENCE; PRELEVEMENT

Objective To compare Pseudomonas aeruginosa prevalence in electronic and manual faucets and assess the influence of connecting pipes and water quality. Setting Faucets in 4 healthcare centers in Quebec, Canada. Methods Water samples from 105 electronic, 90 manual, and 14 foot-operated faucets were analyzed for P. aeruginosa by culture and enzymatic detection, and swab samples from drains and aerators were analyzed by culture. Copper and residual chlorine concentrations, temperature, and flow rate were measured. P. aeruginosa concentrations were analyzed in 4 consecutive volumes of cold water and a laboratory study was conducted on copper pipes and flexible hoses. Results P. aeruginosa contamination was found in drains more frequently (51%) than in aerators (1%) or water (culture: 4%, enzyme detection: 16%). Prevalence in water samples was comparable between manual

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(14%) and 2 types of electronic faucets (16%) while higher for foot-operated faucets (29%). However, type 2 electronic faucets were more often contaminated (31%) than type 1 (14%), suggesting that faucet architecture and mitigated volume (30 mL vs 10 mL) influence P. aeruginosa growth. Concentrations were 100 times higher in the first 250 mL than after flushing. Flexible hoses were more favorable to P. aeruginosa growth than copper and a temperature of 40°C led to higher counts.Conclusions The types of faucets and connecting pipes, flow rate, and water quality are important parameters influencing the prevalence and the concentrations of P. aeruginosa in faucets. High concentrations of P. aeruginosa in the first 250 mL suggest increased risk of exposure when using the first flush.

Réglementation

NosoBase ID notice : 395089Instruction DGOS/PF2/DGS/PP2 n° 2015-85 du 20 mars 2015 relative à la gestion des risques liée à l'activité de nutrition parentérale en réanimation néonatale, en néonatologie et en pédiatrie par la mise en place de bonnes pratiques organisationnelles

Ministère des affaires sociales, de la santé et des droits des femmes. Instruction DGOS/PF2/DGS/PP2 n° 2015-85 du 20 mars 2015 relative à la gestion des risques liée à l'activité de nutrition parentérale en réanimation néonatale, en néonatologie et en pédiatrie par la mise en place de bonnes pratiques organisationnelles. Non parue au journal officiel: 11 pages.

Mots-clés : ALIMENTATION PARENTERALE; ASSISTANCE NUTRITIONNELLE; GESTION DES RISQUES; SECURITE SANITAIRE; RECOMMANDATIONS DE BONNE PRATIQUE; NEONATOLOGIE; PEDIATRIE

La présente instruction a pour objectif de rappeler les risques liés à l’activité de nutrition parentérale et à l’obligation d’une mise en place d’une gestion des risques liée à cette activité. Cette instruction demande aux agences régionales de santé d’effectuer un diagnostic de territoire de cette activité.

Staphylococcus aureus

NosoBase ID notice : 393637Prévalence, facteurs prédictifs et évolution d’infections à Staphylococcus aureus méticillino-résistante parmi des patients bénéficiant de procédures chirurgicales majeures aux Etats-Unis : étude de population

Allareddy V; Das A; Lee MK; Nalliah RP; Rampa S; Allareddy V; et al. Prevalence, predictors, and outcomes of methicillin-resistant Staphylococcus aureus infections in patients undergoing major surgical procedures in the United States: a population-based study. The American journal of surgery 2015/01/29; in press: 1-9.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PREVALENCE; CHIRURGIE; FACTEUR DE RISQUE; DUREE DE SEJOUR; MORTALITE; PRONOSTIC; ETUDE RETROSPECTIVE

Background: National estimates of methicillin-resistant Staphylococcus aureus (MRSA) infection rates in hospitalized surgical patients and outcomes are lacking. We sought to estimate the prevalence, identify the predictors, and describe the outcomes of MRSA infections in hospitalized patients undergoing major surgical procedures (MSPs) in the United States.Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample, the largest all-payer hospital discharge database in the United States, for the years 2009 to 2010.Results: Of the 22,932,948 hospitalizations that had an MSP, MRSA infection occurred in 235,636 (1.03%) patients. Factors associated with "significantly" lower risk of MRSA occurrence include women (odds ratio [OR] .68), elective procedure (OR .38), teaching institutes (OR .94), and large hospital size (OR .87). Blacks (OR 1.19), native Americans (OR 1.27), increased comorbid burden (OR 1.38), and uninsured patients were associated with higher risk of MRSA occurrence. Outcomes in MSPs "with" MRSA versus "without" MRSA include mean length of stay (14 vs 5 days) and in-hospital mortality (IHM) rate (3.7% vs 1.2%). Occurrence of an MRSA was associated with significantly longer length of stay and higher odds of IHM (OR 1.39, 95% confidence interval 1.30 to 1.48).Conclusions: Although the occurrence of MRSA infections complicating MSPs was low, it is associated with worse outcomes. Certain predictors of MRSA infection are identified.

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NosoBase ID notice : 394241Dépistage de Staphylococcus aureus méticillino-résistant dans une cohort de patients hémodialysés : colonisation, caractéristiques démographiques et évolution

Price A; Sarween N; Gupta I; Baharani J. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and outcomes. The journal of hospital infection 2015/01/13; in press: 1-6.

Mots-clés : STAPHYLOCOCCUS AUREUS; DEPISTAGE; COHORTE; HEMODIALYSE; COLONISATION; PREVALENCE; DISPOSITIF MEDICAL; MORTALITE; ERADICATION; CHLORHEXIDINE; MUPIROCINE

Background: Patients on haemodialysis are vulnerable to colonization with Staphylococcus aureus due to frequent hospital contact, indwelling devices, and impaired immunity. Additionally colonization is associated with increased risk of infection.Aim: To determine the prevalence of both meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA) carriage in our haemodialysis cohort and to identify any risk factors predisposing to carriage, recolonization, or persistent carriage following a decolonization programme.Methods: All haemodialysis patients screened for S. aureus carriage between June 2009 and May 2011 were retrospectively followed up for 18 months using hospital electronic records. Statistical analysis was performed using IBM SPSS version 19.Findings: Out of 578 patients screened, 288 patients (49%) had at least one positive swab (10% MRSA, 90% MSSA). Of these patients, 265 completed a course of decolonization therapy following which 36% successfully eradicated (eradicators) and 64% did not (non-eradicators). There was no statistically significant difference in patient demography, type of vascular access, 18-month patient mortality, or number of hospital admissions between the two groups. Those who failed to eradicate were more likely to have had an episode of S. aureus bacteraemia within the study period compared to those who successfully decolonized (P=0.003).Conclusion: Half of our haemodialysis cohort was colonized with S. aureus at any one time over an 18-month period. Following decolonization, one-third of patients remained successfully eradicated for 18 months. Non-eradicators have an increased risk of bacteraemia, which is associated with poor mortality. We would recommend routine screening and aggressive attempts to decolonize.

NosoBase ID notice : 393745Caractéristiques moléculaires et cliniques de souches de Staphylococcus aureus méticillino-résistant d’apparition communautaire ou hospitalière associée à des bactériémies

Wang SH; Hines L; van Balen J; Mediavilla JR; Pan X; Hoet A; et al. Molecular and clinical characteristics of hospital and community onset methicillin-resistant Staphylococcus aureus strains associated with blood stream infections. Journal of clinical microbiology 2015/03/04; in press: 27 pages.

Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERIEMIE; BIOLOGIE MOLECULAIRE; TYPAGE; PCR; PFGE; FACTEUR DE RISQUE;SARM

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are classified epidemiologically as healthcare-associated hospital-onset (HAHO), healthcare-associated community-onset (HACO), or community-associated (CA)-MRSA. Clinical and molecular differences between HAHO- and HACO-MRSA BSI are not well known. Thus, we evaluated clinical and molecular characteristics of MRSA BSI to determine if distinct features are associated with HAHO- or HACO-MRSA strains. Molecular genotyping and medical record review were conducted on 282 MRSA BSI isolates from 1/2007 to 12/2009. MRSA classifications were 37.6% HAHO-, 54.3% HACO-, and 8% CA-MRSA. Comparing patients with HAHO- to HACO-MRSA, HAHO-MRSA patients had significantly higher rates of malignancy, surgery, recent invasive devices, longer hospital stays and mortality. In comparison, patients with HACO-MRSA were more likely to have history of renal failure, hemodialysis, residence in a long term care facility, long term invasive devices, and higher rate of MRSA relapse. Distinct MRSA molecular strain differences were also seen between HAHO-MRSA (60% SCCmec II, 30% SCCmec III, and 9% SCCmec IV) and HACO-MRSA (47% SCCmec II, 35% SCCmec III, and 16% SCCmec IV) (p<0.001). In summary, our study reveals significant clinical and molecular differences between patients with HAHO- and HACO-MRSA BSI. In order to decrease rates of MRSA infection, preventive efforts needs to be directed toward patients in the community with healthcare associated risk factors in addition to inpatient infection control.

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Stérilisation

NosoBase ID notice : 391913Stérilisation des instruments médicaux : l'employeur est responsable

Fantoni-Quinton S. Stérilisation des instruments médicaux : l'employeur est responsable. Concours médical 2015/01; 137(1): 62-63.

Mots-clés : STERILISATION; INSTRUMENT; RESPONSABILITE; LEGISLATION; DISPOSITIF MEDICAL

Dans un cabinet médical de gynécologie, une salariée – agent d’entretien – a la charge du lavage et de la stérilisation des instruments médicaux. Cette salariée me fait part de son inquiétude quant à sa responsabilité sur la qualité de la stérilisation et quant à sa propre sécurité, car elle n’a pas reçu de formation de qualité pour ces fonctions. Elle a été sommairement renseignée sur les gestes à faire par la salariée (de même niveau professionnel) précédente. Existe-t-il une formation à ces tâches ? Sans cette formation, sa responsabilité peut-elle être engagée ou plutôt celle de son employeur (médecin gynécologue) ?

NosoBase ID notice : 394308Etude de cas sur l’oritentation des pièces à main de phacoémulsification durant les process de stérilisation à la vapeur

van Doornmalen Gomez Hoyos JP; van Wezel RA; van Doornmalen HW. Case study on the orientation of phaco hand pieces during steam sterilization processes. The journal of hospital infection 12015/02/10; in press: 1-7.

Mots-clés : STERILISATION; QUALITE; VAPEUR; CHIRURGIE OPHTALMOLOGIQUE; PRATIQUE

Background: Steam sterilization is an essential part of infection prevention. The literature shows that sterilization of medical instruments containing channels is not trivial. Phaco hand pieces have a simple configuration: a device contains a channel with a constant radius. No literature was found indicating whether the sterilization conditions on the inner surface of a phaco hand piece are influenced by the orientation of the hand piece.Aim: To determine whether the orientation of a phaco hand piece influences the results of a sterilization process of this device.Methods: A qualitative case study, including experiments, is performed with a protocolled combination of steam sterilizer, process, phaco hand piece, orientation of the phaco hand piece, and wrapping.Findings: In this specific case, the orientation of the hand piece influenced the result of the steam sterilization process; in vertically (upright) oriented phaco hand pieces with free water drainage, sterilization conditions are reproducibly established. In the same process, in horizontally oriented or vertically oriented hand pieces without free drainage, these conditions are not established in a reproducible way.Conclusion: In the investigated combination of sterilizer, process, load, loading pattern and wrapping, phaco hand pieces have to be oriented vertically (upright) with free water drainage to obtain steam sterilization conditions on the inner surface. It is likely that instruments with comparable configuration and dimensions will yield comparable results. It is therefore recommended that this issue is considered during the development of medical instruments and during performance qualifications of such instruments.

Surveillance

NosoBase ID notice : 394307Incidence des infections associées aux soins dans un centre hospitalier universitaire : résultats issus d’une période de surveillance électronique de trois années

Puhto T; Syrjälä H. Incidence of healthcare-associated infections in a tertiary care hospital: results from a three-year period of electronic surveillance. The journal of hospital infection 2015/01/26; in press: 1-6.

Mots-clés : INCIDENCE; CENTRE HOSPITALIER UNIVERSITAIRE; SURVEILLANCE; INFORMATIQUE; ANTIBIOTIQUE; TRAITEMENT; CHIRURGIE CARDIO-VASCULAIRE; CHIRURGIE ORTHOPEDIQUE; COHORTE; STATISTIQUE; INFECTION ASSOCIEE AUX SOINS; SENSIBILITE STATISTIQUE

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Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for influenza can be of real value; they enable early introduction of measures to prevent spread and early specific antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment, especially of very young children or immunocompromised patients. In the latter, the shedding of resistant influenza virus can last several weeks. Sporadic instances of nosocomial transmission among immunocompromised patients have been reported. The limitations of bedside tests for influenza make them unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and cost-effective. Recent developments in these tests look promising, offering prospects of increased sensitivity, increased specificity, and screening for antiviral susceptibility.

Tuberculose

NosoBase ID notice : 393642Tuberculose latente dans une vaste cohorte d’étudiants en médecine dans un centre hospitalier universitaire en Italie

Durando P; Alicino C; Orsi A; Barberis I; Paganino C; Dini G; et al. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. BioMed research international 2015; 2015: 1-6.

Mots-clés : TUBERCULOSE; COHORTE; ETUDIANT; MEDECIN; PREVALENCE; FACTEUR DE RISQUE; TEST TUBERCULINIQUE; ANALYSE MULTIVARIEE; MYCOBACTERIUM TUBERCULOSIS; DEPISTAGE

The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.

Vaccination

NosoBase ID notice : 395242Calendrier des vaccinations et recommandations vaccinales 2015. Protégeons-nous, vaccinons-nous

Ministère des affaires sociales et de la santé. Calendrier des vaccinations et recommandations vaccinales 2015. Protégeons-nous, vaccinons-nous. Ministère des affaires sociales et de la santé 2015/03: 1-50.

Mots-clés : VACCINATION; PREVENTION; BORDETELLA PERTUSSIS; GRIPPE; TETANOS; BCG; HEPATITE A; HEPATITE B; PAPILLOMAVIRUS; NEISSERIA MENINGITIDIS; RAGE; ROUGEOLE; OREILLONS; RUBEOLE; TUBERCULOSE; TYPHOIDE; VARICELLE; ADULTE; ENFANT; PERSONNEL

La politique de vaccination est élaborée par le ministre chargé de la santé qui fixe les conditions d’immunisation, énonce les recommandations nécessaires et rend public le calendrier des vaccinations après avis du Haut conseil de la santé publique (HCSP).Le calendrier vaccinal fixe les vaccinations applicables aux personnes résidant en France en fonction de leur âge, émet les recommandations vaccinales générales et des recommandations vaccinales particulières propres à des conditions spéciales (risques accrus de complications, d’exposition ou de transmission) ou à des expositions professionnelles.

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Le calendrier 2015 ne comporte pas de nouvelle recommandation en population générale mais seulement des modifications mineures par rapport à l’an dernier.Après avis du Haut conseil de la santé publique, les principales nouveautés concernent l’actualisation des conduites à tenir devant :- un ou plusieurs cas d’infection invasive à méningocoque ;- un ou plusieurs cas de coqueluche.

Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de votre inter-région :

CCLIN EstTél : 03.83.15.34.73 Fax : [email protected]

CCLIN OuestTél : 02.99.87.35.31Fax : [email protected]

CCLIN Paris-NordTél : 01.40.27.42.00 Fax : [email protected]

CCLIN Sud-EstTél : 04.78.86.49.50Fax : [email protected]

CCLIN Sud-OuestTél : 05.56.79.60.58Fax : [email protected]

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