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NosoVeille – Bulletin de veille
Juin 2016
NosoVeille n°6
Juin 2016
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://www.cclin-arlin.fr/nosobase
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Sommaire de ce numéro :
Antibiotique / antibiorésistance
Bactériémie
Cathétérisme
Chirurgie
Clostridium difficile
Coût
Désinfection
EHPAD
Endoscopie
Environnement
Epidémie
Hépatite C
Hygiène des mains
Infection urinaire
Maternité
Néonatologie
Odontologie
Pédiatrie
Personnel
Prévention
Réglementation
Responsabilité
Soin intensif
Staphylococcus aureus
Stérilisation
Surveillance
Vaccination
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NosoVeille – Bulletin de veille
Juin 2016
Antibiotique / Antibiorésistance
NosoBase ID notice : 414646
Recommandations du bon usage des antibiotiques : améliorer les pratiques médicales et non
assujettir les infectiologues
Roger PM; Leroy J; Garrait V; Guery B. Recommandations du bon usage des antibiotiques : améliorer les
pratiques médicales et non assujettir les infectiologues. Médecine et maladies infectieuses 2016/05; 46(3):
343
Mots-clés :
PRESCRIPTION;
ANTIBIOTIQUE;
PRATIQUE;
RECOMMANDATIONS DE BONNE PRATIQUE; TABLEAU DE BORD
MEDECIN
SPECIALISTE;
NosoBase ID notice : 414858
Mise en place d'un programme de bon usage des antibiotiques : recommandations de l'Infectious
Disease Society of America et de la Society for Healthcare Epidemiology of America
Barlam TF; Cosgrove SE; Abbo LM; MacDougall C; Schuetz AN; Septimus E; et al. Implementing an
Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for
Healthcare Epidemiology of America. Clinical infectious diseases 2016/05/15; 62(10): e51-e77.
Mots-clés : RECOMMANDATIONS DE BONNE PRATIQUE; ANTIBIOTHERAPIE; ANTIBIORESISTANCE;
PREVENTION
Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in
inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the
Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel
included clinicians and investigators representing internal medicine, emergency medicine, microbiology,
critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These
recommendations address the best approaches for antibiotic stewardship programs to influence the optimal
use of antibiotics.
NosoBase ID notice : 413125
Usage des antibiotiques et opportunités de mise en place d’un programme de gestion des
antibiotiques chez des patients souffrant d’une infection respiratoire à virus grippal
Ghazi IM; Nicolau DP; Nailor MD; Aslanzadeh J; Ross JW; Kuti JL. Antibiotic utilization and opportunities for
stewardship among hospitalized patients with influenza respiratory tract infection. Infection control and
hospital epidemiology 2016/05; 37(5): 583-589.
Mots-clés : GRIPPE; INFECTION RESPIRATOIRE BASSE; VIRUS INFLUENZA TYPE A; ANTIBIOTIQUE;
ADMISSION; DUREE DE SEJOUR; COUT
Objective: Hospitalized influenza patients are often treated with antibiotics empirically while awaiting final
diagnosis. The goal of this study was to describe the inappropriate continuation of antibiotics for influenza
respiratory tract infections (RTIs).
Design: We retrospectively studied adults admitted to our institution over 2 respiratory flu seasons with
positive influenza RTIs. Inappropriate antibiotic duration (IAD) was defined as antibiotic use for >24 hours
after a positive influenza test in patients presenting with <72 hours of RTI symptoms and with no other
indications of bacterial infection.
Results: During the study period, 322 patients included in this study were admitted for influenza RTI.
Respiratory cultures were ordered for 50 of these patients (15.5%) and 71 patients (22%) had a positive chest
x-ray, but antibiotics were prescribed to 211 patients (65.5%) on admission. Antibiotics were inappropriately
continued in 73 patients (34.5%). Patients receiving IAD had a longer length of stay (LOS) (median, 6 days;
range, 4-9 days) compared with those whose antibiotics were discontinued appropriately (median, 5 days;
range, 3-8 days) and those who were not treated with antibiotics (median, 4 days; range, 3-6 days; P<.001).
However, mortality was similar among these 3 groups: 3 patients (4.1%) from the IAD cohort died; 6 patients
(4.3%) from the group with an appropriate antibiotic duration died; and 2 patients [1.8%] from the group given
no antibiotics died (P=.510). The 30-day readmission rates were similar as well: 9 patients (12.3%) from the
IAD group were readmitted within 30 days; 21 patients (15.2%) from the group with appropriate antibiotic
duration were readmitted; and 11 patients (9.9%) from the group given no antibiotics were readmitted
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NosoVeille – Bulletin de veille
Juin 2016
(P=.455). Total hospital costs were greater in patients treated with IAD ($10,645; range, $6,485-$18,035)
compared with the group treated with appropriate antibiotic duration ($7,479; range, $4,866-$12,922) and the
group given no antibiotics $5,961 (range, $4,711-$9,575). Thus, the hospital experienced a median loss in
net hospital revenue of $2,076 per IAD patient compared with a patient for which antibiotic duration was
appropriate.
Conclusion: The majority of patients with influenza RTI received antibiotics on admission, and 34.5% were
inappropriately continued on antibiotics without evidence of bacterial infection, which led to increased LOS,
loss of net revenue, and no improvement in outcome. Thus, stewardship initiatives aimed at this population
are warranted.
NosoBase ID notice : 413124
Utiliser un modèle des croyances en santé (Health Belief Model) pour étudier la perception des
patients sur la gestion des antibiotiques dans un établissement de court séjour
Heid C; Knobloch MJ; Schulz LT; Safdar N. Use of the health belief model to study patient perceptions of
antimicrobial stewardship in the acute care setting. Infection control and hospital epidemiology 2016/05;
37(5): 576-582.
Mots-clés : ANTIBIOTIQUE; PERCEPTION; USAGER DE LA SANTE; ANTIBIORESISTANCE; INTERVIEW
Objective: To identify themes associated with patient perceptions of antibiotic use and the role of patients in
inpatient antimicrobial stewardship.
Design: We conducted semi-structured interviews with 30 hospitalized patients using the Health Belief Model
as the framework for questions and analysis.
Setting: An academic tertiary care hospital in Madison, Wisconsin.
Participants: A total of 30 general medicine inpatients receiving at least 1 anti-infective medication were
interviewed.
Results: Participants recognized antibiotic resistance as a serious public health threat but expressed low
perceived susceptibility to being personally affected by antibiotic resistance. Views of susceptibility were
influenced by a high degree of trust in physicians and misperceptions regarding the mechanisms underlying
resistance. Participants expressed high self-efficacy and a desire to be involved in their health care.
Perceived roles for patients in preventing the inappropriate use of antibiotics ranged from asking questions
and speaking up about concerns to active involvement in decision making regarding antibiotic treatments.
Few participants reported being offered the opportunity to engage in such shared decision making while
hospitalized.
Conclusions: Our findings suggest an important role for patients in improving antibiotic use in hospitals.
However, patient engagement has not been recognized as a critical component of antimicrobial stewardship
programs. Our study suggests that the likelihood of patient engagement in stewardship practices is currently
limited by low perceived susceptibility and lack of cues to act. Further investigation into how patients may be
engaged as good stewards of antibiotics may reveal new ways to improve antibiotic prescribing practices in
the inpatient setting.
NosoBase ID notice : 412986
Coût-efficacité du dépistage obligatoire national de Staphylococcus aureus résistant à la méticilline
pour toutes les admissions dans les hôpitaux anglais du National Health Services : étude par un
modèle mathématique
Robotham JV; Deeny SR; Fuller C; Hopkins S; Cookson B; Stone S. Cost-effectiveness of national
mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant
Staphylococcus aureus: a mathematical modelling study. Lancet infectious diseases 2016/03; 16(3): 348-356.
Mots-clés : ANTIBIORESISTANCE;
EFFICACITE
STAPHYLOCOCCUS
AUREUS;
SARM;
DEPISTAGE;
COUT-
Background: In December, 2010, National Health Service (NHS) England introduced national mandatory
screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). We aimed to assess the
effectiveness and cost-effectiveness of this policy, from a regional or national health-care decision makers'
perspective, compared with alternative screening strategies.
Methods: We used an individual-based dynamic transmission model parameterised with national MRSA audit
data to assess the effectiveness and cost-effectiveness of admission screening of patients in English NHS
hospitals compared with five alternative strategies (including no screening, checklist-activated screening, and
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Juin 2016
high-risk specialty-based screening), accompanied by patient isolation and decolonisation, over a 5 year time
horizon. We evaluated strategies for different NHS hospital types (acute, teaching, and specialist), MRSA
prevalence, and transmission potentials using probabilistic sensitivity analyses.
Findings: Compared with no screening, mean cost per quality-adjusted life-year (QALY) of screening all
admissions was £89 000-148 000 (range £68 000-222 000), and this strategy was consistently more costly
and less effective than alternatives for all hospital types. At a £30 000/QALY willingness-to-pay threshold and
current prevalence, only the no-screening strategy was cost effective. The next best strategies were, in acute
and teaching hospitals, targeting of high-risk specialty admissions (30-40% chance of cost-effectiveness;
mean incremental cost-effectiveness ratios [ICERs] £45 200 [range £35 300-61 400] and £48 000/QALY
[£34 600-74 800], respectively) and, in specialist hospitals, screening these patients plus risk-factor-based
screening of low-risk specialties (a roughly 20% chance of cost-effectiveness; mean ICER £62 600/QALY
[£48 000-89 400]). As prevalence and transmission increased, targeting of high-risk specialties became the
optimum strategy at the NHS willingness-to-pay threshold (£30 000/QALY). Switching from screening all
admissions to only high-risk specialty admissions resulted in a mean reduction in total costs per year (not
considering uncertainty) of £2·7 million per acute hospital, £2·9 million per teaching, and £474 000 per
specialist hospital for a minimum rise in infections (about one infection per year per hospital).
Interpretation: Our results show that screening all admissions for MRSA is unlikely to be cost effective in
England at the current NHS willingness-to-pay threshold, and our findings informed modified guidance to
NHS England in 2014. Screening admissions to high-risk specialties is likely to represent better resource use
in terms of cost per QALY gained
NosoBase ID notice : 414461
Klebsiella spp productrice de carbapénèmases dans les siphons de lavabo : investigation sur
l’avantage potentiel des tuyaux en cuivre
Soothill JS. Carbapenemase-bearing Klebsiella spp. in sink drains: investigation into the potential advantage
of copper pipes. The journal of hospital infection 2016/06; 93(2): 152-154.
Mots-clés : CARBAPENEME; KLEBSIELLA; SIPHON; LAVABO; PREVENTION; CUIVRE
Sink drains have long been known to harbour pathogenic bacteria and efforts such as heated sink traps have
been made to control them. Sink outlet pipes have been implicated in outbreaks of infection by multi-resistant
Klebsiella pneumoniae. To investigate whether a change to copper pipes might prevent cross-infection,
sections of standard sink outlet pipe were left in containers of water to which multi-resistant human strains of
K. pneumoniae had been added. Bacterial counts from the water of containers to which copper pipe had been
added were lower than those from containers to which PVC (polyvinyl chloride) pipe had been added.
NosoBase ID notice : 413243
Risque d’infection suite à la colonisation avec des entérobactéries résistantes aux carbapénèmes :
revue systématique
Tischendorf J; de Avila RA; Safdar N. Risk of infection following colonization with carbapenem-resistant
Enterobactericeae: A systematic review. American journal of infection control 2016/05; 44(5): 539-543.
Mots-clés : CARBAPENEME; COLONISATION; ENTEROBACTERIE; ANTIBIORESISTANCE
Background: Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as important health careassociated pathogens. Colonization precedes infection but the risk of developing infection amongst those
colonized with CRE is not clear.
Methods: We searched multiple databases for studies reporting rates of CRE-colonized patients subsequently
developing infection.
Results: Ten studies fulfilled our inclusion criteria, including 1,806 patients used in our analysis. All studies
were observational and conducted among adult inpatients. The cumulative rate of infection was 16.5% in our
study. The most common site of infection was the lung, identified in half of patients, followed in decreasing
frequency by urinary tract; primary bloodstream; and skin and soft tissue, including surgical sites.
Colonization or infection by CRE prolonged stay and was associated with a 10% overall mortality in our
analysis.
Conclusion: Our study results suggest an overall 16.5% risk of infection with CRE amongst patients colonized
with CRE. Given the high mortality rate observed with CRE infection and the difficulty in treating these
infections, research to investigate and develop strategies to eliminate the colonization state are needed.
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NosoBase ID notice : 414460
Entérobactéries productrices de carbapénèmases dans les eaux usées d’un hôpital : un réservoir qui
peut être sans rapport avec les isolats cliniques
White L; Hopkins KL; Meunier D; Perry CL; Pike R; Wilkinson P; et al. Carbapenemase-producing
Enterobacteriaceae in hospital wastewater: a reservoir that may be unrelated to clinical isolates. The journal
of hospital infection 2016/06; 93(2): 145-151.
Mots-clés : CARBAPENEME;
PNEUMONIAE
ENTEROBACTERIE;
EAU
USEE;
ANTIBIOTIQUE;
KLEBSIELLA
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging infection control
problem in hospitals worldwide. Identifying carriers may help reduce potential spread and infections.
Aim: To assess whether testing hospital wastewater for CPE can supplement patient-based screening for
infection prevention purposes in a hospital without a recognized endemic CPE problem.
Methods: Wastewater collected from hospital pipework on 16 occasions during February to March 2014 was
screened for CPE using chromID® CARBA agar and chromID® CPS agar with a 10μg ertapenem disc and
combination disc testing. Minimum inhibitory concentrations were determined using British Society for
Antimicrobial Chemotherapy methodology and carbapenemase genes detected by polymerase chain reaction
or whole-genome sequencing. Selected isolates were typed by pulsed-field gel electrophoresis.
Findings: Suspected CPE were recovered from all 16 wastewater samples. Of 17 isolates sent to the
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, six (four Citrobacter freundii
and two Enterobacter cloacae complex) were New Delhi metallo-β-lactamase (NDM) producers and the
remaining 11 (six Klebsiella oxytoca and five Enterobacter cloacae complex) were Guiana-ExtendedSpectrum-5 (GES-5) producers, the first to be described among Enterobacteriaceae in the UK. The four
NDM-producing C. freundii, two NDM-producing E. cloacae complex, and four out of five GES-5-producing E.
cloacae complex were each indistinguishable isolates of the same three strains, whereas the six GES-5producing K. oxytoca overall shared 79% similarity.
Conclusion: CPE are readily isolated from hospital wastewater using simple culture methods. There are either
undetected carriers of CPE excreting into the wastewater, or these CPE represent colonization of the
pipework from other sources. Surveillance of hospital wastewater for CPE does not appear helpful for
infection control purposes within acute hospitals.
Bactériémie
NosoBase ID notice : 413360
Endophtalmie sévère à Morganella morganii ; suivie par une bactériémie
Demiray T; Aydemir OA; Koroglu M; Ozbek A; Altindis M. A severe Morganella morganii endophthalmitis;
followed by bacteremia. Iranian journal of microbiology 2016/02; 8(1): 70-72.
Mots-clés : BACTERIEMIE; MORGANELLA MORGANII; ENDOPHTALMIE; CONJONCTIVITE; BETALACTAMASE A SPECTRE ELARGI; CIPROFLOXACINE; SENSIBILITE
Morganella morganii is rarely isolated from nosocomial infections. However, postoperative infections due to
Morganella spp. were documented in literature and eye involvements of the infections usually result in severe
sequels. We present a severe case infection, which was caused by M. morganii subsp. morganii, firstly
appearing as conjunctivitis and complicated by bacteremia. The infectious agent isolated from both
conjunctival and consecutive blood cultures. Identification and antimicrobial susceptibility tests were
performed with the Vitek 2® automated system. The isolate was resistant to cephalosporins and carbapenems
and it had ability to produce extended spectrum beta-lactamases. Patient was successfully treated with
intravenous ciprofloxacin according to susceptibility test results. This is the first report of M. morganii infection
detected as a local infection then complicated by bacteremia.
NosoBase ID notice : 412577
Validation d’une méthode d’échantillonnage pour collecter des données d’évaluation du risque
d’acquisition d’une bactériémie sur voie centrale
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Hammami N; Mertens K; Overholser R; Goetghebeur E; Catry B; Lambert ML. Validation of a sampling
method to collect exposure data for central-line-associated bloodstream infections. Infection control and
hospital epidemiology 2016/05; 37(5): 549-554.
Mots-clés : BACTERIEMIE; INFECTION NOSOCOMIALE;
SURVEILLANCE; STATISTIQUE; SOIN INTENSIF
CATHETER
VEINEUX
CENTRAL;
Objective: Surveillance of central-line-associated bloodstream infections requires the labor-intensive counting
of central-line days (CLDs). This workload could be reduced by sampling. Our objective was to evaluate the
accuracy of various sampling strategies in the estimation of CLDs in intensive care units (ICUs) and to
establish a set of rules to identify optimal sampling strategies depending on ICU characteristics.
Design: Analyses of existing data collected according to the European protocol for patient-based surveillance
of ICU-acquired infections in Belgium between 2004 and 2012.
Setting and participants: CLD data were reported by 56 ICUs in 39 hospitals during 364 trimesters.
Methods: We compared estimated CLD data obtained from weekly and monthly sampling schemes with the
observed exhaustive CLD data over the trimester by assessing the CLD percentage error (ie, observed CLDs
- estimated CLDs/observed CLDs). We identified predictors of improved accuracy using linear mixed models.
Results: When sampling once per week or 3 times per month, 80% of ICU trimesters had a CLD percentage
error within 10%. When sampling twice per week, this was >90% of ICU trimesters. Sampling on Tuesdays
provided the best estimations. In the linear mixed model, the observed CLD count was the best predictor for a
smaller percentage error. The following sampling strategies provided an estimate within 10% of the actual
CLD for 97% of the ICU trimesters with 90% confidence: 3 times per month in an ICU with >650 CLDs per
trimester or each Tuesday in an ICU with >480 CLDs per trimester.
Conclusion: Sampling of CLDs provides an acceptable alternative to daily collection of CLD data.
NosoBase ID notice : 413259
Caractéristiques de performance et résultats associés à l’outil de surveillance automatisé pour les
bactériémies
Ridgway JP; Sun X; Tabak YP; Johannes RS; Robicsek A. Performance characteristics and associated
outcomes for an automated surveillance tool for bloodstream infection. American journal of infection control
2016/05; 44(5): 567-571.
Mots-clés : SURVEILLANCE; BACTERIEMIE; INFORMATIQUE
Background: The objective of this study was to evaluate performance metrics and associated patient
outcomes of an automated surveillance system, the blood Nosocomial Infection Marker (NIM).
Methods: We reviewed records of 237 patients with and 36,927 patients without blood NIM using the National
Healthcare Safety Network (NHSN) definition for laboratory-confirmed bloodstream infection (BSI) as the gold
standard. We matched cases with noncases by propensity score and estimated attributable mortality and cost
of NHSN-reportable central line-associated bloodstream infections (CLABSIs) and non-NHSN-reportable
BSIs.
Results: For patients with central lines (CL), the blood NIM had 73.2% positive predictive value (PPV), 99.9%
negative predictive value (NPV), 89.2% sensitivity, and 99.7% specificity. For all patients regardless of CL
status, the blood NIM had 53.6% PPV, 99.9% NPV, 84.0% sensitivity, and 99.9% specificity. For CLABSI
cases compared with noncases, mortality was 17.5% versus 9.4% (P=.098), and median charge was
$143,935 (interquartile range [IQR], $89,794-$257,447) versus $115,267 (IQR, $74,937-$173,053) (P<.01).
For non-NHSN-reportable BSI cases compared with noncases, mortality was 23.6% versus 6.7% (P<.0001),
and median charge was $86,927 (IQR, $54,728-$156,669) versus $62,929 (IQR, $36,743-$115,693)
(P<.0001).
Conclusions: The NIM is an effective screening tool for BSI. Both NHSN-reportable and nonreportable BSI
cases were associated with increased mortality and cost.
NosoBase ID notice : 414859
Organismes en cause et antibiorésistances associées dans les bactériémies sur voie centrale
associées aux soins dans des services d'oncologie, 2009-2012
See I; Freifeld A; Magill SS. Causative organisms and associated antimicrobial resistance in healthcareassociated, central line-associated bloodstream infections from oncology settings, 2009-2012. Clinical
infectious diseases 2016/05/15; 62(10): 1203-1209.
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NosoVeille – Bulletin de veille
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Mots-clés : ANTIBIORESISTANCE; BACTERIEMIE; CANCEROLOGIE; CATHETER VEINEUX CENTRAL;
PREVENTION; ESCHERICHIA COLI; STAPHYLOCOQUE A COAGULASE NEGATIVE; ENTEROCOCCUS
FAECIUM
Background: Recent antimicrobial resistance data are lacking from inpatient oncology settings to guide
infection prophylaxis and treatment recommendations. We describe central line-associated bloodstream
infection (CLABSI) pathogens and antimicrobial resistance patterns reported from oncology locations to the
Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN).
Methods: CLABSI data reported to NHSN from 2009 to 2012 from adult inpatient oncology locations were
compared to data from nononcology adult locations within the same hospitals. Pathogen profile, antimicrobial
resistance rates, and CLABSI incidence rates per 1000 central line-days were calculated. CLABSI incidence
rates were compared using Poisson regression.
Results: During 2009-2012, 4654 CLABSIs were reported to NHSN from 299 adult oncology units. The most
common organisms causing CLABSI in oncology locations were coagulase-negative staphylococci (16.9%),
Escherichia coli (11.8%), and Enterococcus faecium (11.4%). Fluoroquinolone resistance was more common
among E. coli CLABSI in oncology than nononcology locations (56.5% vs 41.5% of isolates tested; P < .0001)
and increased significantly from 2009-2010 to 2011-2012 (49.5% vs 60.4%; P=.01). Furthermore, rates of
CLABSI were significantly higher in oncology compared to nononcology locations for fluoroquinolone-resistant
E. coli (rate ratio, 7.37; 95% confidence interval [CI], 6.20-8.76) and vancomycin-resistant E. faecium (rate
ratio, 2.27, 95% CI, 2.03-2.53). However, resistance rates for some organisms, such as Klebsiella species
and Pseudomonas aeruginosa, were lower in oncology than in nononcology locations.
Conclusions: Antimicrobial-resistant E. coli and E. faecium have become significant pathogens in oncology.
Practices for antimicrobial prophylaxis and empiric antimicrobial therapy should be regularly assessed in
conjunction with contemporary antimicrobial resistance data.
NosoBase ID notice : 413262
L'influence des bactériémies associées aux voies centrales sur la mortalité hospitalière : analyse de
risque ajustée dans un seul centre
Wong SW; Gantner D; McGloughlin S; Leong T; Worth LJ; Klintworth G; et al. The influence of intensive care
unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center riskadjusted analysis. American journal of infection control 2016/05; 44(5): 587-592.
Mots-clés : SOIN INTENSIF; MORTALITE; BACTERIEMIE; CATHETER; MICROORGANISME
Objective: To explore the risk-adjusted association between intensive care unit (ICU)-acquired central lineassociated bloodstream infection (CLABSI) and in-hospital mortality.
Design: Retrospective observational study.
Setting: Forty-five-bed adult ICU.
Patients: All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30,
2014, requiring a central venous catheter (CVC), with a length of stay >48 hours, were included.
Methods: Data were extracted from our infection prevention and ICU databases. A multivariable logistic
regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The
propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality.
Results: Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired
CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent
risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95%
confidence interval [CI], 1.16-5.77), CVC exposure >7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion
before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater inhospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR,
1.20; 95% CI, 0.54-2.68).
Conclusions: A greater propensity toward ICU-acquired CLABSI was independently associated with higher inhospital mortality, although line infection itself was not. The requirement for prolonged specialized central
venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a
marker of persistent organ dysfunction.
Cathétérisme
NosoBase ID notice : 414475
L’impact de la définition et des procédures utilisées lors de l’absence de donnée d’hémoculture sur le
taux d’infections liées aux cathéters vasculaires en nutrition parentérale
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Austin PD; Hand KS; Elia E. Impact of definition and procedures used for absent blood culture data on the
rate of intravascular catheter infection during parenteral nutrition. The journal of hospital infection 2016/06;
93(2): 197-205.
Mots-clés : HEMOCULTURE; CATHETER; ALIMENTATION PARENTERALE; INFECTION
Background: Diagnosis of intravascular catheter infection may be affected by the definition and procedures
applied in the absence of blood culture data.
Aim: To examine the extent to which different definitions of catheter infection and procedures for handling
absent blood culture data can affect reported catheter infection rates.
Methods: Catheter infection rates were established in a cohort of hospitalized patients administered
parenteral nutrition according to three clinical and four published definitions. Paired and unpaired
comparisons were made using available case analyses, sensitivity analyses and intention-to-categorize
analyses.
Findings: Complete data were available for each clinical definition (N=193), and there were missing data (4.126.9%) for the published definitions. In an available case analysis, the catheter infection rate was 13.0-36.8%
for the clinical definitions and 2.1-12.4% for the published definitions. For the published definitions, the rate
was 1.6-32.1% in a sensitivity analysis and 11.4-16.9% in an intention-to-categorize analysis, with suggestion
of bias towards a higher catheter infection rate in those with missing data, in keeping with the analyses of the
clinical definitions. For paired comparisons, the strength of agreement between definitions varied from 'poor'
(Cohen's kappa <0.21) to 'very good' (Cohen's kappa ≥0.81).
Conclusion: The use of different definitions of catheter infection and procedures applied in the absence of
blood culture data produced widely different catheter infection rates, which could compromise measurements
or comparisons of service quality or study outcome. As such, there is a need to establish and use a valid,
consistent and practical definition.
Chirurgie
NosoBase ID notice : 412573
Epidémiologie des infections du site opératoire dans un réseau de centres hospitaliers
Baker AW; Dicks KV; Durkin MJ; Weber DJ; Lewis SS; Moehring RW; et al. Epidemiology of surgical site
infection in a community hospital network. Infection control and hospital epidemiology 2016/05; 37(5): 519526.
Mots-clés : INFECTION NOSOCOMIALE; CHIRURGIE; CHIRURGIE DIGESTIVE; CHIRURGIE
VASCULAIRE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; PREVALENCE;
TAUX; ETUDE PROSPECTIVE
Objective: To describe the epidemiology of complex surgical site infection (SSI) following commonly
performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates
over time for MRSA and other common pathogens.
Methods: We prospectively collected SSI data at 29 community hospitals in the southeastern United States
from 2008 through 2012. We determined the overall prevalence rates of SSI for commonly performed
procedures during this 5-year study period. For each year of the study, we then calculated prevalence rates of
SSI stratified by causative organism. We created log-binomial regression models to analyze trends of SSI
prevalence over time for all pathogens combined and specifically for MRSA.
Results: A total of 3,988 complex SSIs occurred following 532,694 procedures (prevalence rate, 0.7 infections
per 100 procedures). SSIs occurred most frequently after small bowel surgery, peripheral vascular bypass
surgery, and colon surgery. Staphylococcus aureus was the most common pathogen. The prevalence rate of
SSI decreased from 0.76 infections per 100 procedures in 2008 to 0.69 infections per 100 procedures in 2012
(prevalence rate ratio [PRR], 0.90; 95% confidence interval [CI], 0.82-1.00). A more substantial decrease in
MRSA SSI (PRR, 0.69; 95% CI, 0.54-0.89) was largely responsible for this overall trend.
Conclusions: The prevalence of MRSA SSI decreased from 2008 to 2012 in our network of community
hospitals. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence over the study
period.
NosoBase ID notice : 413209
L’utilisation de stimuli visuels passifs pour améliorer l’observance du lavage des mains dans un
contexte périopératoire
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Beyfus TA; Dawson NL; Danner CH; Rawal B; Gruber PE; Petrou SP. The use of passive visual stimuli to
enhance compliance with handwashing in a perioperative setting. American journal of infection control
2016/05; 44(5): 496-499.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; ALCOOL; OEIL
Background: To encourage handwashing, we analyzed the effect that a passive visual stimulus in the form of
a picture of a set of eyes had on self-directed hand hygiene among health care staff.
Methods: This was a prospective, single-blind study using a repeated measure design. Four dispensers of
alcohol foam located in positions identified as #1, #2, #3, and #4 were used to deliver a single uniform volume
of alcohol foam in an automated fashion. Pictures of eyes were placed on dispensers #1 and #3 but not
dispensers #2 and #4 for 1 time period. The visual stimulus was rotated with each study time period. At the
end of each study period, the volumes dispensed were examined to determine if the visual stimulus had a
statistically significant influence on the volume dispensed.
Results: There were a total of 6 time periods. The average volume dispensed in stations with eyes was 279 cc
versus that in the stations without eyes, which was 246 cc, and this was a statistically significant difference
(P=.009).
Conclusion: The correct visual stimuli may enhance compliance with hand hygiene in health care settings.
NosoBase ID notice : 414854
Prévention des infections du site opératoire : pas de décolonisation universelle pour tous mais pour
une sélection de patients de chirurgie
Leenders AC. Prevention of surgical site infections: universal decontamination not for all, but for a selection of
surgical patients. Clinical infectious diseases 2016/06/01; 62(11): 1469-1470.
Mots-clés : INFECTION
DECONTAMINATION; EAU
NOSOCOMIALE;
PREVENTION;
SITE
OPERATOIRE;
CHIRURGIE;
Hospital water may serve as a reservoir of healthcare-associated pathogens, and contaminated water can
lead to outbreaks and severe infections. The clinical features of waterborne outbreaks and infections as well
as prevention strategies and control measures are reviewed. The common waterborne pathogens were
bacteria, including Legionella and other gram-negative bacteria, and nontuberculous mycobacteria, although
fungi and viruses were occasionally described. These pathogens caused a variety of infections, including
bacteremia and invasive and disseminated diseases, particularly among immunocompromised hosts and
critically ill adults as well as neonates. Waterborne outbreaks occurred in healthcare settings with emergence
of new reported reservoirs, including electronic faucets (Pseudomonas aeruginosa and Legionella),
decorative water wall fountains (Legionella), and heater-cooler devices used in cardiac surgery
(Mycobacterium chimaera). Advanced molecular techniques are useful for achieving a better understanding
of reservoirs and transmission pathways of waterborne pathogens. Developing prevention strategies based
on water reservoirs provides a practical approach for healthcare personnel.
NosoBase ID notice : 412572
Stabilité de la composition de l’équipe chirurgicale et risque d’exposition au sang et aux liquides
biologiques par piqûre/coupure pendant les interventions
Myers DJ; Lipscomb HJ; Epling C; Hunt D; Richardson W; Smith-Lovin L; et al. Surgical team stability and
risk of sharps-related blood and body fluid exposures during surgical procedures. Infection control and
hospital epidemiology 2016/05; 37(5): 512-518.
Mots-clés : BLOC OPERATOIRE; ACCIDENT D'EXPOSITION AU SANG; PERSONNEL; CHIRURGIEN;
INFIRMIER; PIQURE; SUTURE; RELATION DE TRAVAIL; ETUDE RETROSPECTIVE
Objective: To explore whether surgical teams with greater stability among their members (ie, members have
worked together more in the past) experience lower rates of sharps-related percutaneous blood and body
fluid exposures (BBFE) during surgical procedures.
Design: A 10-year retrospective cohort study.
Setting: A single large academic teaching hospital.
Participants: Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010
and 2,113 reported percutaneous BBFE were analyzed.
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Methods: A social network measure (referred to as the team stability index) was used to quantify the extent to
which surgical team members worked together in the previous 6 months. Poisson regression was used to
examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and
accounting for procedure duration. Separate regression models were generated for percutaneous BBFE
involving suture needles and those involving other surgical devices.
Results: The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93
[95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other
than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture
needles (0.96 [0.88-1.04]).
Conclusions: Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures,
particularly for exposures involving devices other than suture needles. Additional research should be
conducted on the basis of primary data gathered specifically to measure qualities of relationships among
surgical team personnel.
NosoBase ID notice : 413713
Le risque d'infection dans les procédures chirurgicales stériles
Tacconelli E; Müller NF; Lemmen S; Mutters NT; Hagel S; Meyer E. Infection risk in sterile operative
procedures. Deutsches ärzteblatt international 2016/04; 113(16): 271-278.
Mots-clés : CHIRURGIE; PREVENTION; META-ANALYSE; CATHETER; INCIDENCE; REVUE DE LA
LITTERATURE
Background: The main objective of hospital hygiene and infection prevention is to protect patients from
preventable nosocomial infections. It was recently stated that the proper goal should be for zero infection
rates in sterile surgical procedures. In this article, we attempt to determine whether this demand is supported
by the available literature.
Methods: We systematically searched the Medline and EMBASE databases for studies published in the last
10 years on the efficacy of infection control measures and carried out a meta-analysis according to the
PRISMA tool. We used the following search terms: "aseptic surgery," "intervention," "surgical site infection,"
"nosocomial infection," "intervention," and "prevention."
Results: 2277 articles were retrieved, of which 204 were acquired in full text and analyzed. The quantitative
analysis included 7 prospective cohort studies on the reduction of nosocomial infection rates after aseptic
surgery. The measures used included training sessions, antibiotic prophylaxis, and operative-site disinfection
and cleaning techniques. These interventions succeeded in reducing postoperative wound infections (relative
risk (RR] 0.99 [0.98; 1.00]). Subgroup analyses on antibiotic prophylaxis (RR 0.99 [0.98; 1.01]) and
noncontrolled trials (RR 0.97 [0.92; 1.02]) revealed small, insignificant effects.
Conclusion: A multimodal approach with the participation of specialists from various disciplines can further
reduce the rate of postoperative infection. A reduction to zero is not realistic and is not supported by available
evidence.
Clostridium difficile
NosoBase ID notice : 413332
Le poids de l’infection à Clostridium difficile : estimation de l’incidence des ICD à partir des bases de
données administratives américaines
Olsen MA; Young-Xu Y; Stwalley D; Kelly CP; Gerding DN; Saeed MJ; et al. The burden of Clostridium
difficile infection: estimates of the incidence of CDI from U.S. Administrative databases. BMC infectious
diseases 2016/04/22; 16(177): 1-8.
Mots-clés : CLOSTRIDIUM DIFFICILE; INCIDENCE; ADULTE; PERSONNE AGEE; INFORMATIQUE;
BASE DE DONNEES
Background: Many administrative data sources are available to study the epidemiology of infectious diseases,
including Clostridium difficile infection (CDI), but few publications have compared CDI event rates across
databases using similar methodology. We used comparable methods with multiple administrative databases
to compare the incidence of CDI in older and younger persons in the United States.
Methods: We performed a retrospective study using three longitudinal data sources (Medicare, OptumInsight
LabRx, and Healthcare Cost and Utilization Project State Inpatient Database (SID)), and two hospital
encounter-level data sources (Nationwide Inpatient Sample (NIS) and Premier Perspective database) to
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identify CDI in adults aged 18 and older with calculation of CDI incidence rates/100,000 person-years of
observation (pyo) and CDI categorization (onset and association).
Results: The incidence of CDI ranged from 66/100,000 in persons under 65 years (LabRx), 383/100,000 in
elderly persons (SID), and 677/100,000 in elderly persons (Medicare). Ninety percent of CDI episodes in the
LabRx population were characterized as community-onset compared to 41% in the Medicare population. The
majority of CDI episodes in the Medicare and LabRx databases were identified based on only a CDI
diagnosis, whereas almost ¾ of encounters coded for CDI in the Premier hospital data were confirmed with a
positive test result plus treatment with metronidazole or oral vancomycin. Using only the Medicare inpatient
data to calculate encounter-level CDI events resulted in 553 CDI events/100,000 persons, virtually the same
as the encounter proportion calculated using the NIS (544/100,000 persons).
Conclusions: We found that the incidence of CDI was 35% higher in the Medicare data and fewer episodes
were attributed to hospital acquisition when all medical claims were used to identify CDI, compared to only
inpatient data lacking information on diagnosis and treatment in the outpatient setting. The incidence of CDI
was 10-fold lower and the proportion of community-onset CDI was much higher in the privately insured
younger LabRx population compared to the elderly Medicare population. The methods we developed to
identify incident CDI can be used by other investigators to study the incidence of other infectious diseases
and adverse events using large generalizable administrative datasets.
NosoBase ID notice : 413257
Transplantation de microbiote fécal pour infection à Clostridium difficile récurrente : l’expérience du
patient
Pakyz AL; Moczygemba LR; VanderWielen LM; Edmond MB. Fecal microbiota transplantation for recurrent
Clostridium difficile infection: The patient experience. American journal of infection control 2016/05; 44(5):
554-559.
Mots-clés : CLOSTRIDIUM DIFFICILE; TRANSPLANTATION; USAGER DE LA SANTE; MICROBIOTE
FECAL
Background: Although effectiveness of fecal microbiota transplantation (FMT) has been adequately
documented, the patient experience of undergoing FMT has not.
Methods: We carried out a qualitative interview study using semistructured questions relating to aspects of
health pre-FMT, during FMT, and post-FMT periods with 17 participants. Inductive coding was used to identify
core themes during the periods.
Results: Pre-FMT themes included physical (continuous diarrhea and weight loss), mental (depression,
wanting to die, and fear), quality of life (unable to perform normal activities), social support, and financial
(medication costs) factors. Provider resistance/limited awareness were barriers to FMT. Participants reached
a tipping point, experiencing feelings of hopelessness, which led them to pursue FMT. During FMT,
participants commented on lack of a so-called ick factor. During the posttreatment period, participants
experienced symptom relief, but had residual fears. Patient activation was present during all phases,
including information seeking and empowerment.
Conclusions: During the pre-FMT period, participants experienced extreme discomfort and encountered FMT
barriers. Undergoing FMT was reported as easy but residual fear remained. There were displays of patient
activation at all FMT time periods, including the seeking of FMT. Participants could have benefited from
having undergone FMT sooner, demonstrating a need for improvement in provider education and health
system barriers regarding FMT.
Coût
NosoBase ID notice : 413210
Les coûts des soins de santé directs et la durée de séjour à l'hôpital dus aux infections
nosocomiales, chez les patients adultes, basés sur des mesures de prévalence ponctuelles
Rahmqvist M; Samuelsson A; Bastami S; Rutberg H. Direct health care costs and length of hospital stay
related to health care-acquired infections in adult patients based on point prevalence measurements.
American journal of infection control 2016/05; 44(5): 500-506.
Mots-clés : PREVALENCE; MORTALITE; DUREE DE SEJOUR; COUT
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Background: The incidence of health care-acquired infection (HAI) and the consequence for patients with HAI
tend to vary from study to study. By including all patients, all medical specialties, and performing a follow-up
analysis, this study contributes to previous findings in this research field.
Methods: Data from the Swedish National Point Prevalence Surveys of HAI 2010-2012 was merged with cost
per patient data from the county Health Care Register (N=6,823). Extended length of stay (LOS) and costs
related to an HAI were adjusted for sex, age, intensive care unit use, and surgery.
Results: Patients with HAI (n=732) had a larger proportion of readmissions compared with patients with no
HAI (29.0% vs 16.5%). Of the total bed days, 9.3% was considered to be excess days attributed to the group
of patients with an HAI. The excess LOS comprised 11.4% of the total costs (95% CI, 10.2-12.7). The 1-year
overall mortality rate for patients with HAI in comparison to all other patients was 1.75 (95% CI, 1.45-2.11), all
5 of these differences were statistically significant (P<.001).
Conclusions: Even if not all outcomes for patients with an HAI can be explained by the HAI itself, the increase
in inpatient days, readmissions, associated costs, and higher mortality rates are quite notable.
Désinfection
NosoBase ID notice : 413199
Problèmes particuliers liés au traitement des instruments dans les établissements de soins
ambulatoires
Bringhurst J. Special problems associated with reprocessing instruments in outpatient care facilities.
American journal of infection control 2016/05; 44(Suppl. 5): e63-e67.
Mots-clés : TRAITEMENT; DESINFECTION; DISPOSITIF MEDICAL; TRANSMISSION; ENDOSCOPIE
EHPAD
NosoBase ID notice : 413211
Modèles pour prévenir la prévalence et la transition dynamique de Staphylococcus aureus méticillinorésistant dans les maisons de retraite communautaires
Batina NG; Crnich CJ; Anderson DF; Döpfer D. Models to predict prevalence and transition dynamics of
methicillin-resistant Staphylococcus aureus in community nursing homes. American journal of infection
control 2016/05; 44(5): 507-514.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
COLONISATION; FACTEUR DE RISQUE; EHPAD; ANTIBIOTIQUE
PREVALENCE;
Background: Recent spread of USA300 methicillin-resistant Staphylococcus aureus (MRSA) to nursing
homes has been of particular concern. We sought to predict the ultimate prevalence of USA300 and nonUSA300 MRSA and to examine the influence of potential risk factors on MRSA acquisition in community
nursing homes.
Methods: The data were collected during a longitudinal MRSA surveillance study that involved 449 residents
in 6 community nursing homes in Wisconsin. The subjects were screened every 3 months for up to 1 year.
Markov chain models were employed to predict strain-specific prevalence of MRSA at steady state, and to
assess the influence of potential risk factors, including recent hospitalizations, invasive medical devices, and
antibiotic exposure on MRSA acquisition rates and average duration of colonization.
Results: At steady state, 20% (95% confidence interval [CI], 15%-25%) of residents were predicted to remain
colonized with non-USA300 and 4% (95% CI, 2%-7%) with USA300 MRSA. Residents who used antibiotics
during the previous 3 months were twice more likely to acquire MRSA than those who did not (acquisition
rates, 0.052; 95% CI, 0.038-0.075 and 0.025; 95% CI, 0.018-0.037, respectively).
Conclusions: Non-USA300 was predicted to remain the dominant MRSA strain in community nursing homes.
The higher rate of MRSA acquisition among residents with recent antibiotic exposure suggests that antibiotic
stewardship may reduce MRSA colonization in this setting.
NosoBase ID notice : 413140
Infections dans des EHPAD australiens : évaluer l’impact des critères révisés de McGeer sur la
surveillance des infections urinaires
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Bennett NJ; Johnson SA; Richards MJ; Smith MA; Worth LJ. Infections in Australian aged-care facilities:
evaluating the impact of revised McGeer criteria for surveillance of urinary tract infections. Infection control
and hospital epidemiology 2016/05; 37(5): 610-612.
Mots-clés : INFECTION URINAIRE;
EVALUATION; SURVEILLANCE
GERIATRIE;
DEFINITION;
INFECTION
NOSOCOMIALE;
Our survey of 112 Australian aged-care facilities demonstrated the prevalence of healthcare-associated
infections to be 2.9%. Urinary tract infections (UTIs) defined by McGeer criteria comprised 35% of all clinically
defined UTIs. To estimate the infection burden in these facilities where microbiologic testing is not routine,
modified surveillance criteria for UTIs are necessary.
NosoBase ID notice : 413238
Colonisation rectale asymptomatique à Enterobactéries résistantes aux carbapénèmes et Clostridium
difficile chez les résidents d’un établissement de soins de longue durée à New York
Prasad N; Labaze G; Kopacz J; Chwa S; Platis D; Pan CX; et al. Asymptomatic rectal colonization with
carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care
facility in New York City. American journal of infection control 2016/05; 44(5): 525-532.
Mots-clés : CLOSTRIDIUM DIFFICILE; COLONISATION;
ANTIBIORESISTANCE; EHPAD; FACTEUR DE RISQUE
CARBAPENEME;
ENTEROBACTERIE;
Background: Residents of long-term care facilities (LTCFs) are at increased risk for colonization and
development of infections with multidrug-resistant organisms. This study was undertaken to determine
prevalence of asymptomatic rectal colonization with Clostridium difficile (and proportion of 027/NAP1/BI
ribotype) or carbapenem-resistant Enterobacteriaceae (CRE) in an LTCF population.
Methods: Active surveillance was performed for C difficile and CRE rectal colonization of 301 residents in a
320-bed (80-bed ventilator unit), hospital-affiliated LTCF with retrospective chart review for patient
demographics and potential risk factors.
Results: Over 40% of patients had airway ventilation and received enteral feeding. One-third of these patients
had prior C difficile-associated infection (CDI). Asymptomatic rectal colonization with C difficile occurred in 58
patients (19.3%, one-half with NAP1+), CRE occurred in 57 patients (18.9%), and both occurred in 17
patients (5.7%). Recent CDI was significantly associated with increased risk of C difficile ± CRE colonization.
Multivariate logistic regression analysis revealed presence of tracheostomy collar to be significant for C
difficile colonization, mechanical ventilation to be significant for CRE colonization, and prior CDI to be
significant for both C difficile and CRE colonization.
Conclusions: The strong association of C difficile or CRE colonization with disruption of normal flora by
mechanical ventilation, enteral feeds, and prior CDI carries important implications for infection control
intervention in this population.
Endoscopie
NosoBase ID notice : 413198
Traitement des éléments semi-critiques : enjeux actuels et nouvelles technologies
Rutala WA; Weber DJ. Reprocessing semicritical items: Current issues and new technologies. American
journal of infection control 2016/05; 44(Suppl. 5): e53-e62.
Mots-clés :
ENDOSCOPIE;
DESINFECTION;
STERILISATION;
LARYNGOSCOPIE; PEROXYDE D'HYDROGENE; PAPILLOMAVIRUS
ENDOSCOPIE
DIGESTIVE;
Semicritical medical devices are defined as items that come into contact with mucous membranes or
nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices minimally
require high-level disinfection. Because many of these items are temperature sensitive, low-temperature
chemical methods are usually used rather than steam sterilization. Strict adherence to current guidelines is
required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and
other semicritical items undergoing high-level disinfection than any other reusable medical device.
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Environnement
NosoBase ID notice : 412578
Impact des variations dans les méthodes de tests sur les performances de décontamination des
chambres par rayonnement ultra-violet C
Cadnum JL; Tomas ME; Sankar T; Jencson AL; Mathew JI; Kundrapu S; et al. Effect of variation in test
methods on performance of ultraviolet-C radiation room decontamination. Infection control and hospital
epidemiology 2016/05; 37(5): 555-560.
Mots-clés : BIONETTOYAGE; DESINFECTION; ENVIRONNEMENT; ULTRA-VIOLET; SURFACE;
CONTAMINATION; INFECTION NOSOCOMIALE; CLOSTRIDIUM DIFFICILE; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; SARM; EVALUATION
Objective: To determine the effect of variation in test methods on performance of an ultraviolet-C (UV-C)
room decontamination device.
Design: Laboratory evaluation.
Methods: We compared the efficacy of 2 UV-C room decontamination devices with low pressure mercury gas
bulbs. For 1 of the devices, we evaluated the effect of variation in spreading of the inoculum, carrier
orientation relative to the device, type of organic load, type of carrier, height of carrier, and uninterrupted
versus interrupted exposures on measured UV-C killing of methicillin-resistant Staphylococcus aureus and
Clostridium difficile spores.
Results: The 2 UV-C room decontamination devices achieved similar log10 colony-forming unit reductions in
the pathogens with exposure times ranging from 5 to 40 minutes. On steel carriers, spreading of the inoculum
over a larger surface area significantly enhanced killing of both pathogens, such that a 10-minute exposure
on a 22-mm2 disk resulted in greater than 2 log reduction in C. difficile spores. Orientation of carriers in
parallel rather than perpendicular with the UV-C lamps significantly enhanced killing of both pathogens.
Different types of organic load also significantly affected measured organism reductions, whereas type of
carrier, variation in carrier height, and interrupted exposure cycles did not.
Conclusions: Variation in test methods can significantly impact measured reductions in pathogens by UV-C
devices during experimental testing. Our findings highlight the need for standardized laboratory methods for
testing the efficacy of UV-C devices and for evaluations of the efficacy of short UV-C exposure times in realworld settings.
NosoBase ID notice : 413513
L'eau et la qualité microbiologique de la surface des filtres à eau : une étude comparative
Florentin A; Lizon J; Asensio E; Forin J; Rivier A. Water and surface microbiologic quality of point-of-use
water filters: A comparative study. American journal of infection control 2016/04/14; in press: 1-2.
Mots-clés : EAU; MICROBIOLOGIE; QUALITE; LEGIONELLA; FILTRE
Waterborne pathogens, such Legionella pneumophila and Pseudomonas aeruginosa, are major contributors
to hospital-associated infection. Point-of-use water filtration has demonstrated benefits to prevent infection
implicating waterborne pathogens. Despite the quality of the filters, misuse may expose patients to these
pathogens.
NosoBase ID notice : 413104
Décontamination de la chambre d’un patient à la vapeur de peroxyde d’hydrogène en se servant des
calicivirus félins et norovirus murins comme virus de substitution aux norovirus humains
Holmdahl T; Walder M; Uzcátegui N; Odenholt I; Lanbeck P; Medstrand P; et al. Hydrogen peroxide vapor
decontamination in a patient room using feline Calicivirus and murine Norovirus as surrogate markers for
human Norovirus. Infection control and hospital epidemiology 2016/05; 37(5): 561-566.
Mots-clés : PEROXYDE D'HYDROGENE; VAPEUR; SURFACE; CONTAMINATION;
NOSOCOMIALE; DESINFECTION; BIONETTOYAGE; NOROVIRUS; CALICIVIRUS
INFECTION
Objective: To determine whether hydrogen peroxide vapor (HPV) could be used to decontaminate
caliciviruses from surfaces in a patient room.
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Design: Feline calicivirus (FCV) and murine norovirus (MNV) were used as surrogate viability markers to
mimic the noncultivable human norovirus. Cell culture supernatants of FCV and MNV were dried in triplicate
35-mm wells of 6-well plastic plates. These plates were placed in various positions in a nonoccupied patient
room that was subsequently exposed to HPV. Control plates were positioned in a similar room but were never
exposed to HPV.
Methods: Virucidal activity was measured in cell culture by reduction in 50% tissue culture infective dose titer
for FCV and by both 50% tissue culture infective dose titer and plaque reduction for MNV.
Results: Neither viable FCV nor viable MNV could be detected in the test room after HPV treatment. At least
3.65 log reduction for FCV and at least 3.67 log reduction for MNV were found by 50% tissue culture infective
dose. With plaque assay, measurable reduction for MNV was at least 2.85 log units.
Conclusions: The successful inactivation of both surrogate viruses indicates that HPV could be a useful tool
for surface decontamination of a patient room contaminated by norovirus. Hence nosocomial spread to
subsequent patients can be avoided.
NosoBase ID notice : 413508
L'air à l'hôpital : une voie potentielle pour la transmission des infections provoquées par des
bactéries résistantes aux bêta-lactamines
Mirhoseini SH; Nikaeen M; Shamsizadeh Z; Khanahmad H. Hospital air: A potential route for transmission of
infections caused by β-lactam-resistant bacteria. American journal of infection control 2016/03/24; in press :
1-7.
Mots-clés : TRANSMISSION; AIR; ANTIBIORESISTANCE; BETALACTAMINE
Background: The emergence of bacterial resistance to β-lactam antibiotics seriously challenges the treatment
of various nosocomial infections. This study was designed to investigate the presence of β-lactam-resistant
bacteria (BLRB) in hospital air.
Methods: A total of 64 air samples were collected in 4 hospital wards. Detection of airborne bacteria was
carried out using culture plates with and without β-lactams. BLRB isolates were screened for the presence of
5 common β-lactamase-encoding genes. Sequence analysis of predominant BLRB was also performed.
Results: The prevalence of BLRB ranged between 3% and 34%. Oxacillin-resistant bacteria had the highest
prevalence, followed by ceftazidime- and cefazolin-resistant bacteria. The frequency of β-lactamase-encoding
genes in isolated BLRB ranged between 0% and 47%, with the highest and lowest detection for OXA-23 and
CTX-m-32, respectively. MecA had a relatively high frequency in surgery wards and operating theaters,
whereas the frequency of blaTEM was higher in intensive care units and internal medicine wards. OXA-51
was detected in 4 wards. Acinetobacter spp, Acinetobacter baumannii, and Staphylococcus spp were the
most predominant BLRB.
Conclusions: The results revealed that hospital air is a potential route of transmission of BLRB, such as
Acinetobacter and Staphylococcus, 2 important causative agents of nosocomial infections. Therefore,
improvement of control measures against the spreading of airborne bacteria in hospital environments is
warranted.
NosoBase ID notice : 413200
Suivi et amélioration de l’efficacité du nettoyage et de la désinfection des surfaces
Rutala WA; Weber DJ. Monitoring and improving the effectiveness of surface cleaning and disinfection.
American journal of infection control 2016/05; 44(Suppl. 5): e69-e76.
Mots-clés : DESINFECTION; NETTOYAGE; SURFACE; DESINFECTANT; CHAMBRE DU MALADE;
ULTRA-VIOLET
Disinfection of noncritical environmental surfaces and equipment is an essential component of an infection
prevention program. Noncritical environmental surfaces and noncritical medical equipment surfaces may
become contaminated with infectious agents and may contribute to cross-transmission by acquisition of
transient hand carriage by health care personnel. Disinfection should render surfaces and equipment free of
pathogens in sufficient numbers to prevent human disease (ie, hygienically clean).
NosoBase ID notice : 413203
Efficacité des dispositifs ultraviolets et des systèmes à péroxyde d’hydrogène pour la désinfection
terminale des chambres : gros plan sur les essais cliniques
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Weber DJ; Rutala WA; Anderson DJ; Chen LF; Sickbert-Bennett EE; Boyce JM. Effectiveness of ultraviolet
devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials. American
journal of infection control 2016/05; 44(Suppl. 5): e77-e84.
Mots-clés : CHAMBRE DU MALADE; DESINFECTION; ULTRA-VIOLET; PEROXYDE D'HYDROGENE;
SURFACE; DESINFECTION COMPLEMENTAIRE
Over the last decade, substantial scientific evidence has accumulated that indicates contamination of
environmental surfaces in hospital rooms plays an important role in the transmission of key health careassociated pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci,
Clostridium difficile, Acinetobacter spp). For example, a patient admitted to a room previously occupied by a
patient colonized or infected with one of these pathogens has a higher risk for acquiring one of these
pathogens than a patient admitted to a room whose previous occupant was not colonized or infected. This
risk is not surprising because multiple studies have demonstrated that surfaces in hospital rooms are poorly
cleaned during terminal cleaning. To reduce surface contamination after terminal cleaning, no touch methods
of room disinfection have been developed. This article will review the no touch methods, ultraviolet light
devices, and hydrogen peroxide systems, with a focus on clinical trials which have used patient colonization
or infection as an outcome.
Multiple studies have demonstrated that ultraviolet light devices and hydrogen peroxide systems have been
shown to inactivate microbes experimentally plated on carrier materials and placed in hospital rooms and to
decontaminate surfaces in hospital rooms naturally contaminated with multidrug-resistant pathogens. A
growing number of clinical studies have demonstrated that ultraviolet devices and hydrogen peroxide systems
when used for terminal disinfection can reduce colonization or health care–associated infections in patients
admitted to these hospital rooms.
Epidémie
NosoBase ID notice : 409463
L’acceptation de la suspension temporaire des visites lors d’une épidémie à Norovirus : une enquête
auprès des patients, des visiteurs et de l’opinion publique
Currie K; Price L; Curran E; Bunyan D; Knussen C. Acceptability of temporary suspension of visiting during
norovirus outbreaks: investigating patient, visitor and public opinion. The journal of hospital infection 2016/06;
93(2): 121-126.
Mots-clés : NOROVIRUS; USAGER DE LA SANTE; VISITE AUX HOSPITALISES; TRANSMISSION
Background: Noroviruses are a leading cause of outbreaks globally and the most common cause of service
disruption due to ward closures. Temporary suspension of visiting (TSV) is increasingly a recommended
public health measure to reduce exposure, transmission and impact during norovirus outbreaks; however,
preventing patient-visitor contact may contravene the ethos of person-centred care, and public acceptability of
this measure is not known.
Aim: To investigate the acceptability of TSV during norovirus outbreaks from the perspectives of patients,
visitors and the wider public.
Methods: Cross-sectional survey of patients (N=153), visitors (N=175) and the public (N=224) in three diverse
areas in Scotland. Health Belief Model constructs were applied to understand ratings of acceptability of TSV
during norovirus outbreaks, and to determine associations between these levels and various predictor
variables.
Findings: The majority (84.6%) of respondents indicated that the possible benefits of TSV are greater than the
possible disadvantages. Conversely, the majority (70%) of respondents disagreed that TSV 'is wrong as it
ignores people's rights to have contact with family and friends'. The majority (81.6%) of respondents agreed
that TSV would be more acceptable if exceptions were made for seriously ill or dying patients. Correlational
analysis demonstrated that overall acceptability was positively related to perceived severity (r=0.65),
identified benefits (r=0.54) and implementing additional communication strategies (r=0.60); acceptability was
negatively related to potential barriers (r=-0.49).
Conclusions: There is greater service user and public support for the use of TSV than concerns around
impinging upon patients' rights to have visitors. TSV should be considered as an acceptable infection control
measure that could be implemented consistently during norovirus outbreaks.
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NosoBase ID notice : 414134
Epidémie d’un nouveau variant de la rougeole génotype B3 dans une population de roms/sintis avec
transmission nosocomiale
Filia A; Amendola A; Faccini M; Del Manso M; Senatore S; Bianchi S; et al. Outbreak of a new measles B3
variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April
2016. Eurosurveillance 2016/05/19; 21(20): 1-6.
Mots-clés : INFECTION NOSOCOMIALE; EPIDEMIE; ROUGEOLE; PEDIATRIE; PERSONNEL
A measles outbreak occurred from November 2015 to April 2016 in two northern Italian regions, affecting the
Roma/Sinti ethnic population and nosocomial setting. Overall, 67 cases were reported. Median age of 43
cases in three Roma/Sinti camps was four years, nosocomial cases were mainly adults. The outbreak was
caused by a new measles virus B3.1 variant. Immunisation resources and strategies should be directed at
groups with gaps in vaccine coverage, e.g. Roma/Sinti and healthcare workers.
NosoBase ID notice : 414853
Epidémies liées aux soins associées à un réservoir hydrique et stratégies de prévention
Kanamori H; Weber DJ; Rutala WA. Healthcare outbreaks associated with a water reservoir and infection
prevention strategies. Clinical infectious diseases 2016/06/01; 62(11): 1423-1435.
Mots-clés : EPIDEMIE; ENVIRONNEMENT; EAU; TRANSMISSION; LEGIONELLA; MYCOBACTERIE
ATYPIQUE; KLEBSIELLA; REVUE DE LA LITTERATURE; INFECTION NOSOCOMIALE
Hospital water may serve as a reservoir of healthcare-associated pathogens, and contaminated water can
lead to outbreaks and severe infections. The clinical features of waterborne outbreaks and infections as well
as prevention strategies and control measures are reviewed. The common waterborne pathogens were
bacteria, including Legionella and other gram-negative bacteria, and nontuberculous mycobacteria, although
fungi and viruses were occasionally described. These pathogens caused a variety of infections, including
bacteremia and invasive and disseminated diseases, particularly among immunocompromised hosts and
critically ill adults as well as neonates. Waterborne outbreaks occurred in healthcare settings with emergence
of new reported reservoirs, including electronic faucets (Pseudomonas aeruginosa and Legionella),
decorative water wall fountains (Legionella), and heater-cooler devices used in cardiac surgery
(Mycobacterium chimaera). Advanced molecular techniques are useful for achieving a better understanding
of reservoirs and transmission pathways of waterborne pathogens. Developing prevention strategies based
on water reservoirs provides a practical approach for healthcare personnel.
NosoBase ID notice : 409484
Un contrôle efficace d’une épidémie à Pseudomonas aeruginosa productrice de bêta-lactamase à
spectre étendu GES-5 dans un établissement de soins de longue durée au Japon
Kanayama A; Kawahara R; Yamagishi T; Goto K; Kobaru Y; Takano M; et al. Successful control of an
outbreak of GES-5 extended-spectrum β-lactamase producing Pseudomonas aeruginosa in a long-term care
facility in Japan. The journal of hospital infection 2016/05; 93(1): 35-41.
Mots-clés : PSEUDOMONAS AERUGINOSA; EPIDEMIE; CONTROLE; BETA-LACTAMASE A SPECTRE
ELARGI; SOIN DE LONGUE DUREE; INVESTIGATION; EPIDEMIOLOGIE DESCRIPTIVE;
CONTAMINATION; HYGIENE DES MAINS; EHPAD
Background: Little is known about multidrug-resistant Pseudomonas aeruginosa (MDRP) outbreaks in longterm care facilities (LTCFs).
Aim: To describe an MDRP outbreak in an LTCF and to clarify risk factors for MDRP acquisition.
Methods: Patients who were positive for MDRP at an LTCF from January 2013 to January 2014 were
analysed. A descriptive analysis, a case‒control study, and a microbiological analysis were performed.
Findings: A total of 23 MDRP cases were identified, 16 of which were confirmed in sputum samples.
Healthcare workers were observed violating hand hygiene procedures when performing oral, wound, and
genital care. Nasogastric tube and oxygen mask use was associated with MDRP acquisition in the respiratory
tract, which might have been confounded by poor hand hygiene. Sharing unhygienic devices, such as
portable oral suction devices for oral care, and washing bottles and ointments for wound and genital care with
inadequate disinfection could explain the transmission of MDRP in some cases. Isolates from 11 patients
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were found to be indistinguishable or closely related by pulsed-field gel electrophoresis and harbouring the
blaGES-5 gene. Subsequent enhanced infection control measures were supported by nearby hospitals and a
local public health centre. No additional cases were identified for a year after the last case occurred in
January 2014.
Conclusion: An outbreak of MDRP with an antimicrobial resistance gene, blaGES-5, occurred in a Japanese
LTCF. It was successfully controlled by enhanced infection control measures, which neighbouring hospitals
and a local public health centre supported.
NosoBase ID notice : 413196
Epidémies des infections à Entérobactéries résistant aux carbapénèmes
duodénoscopes : que pouvons-nous faire pour prévenir les infections ?
associées
aux
Rutala WA; Weber DJ. Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with
duodenoscopes: What can we do to prevent infections? American journal of infection control 2016/05;
44(Suppl. 5): e47-e51.
Mots-clés : CARBAPENEME; PREVENTION; ENTEROBACTERIE; EPIDEMIE; ENDOSCOPIE;
ANTIBIORESISTANCE; DESINFECTION; STERILISATION; ENDOSCOPIE DIGESTIVE; DUODENOSCOPE
Recent outbreaks with carbapenem-resistant Enterobacteriaceae (CRE) in patients who have undergone
endoscopic retrograde cholangiopancreatography (ERCP) have raised concerns of whether current
endoscope reprocessing guidelines are adequate to ensure a patient-safe endoscope. Unlike previous
outbreaks, these CRE outbreaks occurred even though manufacturer’s instructions and professional
guidelines were followed correctly. This article reviews why outbreaks associated with endoscopes continue
to occur; what alternatives exist that might improve the margin of safety associated with duodenoscope
reprocessing; and how to prevent future outbreaks associated with ERCP procedures. The advantages and
disadvantages for the proposed enhancements for reprocessing duodenoscopes are reviewed as well as
future strategies to prevent GI endoscope-related outbreaks.
Hépatite C
NosoBase ID notice : 414502
Un cas de transmission nosocomiale du virus de l’hépatite C (VHC) en hémodialyse : analyse des
causes a posteriori selon la méthode ALARM, France, 2015
Seringe E; Colin L; Aggoune M; Novakova I; Astagneau P. Un cas de transmission nosocomiale du virus de
l’hépatite C (VHC) en hémodialyse : analyse des causes a posteriori selon la méthode ALARM, France, 2015.
Bulletin épidémiologique hebdomadaire 2016/05/17; 13-14: 244-249.
Mots-clés : TRANSMISSION; HEMODIALYSE; ANALYSE DES CAUSES; GESTION DES RISQUES;
HEPATITE C; TRANSMISSION SOIGNE-SOIGNE; PRECAUTION STANDARD; PREVALENCE;
DESINFECTION; HYGIENE DES MAINS; GANT; INVESTIGATION; SEROCONVERSION; EVALUATION
DES PRATIQUES PROFESSIONNELLES; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION;
DECHET D'ACTIVITE DE SOINS A RISQUE INFECTIEUX; USAGER DE LA SANTE; TENUE
VESTIMENTAIRE; METHODE ALARM; ASSOCIATION OF LITIGATION AND RISK MANAGEMENT
Introduction : La transmission associée aux soins du virus de l’hépatite C (VHC), bien que peu fréquente,
reste l’un des modes de contamination décrits. Le Centre de coordination de la lutte contre les infections
nosocomiales (CClin) Paris-Nord a reçu, le 7 mai 2015, le signalement d’un cas de séroconversion au VHC,
identifié en avril 2015 dans une unité de dialyse médicalisée chez une patiente dialysée aux mêmes séances
qu’un autre patient, connu comme étant porteur du VHC. L’objectif de ce travail était d’identifier les facteurs
ayant contribué à cette transmission du VHC entre deux patients dans un centre de dialyse.
Matériel et méthodes : Après avoir reconstitué la chronologie de l’évènement, réalisé un audit des pratiques
et conduit des entretiens individuels avec les personnels du centre, nous avons utilisé la méthode ALARM
pour identifier les causes immédiates, contributives et latentes à l’origine de cette transmission du VHC.
Résultats : Le Centre national de référence (CNR) des hépatites virales a mis en évidence le fait que les deux
souches étaient identiques.
Les causes immédiates identifiées de la transmission sont : respect non optimal des précautions standard,
absence de maîtrise du risque lié aux projections de sang, absence d’hygiène des mains des patients.
Les causes contributives sont liées : aux patients (saignements post-pansement fréquents, pas toujours bien
formés aux mesures d’hygiène) ; aux professionnels (non vérification de l’hygiène des mains des patients,
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méconnaissance du risque viral lié aux projections) ; à l’équipe (entraide importante entre les professionnels
responsable d’une désorganisation des soins avec interruption fréquente des tâches) ; à l’environnement de
travail.
Les causes latentes sont : organisationnelles, avec renouvellement du tiers de l’équipe à partir de juin 2014
et nouveaux arrivants à former, absence de politique d’éducation thérapeutique du patient.
Discussion : Cette étude de cas nous a permis d’identifier plusieurs défaillances de pratiques qui ont pu
favoriser la transmission nosocomiale du VHC en unité de dialyse médicalisée. La méthode ALARM apparaît
très pertinente pour aider à mettre en œuvre des mesures visant à améliorer l’organisation des soins.
Hygiène des mains
NosoBase ID notice : 414466
Rôle des parents dans la promotion de l’hygiène des mains en pédiatrie : une revue systématique de
littérature
Bellissimo-Rodrigues F; Pires D; Zingg W; Pittet D. Role of parents in the promotion of hand hygiene in the
paediatric setting: a systematic literature review. The journal of hospital infection 2016/06; 93(2): 159-163.
Mots-clés : HYGIENE DES MAINS; PEDIATRIE; ENFANT; REVUE DE LA LITTERATURE; INFORMATION;
USAGER DE LA SANTE; PARENT; PERSONNEL
Background: When a child is hospitalized, parents have to share their role to protect the child with the
hospital, and establish a partnership with healthcare workers to deliver safe care to the child, including
undertaking good hand hygiene practices.
Aim: To review the scientific evidence about the participation of parents in the promotion of hand hygiene in
paediatric settings.
Methods: A systematic search of MEDLINE, EMBASE and SciELO databases was undertaken using the
following terms: ('hand hygiene'[MeSH] OR 'hand hygiene' OR 'hand disinfection'[MeSH] OR hand disinf* OR
hand wash* OR handwash* OR hand antisep*) AND (parent OR caregiver OR mother OR father OR family
OR families OR relatives). The Integrated Quality Criteria for Review of Multiple Study Designs tool was used
for quality assessment.
Findings: The literature search yielded 1645 articles, and 11 studies met the inclusion criteria for the final
analysis. Most studies were observational, and were based on questionnaires or interviews. Most parents had
little knowledge about the indications to perform hand hygiene, but recognized hand hygiene as a relevant
tool for the prevention of healthcare-associated infections. Their willingness to remind healthcare workers
about a failed opportunity to perform hand hygiene was variable and, overall, rather low. Parents felt more
comfortable about reminding healthcare workers about hand hygiene if they had previously been invited to do
so.
Conclusions: Literature on the subject is scarce. The promotion of hand hygiene by parents should be further
explored by research as a potential intervention for enhancing patient safety in paediatric settings.
NosoBase ID notice : 413188
Défis dans la mise en œuvre des systèmes de surveillance électronique de l’hygiène des mains
Conway LJ. Challenges in implementing electronic hand hygiene monitoring systems. American journal of
infection control 2016/05; 44(Suppl. 5): e7-e12.
Mots-clés : HYGIENE DES MAINS; SURVEILLANCE; OBSERVANCE
Electronic hand hygiene (HH) monitoring systems offer the exciting prospect of a more precise, less biased
measure of HH performance than direct observation. However, electronic systems are challenging to
implement. Selecting a system that minimizes disruption to the physical infrastructure and to clinician
workflow, and that fits with the organization’s culture and budget, is challenging. Getting front-line workers’
buy-in and addressing concerns about the accuracy of the system and how the data will be used are also
difficult challenges. Finally, ensuring information from the system reaches front-line workers and is used by
them to improve HH practice is a complex challenge. We describe these challenges in detail and suggests
ways to overcome them.
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NosoBase ID notice : 413255
Développement réussi d’un programme d’observation directe pour mesurer l’hygiène des mains des
professionnels de santé grâce à plusieurs bénévoles formés
Linam WM; Honeycutt MD; Gilliam CH; Wisdom CM; Bai S; Deshpande JK. Successful development of a
direct observation program to measure health care worker hand hygiene using multiple trained volunteers.
American journal of infection control 2016/05; 44(5): 544-547.
Mots-clés : HYGIENE DES MAINS; QUALITE; PERSONNEL; OBSERVANCE; OBSERVATION
Background: Direct observation of health care worker (HCW) hand hygiene (HH) remains the gold standard,
but implementation is challenging. Our objective was to develop an accurate HH observation program using
multiple HCW volunteers.
Methods: HH compliance was defined as correct HH performed before and after contact with a patient or a
patient's environment. HCW volunteers from each unit at our children's hospital were trained by infection
preventionists to covertly collect HH observations during routine care using an electronic tool. Questionnaires
sent to observers in February and December 2014 recorded demographic characteristics, observation time,
and scenarios assessing accuracy. HCWs were surveyed regarding their awareness that their HH behavior
was being recorded.
Results: There were 146 HH observers. The majority of observers reported making 1-2 observations per shift
(65%) and taking ≤10 minutes recording an observation (85%). Between January 2012 and December 2014
there were 22,484 HH observations (average, 622 per month), including nurses (46%), physicians (21%), and
other HCWs (33%). Observers correctly recorded HH behavior more than 90% of the time in 5 of the 6
scenarios. Most HCWs (86%) were unaware they were being observed.
Conclusion: A direct observation program staffed by multiple HCW volunteers can inexpensively and
accurately collect HCW HH data.
NosoBase ID notice : 413123
Evaluation du respect des programmes d’intervention mis en place pour améliorer l’hygiène des
mains du personnel soignant : revue systématique
Musuuza JS; Barker A; Ngam C; Vellardita L; Safdar N. Assessment of fidelity in interventions to improve
hand hygiene of healthcare workers: A systematic review. Infection control and hospital epidemiology
2016/05; 37(5): 567-575.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PERSONNEL; INFECTION NOSOCOMIALE; REVUE
DE LA LITTERATURE; FORMATION; COMPORTEMENT
Objective: Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet
remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene
compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3)
quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation.
Design: Systematic review
Methods: A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied
Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The
review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and
assessment of study quality was conducted for each study reviewed.
Results: A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures
of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100
(20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of
the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the
intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most
frequently reported measure.
Conclusions: Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To
facilitate replication and effective implementation, reporting fidelity should be standard practice when
describing results of complex behavioral interventions such as hand hygiene.
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NosoBase ID notice : 413514
Amélioration de l'observance de l'hygiène des mains chez le personnel de santé d'une unité
d'hémodialyse grâce à l'utilisation d'un retour d'information par surveillance vidéo
Sánchez-Carrillo LA; Rodríguez-López JM; Galarza-Delgado DA; Baena-Trejo L; Padilla-Orozco M;
Mendoza-Flores L; et al. Enhancement of hand hygiene compliance among health care workers from a
hemodialysis unit using video-monitoring feedback. American journal of infection control 2016/04/08; in press:
1-5.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PERSONNEL; HEMODIALYSE; VIDEO
Background: The importance of hand hygiene in the prevention of health care-associated infection is well
known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce.
Methods: This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a
13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150
hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted
observer. Feedback was given to health care workers in the form of educational sessions and confidential
reports and video analysis of compliance and noncompliance.
Results: A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video
footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline
evaluation was observed by video monitoring compared with direct observation (P <0.05). Discrepancy
between both methods was 29.2% (0.4%-59.8%); the average improvement in compliance during the study
was 30.6% (range, 7.3%-75.5%). Global and Individual results for each subject revealed a statistically
significant Improvement in the majority. Noncompliance according to WHO's 5 Moments for HH was greater
for moment 5 (30.1%). We estimated that a health care worker in a hemodialysis unit could take 22-44.3% of
working hours for proper hand hygiene compliance.
Conclusions: Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a
hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that
includes video examples and confidential reports.
Infection urinaire
NosoBase ID notice : 413138
Evaluation d’un nouveau programme d’interventions pour diminuer le nombre d’ECBU superflus dans
les services de soins intensifs d’un centre hospitalier universitaire du Maryland
Epstein L; Edwards JR; Halpin AL; Preas MA; Blythe D; Harris AD; et al. Evaluation of a novel intervention to
reduce unnecessary urine cultures in intensive care units at a tertiary care hospital in Maryland, 2011-2014.
Infection control and hospital epidemiology 2016/05; 37(5): 606-609.
Mots-clés : URINE; TECHNIQUE DE DIAGNOSTIC; INFECTION URINAIRE; TAUX; INFECTION
NOSOCOMIALE; SOIN INTENSIF
We assessed the impact of a reflex urine culture protocol, an intervention aimed to reduce unnecessary urine
culturing, in intensive care units at a tertiary care hospital. Significant decreases in urine culturing rates and
reported rates of catheter-associated urinary tract infection followed implementation of the protocol.
Maternité
NosoBase ID notice : 409478
Décontamination des kits de collecte de lait maternel et matériels associés à la maison et à l’hôpital :
conseil du groupe de travail conjoint de la Healthcare Infection Society et l’Infection Prevention
Society
Price E; Weaver G; Hoffman P; Jones M; Gilks J; O'Brien V; et al. Decontamination of breast pump milk
collection kits and related items at home and in hospital: guidance from a Joint Working Group of the
Healthcare Infection Society and Infection Prevention Society. The journal of hospital infection 2016/03; 92(3):
213-221.
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Mots-clés : RECOMMANDATIONS DE BONNE PRATIQUE; LAIT;
STERILISATION; NETTOYAGE; DECONTAMINATION; DESINFECTION
Juin 2016
ALLAITEMENT
MATERNEL;
Introduction: A variety of methods are in use for decontaminating breast pump milk collection kits and related
items associated with infant feeding. This paper aims to provide best practice guidance for decontamination
of this equipment at home and in hospital. It has been compiled by a Joint Working Group of the Healthcare
Infection Society and the Infection Prevention Society.
Methods: The guidance has been informed by a search of the literature in Medline, the British Nursing Index,
the Cumulative Index to Nursing and Allied Health Literature, Midwifery and Infant Care, and the results of
two surveys of UK neonatal units in 2002/3 and 2006, and of members of the Infection Prevention Society in
2014. Since limited good quality evidence was available from these sources, much of the guidance
represents good practice based on the consensus view of the Working Group.
Key recommendations: Conclusion: This guidance provides practical recommendations to support the safe
decontamination of breast pump milk collection kits for healthcare professionals to use and communicate to
other groups such as parents and carers.
Néonatologie
NosoBase ID notice : 414082
Streptococcus groupe B : le développement d’un corrélat de protection pour un vaccin contre les
infections néonatales
Dangor Z; Lala SG; Kwatra G; Madhi SA. Group B Streptococcus: developing a correlate of protection for a
vaccine against neonatal infections. Current opinion in infectious diseases 2016/06; 29(3): 262-267.
Mots-clés : NEONATOLOGIE; STREPTOCOCCUS GROUPE B; VACCIN; NOUVEAU-NE; IMMUNITE;
TRANSMISSION
MATERNO-FOETALE;
LAIT;
ANTICORPS;
BIOLOGIE
MOLECULAIRE;
IMMUNOGLOBULINE; COLONISATION; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; REVUE DE LA
LITTERATURE
Purpose of review: Maternal vaccination to prevent invasive Group B Streptococcus (GBS) disease in infants
is an important alternative strategy to intrapartum antibiotic prophylaxis. Licensure of GBS vaccines could be
expedited using immunological correlates of protection.
Recent findings: Between 2014 and 2015, we identified two studies that demonstrated an inverse association
between invasive GBS disease and maternal serotype III capsular antibody levels greater than 1 μg/ml and
greater than 3 μg/ml, and higher maternal antibody levels were associated with protection against serotype Ia
disease. Furthermore, serotype Ia and III antibody levels greater than 3 μg/ml were associated with a reduced
risk of GBS colonization in pregnant women. Experimental studies have investigated the use of GBS surface
proteins as vaccine candidates. Although the immunogenic potential of pilus island and other surface proteins
has been shown in animal-model studies, no association between maternal pilus island antibody levels and
invasive GBS disease was demonstrated in infants. Additionally, several novel innate immune mediators that
prevent GBS infection have been described in human and experimental studies.
Summary: Recent studies suggest that maternal capsular antibody thresholds may be used as immunological
correlates of protection for vaccine licensure. Surface proteins, as candidate vaccines or conjugates to the
polysaccharide-protein vaccine, may broaden protection against invasive GBS disease.
NosoBase ID notice : 413455
Etiologie, antibiorésistance et facteurs de risque de septicémie néonatale dans un centre hospitalier
universitaire en Zambie
Kabwe M; Tembo J; Chilukutu L; Chilufya M; Ngulube F; Lukwesa C; et al. Etiology, antibiotic resistance and
risk factors for neonatal sepsis in a large referral center in Zambia. Pediatric infectious disease journal
2016/03/30; in press: 1-23.
Mots-clés : ANTIBIORESISTANCE; FACTEUR DE RISQUE; ETIOLOGIE; SEPTICEMIE; NEONATOLOGIE;
NOUVEAU-NE; CENTRE HOSPITALIER UNIVERSITAIRE; MULTIRESISTANCE; TRANSMISSION;
KLEBSIELLA PNEUMONIAE; STAPHYLOCOQUE A COAGULASE NEGATIVE; STAPHYLOCOCCUS
AUREUS; ESCHERICHIA COLI; CANDIDA; VIRUS DE L'IMMUNODEFICIENCE HUMAINE
Background: In sub-Saharan Africa there is scanty data on the causes of neonatal sepsis and antimicrobial
resistance among common invasive pathogens that might guide policy and practice.
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Methods: A cross-sectional observational prevalence and aetiology study of neonates with suspected sepsis
admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October
2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared
with multivariate analysis of risk factors for neonatal sepsis.
Results: Of 313 neonates with suspected sepsis, 54% (170/313) were male. 20% (62/313) were born to HIV
positive mothers. 33% (103/313) had positive blood cultures, of which 85% (88/103) were early onset sepsis
(EOS). Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by
coagulase negative staphylococci (6% (7/103)), Staphylococcus aureus (6% (6/103)), Escherichia coli (5%
(5/103) and Candida species (5% (5/103). For Klebsiella species antibiotic resistance ranged from 96-99% for
WHO-recommended first line therapy (gentamicin and ampicillin/penicillin) to 94-97% for third generation
cephalosporins. The prevalence of culture confirmed sepsis increased from 0-39% during the period Dec
2013-Mar 2014, during which time mortality increased 29-47%. 93% (14/15) of late onset sepsis (LOS) and
82% (37/45) of EOS aged 4-7 days were admitted > 2 days prior to onset of symptoms. Culture results for
only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated
with a reduced risk of neonatal sepsis (OR 0.46 [0.23-0.93], p=0.029).
Conclusion: Outbreaks of nosocomial multi-antibiotic resistant infections are an important cause of neonatal
sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is
counterintuitive and requires further investigation.
NosoBase ID notice : 414080
Toxicité de la vancomycine en néonatologie : une revue des preuves
Lestner JM; Hill LF; Heath PT; Sharland M. Vancomycin toxicity in neonates: a review of the evidence.
Current opinion in infectious diseases 2016/06; 29(3): 237-247.
Mots-clés : VANCOMYCINE; NEONATOLOGIE; TOXICITE; NOUVEAU-NE; EFFET INDESIRABLE; REVUE
DE LA LITTERATURE; GENTAMICINE; AMINOSIDE; SURDITE; REIN
Purpose of review: Vancomycin is a first-line agent in the treatment of serious Gram-positive infections in the
neonatal population. The published evidence on vancomycin toxicity in neonates is limited. This review
summarizes preclinical studies and clinical trials describing vancomycin toxicity. We discuss proposed
pathophysiology and summarize evidence supporting dose-response relationships, genetic and
environmental determinants, and consider future research required to further define vancomycin toxicity.
Recent findings: Current dosing regimens for vancomycin result in subtherapeutic levels in a large proportion
of patients. Higher daily doses have been proposed, which have led to concerns regarding increased toxicity.
Nephrotoxicity occurs in 1-9% of neonates receiving currently recommended doses. The incidence is highest
in those receiving concomitant nephrotoxic drugs. Vancomycin-associated ototoxicity is rare in patients of all
ages. Exposure-toxicity relationships in relation to nephrotoxicity and ototoxicity have not been clearly defined
in neonates receiving vancomycin.
Summary: Current evidence supports the favourable safety profile of vancomycin in neonates. Further studies
that address safety concerns relating to high-dose intermittent dosing regimens are needed. Such studies
must include robust and standardized definitions of renal and hearing impairment, and include follow-up of
sufficient length to establish the long-term implications of experimental findings.
Odontologie
NosoBase ID notice : 413347
Tuberculose : risques professionnels chez les professionnels du secteur dentaire et risque
d’infection chez les patients
Petti S. Tuberculosis: Occupational risk among dental healthcare workers and risk for infection among dental
patients. A meta-narrative review. Journal of dentistry 2016/06; 49: 1-8.
Mots-clés :
TUBERCULOSE;
PERSONNEL;
ODONTOLOGIE;
MYCOBACTERIUM TUBERCULOSIS; REVUE DE LA LITTERATURE
CHIRURGIEN
DENTISTE;
Objectives: Tuberculosis transmission among healthcare workers (HCWs) and patients is due to the level of
Mycobacterium tuberculosis (MT) circulation in the community and in the healthcare settings where HCWs
are active. In contrast, most papers about dentistry report that dental HCWs (DHCWs) and patients are at
relatively high risk, mainly based on tuberculosis case series that occurred in the 80's-90's. This meta-
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Juin 2016
narrative review was designed to evaluate the tuberculosis risk in dentistry accounting for the historicalgeographical contexts.
Data: All available studies reporting data on MT infection (active/latent tuberculosis, tuberculin skin test)
among patients and DHCWs.
Sources: PubMed, Scopus, GOOGLE Scholar.
Results: 238 of the 351 titles were excluded because did not concern dental healthcare providing, 94 papers
were excluded because they did not provide original data. Thirteen studies on occupational risk, nine on
transmission to patients remained. Some, often non-confirmed, cases of MT infection among patients were
reported in specific historical-geographical contexts where MT was endemic. The risk of active pulmonary
tuberculosis transmission from infected DHCWs to patients is minimal today, provided that the basic infection
control guidelines are applied. The development of active tuberculosis among DHCWs is occasional and is
associable to MT circulation rather than dental healthcare providing.
Clinical significance: Tuberculosis transmission in dental healthcare settings was due to the lack of basic
infection control measures, while the risk is acceptable (i.e., similar to the general population) nowadays.
Therefore, tuberculosis transmission can be safely prevented wearing gloves and surgical mask and
providing regular air changes in the operative and non-operative dental healthcare settings. Precautionary
Principle-based measures are implementable when patients with active pulmonary tuberculosis are routinely
treated.
Pédiatrie
NosoBase ID notice : 412574
Un nouveau “bundle” de mesures de prévention pour diminuer les infections du site opératoire chez
des enfants ayant subi une arthrodèse vertébrale
Gould JM; Hennessey P; Kiernan A; Safier S; Herman M. A novel prevention bundle to reduce surgical site
infections in pediatric spinal fusion patients. Infection control and hospital epidemiology 2016/05; 37(5): 527534.
Mots-clés : CHIRURGIE ORTHOPEDIQUE; VERTEBRE; INFECTION NOSOCOMIALE; PEDIATRIE; TAUX;
PRE-OPERATOIRE; PERIOPERATOIRE; POST-OPERATOIRE; SORTIE; FORMATION; PEAU;
ANTISEPTIQUE; BLOC OPERATOIRE
Background: The Surgical Care Improvement Project bundle emphasizes operative infection prevention
practices. Despite implementing the Surgical Care Improvement Project bundle in 2008, spinal fusion surgical
site infections (SF-SSI) continued to be prevalent for this low-volume, high-risk surgery.
Objective: To design a combined pre-, peri-, and postoperative bundle (PPPB) that would lead to sustained
reductions in SF-SSI rates.
Design: Quality improvement project, before-after trial with cost-effectiveness analysis.
Setting: Children's hospital.
Patients: All spinal fusion patients, 2008-2015.
Intervention: A multidisciplinary team developed the PPPB composed of Surgical Care Improvement Project
elements plus improved wound care practices, nursing standard of care, dedicated nursing unit, dermatology
assessment tool and consultation, nursing education tool using "teach back" technique, and a "Back Home"
kit. SF-SSI rates were compared before (2008-2010) and after (2011-February 2015) implementation of
PPPB. PPPB compliance was monitored.
Results: A total of 224 SF surgeries were performed from 2008 to February 2015. Pre-PPPB analysis
revealed median time to SF-SSI of 28 days, secondary to skin and bowel flora. Mean 3-year pre-PPPB SFSSI rate per 100 SF surgeries was 8.2 (8/98) (2008: 13.3 [4/30], 2009: 2.7 [1/37], 2010: 9.7 [3/31]). Mean SFSSI rate after PPPB was 2.4 (3/126) (January 2011-February 2015); there was a 71% reduction in mean SSI
rate (P=.0695). No SF-SSI occurred in neuromuscular patients (P=.008) after PPPB. Compliance with PPPB
elements has been 100%.
Conclusions: PPPB led to sustained improvement in SF-SSI rates over 50 months. The PPPB could be
reproduced for other surgeries.
NosoBase ID notice : 409485
Impact précoce de la vaccination contre le rotavirus dans un grand hôpital pédiatrique du RoyaumeUni
Hungerford D; Read JM; Cooke RP; Vivancos R; Iturriza-Gómara M; Allen DJ; et al. Early impact of rotavirus
vaccination in a large paediatric hospital in the UK. The journal of hospital infection 2015/12/31; in press: 1-4.
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Mots-clés : PEDIATRIE; VACCINATION; ROTAVIRUS; EPIDEMIOLOGIE; ENFANT
The impact of routine rotavirus vaccination on community-acquired (CA) and healthcare-associated (HA)
rotavirus gastroenteritis (RVGE) at a large paediatric hospital, UK, was investigated over a 13-year period. A
total of 1644 hospitalized children aged 0-15 years tested positive for rotavirus between July 2002 and June
2015. Interrupted time-series analysis demonstrated that, post vaccine introduction (July 2013 to June 2015),
CA- and HA-RVGE hospitalizations were 83% [95% confidence interval (CI): 72-90%) and 83% (95% CI: 6692%] lower than expected, respectively. Rotavirus vaccination has rapidly reduced the hospital rotavirus
disease burden among both CA- and HA-RVGE cases.
NosoBase ID notice : 413266
La surveillance électronique pour les infections urinaires associées aux cathéters dans un hôpital
universitaire pédiatrique
Sen AI; Balzer K; Mangino D; Messina M; Ross B; Zachariah P; et al. Electronic surveillance for catheterassociated urinary tract infections at a university-affiliated children's hospital. American journal of infection
control 2016/05; 44(5): 599-601.
Mots-clés :
URINAIRE
SURVEILLANCE;
PEDIATRIE;
INFORMATIQUE;
INFECTION
URINAIRE;
SONDAGE
We sought to describe the characteristics of catheter-associated urinary tract infections (CAUTIs) in a
children's hospital while demonstrating efficacy of electronic identification of CAUTIs. There were 25 CAUTIs
identified over 24 months, with most (88%) occurring in the intensive care units (ICUs). The incidence of ICU
CAUTIs decreased during the study period (P=.04). Concordance between electronic identification and
validation by infection control staff was 83% and increased to 100% with correction of nursing documentation.
NosoBase ID notice : 413212
Impact de la colonisation par des entérocoques résistant à la vancomycine en réanimation
pédiatrique
Sutcu M; Akturk H; Acar M; Salman N; Aydin D; Akgun Karapinar B; et al. Impact of vancomycin-resistant
enterococci colonization in critically ill pediatric patients. American journal of infection control 2016/05; 44(5):
515-519.
Mots-clés : VANCOMYCINE; COLONISATION; PEDIATRIE; ENTEROCOCCUS; ANTIBIORESISTANCE;
SOIN INTENSIF
Background: We aimed to determine the frequency of vancomycin-resistant enterococci (VRE) infection
occurrence in previously VRE-colonized children in a pediatric intensive care unit (PICU) and to identify
associated risk factors.
Methods: Infection control nurses have performed prospective surveillance of health care-associated
infections and rectal VRE carriage in PICUs from January 2010-December 2014. This database was
reviewed to obtain information about VRE-colonized and subsequently infected patients. A case-control study
was performed to identify risk factors associated with VRE infection development in previously VRE-colonized
patients.
Results: Out of 1,134 patients admitted to the PICU, 108 (9.5%) were found to be colonized with VRE
throughout the study period. Systemic VRE infections developed in 11 VRE-colonized patients (10.2%), and
these included primary bloodstream infection (n=6), urinary tract infection (n=3), meningitis and bloodstream
infection (n=1), and meningitis (n=1). Logistic regression analysis indicated long hospital stay (≥30 days) and
glycopeptide use after detection of VRE colonization as risk factors for developing VRE infection in VREcolonized patients (odds ratio [OR], 5.76; 95% confidence interval [CI], 1.6-15.8; P = .017 and OR, 12.8; 95%
CI, 1.9-26.6; P=.012, respectively).
Conclusions: VRE colonization has important consequences in pediatric critically ill patients. Strict infection
control measures should be implemented to prevent VRE colonization and thereby VRE infections.
Furthermore, irrational antibiotic use and particularly glycopeptide use in VRE-colonized patients should be
restricted.
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Personnel
NosoBase ID notice : 407802
Comment promouvoir le respect des bonnes pratiques de perfusion en allant à la rencontre des
soignants ?
Le Reste C; Fiedler A; Dubois S; Dewailly A; Le Du I; Cogulet V. Comment promouvoir le respect des bonnes
pratiques de perfusion en allant à la rencontre des soignants ? Annales pharmaceutiques françaises 2016/06;
74(3): 232-243.
Mots-clés : PERFUSION; EVALUATION DES PRATIQUES PROFESSIONNELLES; MEDICAMENT;
RECOMMANDATIONS DE BONNE PRATIQUE; AUDIT CLINIQUE; ANTISEPTIQUE; FORMATION
Introduction : L’administration des médicaments par perfusion est un acte très courant mais non dénué de
risques. Pour évaluer cette pratique et dégager d’éventuelles actions d’amélioration, un audit des pratiques
de perfusion par gravité a été réalisé.
Materiel et méthode : L’audit, basé sur une grille comportant 66 items de la prescription à la fin de
l’administration, a été effectué dans 6 unités de soins les plus consommatrices de perfuseurs simples. Un
groupe de travail pluridisciplinaire a ensuite été créé afin de proposer et mettre en oeuvre des actions
prioritaires d’amélioration des pratiques et de la qualité des soins.
Résultats : L’observation de 90 heures de pratiques infirmières (96 perfusions) a mis en évidence des
pratiques hétérogènes et parfois inappropriées ainsi qu’un mésusage de certains dispositifs médicaux.
Quatre thématiques de travail ont été identifiées : étiquetage des perfusions, formation des professionnels
aux bonnes pratiques, argumentation pour l’achat de pompes volumétriques, harmonisation des montages de
perfusion. Afin d’encourager le respect des bonnes pratiques, des formations sous forme d’ateliers
comprenant plusieurs points (identification permanente de la perfusion, respect des règles d’hygiène, réglage
du débit de perfusion, bon usage des pompes et des régulateurs de débit) ont été proposées aux infirmiers.
Discussion : L’audit des pratiques a permis de dégager des axes de travail. Les ateliers inter-actifs, lieux
d’échanges entre professionnels, ont été très appréciés et devront être pérennisés.
Conclusion : Cette démarche collaborative entre pharmaciens, infirmiers, équipe opérationnelle d’hygiène et
techniciens biomédicaux nous a permis de garantir une meilleure prise en charge médicamenteuse des
patients.
NosoBase ID notice : 412570
Protocole basé sur un modèle pour évaluer les matériels de sécurité et comparer les mécanismes de
protection des aiguilles de ponction veineuse avec ailettes
Haupt C Spaeth J; Ahne T; Goebel U; Steinmann D. A model-based product evaluation protocol for
comparison of safety-engineered protection mechanisms of winged blood collection needles. Infection control
and hospital epidemiology 2016/05; 37(5): 505-511.
Mots-clés : MATERIEL DE SECURITE; DISPOSITIF MEDICAL; AIGUILLE; PREVENTION; VEINE;
ACCIDENT D'EXPOSITION AU SANG; RANDOMISATION; EVALUATION
Objective: To evaluate differences in product characteristics and user preferences of safety-engineered
protection mechanisms of winged blood collection needles.
Design: Randomized model-based simulation study.
Setting: University medical center.
Participants: A total of 33 third-year medical students.
Methods: Venipuncture was performed using winged blood collection needles with 4 different safety
mechanisms: (a) Venofix Safety, (b) BD Vacutainer Push Button, (c) Safety-Multifly, and (d) Surshield Surflo.
Each needle type was used in 3 consecutive tries: there was an uninstructed first handling, then instructions
were given according to the operating manual; subsequently, a first trial and second trial were conducted.
Study end points included successful activation, activation time, single-handed activation, correct activation,
possible risk of needlestick injury, possibility of deactivation, and preferred safety mechanism.
Results: The overall successful activation rate during the second trial was equal for all 4 devices (94%-100%).
Median activation time was (a) 7 s, (b) 2 s, (c) 9 s, and (d) 7 s. Single-handed activation during the second
trial was (a) 18%, (b) 82%, (c) 15%, and (d) 45%. Correct activation during the second trial was (a) 3%, (b)
64%, (c) 15%, and (d) 39%. Possible risk of needlestick injury during the second trial was highest with (d).
Possibility of deactivation was (a) 0%, (b) 12%, (c) 9%, and (d) 18%. Individual preferences for each system
were (a) 11, (b) 17, (c) 5, and (d) 0. The main reason for preference was the comprehensive safety
mechanism.
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Conclusion: Significant differences exist between safety mechanisms of winged blood collection needles.
NosoBase ID notice : 412569
Impact des matériels de sécurité sur l'incidence des accidents d’exposition au sang et aux liquides
biologiques chez le personnel soignant d’un centre hospitalier universitaire, 2000-2014
Kanamori H; Weber DJ; DiBiase LM; Pitman KL; Consoli SA; Hill JJ; et al. Impact of safety-engineered
devices on the incidence of occupational blood and body fluid exposures among healthcare personnel in an
academic facility, 2000-2014. Infection control and hospital epidemiology 2016/05; 37(5): 497-504.
Mots-clés : ACCIDENT D'EXPOSITION AU SANG; MATERIEL DE SECURITE; DISPOSITIF MEDICAL;
INCIDENCE; TAUX; PERSONNEL; HEPATITE B; HEPATITE C; VIRUS DE L'IMMUNODEFICIENCE
HUMAINE; ETUDE RETROSPECTIVE
Background: Legislative actions and advanced technologies, particularly dissemination of safety-engineered
devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures
(BBFE).
Objective: To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of
safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated
with these devices.
Methods: Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic
facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records
(2000-2014). Exposures associated with safety-engineered and conventional devices were compared.
Generalized linear models were applied to measure the annual incidence rate difference by exposure type
over time.
Results: A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence
rate for overall BBFE was significantly reduced during 2000-2014 (incidence rate difference, 1.72; P=.0003).
The incidence rate for percutaneous injuries was also dramatically reduced during 2001-2006 (incidence rate
difference, 1.37; P=.0079) but was less changed during 2006-2014. Percutaneous injuries associated with
safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting
through skin, placing intravenous catheters, and blood drawing.
Conclusions: Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in
part to the impact of safety-engineered devices but also identified that a considerable proportion of
percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to
further reduce percutaneous injuries and improve design of safety-engineered devices.
NosoBase ID notice : 413205
Les risques professionnels associés à l’utilisation des germicides dans les soins
Weber DJ; Consoli SA; Rutala WA. Occupational health risks associated with the use of germicides in health
care. American journal of infection control 2016/05; 44(Suppl. 5): e85-e89.
Mots-clés : DESINFECTION; DESINFECTANT; ECZEMA; PERSONNEL; GLUTARALDEHYDE; ACIDE
PERACETIQUE; FORMALDEHYDE; GERMICIDE; DERMATITE
Environmental surfaces have been clearly linked to transmission of key pathogens in health care facilities,
including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Clostridium
difficile, norovirus, and multidrug-resistant gram-negative bacilli. For this reason, routine disinfection of
environmental surfaces in patient rooms is recommended. In addition, decontamination of shared medical
devices between use by different patients is also recommended. Environmental surfaces and noncritical
shared medical devices are decontaminated by low-level disinfectants, most commonly phenolics, quaternary
ammonium compounds, improved hydrogen peroxides, and hypochlorites. Concern has been raised that the
use of germicides by health care personnel may increase the risk of these persons for developing respiratory
illnesses (principally asthma) and contact dermatitis. Our data demonstrate that dermatitis and respiratory
symptoms (eg, asthma) as a result of chemical exposures, including low-level disinfectants, are exceedingly
rare. Unprotected exposures to high-level disinfectants may cause dermatitis and respiratory symptoms.
Engineering controls (eg, closed containers, adequate ventilation) and the use of personal protective
equipment (eg, gloves) should be used to minimize exposure to high-level disinfectants. The scientific
evidence does not support that the use of low-level disinfectants by health care personnel is an important risk
for the development of asthma or contact dermatitis.
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Prévention
NosoBase ID notice : 409435
Efficacité du CareCentre® sur l’amélioration des précautions contact : simulation aléatoire et
évaluations cliniques
Anderson O; Hanna GB. Effectiveness of the CareCentre® at improving contact precautions: randomized
simulation and clinical evaluations. The journal of hospital infection 2016/04; 92(4): 332-336.
Mots-clés : PRECAUTION CONTACT; HYGIENE DES MAINS; GANT; EQUIPEMENT MOBILIER; ETUDE
PROSPECTIVE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; FORMATION CONTINUE;
METHODE
PEDAGOGIQUE;
EVALUATION;
OBSERVANCE;
TENUE
VESTIMENTAIRE;
RECOMMANDATIONS DE BONNE PRATIQUE; SIMULATION
Background: Bedside hygiene is important to reduce healthcare-associated infection rates. The CareCentre®
is an end-of-hospital-bed table, housing: alcohol-based hand rub, gloves, aprons, waste bin, and an
ergonomic writing surface.
Aim: To determine the effectiveness of the CareCentre at improving bedside hygiene.
Methods: In the randomized cross-over simulation evaluation, 20 participants used the CareCentre and
standard conditions to perform common bedside tasks. In the randomized cross-over clinical evaluation, nine
pairs of acute adult hospital ward bays received CareCentres and standard conditions for one week each.
Researchers measured adherence to the World Health Organization's 'my five moments for hand hygiene'
and donning and disposing of gloves and aprons at the bedside.
Findings: Adherence to hand hygiene guidelines improved from 48% to 67% (P=0.04) in the simulation and
from 14% to 40% (P<0.001) in the clinical evaluation. Donning and disposing of gloves at the bedside
improved from 19% to 79% (P<0.001) in the simulation and from 30% to 65% (P=0.014) in the clinical
evaluation. Donning and disposing of aprons at the bedside improved from 14% to 78% (P<0.001) in the
simulation and from 10% to 53% (P=0.180) in the clinical evaluation.
Conclusion: The CareCentre improved bedside hygiene and might help reduce healthcare-associated
infection rates as part of a multimodal strategy.
NosoBase ID notice : 413346
Prévention de l’infection nosocomiale du passé au présent : évolution des rôles et des priorités
changeantes
Doll M; Hewlett AL; Bearman GM. Infection prevention in the hospital from past to present: evolving roles and
shifting priorities. Current infectious disease reports 2016/05; 18(5): 1-9.
Mots-clés : PREVENTION; EPIDEMIOLOGIE; SURVEILLANCE; HISTORIQUE; ANTIBIOTIQUE
Hospital epidemiologists are vital components of integrated health centers. This central place in the
healthcare landscape has rapidly evolved over a half century. Early hospital epidemiologists possessed a
visionary focus on patient safety many decades prior to the quality revolution of the 1990s. A systematic and
scientific approach to infection prevention has facilitated the evolution of hospital epidemiology, along with
advances in technology, and increasing public attention to infectious complications in the hospital. Currently,
the growing expansion of tasks and moving regulatory targets strain existing resources. These challenges
threaten to limit the effectiveness of some infection-prevention activities, while also providing important
opportunities for improving care. It will be increasingly important to advocate for appropriate resources to
address a diverse set of changing infection prevention priorities.
NosoBase ID notice : 413190
Effet de bain de chlorhexidine dans la prévention des infections et la réduction de la colonisation
cutanée et la contamination environnementale : revue de la littérature
Donskey CJ; Deshpande A. Effect of chlorhexidine bathing in preventing infections and reducing skin burden
and environmental contamination: A review of the literature. American journal of infection control 2016/05;
44(Suppl. 5): e17-e21.
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Mots-clés :
CHLORHEXIDINE;
PEAU;
COLONISATION
CUTANEE;
ENTEROCOCCUS;
STAPHYLOCOCCUS AUREUS; RESISTANCE; ANTIBIORESISTANCE; VANCOMYCINE; REVUE DE LA
LITTERATURE
Chlorhexidine bathing is effective in reducing levels of pathogens on skin. In this review, we examine the
evidence that chlorhexidine bathing can prevent colonization and infection with health care-associated
pathogens and reduce dissemination to the environment and the hands of personnel. The importance of
education and monitoring of compliance with bathing procedures is emphasized in order to optimize
chlorhexidine bathing in clinical practice.
NosoBase ID notice : 413261
Evaluation de la vérification de l'étanchéité sur la détection de fuite sur 3 modules différents
d'appareils de protection respiratoire N95
Lam SC; Lui AK; Lee LY; Lee JK; Wong KF; Lee CN. Evaluation of the user seal check on gross leakage
detection of 3 different designs of N95 filtering facepiece respirators. American journal of infection control
2016/05; 44(5): 579-586.
Mots-clés : MASQUE; APPAREIL RESPIRATOIRE; TRANSMISSION; QUALITE
Background: The use of N95 respirators prevents spread of respiratory infectious agents, but leakage
hampers its protection. Manufacturers recommend a user seal check to identify on-site gross leakage.
However, no empirical evidence is provided. Therefore, this study aims to examine validity of a user seal
check on gross leakage detection in commonly used types of N95 respirators.
Methods: A convenience sample of 638 nursing students was recruited. On the wearing of 3 different designs
of N95 respirators, namely 3M-1860s, 3M-1862, and Kimberly-Clark 46827, the standardized user seal check
procedure was carried out to identify gross leakage. Repeated testing of leakage was followed by the use of a
quantitative fit testing (QNFT) device in performing normal breathing and deep breathing exercises.
Sensitivity, specificity, predictive values, and likelihood ratios were calculated accordingly.
Results: As indicated by QNFT, prevalence of actual gross leakage was 31.0%-39.2% with the 3M respirators
and 65.4%-65.8% with the Kimberly-Clark respirator. Sensitivity and specificity of the user seal check for
identifying actual gross leakage were approximately 27.7% and 75.5% for 3M-1860s, 22.1% and 80.5% for
3M-1862, and 26.9% and 80.2% for Kimberly-Clark 46827, respectively. Likelihood ratios were close to 1
(range, 0.89-1.51) for all types of respirators.
Conclusions: The results did not support user seal checks in detecting any actual gross leakage in the
donning of N95 respirators. However, such a check might alert health care workers that donning a tight-fitting
respirator should be performed carefully.
Réglementation
NosoBase ID notice : 414254
Décret n° 2016-658 du 20 mai 2016 relatif aux hôpitaux de proximité et à leur financement
Ministère des affaires sociales et de la santé. Décret n° 2016-658 du 20 mai 2016 relatif aux hôpitaux de
proximité et à leur financement. Journal officiel de la République française Lois et décrets 2016/05/24; 119: 3
pages.
Mots-clés : HOPITAL LOCAL; ETABLISSEMENT PUBLIC DE SANTE; FINANCEMENT; ECONOMIE DE LA
SANTE; ACCES AUX SOINS; POPULATION DEFAVORISEE; OFFRE DE SOINS; GEOGRAPHIE DE LA
SANTE; POLITIQUE DE SANTE; LEGISLATION; MEDECINE; HOPITAL; SOIN DE LONGUE DUREE;
EHPAD; HOPITAL DE PROXIMITE
NosoBase ID notice : 413942
Arrêté du 3 mai 2016 fixant la liste des indicateurs obligatoires pour l'amélioration de la qualité et de
la sécurité des soins et les conditions de mise à disposition du public de certains résultats par
l'établissement de santé
Ministère des affaires sociales et de la santé. Arrêté du 3 mai 2016 fixant la liste des indicateurs obligatoires
pour l'amélioration de la qualité et de la sécurité des soins et les conditions de mise à disposition du public de
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certains résultats par l'établissement de santé. Journal officiel de la République française Lois et décrets
2016/05/18; 114: 5 pages.
Mots-clés : INDICATEUR; QUALITE DES SOINS; LEGISLATION; ICSHA; ICATB; ICALIN; INFORMATION;
USAGER DE LA SANTE; MULTIRESISTANCE; ANTIBIOTIQUE; ICALIN; ICATB2; ICA-BMR; BN-SARM;
ICALIN2; ICA-LISO
Responsabilité
NosoBase ID notice : 415034
Infection nosocomiale et responsabilité
Safar H. Infection nosocomiale et responsabilité. Droit déontologie et soin 2016; in press: 1-5.
Mots-clés : RESPONSABILITE; LEGISLATION; SOIN INTENSIF; DIABETE
Sommaire de l’article :
1- Infection nosocomiale et question prioritaire de constitutionnalité
2- Caractère nosocomial de l’infection survenue à l’occasion d’une intervention chirurgicale
3- Qualification du caractère nosocomial de l’infection en cas de lésion du pied chez un diabétique
4- Caractère nosocomial d’une infection après un séjour en réanimation
Soin intensif
NosoBase ID notice : 413240
Effet de la décolonisation ciblée sur la colonisation ou l’infection à Staphylococcus aureus
méticillino-résistant dans une unité de réanimation chirurgicale
Cho OH; Baek EH; Bak MH; Suh YS; Park KH; Kim S; et al. The effect of targeted decolonization on
methicillin-resistant Staphylococcus aureus colonization or infection in a surgical intensive care unit.
American journal of infection control 2016/05; 44(5): 533-538.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
INTENSIF; CHIRURGIE; CHLORHEXIDINE; MUPIROCINE
COLONISATION;
SOIN
Background: The effect of decolonization on the control of methicillin-resistant Staphylococcus aureus
(MRSA) may differ depending on intensive care unit (ICU) settings and the prevalence of antiseptic resistance
in MRSA.
Methods: This study was conducted in a 14-bed surgical ICU over a 40-month period. The baseline period
featured active surveillance for MRSA and institution of contact precautions. MRSA decolonization via
chlorhexidine baths and intranasal mupirocin was implemented during a subsequent 20-month intervention
period. Pre-post and interrupted time series analysis were used to evaluate changes in the clinical incidence
of hospital-acquired MRSA colonization or infection. MRSA isolates were tested for the presence of qacA/B
genes and mupirocin resistance.
Results: In pre-post analysis, the clinical incidence of MRSA significantly decreased by 61.6% after
implementation of decolonization (P<.001). Meanwhile, interrupted time series analysis showed decreases in
both the level (β = -0.686; P=.210) and trend (β=-0.011; P=.819) of clinical MRSA incidence, but these
changes were not statistically significant. Of 169 MRSA isolates, 64 (37.8%) carried the qacA/B genes, and
22 (13.0%) showed either low- (n=20) or high-level (n=2) resistance to mupirocin. Low-level mupirocin
resistance significantly increased from 0%-19.4% during the study period.
Conclusion: Although decolonization using antiseptic agents was helpful to decrease hospital-acquired MRSA
rates, the emergence of antiseptic resistance should be monitored.
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NosoBase ID notice : 412576
Colonisation à Pseudomonas aeruginosa dans une unité de soins intensifs : prévalence, facteurs de
risque et évolution clinique
Harris AD; Jackson SS; Robinson G; Pineles L; Leekha S; Thom KA; et al. Pseudomonas aeruginosa
colonization in the intensive care unit: prevalence, risk factors, and clinical outcomes. Infection control and
hospital epidemiology 2016/05; 37(5): 544-548.
Mots-clés : PSEUDOMONAS AERUGINOSA; PREVALENCE; SOIN INTENSIF; ADMISSION; INFECTION
NOSOCOMIALE; FACTEUR DE RISQUE; COHORTE; DIAGNOSTIC; ANTIBIOTIQUE
Objective: To determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU)
admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P.
aeruginosa among those colonized and not colonized.
Methods: We conducted a cohort study of patients admitted to a medical or surgical intensive care unit of a
tertiary care hospital. Patients had admission perirectal surveillance cultures performed. Risk factors analyzed
included comorbidities at admission, age, sex, antibiotics received during current hospitalization before ICU
admission, and type of ICU.
Results: Of 1,840 patients, 213 (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk
factors in the multivariable analysis for colonization were age (odds ratio, 1.02 [95% CI, 1.01-1.03]), anemia
(1.90 [1.05-3.42]), and neurologic disorder (1.80 [1.27-2.54]). Of the 213 patients colonized with P.
aeruginosa on admission, 41 (19.2%) had a subsequent clinical culture positive for P. aeruginosa on ICU
admission and 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa in the current
hospitalization (ICU period and post-ICU period). Of these 60 patients, 49 (81.7%) had clinical infections. Of
the 1,627 patients not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P.
aeruginosa in the current hospitalization. Patients colonized with P. aeruginosa were more likely to have a
subsequent positive clinical culture than patients not colonized (incidence rate ratio, 6.74 [95% CI, 4.919.25]).
Conclusions: Prediction rules or rapid diagnostic testing will help clinicians more appropriately choose
empirical antibiotic therapy for subsequent infections.
NosoBase ID notice : 413823
Tendances des infections nosocomiales et des micro-organismes multit-résistants dans une unité de
soins intensifs pédiatriques espagnole
Jordan Garcia I; Esteban Torné E; Bustinza Arriortua A; de Carlos Vicente JC; García Soler P; Concha Torre
JA; et al. Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric
intensive care units. Enfermedades infecciosas y microbiología clínica 2016/05; 34(5): 286-292.
Mots-clés : SOIN INTENSIF; PEDIATRIE; MICROORGANISME; ANTIBIORESISTANCE; SURVEILLANCE
Introduction: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems
enable data to be compared and to implement new measures to improve our practice.
Methods: A multicentre, prospective, descriptive and observational study was conducted using the data from
surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data
were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective
was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms
in Spanish pediatric intensive care units.
Results: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%)
patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated
bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000
endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The
comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant
differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream
infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia
10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract
infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The
microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were
resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections.
Conclusions: The local surveillance systems provide information for dealing with nosocomial infections rates.
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NosoBase ID notice : 412575
Prévalence et épidémiologie moléculaire d’une colonisation à entérobactéries multirésistantes dans
une unité de soins intensifs pédiatrique
Suwantarat N; Logan LK; Carroll KC; Bonomo RA; Simner PJ; Rudin SD; et al. The prevalence and molecular
epidemiology of multidrug-resistant Enterobacteriaceae colonization in a pediatric intensive care unit.
Infection control and hospital epidemiology 2016/05; 37(5): 535-543.
Mots-clés : MULTIRESISTANCE; ENTEROBACTERIE; COLONISATION; INFECTION NOSOCOMIALE;
PREVALENCE; EPIDEMIOLOGIE; SOIN INTENSIF; PEDIATRIE; PREVALENCE; ETUDE PROSPECTIVE
Objective: To determine the prevalence and acquisition of extended-spectrum β-lactamases (ESBLs),
plasmid-mediated AmpCs (pAmpCs), and carbapenemases ("MDR Enterobacteriaceae") colonizing children
admitted to a pediatric intensive care unit (PICU).
Design: Prospective study.
Setting: 40-bed PICU.
Methods: Admission and weekly thereafter rectal surveillance swabs were collected on all pediatric patients
during a 6-month study period. Routine phenotypic identification and antibiotic susceptibility testing were
performed. Enterobacteriaceae displaying characteristic resistance profiles underwent further molecular
characterization to identify genetic determinants of resistance likely to be transmitted on mobile genetic
elements and to evaluate relatedness of strains including DNA microarray, multilocus sequence typing,
repetitive sequence-based PCR, and hsp60 sequencing typing.
Results: Evaluating 854 swabs from unique children, the overall prevalence of colonization with an MDR
Enterobacteriaceae upon admission to the PICU based on β-lactamase gene identification was 4.3% (n=37),
including 2.8% ESBLs (n=24), 1.3% pAmpCs (n=11), and 0.2% carbapenemases (n=2). Among 157 pediatric
patients contributing 603 subsequent weekly swabs, 6 children (3.8%) acquired an incident MDR
Enterobacteriaceae during their PICU stay. One child acquired a pAmpC (E. coli containing bla DHA) related
to an isolate from another patient.
Conclusions: Approximately 4% of children admitted to a PICU were colonized with MDR Enterobacteriaceae
(based on β-lactamase gene identification) and an additional 4% of children who remained in the PICU for at
least 1 week acquired 1 of these organisms during their PICU stay. The acquired MDR Enterobacteriaceae
were relatively heterogeneous, suggesting that a single source was not responsible for the introduction of
these resistance mechanisms into the PICU setting.
Staphylococcus aureus
NosoBase ID notice : 413126
Prévalence de gènes qacA/B et de la résistance à la mupirocine dans des isolats de Staphylococcus
aureus résistant à la méticilline (SARM) après des toilettes quotidiennes à la chlorhexidine sans
mupirocine
Warren D; Prager M; Munigala S; Wallace MA; Kennedy CR; Bommarito KM; et al. Prevalence of qacA/B
genes and mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) isolates in the
setting of chlorhexidine bathing without mupirocin. Infection control and hospital epidemiology 2016/05; 37(5):
590-597.
Mots-clés : MUPIROCINE; RESISTANCE; PREVALENCE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; SARM; CHLORHEXIDINE; TOILETTE DU PATIENT; NEZ; GENOTYPE; SOIN INTENSIF;
ETUDE RETROSPECTIVE
Objective: We aimed to determine the frequency of qacA/B chlorhexidine tolerance genes and high-level
mupirocin resistance among MRSA isolates before and after the introduction of a chlorhexidine (CHG) daily
bathing intervention in a surgical intensive care unit (SICU).
Design: Retrospective cohort study (2005-2012)
Setting: A large tertiary-care center
Patients: Patients admitted to SICU who had MRSA surveillance cultures of the anterior nares
Methods: A random sample of banked MRSA anterior nares isolates recovered during (2005) and after (20062012) implementation of a daily CHG bathing protocol was examined for qacA/B genes and high-level
mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) typing was also performed.
Results: Of the 504 randomly selected isolates (63 per year), 36 (7.1%) were qacA/B positive (+) and 35
(6.9%) were mupirocin resistant. Of these, 184 (36.5%) isolates were SCCmec type IV. There was a
significant trend for increasing qacA/B (P=.02; highest prevalence, 16.9% in 2009 and 2010) and SCCmec
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type IV (P<.001; highest prevalence, 52.4% in 2012) during the study period. qacA/B(+) MRSA isolates were
more likely to be mupirocin resistant (9 of 36 [25%] qacA/B(+) vs 26 of 468 [5.6%] qacA/B(-); P=.003).
Conclusions: A long-term, daily CHG bathing protocol was associated with a change in the frequency of
qacA/B genes in MRSA isolates recovered from the anterior nares over an 8-year period. This change in the
frequency of qacA/B genes is most likely due to patients in those years being exposed in prior admissions.
Future studies need to further evaluate the implications of universal CHG daily bathing on MRSA qacA/B
genes among hospitalized patients.
Stérilisation
NosoBase ID notice : 413187
Désinfection, stérilisation et antisepsie : revue générale
Rutala WA; Weber DJ. Disinfection, sterilization, and antisepsis: An overview. American journal of infection
control 2016/05; 44(Suppl. 5): e1-e6.
Mots-clés : DESINFECTION; STERILISATION; ANTISEPTIQUE; DESINFECTANT; SURFACE;
ENVIRONNEMENT; PEROXYDE D'HYDROGENE; ACIDE PERACETIQUE; CHLORHEXIDINE;
GLUTARALDEHYDE; AMMONIUM QUATERNAIRE
All invasive procedures involve contact by a medical device or surgical instrument with a patient’s sterile
tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the
object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact
mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as
stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively.
Cleaning must always precede high-level disinfection and sterilization.
Antiseptics are essential to infection prevention as part of a hand hygiene program as well as several other
uses such as surgical hand antisepsis and pre-operative skin preparation.
Surveillance
NosoBase ID notice : 413518
Utilisation des réseaux sociaux pour la surveillance en santé publique
Fung IC; Tse ZT; Fu KW. The use of social media in public health surveillance. WPSAR - Western Pacific
surveillance and response journal 2015/06; 6(2): 3-6.
Mots-clés : SURVEILLANCE; INTERNET; SANTE PUBLIQUE; VIGILANCE SANITAIRE; INFORMATION;
GRIPPE; RESEAU SOCIAL
Vaccination
NosoBase ID notice : 415156
Avis relatif à la vaccination antigrippale en situation de pandémie des personnes présentant une
allergie aux protéines de l’œuf et aux aminosides
Haut conseil de la santé publique (HCSP). Avis relatif à la vaccination antigrippale en situation de pandémie
des personnes présentant une allergie aux protéines de l’œuf et aux aminosides. HCSP 2016/01/12: 7
pages.
Mots-clés : VACCINATION; GRIPPE; ALLERGIE; ENFANT; CHOC ANAPHYLACTIQUE; AMINOSIDE;
OEUF
Les vaccins grippaux actuels sont pour la plupart préparés à partir de virus grippaux cultivés sur œuf.
Le HCSP a pris en considération la problématique de l’allergie à l’œuf et/ou aux aminosides et les
alternatives à la vaccination contre la grippe en cas de contre-indications réelles.
Le HCSP considère que seules les personnes ayant présenté antérieurement des manifestations de type
anaphylactique après ingestion ou administration parentérale de produits contenant des protéines de l’œuf,
ou après l’administration d’un aminoside, doivent être considérées pour une éventuelle contre-indication à
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l’administration de vaccins pandémiques contenant ces produits. Ces personnes devront être référées à un
spécialiste de l’allergie qui fera une évaluation de la balance bénéfice/risque de la vaccination en prenant en
compte la gravité de la grippe pandémique et l’efficacité du vaccin. Pour les personnes pour lesquelles une
contre-indication vaccinale sera posée, le HCSP recommande :
- l’utilisation des antiviraux sur la base des recommandations qu’il a formulées en décembre 2011 et sous
certaines conditions détaillées dans le présent avis, notamment chez les nourrissons âgés de moins de 1 an ;
- l’application des mesures barrière selon les recommandations faites en situation pandémique ;
- la vaccination de l’entourage pour protéger la personne non vaccinée.
NosoBase ID notice : 413397
Couverture vaccinale anti-pneumococcique chez des patients à risque hospitalisés : évaluation et
propositions d’amélioration
Richard C; Le Garlantezec P; Lamand V; Rasamijao V; Rapp C. Couverture vaccinale anti-pneumococcique
chez des patients à risque hospitalisés : évaluation et propositions d’amélioration. Annales pharmaceutiques
françaises 2016/05; 74(3): 244-251.
Mots-clés : STREPTOCOCCUS PNEUMONIAE; VACCIN PNEUMOCOCCIQUE HEPTAVALENT
CONJUGUE; INDICATION; FACTEUR DE RISQUE; PATIENT; VACCIN; USAGER DE LA SANTE;
COUVERTURE VACCINALE
Streptococcus pneumoniae est responsable d’infections invasives dont l’incidence et la gravité varient en
fonction des facteurs de risque du patient. Dans un contexte de résistance aux antibiotiques de référence, la
vaccination anti-pneumococcique est un enjeu majeur de santé publique. L’objectif de cette étude était
d’évaluer la couverture vaccinale anti-pneumococcique de l’adulte à risque hospitalisé. Il s’agissait d’une
étude prospective qui incluait les patients présentant au moins une indication à la vaccination antipneumococcique selon les recommandations du bulletin épidémiologique hebdomadaire (BEH), auxquelles
trois indications américaines ont été ajoutées (diabète, obésité et âge > 65 ans). Cent trente-quatre patients
d’âge moyen de 70 ans ont été inclus. Le statut vaccinal n’a pu être confirmé par le médecin traitant que pour
68 % d’entre eux. La couverture vaccinale selon les recommandations du BEH était de 30 % (n = 54). Tous
les patients VIH étaient vaccinés (n = 2) et la couverture vaccinale était de 75 % (n = 8) chez les patients
traités pour une maladie auto-immune et seulement 10 % (n = 20) chez les patients traités par
chimiothérapies. Les patients non vaccinés n’avaient pas connaissance de l’existence du vaccin ou ne
savaient pas que la vaccination leur était recommandée. Cette étude a mis en évidence un défaut de
couverture vaccinale anti-pneumococcique et une méconnaissance de l’existence de la vaccination. En plus
d’un développement de l’information des patients et de la formation des soignants, la mise en place du carnet
vaccinal électronique pourrait permettre l’amélioration du statut vaccinal.
Responsables de la rubrique NosoVeille : N. Sanlaville, S. Yvars, A, K. Trouilloud (CClin Sud-Est), I. Girot
(CClin Ouest), K. Lebascle (CClin Paris-Nord). Secrétaire : N. Vincent (CClin Sud-Est)
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
nathalie.vincent@chu
-lyon.fr
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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