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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 Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Désabonnement 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 1 / 34 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 2 / 34 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 3 / 34 NosoVeille – Bulletin de veille 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. 4 / 34 NosoVeille – Bulletin de veille Juin 2016 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 5 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 6 / 34 NosoVeille – Bulletin de veille Juin 2016 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 7 / 34 NosoVeille – Bulletin de veille Juin 2016 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 8 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 9 / 34 NosoVeille – Bulletin de veille Juin 2016 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 10 / 34 NosoVeille – Bulletin de veille Juin 2016 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 11 / 34 NosoVeille – Bulletin de veille Juin 2016 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 12 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 13 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 14 / 34 NosoVeille – Bulletin de veille Juin 2016 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 15 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 16 / 34 NosoVeille – Bulletin de veille Juin 2016 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 17 / 34 NosoVeille – Bulletin de veille Juin 2016 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, 18 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 19 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 20 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 21 / 34 NosoVeille – Bulletin de veille 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. 22 / 34 NosoVeille – Bulletin de veille Juin 2016 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- 23 / 34 NosoVeille – Bulletin de veille 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. 24 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 25 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 26 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 27 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 28 / 34 NosoVeille – Bulletin de veille Juin 2016 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 29 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 30 / 34 NosoVeille – Bulletin de veille Juin 2016 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. 31 / 34 NosoVeille – Bulletin de veille Juin 2016 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 32 / 34 NosoVeille – Bulletin de veille Juin 2016 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 33 / 34 NosoVeille – Bulletin de veille Juin 2016 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] 34 / 34