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NosoVeille – Bulletin de veille du CCLIN SE
Mars 2009
NosoVeille n°3
Mars 2009
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les
publications scientifiques publiées au cours du mois écoulé.
La recherche documentaire est effectuée dans la base de données
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro
Antibiotique / Antibiorésistance
Cathétérisme
Clostridium difficile
Environnement
Epidémie
Gestion des risques
Hygiène des mains
Norovirus
Pédiatrie
Personnel
Personne âgée
Prévention
Qualité
Stérilisation
Surveillance
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NosoVeille – Bulletin de veille du CCLIN SE
Antibiotique/Antibiorésistance
Mars 2009
sommaire
NosoBase n°23491
Stratégie pour modifier les comportements dans la lutte contre la résistance bactérienne aux
antibiotiques : un travail de marketing social
Edgar T; Boyd S; Palame M. Sustainability for behaviour change in the fight against antibiotic resistance : a
social marketing framework. Journal of antimicrobial and chemotherapy 2009; 63(2): 230-237.
Mots-clés : ANTIBIOTIQUE; ANTIBIORESISTANCE; COMMUNICATION; COMPORTEMENT
Antibiotic resistance is one of today’s most urgent public health problems, threatening to undermine the
effectiveness of infectious disease treatment in every country of the world. Specific individual behaviours
such as not taking the entire antibiotic regimen and skipping doses contribute to resistance development as
does the taking of antibiotics for colds and other illnesses that antibiotics cannot treat. Antibiotic resistance is
as much a societal problem as it is an individual one; if mass behaviour change across the population does
not occur, the problem of resistance cannot be mitigated at community levels. The problem is one that
potentially can be solved if both providers and patients become sufficiently aware of the issue and if they
engage in appropriate behaviours. Although a number of initiatives have been implemented in various parts
of the world to elicit behaviour change, results have been mixed, and there is little evidence that trial
programmes with positive outcomes serve as models of sustainability. In recent years, several scholars
have suggested social marketing as the framework for behaviour change that has the greatest chance of
sustained success, but the antibiotic resistance literature provides no specifics for how the principles of
social marketing should be applied. This paper provides an overview of previous communication-based
initiatives and offers a detailed approach to social marketing to guide future efforts.
NosoBase n°22273
Évaluation de la qualité des prescriptions d’antibiotiques dans le service d’accueil des urgences
d’un CHU en région parisienne
Goulet H; Daneluzzi V; Dupont C; Heym B; Page B; Almeida K. A prospective study of antibiotic prescribing
in an emergency care unit. Médecine et maladies infectieuses 2009; 39(1): 48-54.
Mots-clés : ANTIBIOTIQUE; EVALUATION; ETUDE PROSPECTIVE; INFECTION URINAIRE; APPAREIL
RESPIRATOIRE; PEAU; QUALITE; URGENCE; CENTRE HOSPITALIER UNIVERSITAIRE;
RECOMMANDATION; FORMATION; AUDIT
Objectifs : Évaluer la qualité des prescriptions initiales d'antibiotiques réalisées dans le service d'accueil des
urgences (SAU) d'un CHU de région parisienne. Patients et méthodes : Étude prospective menée durant
deux semaines pendant lesquelles tous les patients traités par antibiotiques au SAU ont été inclus. Les
traitements antibiotiques ont été revus par des médecins experts et confrontés aux recommandations du
guide local des anti-infectieux (référentiel) : prescription jugée adéquate si l'indication, le choix de la
molécule et les modalités d'administration étaient validés par les experts ; non acceptable si l'indication ou le
choix de l'antibiotique n'était pas correct ; discutable dans les autres cas. Résultats : Cent quatre patients
ont été inclus, traités majoritairement pour une infection urinaire (31 cas), pulmonaire (26) ou cutanée (23).
Dans 84,5 % des cas, l'indication figurait dans le référentiel. Les bêtalactamines représentaient 60 % des
prescriptions, suivies des fluoroquinolones (32,5 %). En combinant trois critères (indication, choix, modalités
d’administration), 54 % des prescriptions seulement étaient adéquates, 31 % discutables et 15 % non
acceptables. La qualité de l'antibiothérapie était significativement meilleure si le prescripteur était informé de
l'enquête et si l'indication était présente dans le référentiel. Conclusion : Mettre à la disposition des
prescripteurs du SAU un guide d'antibiothérapie est indispensable mais insuffisant pour garantir la qualité
des prescriptions antibiotiques. Des formations pour les médecins urgentistes, l'intervention d'un médecin
infectiologue au SAU, la discussion autour des résultats d'audits cliniques répétés devraient permettre une
amélioration du bon usage des antibiotiques dans le service des urgences.
NosoBase n°22252
Evolution dans le temps des hospitalisations associées aux infections à Enterococcus résistant à la
vancomycine aux Etats-Unis, 2000-2006
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Mars 2009
Ramsey AM; Zilberberg MD. Secular trends of hospitalization with vancomycin-resistant Enterococcus
infection in the United States, 2000-2006. Infection control and hospital epidemiology 2009; 30(2): 184-186.
Mots-clés : VANCOMYCINE; ENTEROCOCCUS; INCIDENCE; ANTIBIORESISTANCE
Although the incidence of hospitalizations with infection due to vancomycin-resistant pathogens in the United
States remained stable during 2000–2003, it increased from 4.60 to 9.48 hospitalizations per 100,000
population during 2003–2006. Hospitalizations with infection due to vancomycin-resistant pathogens also
increased as a proportion of all US hospitalizations, from 3.16 to 6.51 hospitalizations with VRE infection per
10,000 total hospitalizations during 2003–2006. The number of hospitalizations with infection due to
vancomycin-resistant pathogens is increasing in the United States. Because infection due to vancomycinresistant organisms is associated with poor outcomes, the epidemiology of this trend needs further
exploration
Cathétérisme
sommaire
NosoBase n°23514
Bactériémies à Staphylococcus aureus méticillino-résistant associées aux voies centrales dans des
unités de réanimation aux Etats-Unis, 1997-2007
Burton DC; Edwards JR; Horan TC; Jernigan JA; Fridkin SK. Methicillin-resistant Staphylococcus aureus
central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009; 301(7):
727-736.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERIEMIE; SOIN
INTENSIF; INCIDENCE; TAUX; CATHETER VEINEUX CENTRAL; SURVEILLANCE
Context: Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health careassociated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA
infections.
Objective: To examine trends in the incidence of MRSA central line-associated bloodstream infections
(BSIs) in US intensive care units (ICUs). DESIGN, SETTING, AND PARTICIPANTS: Data reported by
hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate
pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal
pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that
were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI
metrics over the analysis period. MAIN OUTCOME MEASURES: Incidence rate of central line-associated
BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs.
Results: Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing
16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4%) were MRSA and
1590 (4.7%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteachingaffiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central lineassociated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical,
and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central lineassociated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence
rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5% (95% CI,
-33.7% to -64.6%; P < .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central
line days) to -69.2% (95% CI, -57.9% to -77.7%; P < .001) in surgical ICUs (0.58 vs 0.18 per 1000 central
line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007,
with changes in incidence ranging from -60.1% (95% CI, -41.2% to -73.1%; P < .001) in surgical ICUs (0.24
vs 0.10 per 1000 central line days) to -77.7% (95% CI, -68.2% to -84.4%; P < .001) in medical ICUs (0.40 vs
0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs
due to MRSA increased 25.8% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI
incidence decreased 49.6% (P < .001) over this period.
Conclusions: The incidence of MRSA central line-associated BSI has been decreasing in recent years in
most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.
Clostridium difficile
sommaire
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Mars 2009
NosoBase n°22211
Revue de la littérature actuelle sur le poids économique des infections à Clostridium difficile
Dubberke ER; Wertheimer AI. Review of current literature on the economic burden of Clostridium difficile
infection. Infection control and hospital epidemiology 2009; 30(1): 57-66.
Mots-clés : CLOSTRIDIUM DIFFICILE; COUT; INFECTION; INCIDENCE; BIBLIOGRAPHIE
Clostridium difficile is well recognized as the most common infectious cause of healthcare-associated
diarrhea. Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and
virulent illness that is often refractory to treatment. An analysis by the Centers for Disease Control and
Prevention revealed that, in the United States, the number of patients discharged from hospitals who
received the International Classification of Diseases, Ninth Revision discharge diagnosis code for C. difficile
infection (CDI) more than doubled from 2000 to 2003. Unpublished data indicate that this trend has
continued and that more than 250,000 US hospitalizations were associated with CDI in 2005. A previously
uncommon hypervirulent strain of C. difficile is thought to contribute, in part, to the dramatic increase in the
incidence and severity of the infection. Although the economic impact of the disease is believed to be
profound and is expected to increase, data on the costs associated with CDI are scarce. To more completely
assess its economic burden, we performed a review of available literature that reported costs associated
with the infection.
NosoBase n°23307
Pratiques de lutte contre le risque infectieux liées à des infections à Clostridium difficile dans des
centres hospitaliers pour soins aigus au Canada
Gravel D; Gardam M; Taylor G; Miller M; Simor A; McGeer A. Infection control practices related to
Clostridium difficile infection in acute care hospitals in Canada. American journal of infection control 2009;
37(1): 9-14.
Mots-clés :
CLOSTRIDIUM
DIFFICILE;
CONTROLE;
PREVENTION;
DIAGNOSTIC;
GANT;
DESINFECTANT; SURVEILLANCE; ETUDE PROSPECTIVE; OBSERVANCE; RECOMMANDATION;
DIARRHEE
Background: We carried out a survey to identify the infection prevention and control practices in place in
Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP).
Methods: An infection prevention and control practices survey was sent to CNISP hospitals at the beginning
of November 2004, the same time that CNISP started a 6-month prospective surveillance for Clostridium
difficile infection (CDI) to evaluate their infection prevention and control measures and laboratory methods
for C difficile.
Results: A total of 33 hospitals completed and returned the survey. Infection control precautions were
initiated in 18 hospitals (55%) due to the presence of a symptomatic patient before the C difficile laboratory
tests were available. All of the hospitals used gloves and gowns as additional precautions. Twenty-three
hospitals (70%) tested liquid stools based on a clinician's order, and 8 (24%) tested all liquid stools
submitted whether of not C difficile testing was requested. The hospitals used 1 of 3 different products as a
standard hospital-wide disinfectant; 24 (73%) used a quaternary ammonium compound, 8 (24%) used
accelerated hydrogen peroxide, and 1 (3%) used a hypochlorite solution (1:10 bleach solution).
Conclusion: Although the hospitals used contact precautions quite uniformly, considerable variation was
seen among hospitals in terms of testing strategies, cleaning and disinfection protocols and products, and
isolation practices. The timing for the initiation of infection control precautions is important to prevent
secondary transmission of CDI. Most of the hospitals implemented precautions while waiting for the toxin
assay results.
NosoBase n°23500
Le score de Waterlow pour prédire les patients à risque de développer une infection liée à
Clostridium difficile
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Tanner J; Khan D; Anthony D; Paton J. Waterlow score to predict patients at risk of developing Clostridium
difficile-associated disease. The Journal of hospital infection 2009/03; 71(3): 239-244.
Mots-clés : CLOSTRIDIUM DIFFICILE; SCORE; FACTEUR DE RISQUE; SENSIBILITE; SPECIFICITE
This study describes the development and testing of an assessment tool to predict the risk of patients
developing Clostridium difficile-associated disease (CDAD). The three phases of the study include the
development of the tool, prospective testing of the validity of the tool using 1468 patients in a medical
assessment unit and external retrospective testing using data from 29 425 patients. In the first phase of the
study, receiver operating characteristic (ROC) analysis identified the Waterlow assessment score as having
the ability to predict CDAD (area under the curve: 0.827). The Waterlow tool was then tested prospectively
with 1468 patients admitted to a medical assessment unit. A total of 1385 patients (94%) had a Waterlow
score <20 and 83 patients (6%) had a Waterlow score of >/=20. After a three-month follow-up, six patients in
the low Waterlow score group developed CDAD (0.4%) and 14 patients in the high score group developed
CDAD (17%). The sensitivity and specificity of the Waterlow score to predict the risk of developing CDAD
were 70% and 95%, respectively. Similar results were obtained when the tool was tested retrospectively on
a large external patient data set. The Waterlow score appears to predict patients' risk of developing CDAD
and although it did not identify all cases, it highlighted a small group of patients who had a disproportionately
large number of CDAD cases. The Waterlow score can be used to target patients most at risk of developing
CDAD.
Environnement
sommaire
NosoBase n°23308
Qu'y a-t-il sur ce clavier ? Détection de réservoirs environnementaux cachés de Clostridium difficile
durant une épidémie liée à des souches North American type I à l'électrophorèse
Dumford DM; Nerandzic MM; Eckstein BC; Donskey CJ. What is on that keyboard? Detecting hidden
environmental reservoirs of Clostridium difficile during an outbreak associated with North American pulsedfield gel electrophoresis type I strains. American journal of infection control 2009; 37(1): 15-19.
Mots-clés : CLOSTRIDIUM DIFFICILE; ENVIRONNEMENT; EPIDEMIE; ELECTROPHORESE EN CHAMP
PULSE; SURFACE; CONTAMINATION; MATERIEL MEDICO-CHIRURGICAL; ORDINATEUR; PCR;
RIBOTYPIE; PREVALENCE
Background: Numerous studies have demonstrated that environmental surfaces in the rooms of patients
with Clostridium difficile infection (CDI) are often contaminated with spores. However, less information is
available regarding the frequency of contamination of environmental surfaces outside of CDI isolation
rooms.
Methods: We performed a point-prevalence culture survey for C difficile in rooms of patients not in isolation
for CDI, in physician and nurse work areas, and on portable equipment, including pulse oximetry devices,
electrocardiogram machines, mobile computers, and medication distribution carts. Isolates were
characterized by assessment of toxin production, polymerase chain reaction (PCR) ribotyping, and PCR for
binary toxin genes.
Results: Of 105 nonisolation rooms, 17 (16%) were contaminated with toxin-producing C difficile, with the
highest rate of contamination on the spinal cord injury unit (32%). Of 87 surfaces cultured outside of patient
rooms, 20 (23%) were contaminated, including 9 of 29 (31%) in physician work areas, 1 of 10 (10%) in nurse
work areas, and 9 of 43 (21%) portable pieces of equipment, including a pulse oximetry finger probe,
medication carts, and bar code scanners on medication carts. Of 26 isolates subjected to typing, 19 (73%)
matched ribotype patterns detected in stool samples from CDI patients and 13 (50%) were epidemic, binary
toxin-positive strains. CONCLUSION: In the context of a CDI outbreak, we found that environmental
contamination was common in nonisolation rooms, in physician and nurse work areas, and on portable
equipment. Further research is needed to determine whether contamination in these areas plays a
significant role in transmission.
NosoBase n°23502
Dispersion aérienne de Staphylococcus aureus méticillino-résistant dans des chambres d'hôpital
par des patients infectés ou colonisés
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Gehanno JF; Louvel A; Nouvellon M; Caillard JF; Pestel-Caron M. Aerial dispersal of meticillin-resistant
Staphylococcus aureus in hospital rooms by infected or colonised patients. The Journal of hospital infection
2009/03; 71(3): 256-262.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
CHAMBRE;
AIR;
COLONISATION;
APPAREIL
RESPIRATOIRE;
PRELEVEMENT;
ANTIBIORESISTANCE;
ELECTROPHORESE EN CHAMP PULSE; ENVIRONNEMENT; CONTAMINATION
The aim of this study was to assess to what extent patients with meticillin-resistant Staphylococcus aureus
(MRSA) at respiratory sites shed viable MRSA into the air of hospital rooms. We also evaluated whether the
distance from the patient could influence the level of contamination. Air sampling was performed directly
onto MRSA-selective agar in 24 hospital rooms containing patients with MRSA colonization or infection of
the respiratory tract. Samplings were performed in duplicate at 0.5, 1 and 2-3m from the patients' heads.
Clinical and environmental isolates were compared using antimicrobial resistance patterns and pulsed-field
gel electrophoresis. MRSA strains were isolated from 21 out of 24 rooms, in quantities varying from between
1 and 78cfu/m(3). In each of the 21 rooms, at least one of the environmental isolates was identical to a
clinical isolate from the patient in that room. There was no significant difference in MRSA counts between
the distance from the patient's head and the sampler. This study demonstrates that most patients with
MRSA infection or colonisation of the respiratory tract shed viable MRSA into the air of their room. The
results emphasise the need to study MRSA in air in more detail in order to improve infection control
recommendations.
NosoBase n°23319
Les comptes bactériens des cravates des médecins hospitaliers sont plus élevés que ceux des
chemises
Lopez PJ; Ron R; Parthasarathy P; Soothill J; Spitz L. Bacterial counts from hospital doctors' ties are higher
than those from shirts. American journal of infection control 2009; 37(1): 79-80.
Mots-clés : TENUE VESTIMENTAIRE; MEDECIN; CHIRURGIEN; CONTAMINATION
Doctor ties are often contaminated with bacteria, and it has been suggested that they should not be worn.
We have compared bacterial counts from the ties and shirt pockets of 50 doctors. Counts were higher (P =
.002) from ties that were rarely, if ever, cleaned than from shirts that were washed every 2 days or more
frequently. The results support the need for further research on unwashable clothing of hospital staff.
NosoBase n°23363
Survie de bactéries et de spores nosocomiales sur des surfaces et inactivation par la vapeur de
peroxyde d'hydrogène
Otter JA; French GI. Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen
peroxide vapour. Journal of clinical microbiology 2009; 17(1): 205-207.
Mots-clés : SURFACE; PEROXYDE; DESINFECTANT; BACTERICIDIE; SPORICIDIE; TEST; PEROXYDE
D’HYDROGENE
With inocula of 6 to 7 log10 CFU, most vegetative bacteria and spores tested survived on surfaces for more
than 5 weeks, but all were inactivated within 90 min of exposure to hydrogen peroxide vapor in a 100-m3
test room even in the presence of 0.3% bovine serum albumin to simulate biological soiling.
NosoBase n°23309
Réduction des risques d'infection à l'aide du traitement de surfaces microbiologiquement
contaminées par un nouveau système portable de désinfection à la vapeur saturée
Tanner BD. Reduction in infection risk through treatment of microbially contaminated surfaces with a novel,
portable, saturated steam vapor disinfection system. American journal of infection control 2009; 37(1): 2027.
Mots-clés : RISQUE; DESINFECTION; SURFACE; CONTAMINATION; EFFICACITE; VAPEUR
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Background: Surface-mediated infectious disease transmission is a major concern in various settings,
including schools, hospitals, and food-processing facilities. Chemical disinfectants are frequently used to
reduce contamination, but many pose significant risks to humans, surfaces, and the environment, and all
must be properly applied in strict accordance with label instructions to be effective. This study set out to
determine the capability of a novel chemical-free, saturated steam vapor disinfection system to kill
microorganisms, reduce surface-mediated infection risks, and serve as an alternative to chemical
disinfectants.
Methods: High concentrations of Escherichia coli, Shigella flexneri, vancomycin-resistant Enterococcus
faecalis (VRE), methicillin-resistant Staphylococcus aureus (MRSA), Salmonella enterica, methicillinsensitive Staphylococcus aureus, MS2 coliphage (used as a surrogate for nonenveloped viruses including
norovirus), Candida albicans, Aspergillus niger, and the endospores of Clostridium difficile were dried
individually onto porous clay test surfaces. Surfaces were treated with the saturated steam vapor
disinfection system for brief periods and then numbers of surviving microorganisms were determined.
Infection risks were calculated from the kill-time data using microbial dose-response relationships published
in the scientific literature, accounting for surface-to-hand and hand-to-mouth transfer efficiencies.
Results: A diverse assortment of pathogenic microorganisms was rapidly killed by the steam disinfection
system; all of the pathogens tested were completely inactivated within 5 seconds. Risks of infection from the
contaminated surfaces decreased rapidly with increasing periods of treatment by the saturated steam vapor
disinfection system. CONCLUSIONS: The saturated steam vapor disinfection system tested for this study is
chemical-free, broadly active, rapidly efficacious, and therefore represents a novel alternative to liquid
chemical disinfectants.
Epidémie
sommaire
NosoBase n°23313
Epidémie d'infections associées aux soins à Salmonella Tennessee dans une unité de réanimation
en néonatalogie
Boehmer TK; Bamberg WM; Ghosh TS; Cronquist A; Fornof ME; Cichon MK. Health care-associated
outbreak of Salmonella Tennessee in a neonatal intensive care unit. American journal of infection control
2009; 3(7): 149-55.
Mots-clés :EPIDEMIE; SALMONELLA TENNESSEE; COHORTE; PRELEVEMENT; ENVIRONNEMENT;
SELLE; LAVABO; LAVAGE DES MAINS; TRANSMISSION; ENQUETE; EPIDEMIOLOGIE
Background : In December 2006, we investigated an outbreak of Salmonella serotype Tennessee in a
neonatal intensive care unit (NICU) that coincided with a nationwide Salmonella Tennessee outbreak
associated with contaminated peanut butter.
Methods : Salmonellosis was defined as isolation of Salmonella Tennessee from any clinical specimen or
more than 1 episode of bloody stool within a 24-hour period. We conducted a cohort study among 13 NICU
infants, reviewed medical records, cultured stool from infants and staff, collected environmental samples,
and examined infection control practices.
Results : Ten of the 13 infants had salmonellosis (77%). No medical or dietary risk factors were identified.
The proportion of days in which the NICU census exceeded its 11-bed design capacity was higher in
December compared with the previous 11 months (41.9% vs 0.3%; P , .001). Hand sinks did not meet
operational standards. Salmonella Tennessee was isolated from 9 of the 13 infants, 2 of 40 staff members,
and 6 of 42 environmental samples; all isolates matched the pulsed-field gel electrophoresis pattern of the
nationwide Salmonella Tennessee outbreak.
Conclusions : Although the source of Salmonella Tennessee was not identified, the high census and limited
access to sinks likely facilitated transmission to the NICU infants. Infection control interventions, including
halting new NICU admissions, interrupted further transmission.
NosoBase n°22207
Epidémie nosocomiale d'infections à Acinetobacter baumannii multirésistant dans un centre
hospitalier universitaire à Taïwan
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Chang Hl; Tang CH; Hsu YM; Wan L; Chang Yf; Lin CT. Nosocomial outbreak of infection with multidrugresistant Acinetobacter baumannii in a medical centre in Taiwan. Infection control and hospital epidemiology
2009; 30(1): 34-38.
Mots-clés : ACINETOBACTER BAUMANNII; SOIN INTENSIF; EPIDEMIE; INVESTIGATION;
MULTIRESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE
Objective: To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR) Acinetobacter
baumannii in the intensive care units at China Medical University Hospital in Taiwan.
Design: Prospective outbreak investigation.
Setting: Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.
Methods: Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive
procedure, were enrolled in our study. Ninety-four A. baumannii strains were isolated from the patients or
the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006.
We characterized A. baumannii isolates by use of repetitive extragenic palindromic.polymerase chain
reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical
characteristics of the source patients and the environment were noted. Results: All of the clinical isolates
were determined to belong to the same epidemic strain of MDR A. baumannii by the use of antimicrobial
susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had
undergone an invasive procedure. The outbreak strain was also isolated from the environment and the
equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units
found that both the patients and the environment harbored the same outbreak strain. Conclusion: The
outbreak strain of A. baumannii might have been transmitted among medical staff and administration
equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing
recurrent outbreaks of nosocomial infection with MDR A. baumannii.
NosoBase n°23304
Epidémie inhabituelle d'infections au virus respiratoire syncytial dans un service de psychiatrie pour
adultes
Huang Fl; Chen PY; Shi ZY; Chan CH; Huang SK. An unusual respiratory syncytial virus nosocomial
outbreak in an adult psychiatry ward. Japanese journal of infectious diseases 2009; 62(1): 61-62.
Mots-clés : EPIDEMIE; PNEUMOVIRUS; PSYCHIATRIE; PERSONNEL; INFECTION RESPIRATOIRE
HAUTE; PCR; PREVENTION; TRANSMISSION; VIRUS RESPIRATOIRE SYNCYTIAL
We report our experience in containing an outbreak of nosocomial respiratory syncytial virus (RSV) infection
in a psychiatric ward in central Taiwan during a non-widespread RSV seasonal occurrence. A total of 8
patients and 4 healthcare workers in the psychiatric ward developed febrile illness or upper respiratory tract
infection symptoms between August 23 and 29, 2005. RSV was identified by either viral culture or reverse
transcriptase-polymerase chain reaction (RT-PCR) assay. RSV was isolated from a symptomatic staff
member (8,3 %), and was detected in 5 (42 %) by RT-PCR among 12 cases. All 5 of these RSV cases
detected belonged to genotype A. in our experience, single cubicle isolation of infectious patients and a
cohort of nursing care are the most important factors in the successful control of an RSV outbreak.
NosoBase n°23318
Gestion d'une épidémie de grippe dans un service de psychiatrie fermé
Risa KJ; Mc Andrew JM; Muder RR. Influenza outbreak management on a locked behavioral health unit
American journal of infection control 2009; 37(1): 76-78.
Mots-clés : GRIPPE; EPIDEMIE; PSYCHIATRIE; PCR; IMMUNITE; PRECAUTIONS COMPLEMENTAIRES.
Background: In January 2006, 8 patients on a locked behavioral health (BH) ward were identified with
influenza-like illness (ILI) based on syndrome of fever, malaise, myalgia, cough, and rhinitis. Two patients
initially had rapid antigen testing positive for influenza and confirmed by polymerase chain reaction. All
patients present on the ward (N=26) had been ordered influenza immunizations 6 weeks earlier: 46%
(12/26) were immunized, 42% (11/26) refused, 12% (3/26) had no record of immunization. All direct care
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staff who worked on the unit during the outbreak had been offered immunizations in the fall: 55% (22/40)
were immunized.
Methods: When first symptoms were identified, provider notified infection control nurse and hospital
epidemiologist, who instituted control measures: patients were confined to unit, unit was closed to
admissions, nonimmunized asymptomatic patients were offered immunization, temperatures were recorded
every 4hours, and nonimmunized providers were offered immunizations and prophylaxis. Patients with ILI
were either admitted to acute care and placed in Droplet/Contact Precautions until afebrile for 48hours or
managed on the unit with modified isolation. All patients remaining on the unit were instructed in hand
hygiene and respiratory etiquette; asymptomatic patients were offered oseltamivir phosphate prophylaxis;
and previously nonimmunized patients and staff were again offered the vaccine.
Results: Twenty-six patients and 28 staff were on the unit during the outbreak. Eight patients and 8 staff
members reported ILI within 5 days. Of the ill patients, 3 had been immunized, 5 had not (2 refused, 3
reason unclear presumed to have refused), and 4 were admitted to acute care and placed in Droplet/Contact
Precautions until asymptomatic for 48hours. Of 22 patients who remained on the unit, 4 were symptomatic;
18 asymptomatic patients took prophylaxis, and 1 refused; 8 (89%) patients who had earlier refused vaccine
were immunized. Of the 40 staff members, 55% (22/40) were immunized, and 20% (8/40) were symptomatic
(all presumptive, encouraged to remain off duty). Fifty percent (4/8) of symptomatic staff had been
immunized. After 7 days, no new cases had been identified, and the unit was reopened to admissions. No ill
effects resulted from the prophylaxis.
Conclusion: Prompt detection of ILI and institution of control measures effectively contained the outbreak;
the relatively high immunization rates among both patients and staff helped curtail spread. Refusal of
immunization is a long-standing problem among BH patients and staff. Our study shows importance of
immunization in preventing outbreaks in inpatient BH settings. Recommendations included development of
more aggressive immunization campaign for patients and staff who historically refuse and continued high
priority for provider vigilance in immunization campaign and surveillance for symptoms.
NosoBase n°23312
Vaste épidémie d'infections à Trichophyton tonsurans parmi le personnel soignant d'un centre
hospitalier pédiatrique
Shroba J; Olson-Burgess C; Preuett B; Abdel-Rahman SM. A large outbreak of trichophyton tonsurans
among health care workers in a pediatric hospital. American journal of infection control 2009; 37(1): 43-48.
Mots-clés : PEDIATRIE; EPIDEMIE; MYCOLOGIE; PERSONNEL; EPIDEMIOLOGIE; BIOLOGIE
MOLECULAIRE; TRICHOPHYTON TONSURANS; TEIGNE
Background : Although Trichophyton tonsurans remains a major cause of dermataophytoses in US children,
nosocomial spread may go unrecognized in health care settings. We describe a staff outbreak of T
tonsurans infection among health care workers in a freestanding pediatric hospital.
Methods : Epidemiologic evaluation (retrospective and prospective) was performed in the health care
providers and ancillary staff assigned to a 27-bed inpatient medical unit in which the suspected outbreak
occurred.
Results : Twenty-one individuals, including staff, a hospital volunteer, and a patient, developed tinea
corporis during a 5-month period. All infections coincided with multiple admissions of a 2-year-old suspected
index patient who demonstrated persistent infections of the scalp and arm. Fungal isolates obtained from the
index patient and affected staff (when available) were subjected to multilocus strain typing, which revealed
an identical genetic match between the index case and infected hospital personnel.
Conclusion : T tonsurans can spread widely among staff members caring for children with recalcitrant
dermatophyte infections. Recognition that workplace transmission may be the etiology of a succession of
infections occurring in a single inpatient unit is necessary to limit the number of infected individuals.
Gestion des risques
sommaire
NosoBase n°23306
Préparation des hôpitaux pour les urgences en maladies infectieuses : étude 2007 auprès de
professionnels en hygiène hospitalière
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Rebmann T; Wilson R; Lapointe S; Russell B; Moroz D. Hospital infectious disease emergency
preparedness: a 2007 survey of infection control professionals. American journal of infection control 2009;
37(1): 1-8.
Mots-clés : PREVENTION; PERSONNEL; EPIDEMIE; MASQUE; URGENCE; MATERIEL MEDICOCHIRURGICAL; GESTION DES RISQUES
Background: Hospital preparedness for infectious disease emergencies is imperative.
Methods: A 40-item hospital preparedness survey was administered to Association for Professionals in
Infection Control and Epidemiology, Inc, members. Kruskal-Wallis tests were used to evaluate the
relationship between hospital size and emergency preparedness in relation to various surge capacity
measures. Significant findings were followed by Mann-Whitney U post hoc tests.
Results: Most hospitals have an infection control professional on their disaster committee, 24/7 infection
control support, a health care worker prioritization plan for vaccine or antivirals, and nonhealth care facility
surge beds but lack health care worker, laboratory, linen, and negative-pressure room surge capacity. Many
hospitals participated in a disaster exercise recently and are stockpiling N95 respirators and medications.
Few are stockpiling ventilators, surgical masks, or patient linens; those that are have <or=7 days worth of
supplies. Less than one quarter have cross trained their staff, convened their ethics committee to discuss
preparedness issues, or developed policies/procedures for altered standards of care during disasters.
Approximately half of all hospitals' plans include staff work incentives. The smallest hospitals (<or=99 beds)
are less prepared than larger hospitals on a variety of surge capacity indicators. CONCLUSION: US
hospitals lack laboratory, negative-pressure room, health care worker, and medical equipment/supplies
surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.
Hygiène des mains
sommaire
NosoBase n°23310
Religion et culture : courants sous-jacents potentiels influençant la promotion de l'hygiène des
mains dans les soins en santé
Allegranzi B; Memish Za; Donaldson L; Pittet D. Religion and culture: potential undercurrents influencing
hand hygiene promotion in health care. American journal of infection control 2009; 37(1): 28-34.
Mots-clés : PERSONNEL; SOLUTION HYDRO-ALCOOLIQUE; OBSERVANCE; HYGIENE DES MAINS
Background: Health care-associated infections affect hundreds of millions of patients worldwide each year.
The World Health Organization's (WHO) First Global Patient Safety Challenge, "Clean Care is Safer Care,"
is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the
project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large
group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in
different health care settings worldwide.
Methods: An extensive literature search was conducted and experts and religious authorities were consulted
to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible
solutions, and suggest areas for future research.
Results: Religious faith and culture can strongly influence hand hygiene behavior in health care workers and
potentially affect compliance with best practices. Interesting data were retrieved on specific indications for
hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of
"visibly dirty" hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some
religions.
Conclusions: The impact of religious faith and cultural specificities must be taken into consideration when
implementing a multimodal strategy to promote hand hygiene on a global scale.
NosoBase n°23513
Avant-bras nus : que pensent les patients ?
Ardolino A; Williams LAP; Crook TB; Taylor HP. Bare below the elbows: what do patients think? The Journal
of hospital infection 2009/03; 71(3): 291-293.
Mots-clés : RECOMMANDATION; PROTOCOLE; TENUE VESTIMENTAIRE; RISQUE; LAVAGE DES
MAINS; OBSERVANCE; BIJOU; MEDECIN; USAGER; HYGIENE DES MAINS
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NosoBase n°23508
Association entre un indicateur de consommation de produits pour la friction des mains et
l'incidence des infections à Staphylococcus aureus méticillino-résistant acquises en réanimation
Eveillard M; Kouatchet A; Rigaud A; Urban M; Lemarie C; Kowalczyk JP et al. Association between an index
of consumption of hand-rub solution and the incidence of acquired meticillin-resistant Staphylococcus
aureus in an intensive care unit. The Journal of hospital infection 2009/03; 71(3): 283-285.
Mots-clés : SOLUTION HYDRO-ALCOOLIQUE; INDICATEUR; INCIDENCE; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; SOIN INTENSIF; OBSERVANCE; FORMATION; EPIDEMIE
NosoBase n°22250
Etude de cohorte sur le respect d'une antisepsie correcte des mains avant et après la réalisation de
soins
Laustsen S; Lund E; Bibby M; Kristensen B; Thulstrup Am; Moller JK. Cohort study of adherence to correct
hand antisepsis before and after performance of clinical procedures. Infection control and hospital
epidemiology 2009; 2: 172-178.
Mots-clés : SOLUTION HYDRO-ALCOOLIQUE; LAVAGE DES MAINS; OBSERVANCE; PERSONNEL;
COHORTE; TAUX; INFORMATION; AUDIT
Objective. To investigate the rate of adherence by hospital staff members to the correct use of alcoholbased hand rub before and after performance of clinical procedures.
Design. A cohort study conducted during the period from 2006 through 2007 and 2 cross-sectional studies
conducted in 2006 and 2007.
Setting. Arhus University Hospital, Skejby, in Arhus, Denmark.
Methods. Following an ongoing campaign promoting the correct use of alcohol-based hand rub, we
observed rates of adherence by hospital staff to the correct use of alcohol-based hand rub. Observations
were made before and after each contact with patients or patient surroundings during 5 weekdays during the
period from 2006 through 2007 in 10 different hospital units. A logistic regression model was used to
estimate the rate of adherence to the correct use of alcohol-based hand rub before and after performance of
a clinical procedure.
Results. A total of 496 participants were observed during 22,906 opportunities for hand hygiene (ie, 11,177
before and 11,729 after clinical procedures) that required the use of alcohol-based hand rub. The overall
rates of adherence to the correct use of alcohol-based hand rub were 62.3% (6,968 of the 11,177
opportunities) before performance and 68.6% (8,041 of the 11,729 opportunities) after performance of
clinical procedures. Compared with male participants, female participants were significantly better at
adhering to the correct use of alcohol-based hand rub before performance (odds ratio [OR] 1.51 [95%
confidence interval {CI}, 1.09–2.10]) and after performance (OR, 1.73 [95% CI, 1.27–2.36]) of clinical
procedures. In general, the rate of adherence was significantly higher after the performance of clinical
procedures, compared with before (OR, 1.43 [95% CI, 1.35–1.52]). For our cohort of 214 participants who
were observed during 14,319 opportunities, the rates of adherence to the correct use of alcohol-based hand
rub were 63.2% (4,469 of the 7,071 opportunities) before performance and 69.3% (5,021 of the 7,248
opportunities) after performance of clinical procedures, and these rates increased significantly from 2006 to
2007, except for physicians.
Conclusion. We found a high and increasing rate of adherence to the correct use of alcohol-based hand rub
before and after performance of clinical procedures following a campaign that promoted the correct use of
alcohol-based hand rub. More hospital staff performed hand hygiene with alcohol-based hand rub after
performance of clinical procedures, compared with before performance. Future campaigns to improve the
rate of adherence to the correct use of alcohol-based hand rub ought be aware that certain groups of
hospital staff (eg, male staff members) are known to exhibit a low level of adherence to the correct use of
alcohol-based hand rub
NosoBase n°22270
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Hygiène des mains des masseurs-kinésithérapeutes : retour sur une évaluation des pratiques
professionnelles
Pergay V; Leroi JC; Nouveau E; Mami K; Duforet M; Tissot-Guerraz F. Techniques hospitalières 2009; 713:
66-67.
Mots-clés : MAIN; GERIATRIE; EVALUATION; KINESITHERAPEUTE; SOLUTION
HYDRO-ALCOOLIQUE; BIJOU
NosoBase n°23499
Brosses et cure-ongles utilisés sur les ongles lors de la désinfection chirurgicale des mains par
lavage : essai randomisé
Tanner J; Khan D; Walsh S; Chernova J; Lamont S; Laurent T. Brushes and picks used on nails during the
surgical scrub to reduce bacteria: a randomised trial. The Journal of hospital infection 2009/03; 71(3): 234238.
Mots-clés : LAVAGE CHIRURGICAL DES MAINS; RANDOMISATION; PERSONNEL; CHLORHEXIDINE ;
ONGLE; BROSSE; DESINFECTION CHIRURGICALE DES MAINS PAR LAVAGE.
Though brushes are no longer used on the hands and forearms during the surgical scrub, they are still
widely used on the nails. The aim of this study was to determine whether nail picks and nail brushes are
effective in providing additional decontamination during a surgical hand scrub. A total of 164 operating
department staff were randomised to undertake one of the following three surgical hand-scrub protocols:
chlorhexidine only; chlorhexidine and a nail pick; or chlorhexidine and a nail brush. Bacterial hand sampling
was conducted before and 1h after scrubbing using a modified version of the glove juice method. No
statistically significant differences in bacterial numbers were found between any two of the three intervention
groups. Nail brushes and nail picks used during surgical hand scrubs do not decrease bacterial numbers
and are unnecessary.
NosoBase n°23507
Accomplissement de l'hygiène des mains dans 214 établissements de santé dans le Sud-Ouest de la
France
Venier AG; Zaro-Goni D; Pefau M; Hauray J; Nunes J; Cadot C et al. Performance of hand hygiene in 214
healthcare facilities in South-Western France. The Journal of hospital infection 2009/03; 71(3): 280-282.
Mots-clés : OBSERVANCE; PERSONNEL; INFIRMIER; ISOLEMENT; GANT; SAVON; SOLUTION
HYDRO-ALCOOLIQUE; TAUX; LAVAGE DES MAINS; DESINFECTION; SANG; CATHETER; DIALYSE
RENALE; ETUDE D'OBSERVATION; HYGIENE DES MAINS
NosoBase n°23498
Désinfection chirurgicale des mains à l'aide d'un produit à base d'alcool : impacts du type d'alcool,
du mode et de la durée d'application
Suchomel M; Gnant G; Weinlich M; Rotter M. Surgical hand disinfection using alcohol: the effects of alcohol
type, mode and duration of application. The Journal of hospital infection 2009/03; 71(3): 228-233.
Mots-clés : ALCOOL; DESINFECTION; NORME; SOLUTION HYDRO-ALCOOLIQUE
Due to their strong antimicrobial activity, rapid action, good dermal tolerance and ease of application,
alcohol-based hand rubs are recommended for pre-operative preparation of the surgical team's hands.
Using the EN 12791 protocol, three commercial products containing either mixtures of propan-1-ol and
propan-2-ol or ethanol at total alcohol concentrations (w/w) between 73% (propanols) and 78.2% (ethanol),
as the main active agents, were tested with a shortened application of 1.5min rather than the usual 3min.
Preparation A containing 30% propan-1-ol and 45% propan-2-ol not only passed the test at this short
application but even exceeded, though not significantly, the efficacy of the reference disinfection procedure
in EN 12791 when applied for 3min. Preparation B containing 45% propan-1-ol and 28% propan-2-ol fulfilled
the required standard whereas the ethanol (78.2%)-based product C did not (P<0.1). This demonstrates that
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some, but not all, alcohol-based hand rubs pass the test even within 1.5min, emphasising the importance of
validation before a product is introduced into clinical practice. In another series with both preparation A and
60% v/v propan-1-ol, it was demonstrated that the additional inclusion of the forearms into the disinfection
procedure, not required by EN 12791 but normal practice in surgical hand disinfection, does not significantly
interfere with the antimicrobial efficacy of either hand rub. Therefore, the mode of test procedure in EN
12791 does not need specific adaptation for hand disinfection by surgical teams.
Norovirus
sommaire
NosoBase n°23494
Norovirus dans un centre hospitalier universitaire aux Pays-Bas (2000-2007) : transmission
nosocomiale fréquente et souches GIIb dominantes chez les jeunes enfants
Beersma MFC; Schutten M; Vennema H; Hartwig NG; Mes THM; Osterhaus A et al. Norovirus in a dutch
tertiary care hospital (2002-2007): frequent nosocomial transmission and dominance of GIIb strains in young
children. The Journal of hospital infection 2009/03; 71(3): 199-205.
Mots-clés : NOROVIRUS; TRANSMISSION; PEDIATRIE; VIRUS; INCIDENCE; PCR; EPIDEMIOLOGIE;
GASTRO-ENTERITE
We report a retrospective analysis of norovirus (NoV) infections occurring in patients of a tertiary care
hospital during five winter seasons (2002/03 to 2006/07). Data were compared with national surveillance
data and with corresponding data for rotavirus. Between July 2002 and June 2007, faecal specimens from
221 (9.0%) of 2458 hospital patients with diarrhoea tested positive for NoV. The incidence in children varied
from 2.52 per 1000 admissions in 2004/05 (when testing began to be performed routinely) to 11.9 per 1000
admissions in 2006/07, while the incidence in adults remained stable (mean: 1.49 per 1000 admissions).
Two genotypes predominated during the study period: GIIb strains occurred mainly in children below the age
of two-and-a-half years [odds ratio (OR): 14.7; P<0.0001] whereas GII.4 strains affected all age groups.
Compared with rotavirus infections, NoV infections in children were more often hospital-acquired (59% vs
39%, OR: 2.29; P<0.01). Among these cases we identified 22 clusters of NoV infection among inpatients.
Twelve of 53 patients from whom follow-up samples were available demonstrated long-term virus shedding.
We report a dynamic pattern of sporadic NoV infections in large hospitals, with frequent nosocomial
transmission and with the predominance of GIIb-related strains in children. Effective prevention strategies
are required to reduce the impact of sporadic NoV infection in vulnerable patients.
NosoBase n°23495
Variant GII.4-2006b responsable d'une épidémie prolongée à norovirus dans un centre hospitalier
universitaire en Finlande
Kanerva M; Maunula L; Lappalainen M; Mannonen L; Von Bonsdorff CH; Anttila VJ. Prolonged norovirus
outbreak in a Finnish tertiary care hospital caused by GII.4-2006b subvariants. The Journal of hospital
infection 2009/03; 71(3): 206-213.
Mots-clés : VIRUS; NOROVIRUS; EPIDEMIE; CENTRE HOSPITALIER UNIVERSITAIRE;
EPIDEMIOLOGIE; PERSONNEL; BIOLOGIE MOLECULAIRE; GASTRO-ENTERITE; PCR; MORTALITE
Norovirus outbreaks are difficult to control in hospitals. Cohorting and contact isolation, disinfective surface
cleaning and hand hygiene are key elements in outbreak control. A new norovirus variant, GII.4.-2006b,
spreading across many continents, caused an exceptionally long epidemic period in Finland, from November
2006 to June 2007. Here, we describe the clinical and molecular characteristics of a norovirus outbreak in a
large tertiary care hospital in Finland. Altogether 240 (18%) patients and 205 (19%) healthcare workers fell ill
in the 504 bedded main building of Helsinki University Central Hospital during December 2006 to May 2007.
The epidemic curve had three peaks in January, February and April, and different wards were affected each
time. During the outbreak, 502 patient stool specimens were tested for norovirus RNA, 181 (36%) of which
were positive. Molecular analysis of 48 positive specimens revealed three main subvariants of GII.4.-2006b
circulating temporally within distinct wards. Of all microbiologically confirmed cases, 121 (67%) were
nosocomial and nine (5%) died within 30 days of diagnosis. Molecular analysis suggested that the three
main GII.4-2006b subvariants entered the hospital with gastroenteritis patients, and the nosocomial spread
within wards coincided with the epidemic peaks. Active control measures, including temporary closure of the
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wards, ultimately confined the single-ward outbreaks. A prolonged outbreak in the community was probably
the source for the prolonged outbreak period in the hospital.
NosoBase n°23301
Epidémie d'infections à norovirus dans une maison de retraite en Italie
Medici MC; Morelli A; Arcangeletti MC; Calderaro A; De Conto F; Martinelli M. An outbreak of norovirus
infection in an italian residential-care facility for the elderly. Clinical microbiology and infection 2009; 15(1):
97-100.
Mots-clés : VIRUS; EPIDEMIE; MAISON DE RETRAITE; PERSONNE AGEE; GASTRO-ENTERITE;
COHORTE; ETUDE RETROSPECTIVE
On December 2006, an outbreak of gastroenteritis occurred at a residential-care facility for the elderly in
northern Italy. Thirty-five of 61 individuals interviewed (attack rate, 57.4%) fell ill. In 94.3% of cases, the
onset of illness was within 48 h of a Christmas party at the facility. Norovirus (NoV) was detected by RTPCR in 24 of 31 individuals examined, including three asymptomatic food-handlers, in whom there was
evidence of long-lasting excretion of viral particles. The identification of a sequence referring to the .2006a
GII.4 NoV variant. in all examined strains supported the hypothesis of a common point source. This
retrospective cohort study is the first report on an outbreak of NoV gastroenteritis in an Italian residentialcare facility for the elderly.
NosoBase n°23496
Modèle mathématique pour le contrôle des norovirus nosocomiaux
Vanderpas J; Louis J; Reynders M; Mascart G; Vandenberg O. Mathematical model for the control of
nosocomial norovirus. The Journal of hospital infection 2009/03; 71(3): 214-222.
Mots-clés : VIRUS; NOROVIRUS; CONTROLE; GASTRO-ENTERITE; EPIDEMIE; LONG SEJOUR;
PREVALENCE; DUREE DE SEJOUR; CENTRE HOSPITALIER UNIVERSITAIRE; STATISTIQUE
A gastroenteritis outbreak in a long-term care facility was analysed by means of a SEIR (Susceptible,
Exposed/Latent phase, Infected/Infectious, and Recovered) compartment model of infection dynamics in a
closed population [96 beds; attack rate=41%; R(0) (basic reproductive number)=3.74; generation time
approximately 1 day; duration of disease approximately 2 days; theoretical infinite (1000 days) duration of
hospital stay]. The patient-turnover variation was simulated to determine the effect of the length of hospital
stay on the endemic level of gastroenteritis perpetuating the epidemic phase in an open population. With all
the other parameters held constant, the prevalence of infected patients in the endemic phase (50 days after
the beginning of the outbreak) increased markedly from five to 18 cases as the hospital stay increased from
one-tenth of a day (one-day care) to one or two days; the prevalence decreased exponentially with the
length of hospital stay, being fewer than five cases for hospital stays >50 days. In conclusion, the endemic
prevalence of norovirus gastroenteritis is critically dependent on the patient turnover within hospital wards.
For the usual range of hospital stay (0.1-20 days), the prevalence level is sufficiently elevated to maintain
the perpetuation of gastroenteritis within the population of institutionalised patients. In long-term care
facilities (hospital stay >20 days), the patient turnover is sufficiently low for one to expect a spontaneous
extinction of epidemic outbreak without endemic perpetuation. When an epidemic outbreak occurs in an
acute-care setting, reinforcement of infection control measures, including closure of the ward, is required to
break the transmission chain.
Pédiatrie
sommaire
NosoBase n°23545
Infections nosocomiales dans des unités de réanimation pédiatrique en Lituanie
Asembergiene J; Gurskis V; Kevalas R; Valinteliene R. Nosocomial infections in the pediatric intensive care
units in Lithuania. Medicina 2009; 45(1): 29-36.
Mots-clés : PEDIATRIE; SOIN INTENSIF; TAUX; INCIDENCE; PNEUMONIE; VENTILATION ASSISTEE;
BACTERIEMIE; INFECTION URINAIRE; HAEMOPHILUS ; ACINETOBACTER; STAPHYLOCOCCUS
AUREUS; ANTIBIOTIQUE; CEPHALOSPORINE; PENICILLINE
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Objective. The aim of the study was to collect the data on incidence rates, pathogens of nosocomial
infections, and antimicrobials for treatment of nosocomial infections.
Material and methods. Data were collected between March 2003 and December 2005 in five pediatric
intensive care units using a modified patient-based HELICS protocol. Nosocomial infection was identified
using the Centers for Disease Control definitions. All patients aged between 1 month and 18 years that
stayed in the units for more than 48 hours were eligible for inclusion in this study.
Results. A total of 1239 patient admissions and 7601 patient-days were evaluated. In 169 children (13.6%),
186 nosocomial infections occurred. The incidence density was 24.5 per 1000 patient-days, the incidence
rate – 15.0 per 100 admissions. The highest incidence density was observed in the 6–12-year age group
(31.2 per 1000 bed-days). Nosocomial infection rates per 1000 device-days were 28.8 for ventilatorassociated pneumonia, 7.7 – for bloodstream infection, and 3.4 – for urinary tract infection. The most
common site of infection was respiratory tract (58.8%). Secondary bacteremia developed in 18 (10.6%)
patients. Haemophilus influenzae (20.1%), Acinetobacter spp. (14.2%), and Staphylococcus aureus (17.6%)
were the most frequently isolated microorganisms. The most common antimicrobials used were first- and
second-generation cephalosporins 74 (31.0%) and broad-spectrum penicillins 70 (29.3%).
Conclusions. In Lithuanian pediatric intensive care units, the incidence rates of nosocomial infections were
comparable to the available data from other countries, except for the ventilatorassociated pneumonia rate,
which was relatively high. H. influenzae, Acinetobacter spp., and S. aureus were the most prevalent
pathogens. The first- and second-generation cephalosporins and broad-spectrum penicillins were the most
common antimicrobials in the treatment of nosocomial infections.
NosoBase n°23510
L'usage de corticostéroïdes est un facteur de risque d'acquisition d'infection nosocomiale en
pédiatrie
Moreira Lll; Netto Em. Use of corticosteroid is a risk factor for nosocomial infection in paediatric patients.
The Journal of hospital infection 2009/03; 71(3): 287-288.
Mots-clés : FACTEUR DE RISQUE; PEDIATRIE; TRAITEMENT; CORTICOTHERAPIE; ANALYSE
MULTIVARIEE
Personnel
sommaire
NosoBase n°23294
Accidents d'exposition au sang par piqûre dans un centre hospitalier universitaire
Jayanth St; Kirupakaran H; Brahmadathan KN; Gnanaraj L; Kang G. Needle stick injuries in a tertiary care
hospitalIndian journal of medical microbiology 2009; 27(1): 44-47.
Mots-clés : FACTEUR DE RISQUE; EXPOSITION AU SANG; PIQURE; PERSONNEL; PREVENTION;
CENTRE HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE
Accidental needle stick injuries (NSIs) are an occupational hazard for healthcare workers (HCWs). A recent
increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to
determine risk factors for injury and potential interventions for prevention. Methods : We reviewed 1-year
(July 2006-June 2007) of ongoing surveillance of NSIs. Results : The 296 HCWs reporting NSIs were 84
(28.4%) nurses, 27 (9.1%) nursing interns, 45 (21.6%) cleaning staff, 64 (21.6%) doctors, 47 (15.9%)
medical interns and 24 (8.1%) technicians. Among the staff who had NSIs, 147 (49.7%) had a work
experience of less than 1 year (P < 0.001). The devices responsible for NSIs were mainly hollow bore
needles (n = 230, 77.7%). In 73 (24.6%) of the NSIs, the patient source was unknown. Recapping of
needles caused 25 (8.5%) and other improper disposal of the sharps resulted in 55 (18.6%) of the NSIs.
Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month
follow-up for human immunode. ciency virus showed zero seroconversion. Conclusion : Improved education,
prevention and reporting strategies and emphasis on appropriate disposal are needed to increase
occupational safety for HCWs.
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NosoBase n°22202
Colonisation à Staphylococcus aureus résistant à la méticilline d'origine communautaire chez des
patients en insuffisance rénale terminale et chez le personnel soignant
Johnson LB; Jose J; Yousif F; Pawlak J; Saravolatz LD. Prevalence of colonization with communityassociated methicillin-resistant Staphylococcus aureus among end-stage renal disease patients and
healthcare workers. Infection control and hospital epidemiology 2009; 30(1): 4-8.
PREVALENCE; COLONISATION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
HEMODIALYSE; PERSONNEL; INFECTION COMMUNAUTAIRE
Candidats mots clés: Leucocidine de Panton-Valentine
Objective: To evaluate the prevalence, epidemiologic features, and molecular characteristics of colonization
with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among hospitalized
dialysis patients and their healthcare workers (HCWs). Design: Prospective observational clinical and
laboratory study of nasal colonization. Setting: A 600-bed urban academic medical center. Subjects: One
hundred twenty hospitalized dialysis inpatients and 100 HCWs. Results: Of 120 patients, 40 (33%) were
colonized with S. aureus; 26 (65%) of these 40 were colonized with MRSA. Among the 26 MRSA isolates,
10 (38.5%) carried staphylococcal cassette chromosome (SCC) mec type IV (ie, CA-MRSA), and 7 of these
10 carried the genes for the Panton-Valentine leukocidin (PVL) toxin. Patients colonized with healthcareassociated MRSA strains and those colonized with CA-MRSA strains were similar, except for a higher
frequency of a history of congestive heart failure among those with healthcare-associated MRSA strains ( ).
Among 10 patients who presented with or developed an S. aureus infection while hospitalized, 8 were
colonized with S. aureus, 7 with MRSA, and 3 with SCCmec type IV strains. Among 100 HCWs, 31 were
colonized with S. aureus, including 6 with MRSA; 2 of the MRSA isolates belonged to CA-MRSA strains, and
soft-tissue infections were reported in one of the HCWs and in the family member of the other HCW
colonized with these strains. Conclusions: There is a high rate of colonization with MRSA and CA-MRSA
among hospitalized dialysis patients and their HCWs. As other studies have found, it appears that
individuals are being colonized with both CA-MRSA strains and healthcare-associated MRSA strains.
Personne âgée
sommaire
NosoBase n°23352
Kit BMR pour les établissements accueillant des personnes âgées
CCLIN SUD-EST; ANTENNE AUVERGNE DU CCLIN SUD-EST. 2009; 50 pages.
Mots-clés : RECOMMANDATION; EHPAD; BACTERIE; MULTIRESISTANCE; PERSONNE AGEE;
PRECAUTION STANDARD; CONDUITE A TENIR; INFORMATION; LAVAGE DES MAINS; TENUE
VESTIMENTAIRE; DECHET; PERSONNEL; ENVIRONNEMENT; CHAMBRE; LINGE; TOILETTE DU
PATIENT; ESCARRE; DEFINITION; REEDUCATION
Ce KIT BMR pour les établissements accueillant des personnes âgées propose des conduites à tenir en cas
de : BMR dans une plaie ; BMR dans les urines ; BMR dans les selles ; BMR dans les voies aériennes.
Pour chacune de ces fiches "conduite à tenir", les aspects suivants sont traités :
- Soins médicaux et paramédicaux (examen médical, soins infirmiers, toilette et prévention d'escarre,
réfection du lit, aide à l'élimination et change des protections, aide au repas, kinésithérapie, ergothérapie,
pédicure, déplacements);
- Autres soins à la personne (visites, activités en groupe, coiffure, esthétique, intervenants extérieurs) ;
- Hygiène de l'environnement (la chambre, matériel de soins, linge du résidant, déchets).
Dans ce document, sont rappelées les précautions standard. Dans le chapitre "Hygiène de mains", un
tableau précise quel type d'hygiène des mains doit être réalisé avant et après les soins à un résidant porteur
de BMR et aussi en fonction du type de soins.
En annexe de ce guide figure un CD ROM contenant des plaquettes, affiches, diaporamas.
NosoBase n°23504
Conséquences sévères des infections associées aux soins parmi des résidents de maisons de
retraite : étude de cohorte
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Mars 2009
Koch Am; Eriksen Hm; Elstrom P; Aavitsland P; Harthug S. Severe consequences of healthcare-associated
infections among residents of nursing homes: a cohort study. The Journal of hospital infection 2009/03;
71(3): 269-274.
Mots-clés :
RANDOMISATION; COHORTE; INCIDENCE; MORTALITE; INFECTION RESPIRATOIRE BASSE;
PERSONNE AGEE; MAISON DE RETRAITE; RISQUE
The aim of this study was to identify the consequences of healthcare-associated infections in Norwegian
nursing homes, to include debilitation, hospital transfer and mortality. We followed the residents of six
nursing homes in two major cities in Norway during the period October 2004 to March 2005. For each
resident with infection we randomly selected two controls among residents who did not have an infection.
Cases and the controls were followed for 30 days as a cohort in order to measure the incidence of
complications and risk ratio (RR) in the two groups. The incidence of infection was 5.2 per 1000 residentdays. After 30 days follow-up 10.9% of residents who had acquired infection demonstrated a reduction in
overall physical condition compared with 4.8% in the unexposed group (RR: 2.3). Altogether 13.0% of
residents with infections were admitted to hospital compared with 1.4% in the unexposed group (RR 9.2),
and 16.1% residents with infections died in the nursing home during follow-up compared with 2.4% in the
unexposed group (RR: 6.6). Residents with lower respiratory tract infections demonstrated higher morbidity
and mortality. In conclusion, healthcare-associated infections cause severe consequences for people living
in nursing homes, including debilitation, hospital admission and death.
Prévention
sommaire
NosoBase n°23282
L'aspiration des sécrétions orales avant un changement de position réduit l'incidence des
pneumonies acquises sous ventilation chez des patients adultes en réanimation : essai clinique
contrôlé
Chao Yf; Chen Yy; Wang Kw; Lee Rp; Tsai H. Removal of oral secretion prior to position change can reduce
the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study.
Journal of clinical nursing 2009; 18(1): 22-28.
Mots-clés : INCIDENCE; PNEUMONIE; VENTILATION ASSISTEE; PREVENTION; ASPIRATION; SOIN
INTENSIF; DUREE DE SEJOUR; COUT; ESSAI THERAPEUTIQUE; MORTALITE
Aim: The purpose of this study was to explore the effect of oral secretion on aspiration and reducing
ventilator-associated pneumonia.
Background: Ventilator-associated pneumonia is a serious hospital-acquired infection with reported
incidence rate of 12.2% and mortality rate of 29.3%. Oral secretion is purported as a media which brings the
oropharyngeal pathogens down to the respiratory track.
Methods: Two-group comparison study design was adopted. Subjects were recruited from an adult general
intensive care unit of a medical centre in Taipei city. Patients in the study group received suction of oral
secretion before each positional care, in contrast with patients in the control group who received routine
care.
Results: Ventilator-associated pneumonia was found in 24 of 159 (15.1%) patients in the control group and
in five of 102 (4.9%) patients in the study group with a reduction of risk ratio of 0.32 (95% CI 0.11-0.92).
Eight of the 24 ventilator-associated pneumonia patients died in the control group; however, none of those
ventilator-associated pneumonia patients died in the study group. The increased chance of survival was
1.50 (95% CI 1.13-1.99). The length of stay in ICU and duration of mechanical ventilation were reduced in
the study group. In consideration of cost, the cost of tubes used to remove oral secretion is much less than
the one used to do continuous subglottal suction. CONCLUSION: Removal of oral secretion is effective in
reducing the incidence of ventilator-associated pneumonia with minimum cost intervention.
Relevance To Clinical Practice: This study provides evidence that removal of oral secretion prior to position
change is cost effective to reduce the incidence of ventilator-associated pneumonia. As such intervention is
an easy task, routine removal of oral secretion is recommended as the standard of daily nursing care of
patients on ventilator.
NosoBase n°23302
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Mars 2009
Infections associées aux soins : épidémiologie, prévention et traitement
Doshi RK; Patel G; Mackay R; Wallach F. Healthcare-associated infections: epidemiology, prevention, and
therapy. Mount sinai journal of medicine 2009; 76(1): 84-94.
Mots-clés : EPIDEMIOLOGIE; PREVENTION; TRAITEMENT; BIBLIOGRAPHIE; CATHETER VEINEUX
CENTRAL; BACTERIEMIE; INFECTION URINAIRE; CATHETER; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE; CLOSTRIDIUM DIFFICILE; MULTIRESISTANCE
Reducing nosocomial infection rates is a major component of healthcare improvement. This article reviews
the epidemiology, prevention, and therapy for some of the most common healthcare-associated infections,
including central line-associated bloodstream infections and catheter-associated urinary tract infections, and
3 common organisms: methicillin-resistant Staphylococcus aureus, multidrug- resistant gram-negative
bacteria, and Clostridium difficile.
Qualité
sommaire
NosoBase n°23503
Influence des fiches de rapport de lutte contre le risque infectieux sur le choix de leur hôpital par les
patients : étude pilote
Merle V; Germain JM; Tavolacci MP; Brocard C; Chefson C; Cyvoct C et al. Influence of infection control
report cards on patients' choice of hospital: pilot survey. The Journal of hospital infection 2009/03; 71(3):
263-268.
Mots-clés : QUALITE; RANDOMISATION; SCORE; USAGER; ATTITUDE; ETUDE MULTICENTRIQUE
The impact on patients' attitudes of quality report cards on infection control in hospitals has never previously
been studied. In 2006, the French government implemented a mandatory report card on infection control
activity (ICALIN) in all hospitals. This approach was aimed at encouraging professionals to change their
routine practices in case they should lose patients due to a low ICALIN score. Our objective was to assess
what impact ICALIN could have on patients' attitude as regards hospital choice. We performed a survey of
patients and visitors in 14 randomly selected hospitals of various ICALIN scores. A convenience sample of
381 patients and visitors completed an anonymous questionnaire on ICALIN, their reasons for choosing a
hospital and attitude in the event of a low ICALIN score. Factors associated with interest in ICALIN and
impact of ICALIN on hospital choice were assessed by logistic regression. Our results showed that 77% of
participants were interested in ICALIN. ICALIN was ranked sixth as a reason for choosing a hospital. In the
case of a low ICALIN, 24.1% of participants would refuse admission and 54.9% would seek advice from their
general practitioner. Sociodemographic factors had no influence on patients' attitude. In conclusion, our
survey suggests that patients take note of poor performance on infection control report cards. As most
patients rely on their general practitioner to interpret these report cards, there is a definite need for further
communication with general practitioners on this issue.
Stérilisation
sommaire
NosoBase n°22265
Construction d'une unité centrale de stérilisation au CHR d'Orléans
Abdelaziz D; Hermelin-Jobet I. Techniques hospitalières 2009; 7(13): 15-30.
Mots-clés : STERILISATION CENTRALE; ARCHITECTURE; STERILISATION; LAVEUR-DESINFECTEUR;
AUTOCLAVE; TRACABILITE; CONTENEUR; INSTRUMENT; TRANSPORT; INFORMATIQUE; AIR
NosoBase n°22264
Amélioration de la qualité en stérilisation : élaboration d'un questionnaire destiné à l'évaluation du
personnel participant à la reconstitution des containers
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Mars 2009
Guillermet A; Gavoille E; Goutelle S; Larcher R; Orng E; Constant H. Techniques hospitalières 2009; 713:
11-14
Mots-clés : STERILISATION; EVALUATION; ENQUETE; PERSONNEL; QUALITE; CONTENEUR;
STERILISATION CENTRALE; INSTRUMENT
NosoBase n°22266
Externalisation partielle de stérilisation pour travaux : expérience de l'hôpital Beaujon (AP-HP)
Roc E; Sigward E; Persuanne M; Le Grand J; Sinegre M. Techniques hospitalières 2009; 713: 31-39.
Mots-clés : STERILISATION; PHARMACIE; COUT; PERSONNEL; TRACABILITE; CAHIER
CHARGES; EXTERNALISATION
Surveillance
DES
sommaire
NosoBase n°22243
Acquisition et transmission croisée de Staphylococcus aureus dans des unités de réanimation
européennes
Bloemendaal AL; Fluit AC; Jansen WM; Vriens MR; Ferry T; Argaud L. Acquisition and cross-transmission of
Staphylococcus aureus in European intensive care units. Infection control and hospital epidemiology 2009;
30(2): 117-124.
Mots-clés : TRANSMISSION; SOIN INTENSIF; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; COLONISATION; DUREE DE SEJOUR; SOLUTION HYDRO-ALCOOLIQUE;
ANTIBIOTIQUE; PRELEVEMENT; CHAMBRE; COHORTE; EUROPE
Objective. To study the acquisition and cross-transmission of Staphylococcus aureus in different intensive
care units (ICUs).
Methods. We performed a multicenter cohort study. Six ICUs in 6 countries participated. During a 3-month
period at each ICU, all patients had nasal and perineal swab specimens obtained at ICU admission and
during their stay. All S. aureus isolates that were collected were genotyped by spa typing and multilocus
variable-number tandem-repeat analysis typing for cross-transmission analysis. A total of 629 patients were
admitted to ICUs, and 224 of these patients were found to be colonized with S. aureus at least once during
ICU stay (22% were found to be colonized with methicillin-resistant S. aureus [MRSA]). A total of 316
patients who had test results negative for S. aureus at ICU admission and had at least 1 follow-up swab
sample obtained for culture were eligible for acquisition analysis.
Results. A total of 45 patients acquired S. aureus during ICU stay (31 acquired methicillin-susceptible S.
aureus [MSSA], and 14 acquired MRSA). Several factors that were believed to affect the rate of acquisition
of S. aureus were analyzed in univariate and multivariate analyses, including the amount of hand
disinfectant used, colonization pressure, number of beds per nurse, antibiotic use, length of stay, and ICU
setting (private room versus open ICU treatment). Greater colonization pressure and a greater number of
beds per nurse correlated with a higher rate of acquisition for both MSSA and MRSA. The type of ICU
setting was related to MRSA acquisition only, and the amount of hand disinfectant used was related to
MSSA acquisition only. In 18 (40%) of the cases of S. aureus acquisition, cross-transmission from another
patient was possible.
Conclusions. Colonization pressure, the number of beds per nurse, and the treatment of all patients in
private rooms correlated with the number of S. aureus acquisitions on an ICU. The amount of hand
disinfectant used was correlated with the number of cases of MSSA acquisition but not with the number of
cases of MRSA acquisition. The number of cases of patient-to-patient cross-transmission was comparable
for MSSA and MRSA.
NosoBase n°22208
Taux d'incidence et coût variable des infections dans différentes unités de soins intensifs
Chen YY; Wang FD; Liu CY; Chou P. Incidence rate and variable cost of nosocomial infections in different
types of intensive care units. Infection control and hospital epidemiology 2009; 30(1): 39-46.
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Mars 2009
Mots-clés : INCIDENCE; SOIN INTENSIF; COUT; ETUDE PROSPECTIVE; COHORTE; ETUDE
RETROSPECTIVE; CHIRURGIE; SITE OPERATOIRE; BACTERIEMIE; PNEUMOPATHIE
Objective: Nosocomial infection (NI) is one of the most serious healthcare issues currently influencing
healthcare costs. This study estimates the impact of NI on costs in intensive care units (ICUs).
Design: Prospective surveillance by a retrospective cohort study.
Setting: A medical ICU, a surgical ICU, and a mixed medical and surgical ICU in a large tertiary referral
medical center.
Methods: Surveillance for NIs was conducted for all patients admitted to adult ICUs from 2003 through 2005.
Retrospective chart review was conducted for each patient. The generalized linear modeling approach was
used to assess the relationship of NIs to the increase in variable costs in individual ICUs and in all ICUs.
Results: A total of 401 NIs occurred in 320 of 2,757 screened patients. The incidence rate was 12.1% in the
medical ICU, 14.7% in the surgical ICU, and 16.7% in the mixed medical and surgical ICU ( ). All of the
mean variable costs were significantly higher for patients with NI than they were for patients without NI, after
controlling for covariates. The medical ICU had the greatest increase in mean cost ($13,456, which was 3.52
times [95% confidence interval {CI}, 2.94.4.22 times] the mean cost for patients without NI), followed by the
mixed medical and surgical ICU ($6,748, which was 2.74 times [95% CI, 2.33.3.22 times] the mean cost for
patients without NI) and the surgical ICU ($5,433, which was 2.46 times [95% CI, 1.99.3.05 times] the mean
cost for patients without NI). Mean cost increases according to the site of NI were $6,056 for bloodstream
infection (2.36 times [95% CI, 1.97.2.84 times] the mean cost for patients without NI), $4,287 for respiratory
tract infection (1.91 times [95% CI, 1.57.2.32 times] the mean cost for patients without NI), $1,955 for urinary
tract infection (1.42 times [95% CI, 1.18.1.72 times] the mean cost for patients without NI), and $1,051 for
surgical site infection (1.23 times [95% CI, 0.90.1.68 times] the mean cost for patients without NI).
Conclusions: The medical ICU had the lowest rate of NI and the largest excess costs, the surgical ICU had
the lowest excess costs, and the mixed medical and surgical ICU had the highest rate of NI. The cost is
largely attributable to bloodstream infection and respiratory tract infection.
NosoBase n°23364
Prévalence des infections associées aux soins en hospitalisation à domicile (HAD) de l'Assistance
publique - Hôpitaux de Paris, France, 2007
Ittah-Desmeulles H; Migueres B; Silvera B; Denic L; Brodin M. Prevalence of healthcare-associated
infections in a home-care setting in 2007, France. Bulletin épidémiologique hebdomadaire 2009; 5 : 44-48.
Mots-clés : PREVALENCE; SOIN A DOMICILE; INFECTION URINAIRE; SITE OPERATOIRE;
ENTEROBACTERIE; INFECTION COMMUNAUTAIRE; ENQUETE; APPAREIL RESPIRATOIRE;
PNEUMOPATHIE; PEAU; TISSU MOU; BACTERIEMIE; APPAREIL GENITAL; AGENT ANTI-INFECTIEUX
Les structures d'hospitalisation à domicile (HAD) ont toujours été exclues des enquêtes nationales de
prévalence des infections nosocomiales. Cependant, une nouvelle enquête de prévalence des infections
associées aux soins (IAS) a été réalisée en HAD de l'Assistance publique - Hôpitaux de Paris (APHP) en
mai 2007. Ses objectifs étaient de disposer de données épidémiologiques afin d'évaluer l'efficacité des
actions mises en place depuis 2000 et de proposer une méthodologie adaptée aux particularités de la prise
en charge en HAD : intrication entre lieux de soins et de vie, dispersion géographique des unités de soins,
prise en charge par des libéraux et absence fréquente d'examens complémentaires. L'étude a inclus 613
patients (99,8 % des patients éligibles). La prévalence des patients infectés et celle des IAS étaient de 5,2
%, celle des IAS acquises en HAD de 2,6 %. Les IAS acquises étaient urinaires, respiratoires et cutanées
(respectivement 9, 5 et 2). Les entérobactéries communautaires étaient les micro-organismes
prédominants. Aucune multirésistance n'a été retrouvée ; 16 % des patients recevaient une antibiothérapie,
dans un tiers des cas pour IAS. S'il est difficile de conclure à une diminution significative des IAS acquises
en HAD de l'APHP entre 2000 et 2007, il existe une réelle possibilité d'adapter la méthodologie de la
prochaine enquête nationale de prévalence, afin que les structures d'HAD puissent y participer.
NosoBase n°23488
Surveillance des résistances bactériennes dans les unités de réanimation européennes : un premier
rapport issu du programme de soins en réanimation pour améliorer le contrôle des infections
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Mars 2009
Hanberger H; Arman D; Gill H; Jindrak V; Kalenic S; Kurcz A. Surveillance of microbial resistance in
European Intensive Care units : a first report from the care-ICU programme for improved infection control.
Intensive Care Medicine 2009; 35(1): 91-100.
Mots-clés : ANTIBIOTIQUE; SURVEILLANCE; ANTIBIORESISTANCE; REANIMATION; EUROPE
Purpose: To report initial results from a European ICU surveillance programme focussing on antibiotic
consumption, microbial resistance and infection control.
Methods: Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and
infection control stewardship measures were entered locally into a web-application. Results were validated
locally, aggregated by project leaders and fed back to support local audit and benchmarking.
Results: Median (range) antibiotic consumption was 1,254 (range 348–4,992) DDD per 1,000 occupied bed
days. The proportion of MRSA was median 11.6% (range 0–100), for ESBL phenotype of E. coli and K.
pneumoniae 3.9% (0–80) and 14.3% (0–77.8) respectively, and for carbapenemresistant P. aeruginosa
22.5% (0–100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of
single rooms for isolation.
Conclusions: The surveillance programme demonstrated wide variation in antibiotic consumption, microbial
resistance and infection control measures. The programme may, by providing rapid access to aggregated
results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.
NosoBase n°23579
Surveillance continue des infections du site opératoire (ISO) au CHU de Limoges, France, de 2002 à
2007 : méthode et résultats.
Mounier M; Descottes B; Moreau JJ; Gueye M; Fourcade L; Gainant A et al. BEH 2009; 6: 49-53.
Mots-clés : SURVEILLANCE; SITE OPERATOIRE; DUREE DE SEJOUR; COUT-BENEFICE
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