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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 1 / 21 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 2 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 3 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 4 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 5 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 6 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 7 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 8 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 9 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 10 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 11 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 12 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 13 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 14 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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. 15 / 21 NosoVeille – Bulletin de veille du CCLIN SE Mars 2009 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 16 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 17 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 18 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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. 19 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 20 / 21 NosoVeille – Bulletin de veille du CCLIN SE 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 21 / 21