Download NosoVeille – Bulletin de veille juin 2009 NosoVeille n°6 Juin 2009

NosoVeille – Bulletin de veille
juin 2009
NosoVeille n°6
Juin 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
Chirurgie
Clostridium difficile
Désinfection
Environnement
Grippe
Hygiène des mains
Odontologie
Personnel
Radiologie
Réanimation
Surveillance
Transmission croisée
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Antibiotique/Antibiorésistance
NosoBase n° 24407
Programmes de gestion des antibiotiques : comment commencer et piloter un programme efficace ?
Drew RH. Antimicrobial stewardship programs: how to start and steer a successful program. Journal of
managed care pharmacy 2009/03; 15(Supplément 2): S18-S23.
Mots-clés : ANTIBIOTIQUE; PERSONNEL; AUDIT; FORMATION; PREVENTION; ANTIBIORESISTANCE
Background : Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by
selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials
has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events,
and limit the potential for emergence of antimicrobial resistance.
Objective : To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital
setting. Several measures can be used to implement such programs and gain multidisciplinary support while
addressing common barriers.
Summary : Implementation of an ASP requires a multidisciplinary approach with an infectious diseases
physician and a clinical pharmacist with infectious diseases training as its core team members. As identified
by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include : (1)
formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other
supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, deescalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers
exist to successful implementation of ASPs. These include obtaining adequate administrative support and
compensation for team members. Gaining physician acceptance can also be challenging if there is a
perceived loss of autonomy in clinical decision making.
Conclusion : ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related
adverse events while improving clinical outcomes. The efforts and expense required to implement and
maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.
NosoBase n° 24392
Antibiorésistance de souches de Staphylococcus épidermidis isolées lors d'infections de prothèses
articulaires en particulier la rifampicine et variabilité du gène rpoB
Hellmark B; Unemo M; Nilsdotter-Augustinsson A; Soderquist B. Antibiotic susceptibility among
Staphylococcus epidermidis isolated from prothetic joint infections with special focus on rifampicin and
variability of the rpoB gene. Journal of infection and chemotherapy 2009/03; 15(3): 238-244.
Mots-clés
:
ANTIBIORESISTANCE;
STAPHYLOCOCCUS;
ANTIBIOTIQUE;
CHIRURGIE
ORTHOPEDIQUE; PROTHESE TOTALE DE HANCHE; PROTHESE TOTALE DE GENOU;
STAPHYLOCOCCUS EPIDERMIDIS; RIFAMPICINE
Staphylococcus epidermidis is the most important pathogen in infections related to implanted foreign
materials, especially prosthetic joint infections (PJIs). The aim of this study was to investigate the
antimicrobial activities of 16 antibiotics against S. epidermidis isolated from PJIs, with special focus on
rifampicin and rpoB variability. Ninety-one per cent of the isolates were multiresistant (i.e. resistant to
members of more than three classes of antibiotics). Thirty-nine per cent were resistant to rifampicin,
associated with one or two single-nucleotide polymorphisms (SNPs) in rpoB. Using IsoSensitest agar with
supplements, 61% were resistant to oxacillin, and using Mueller-Hinton II agar with supplement, 84% were
resistant. Using the Etest, 58% were resistant to cefoxitin, and using the disk diffusion test, 91% were
resistant. The mecA gene was detected in 85% of the isolates. Regarding recently available antibiotics, all
isolates were susceptible to tigecycline and linezolid, and 97% were susceptible to daptomycin. In addition,
two novel antibiotics, dalbavancin and ceftobiprole, were tested, although not yet available for routine use.
The MIC50 and MIC90 values of these novel antibiotics were 0.032 and 0.047 mg/L and 0.5 and 1.5 mg/L,
respectively. Among the other antibiotics, the rates of resistance varied between 0% (vancomycin) and 82%
(trimethoprim-sulphamethoxazole). S. epidermidis strains causing PJIs often show multiresistance, including
resistance to rifampicin, which is mainly caused by one or two SNPs. Some of the newer antimicrobial
agents may provide alternatives for monotherapy or combination therapy with rifampicin. Detection of mecA
is necessary before initiating treatment of infections due to S. epidermidis when it displays intermediate
susceptibility to cefoxitin.
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NosoBase n° 24372
Impact de la consommation d'antibiotiques et de l'usage des solutions hydro-alcooliques sur
l'émergence et la dissémination de souches productrices de bêta-lactamase à spectre étendu :
analyse de séries temporelles
Kaier K; Frank U; Hagist C; Conrad A; Meyer E. The impact of antimicrobial drug consumption and alcoholbased hand rub use on the emergence and spread of extended-spectrum beta-lactamase-producing strains:
a time-series analysis. The Journal of antimicrobial chemotherapy 2009/03; 63(3): 609-614.
Mots-clés : LAVAGE DES MAINS;ANTIBIOTIQUE; SOLUTION HYDRO-ALCOOLIQUE ; BETALACTAMASE A SPECTRE ELARGI; INCIDENCE; ANALYSE MULTIVARIEE
Background : The aim of this study was to explore the temporal relationship between the consumption of
different antibiotics, alcohol-based hand disinfection and the incidence of nosocomial bacterial strains
producing extended-spectrum b-lactamases (ESBLs).
Methods : Time-series analysis was performed based on monthly data available from January 2005 to
October 2007. The incidence of nosocomial ESBL (cases/ 1000 patient-days) was regressed on the different
antibiotic agents and the volume of alcohol-based hand rub orders. Antibiotic consumption was defined as
monthly defined daily doses (DDD)/1000 patient-days, while alcohol-based hand rub was quantified in
litres/1000 patient-days.
Results : The multivariate analysis showed that using alcohol-based hand rub for hand disinfection had a
significant influence on the ESBL incidence (P = 0.002). A higher volume of alcohol-based hand rub use was
subsequently associated with a lower incidence of ESBL-producing strains. Additionally, the model showed
that temporal increase in the use of third-generation cephalosporins (P = 0.022) and fluoroquinolones (P =
0.001) is, after a time lag of up to 3 months, followed by temporal variations in the incidence of nosocomial
ESBLs. Furthermore, the incidence of patients admitted with ESBL was also shown to have an influence on
the incidence of nosocomial ESBLs (P<0.001). The final model explained 75% of the monthly variations in
the incidence of nosocomial ESBLs.
Conclusions : The analysis identifies selective pressure caused by the use of different antimicrobial agents
as a driving factor in the emergence and spread of ESBLs. Furthermore, the study confirms that hand
disinfection is key to the prevention of nosocomial ESBLs. (RESUME D'AUTEUR)
NosoBase n° 24286
Concepts émergents dans l'antibioprophylaxie pour les césariennes
Tita AT; Rouse DJ; Blackwell S; Saade GR; Spong CY; Andrews WW. Emerging concepts in antibiotic
prophylaxis for cesarean delivery. A systematic review. Obstetrics and gynecology 2009/03; 113(3): 675682.
Mots-clés : ANTIBIOTIQUE; CESARIENNE; ANTIBIOPROPHYLAXIE; EFFICACITE; PREVENTION;
BIBLIOGRAPHIE
Objective : To review the current status of antibiotic prophylaxis for cesarean delivery, emerging strategies
to enhance the effectiveness of antibiotic prophylaxis in reducing postcesarean infection, and the
implications of the emerging practices.
Data sources : We conducted a full PubMed (January 1966 to July 2008) search using the key words
"cesarean" and "antibiotic prophylaxis". A total of 277 articles were identified and supplemented by a
bibliographic search.
Methods of study selection : We selected a total of 15 studies, which included all published clinical trials,
meta-analyses of clinical trials, and observational studies evaluating either the timing of antibiotics or the use
of extended-spectrum prophylaxis. We also reviewed nine reports involving national recommendations or
technical reviews supporting current standards for antibiotic prophylaxis.
Tabulation, integration, and results : We conducted an analytic review and tabulation of selected studies
without further meta-analysis. Although current guidelines for antibiotic prophylaxis recommend the
administration of narrow-spectrum antibiotics (cefazolin) after clamping of the umbilical cord, the data
suggest that antibiotic administration before surgical incision or the use of extended-spectrum regimens
(involving azithromycin or metronidazole) after cord clamp may reduce postcesarean maternal infection by
up to 50%. However, these two strategies have not been compared with each other. In addition, their effect
on neonatal infection or infection with resistant organisms warrants further study.
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Conclusion : The use of either cefazolin alone before surgical incision or an extended-spectrum regimen
after cord clamp seems to be associated with a reduction in postcesarean maternal infection. Confirmatory
studies focusing additionally on neonatal outcomes and the effect on resistant organisms, as well as studies
comparing both strategies, are needed.
Cathétérisme
NosoBase n° 24263
Etude de la colonisation des cathéters veineux périphériques insérés par les équipes des services
d'urgence avant l'hospitalisation (SMUR) en France
Ezingeard E; Coudrot M; Guyomarc'h S; Aubert G; Blanc JL; Bertrand JC; et al. Evaluation of colonisation of
peripheral venous catheters inserted by prehospital emergency service teams (SMUR) in France. The
Journal of hospital infection 2009/06; 72(2): 169-175.
Mots-clés : CATHETER; COLONISATION; CATHETER VEINEUX PERIPHERIQUE; URGENCE;
AMBULATOIRE; ETUDE PROSPECTIVE; CONTAMINATION
There are no data in the literature on colonisation of peripheral venous catheters (PVCs) inserted by French
prehospital emergency and resuscitation service teams (SMUR). In a descriptive and prospective study we
evaluated colonisation of PVCs inserted and managed solely by a SMUR team. A total of 171 PVCs were
analysed. Bacteriological results were positive for seven catheters (4.09%/ threshold = 10 exp2 cfu/mL). Our
analyses of the characteristics of patients and interventions show a significantly higher number of elderly
patients among those colonised (P = 0.02) with less satisfactory venous access (P = 0.006) and smaller
catheter bores (P = 0.009). No differences were seen regarding the other evaluation criteria: gender,
aetiology, site of intervention, number and site of venepuncture procedures, blood pressure and duration of
catheterisation. The absolute value of colonisation seen in our study appears consistent with those reported
in the literature, but no comparisons are possible due to widely divergent catheterisation times between
published work (days) and our own data (minutes). Our results suggest a reassessment of current
recommendations of routine changeover of these catheters, with the attendant discomfort for patients and
cost in terms of time and money. We recommend a randomised study comparing catheter colonisation
levels associated with routine catheter replacement with targeted replacement based on risk factors.
NosoBase n° 24402
Bacillus cereus et Bacillus thuringiensis formant un biofilm responsables de bactériémies
nosocomiales
Kuroki R; Kawakami K; Qin L; Kaji C; Watanabe K; Kimura Y; et al. Nosocomial bacteremia caused by
biofilm-forming Bacillus cereus and Bacillus thuringiensis. Internal medicine 2009; 48(10): 791-796.
Mots-clés : BACTERIEMIE; BIOFILM; BACILLUS CEREUS; BACILLUS THURINGIENSIS;
ANTIBIORESISTANCE; CATHETER; PANSEMENT; ENVIRONNEMENT; ELECTROPHORESE EN
CHAMP PULSE; ETUDE MULTICENTRIQUE
NosoBase n° 24409
Prévention des bactériémies liées au cathéter. Penser au-delà de la checklist
Perencevich EN; Pittet D. Preventing catheter-related bloodstream infections. Thinking outside the checklist.
JAMA 2009/03/25; 301(12): 1285-1287.
Mots-clés : PREVENTION; CATHETER; BACTERIEMIE; PREVENTION; PANSEMENT
NosoBase n° 24253
Epidémiologie, évolution médicale et coûts des bactériémies liées aux cathéters dans des unités de
réanimation de quatre pays européens : étude reposant sur des données de la littérature et des
rapports
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Tacconelli E; Smith G; Hieke K; Lafuma A; Bastide P. Epidemiology, medical outcomes and costs of
catheter-related bloodstream infections in intensive care units of four European countries: literature- and
registry-based estimates. The Journal of hospital infection 2009/06; 72(2): 97-103.
Mots-clés : EPIDEMIOLOGIE; COUT; BACTERIEMIE; CATHETER; SOIN INTENSIF; EUROPE;
MORTALITE; SURVEILLANCE; RESEAU; DUREE DE SEJOUR; ETUDE MULTICENTRIQUE; ETUDE
INTERNATIONALE
Despite high incidence rates, little information is available on the burden of illness of catheter-related
bloodstream infections (CRBSIs) in Europe. A review of the available data was performed to estimate the
clinical outcomes and costs associated with CRBSIs during intensive care unit (ICU) stays in four European
countries (France, Germany, Italy and the UK). Based on these data we have estimated the CRBSI-related
mortality and the annual costs associated with CRBSIs in the aforementioned countries. Results show large
variation between countries: 1.12-4.2 CRBSI per 1000 catheter days, 8400-14,400 CRBSIs episodes per
year, 1000-1584 deaths per year, 15,960-201,600 ICU days caused by CRBSIs and euro 35.9 to euro 163.9
million associated costs. Discrepancies are mainly explained by the heterogeneous quality of
epidemiological studies, as well as the variety of national clinical practices. (RESUME D'AUTEUR)
NosoBase n° 24408
Eponges imprégnées de Chlorhexidine et changements de pansements moins fréquents pour la
prévention des infections liées aux cathéters chez des patients adultes en état sévère. Essai
contrôlé randomisé
Timsit JF; Schwebel C; Bouadma L; Geffroy A; Garrouste-Orgeas M; Pease S; et al. Chlorhexidineimpregnated sponges and less frequent dressing changes for prevention of catheter-related infections in
critically ill adults. A randomized controlled trial. JAMA 2009/03/25; 301(12): 1231-1241.
Mots-clés : CHLORHEXIDINE; PANSEMENT; PREVENTION; CATHETER; RANDOMISATION; ESSAI
THERAPEUTIQUE; SYNDROME SEPTIQUE; BACTERIEMIE; SOIN INTENSIF; COLONISATION; EFFET
INDESIRABLE; ANALYSE
Context: Use of a chlorhexidine gluconate impregnated sponge (CHGIS) in intravascular catheter dressings
may reduce catheter-related infections (CRIs). Changing catheter dressings every 3 days may be more
frequent than necessary.
Objective : To assess superiority of CHGIS dressings regarding the rate of major CRIs (clinical sepsis with
or without bloodstream infection) and non inferiority (less than 3% colonization-rate increase) of 7-day vs 3day dressing changes.
Design, setting, and patients: Assessor-blind, 2 x 2 factorial, randomized controlled trial conducted from
December 2006 through June 2008 and recruiting patients from 7 intensive care units in 3 university and 2
general hospitals in France. Patients were adults (>18 years) expected to require an arterial catheter,
central-vein catheter, or both inserted for 48 hours or longer.
Interventions: Use of CHGIS vs standard dressings (controls). Scheduled change of unsoiled adherent
dressings every 3 vs every 7 days, with immediate change of any soiled or leaking dressings.
Main outcome measures: Major CRIs for comparison of CHGIS vs control dressings ; colonization rate for
comparison of 3- vs 7-day dressing changes.
Results: Of 2095 eligible patients, 1636 (3778 catheters, 28 931 catheter-days) could be evaluated. The
median duration of catheter insertion was 6 (interquartile range [IQR], 4-10) days. There was no interaction
between the interventions. Use of CHGIS dressings decreased the rates of major CRIs (10/1953 [0.5%], 0.6
per 1000 catheter-days vs 19/1825 [1.1%], 1.4 per 1000 catheter-days; hazard ratio [HR], 0.39 [95%
confidence interval {CI}, 0.17-0.93]; P=.03) and catheter-related bloodstream infections (6/1953 catheters,
0.40 per 1000 catheter-days vs 17/1825 catheters, 1.3 per 1000 catheter-days; HR, 0.24 [95% CI, 0.090.65]). Use of CHGIS dressings was not associated with greater resistance of bacteria in skin samples at
catheter removal. Severe CHGIS-associated contact dermatitis occurred in8patients (5.3
per1000catheters).Use of CHGIS dressings prevented 1major CRI per 117 catheters. Catheter colonization
rates were 142 of 1657 catheters (7.8%) in the 3-day group (10.4 per 1000 catheter-days) and 168 of 1828
catheters (8.6%) in the 7-day group (11.0 per 1000 catheter-days), a mean absolute difference of0.8%(95%
CI, -1.78% to 2.15%) (HR, 0.99; 95% CI, 0.77-1.28), indicating non inferiority of 7-day changes.The median
number of dressing changes per catheter was 4(IQR, 3-6) in the 3-day group and 3 (IQR, 2-5) in the 7-day
group (P<.001).
Conclusions: Use of CHGIS dressings with intravascular catheters in the intensive care unit reduced risk of
infection even when background infection rates were low. Reducing the frequency of changing unsoiled
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adherent dressings from every 3 days to every 7 days modestly reduces the total number of dressing
changes and appears safe.
Chirurgie
NosoBase n° 24077
Résultats d’un suivi incomplet des infections du site opératoire après la sortie de l’hôpital réalisé en
utilisant l’indice de risque du "National Nosocomial Infection Surveillance system"
Biscione FM; Camargos Couto R; Pedrosa T. Accounting for incomplete postdischarge follow-up during
surveillance of surgical site infection by use of the national nosocomial infections surveillance system's risk
index. Infection control and hospital epidemiology 2009/05; 30(5): 433-439.
Mots-clés : SURVEILLANCE; SITE OPERATOIRE; SCORE; TAUX; ETUDE RETROSPECTIVE;
CHIRURGIE DIGESTIVE; CHIRURGIE GYNECOLOGIQUE; UROLOGIE
Objective: We examined the usefulness of a simple method to account for incomplete postdischarge followup during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections
Surveillance (NNIS) system's risk index.
Design: retrospective cohort study that used data prospectively collected from 1993 through 2006. Setting.
Five private, non university healthcare facilities in Belo Horizonte, Brazil.
Patients: Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on
the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies,
and 6,892 laparotomies.
Methods: For each operative procedure category, 2 SSI risk models were specified. First, a model based on
the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model).
Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based
on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was
assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could
not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was
conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by
use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated.
Results: The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal
hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not
show any significant benefit over the NNIS-based model in any measure. For all other operative procedures,
the modified NNIS-based model showed a significantly improved discriminatory ability and higher G
statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used
to assess the risk of SSI after operations on the genitourinary system or after a cholecystectomy.
Conclusions: Compared with the NNIS-based model, the modified NNIS-based model added potentially
useful clinical information regarding most of the operative procedures. Further work is warranted to evaluate
this method for accounting for incomplete postdischarge follow-up during surveillance of SSI.
NosoBase n° 24256
Réduction des infections du site opératoire chez des patients traités par une pellicule bactérioisolante du site opératoire avant chirurgie pour pontage aorto-coronarien : étude cas-contrôle
Dohmen PM; Gabbieri D; Weymann A; Linneweber J; Konertz W. Reduction in surgical site infection in
patients treated with microbial sealant prior to coronary artery bypass graft surgery: a case-control study.
The Journal of hospital infection 2009/06; 72(2): 119-126.
Mots-clés : SITE OPERATOIRE; CHIRURGIE CARDIO-VASCULAIRE; CAS TEMOIN; INCIDENCE;
PREVENTION
Surgical site infection (SSI) is a serious complication after cardiac surgery. This case-control study
investigated the effect of a cyanoacrylate-based microbial skin sealant (InteguSeal) applied preoperatively
on the SSI rate in patients undergoing coronary artery bypass graft (CABG) surgery. Of 676 patients who
underwent CABG surgery with or without concomitant procedure(s) between March and November 2007,
545 received standard preoperative care and 131 also received pretreatment with the microbial sealant. Of
these, 90 cases pretreated with microbial sealant and 90 controls were matched using established
preoperative and intraoperative risk factors for SSI. Preoperative risk scores for SSI were 9.9+/-4.3 and
9.7+/-4.0 (P=0.747) for the microbial sealant and the control group, respectively, and combined
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preoperative-intraoperative risk scores were 9.7+/-4.1 and 8.7+/-3.5 (P=0.080), respectively. Carotid artery
disease (P=0.019), congestive heart failure (P=0.019), acute myocardial infarction (P=0.001) and
emergency surgery (P=0.026) were significantly more common in the microbial sealant group. Follow-up
was 100% for both groups. Superficial or deep sternal infection 30 days post surgery developed in seven
patients (7.8%) in the control group compared with one patient (1.1%) in the microbial sealant group (odds
ratio 7.5). In summary, the inclusion of microbial sealant in preoperative patient preparation seems to reduce
the incidence of SSI following CABG surgery; further larger studies are needed before firm conclusions can
be drawn.
NosoBase n° 24359
Infection du site opératoire après transplantation hépatique : facteurs de risqué et association à
l’échec de la greffe ou au décès
Hellinger WC; Crook JE; Heckman MG; Diehl NN; Shalev JA; Zubair AC; et al. Surgical site infection after
liver transplantation: risk factors and association with graft loss or death. Transplantation 2009/05; 87(9):
1387-13993.
Mots-clés : SITE OPERATOIRE; TRANSPLANTATION HEPATIQUE; FACTEUR DE RISQUE;
SURVEILLANCE; COHORTE; MORTALITE; RISQUE; ETUDE RETROSPECTIVE
Background: Risk factors for surgical site infection (SSI) after liver transplantation and outcomes associated
with these infections have not been assessed using consensus surveillance and optimal analytic methods.
Methods: A cohort study was performed of patients undergoing first liver transplantation at Mayo Clinic,
Jacksonville, Florida, in 2003 and 2004. SSIs were identified by definitions and methods of the National
Nosocomial Infections Surveillance System. Measures of known or suspected risk factors for SSI, graft loss,
or death were collected on all patients. Associations of SSI with these factors and also with the primary
composite endpoint of graft loss or death within 1 year of liver transplantation were examined using Cox
proportional hazards models; relative risks (RRs) were estimated along with 95% confidence intervals (CIs).
Results: Of 370 patients, 66 (18%) had SSI and 57 (15%) died or sustained graft loss within 1 year after liver
transplantation. Donor liver mass-to-recipient body mass ratio of less than 0.01 (RR 2.56; 95% CI 1.17-5.62;
P=0.019) and increased operative time (RR 1.19 [1-hr increase]; 95% CI 1.03-1.37; P=0.018) were
associated with increased SSI risk. SSI was associated with increased risk of death or graft loss within the
first year after liver transplantation (RR 3.06; 95% CI 1.66-5.64; P<0.001).
Conclusion: SSI is associated with increased risk of death or graft loss during the first year after liver
transplantation. Increased operative time and decreased donor liver-to-recipient body mass ratio showed
evidence of association with SSI.
NosoBase n° 24073
La fréquence de microperforations sur les gants chirurgicaux dépend de leur durée d’utilisation
Partecke L; Goerdt A; Langner I; Jaeger B; Assadian O; Heidecke CD; et al. Incidence of microperforation
for surgical gloves depends on duration of wear. Infection control and hospital epidemiology 2009/05; 30(5):
409-414.
Mots-clés : INCIDENCE; GANT; CHIRURGIE; PERSONNEL
Background: The use of sterile gloves is part of general aseptic procedure, which aims to prevent surgical
team members from transmitting infectious agents to patients during procedures performed in an operating
room. In addition, surgical gloves also protect team members against patient-transmitted infectious agents.
Adequate protection, however, requires that the glove material remain intact. The risk of perforations in
surgical gloves is thought to correlate with the duration of wear, yet very few prospective studies have
addressed this issue.
Methods: We prospectively collected 898 consecutive pairs of used surgical gloves over a 9-month period in
a single institution. After surgical team members wore the gloves during surgical procedures, the gloves
were examined for microperforations using the watertight test described in European Norm 455, part 1. The
gloves were analyzed as a pair; if 1 glove had a perforation, the pair was considered to be perforated. In
addition, we evaluated the use of a hand cream that contained a suspension of cornstarch and ethanol to
determine its potential influence on the rate of microperforation.
Results: Wearing gloves for 90 minutes or less resulted in microperforations in 46 (15.4%) of 299 pairs of
gloves, whereas wearing gloves for 91-150 minutes resulted in perforation of 54 (18.1%) of 299 pairs, and
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71 of (23.7%) of 300 pairs were perforated when the duration of wear was longer than 150 minutes
([Formula: see text]). Subgroup analysis revealed no significant difference in the rates of microperforation for
surgeons (56 [23.0%] of 244 pairs of gloves perforated), first assistants (43 [19.0%] of 226 pairs perforated),
and surgical nurses (53 [20.5%] of 259 pairs perforated). Of 171 microperforations, 114 (66.7%) were found
on the left hand glove (ie, the glove on subjects' nondominant hand), predominantly on the left index finger
(55 [32.3%]). The use of the hand cream had no influence on the rate of microperforation.
Conclusion: Because of the increase in the rate of microperforation over time, it is recommended that
surgeons, first assistants, and surgical nurses directly assisting in the operating field change gloves after 90
minutes of surgery.
NosoBase n° 24429
Infection du site opératoire à Aeromonas sp - Rapport de neuf cas et revue de la littérature
Tena D; Aspiroz C; Figueras MJ; Gonzalez-Praetorius A; Aldea MJ; Alperi A; et al. Surgical site infection
due to Aeromonas species: report of nine cases and literature review. Scandinavian journal of infectious
diseases 2009/03; 41(3): 164-170.
Mots-clés : SITE OPERATOIRE; BACILLE GRAM NEGATIF; BIBLIOGRAPHIE; CHIRURGIE; CHIRURGIE
ABDOMINALE; AEROMONAS
Gastrointestinal and wound infections are the most common clinical presentation of Aeromonas. Surgical
site infections (SSIs) due to this microorganism are rare. We studied the clinical and microbiological
characteristics of 9 cases that appeared at 2 Spanish hospitals and reviewed 15 cases available in the
literature. All patients (including our cases) had gastrointestinal or biliary diseases. 21 patients (91.3%)
developed SSIs after abdominal or pelvic surgery. The mean duration from surgery to the onset of wound
infection was 2.2 d in our 9 patients. The infection was polymicrobial in 17 patients (77.2%) and 19 cases
were nosocomial (95%). Clinical outcome of all cases was uniformly good after treatment except for 2
patients. Two patients were cured only with surgical drainage. In conclusion, SSIs due to Aeromonas
species have a probable endogenous source after abdominal or pelvic surgery and the onset is rapid in
most cases. Clinical outcome is good after antibiotic treatment but surgical drainage without antibiotic
therapy can be sufficient to clear the infection in some cases.
NosoBase n° 24366
Contamination bactérienne des dossiers médicaux des patients dans un service de chirurgie et une
unité de réanimation : impact sur les infections nosocomiales
Teng SO; Lee WS; Ou TY; Hsieh YC; Lee WC; Lin YC. Bacterial contamination of patients' medical charts in
a surgical ward and the intensive care unit: impact on nosocomial infections. Journal of microbiology
immunology and infection 2009/02; 42(1): 86-91.
Mots-clés : CONTAMINATION; CHIRURGIE; SOIN INTENSIF; ECHANTILLON; RANDOMISATION;
STAPHYLOCOCCUS; TRANSMISSION MANUPORTEE; DOSSIER DU PATIENT
Background and purpose: The purpose of this study was to determine the degree of bacterial contamination
of patients' files, and to compare the colonized bacteria between files from the surgical intensive care unit
(ICU) and the surgical ward at the Wan Fang Hospital, Taipei, Taiwan. METHODS: 180 medical charts
were randomly selected from the surgical ICU (n = 90) and the surgical ward (n = 90). The charts were
sampled using sterile swabs moistened with sterile normal saline. The swabs were immediately transferred
to trypticase soy broth and incubated aerobically for 48 h, then subcultured to separated sheep blood and
eosin-methylene blue agars. Microorganisms were identified by the standard methods used in the
microbiological laboratory.
Results: Ninety percent of charts in the surgical ICU (n = 81) and 72.2% in the surgical ward (n = 65) were
contaminated with pathogenic or potentially pathogenic bacteria (p = 0.0023). Coagulase-negative
staphylococci (CoNS) were the most commonly isolated bacteria, both in the surgical ICU (n = 40, 44.44%)
and in the surgical ward (n = 48, 53.33%). Several bacteria isolated from the charts, including multidrugresistant Acinetobacter baumannii, Stenotrophomonas maltophilia, and Klebsiella pneumoniae, had the
same antibiogram as the same bacteria isolated from patients.
Conclusion: This study showed that the patients' charts in the ICU were usually contaminated with
pathogenic and potentially pathogenic bacteria. Contaminated charts can serve as a source for crossCCLIN Sud-Est – [email protected]
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infection. Health care personnel should wash their hands before and after contact with the chart to reduce
the nosocomial infection rate.
Clostridium difficile
NosoBase n° 24384
Infections, diarrhée et colite associées à Clostridium difficile
Hookman P; Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World journal of
gastroenterology 2009/04; 15(12): 1554-1580.
Mots-clés : BIBLIOGRAPHIE; CLOSTRIDIUM DIFFICILE; DIARRHEE; EPIDEMIE; ANTIBIORESISTANCE;
FACTEUR
DE
RISQUE;
ANTIBIOTIQUE;
TRAITEMENT;
DIAGNOSTIC;
CHIRURGIE;
TRANSPLANTATION
A new, hypervirulent strain of Clostridium difficile, called NAP1/BI/027, has been implicated in C. difficile
outbreaks associated with increased morbidity and mortality since the early 2000s. The epidemic strain is
resistant to fluoroquinolones in vitro, which was infrequent prior to 2001. The name of this strain reflects its
characteristics, demonstrated by different typing methods: pulsed-field gel electrophoresis (NAP1),
restriction endonuclease analysis (BI) and polymerase chain reaction (027). In 2004 and 2005, the US
Centers for Disease Control and Prevention (CDC) emphasized that the risk of C. difficile-associated
diarrhea (CDAD) is increased, not only by the usual factors, including antibiotic exposure, but also
gastrointestinal surgery/manipulation, prolonged length of stay in a healthcare setting, serious underlying
illness, immune-compromising conditions, and aging. Patients on proton pump inhibitors (PPIs) have an
elevated risk, as do peripartum women and heart transplant recipients. Before 2002, toxic megacolon in C.
difficile-associated colitis (CDAC), was rare, but its incidence has increased dramatically. Up to twothirds of
hospitalized patients may be infected with C. difficile. Asymptomatic carriers admitted to healthcare facilities
can transmit the organism to other susceptible patients, thereby becoming vectors. Fulminant colitis is
reported more frequently during outbreaks of C. difficile infection in patients with inflammatory bowel disease
(IBD). C. difficile infection with IBD carries a higher mortality than without underlying IBD. This article
reviews the latest information on C. difficile infection, including presentation, vulnerable hosts and choice of
antibiotics, alternative therapies, and probiotics and immunotherapy. We review contact precautions for
patients with known or suspected C. difficile associated disease. Healthcare institutions require accurate and
rapid diagnosis for early detection of possible outbreaks, to initiate specific therapy and implement effective
control measures. A comprehensive C. difficile infection control management rapid response team (RRT) is
recommended for each health care facility. A communication network between RRTs is recommended, in
coordination with each country’s department of health. Our aim is to convey a comprehensive source of
information and to guide healthcare professionals in the difficult decisions that they face when caring for
these oftentimes very ill patients.
NosoBase n° 24222
Prévalence ponctuelle nationale de Clostridium difficile dans des établissements de santé aux EtatsUnis en 2008
Jarvis WR; Schlosser J; Jarvis AA; Chinn RY. National point prevalence of Clostridium difficile in US health
care facility inpatients, 2008. American journal of infection control 2009/05; 37(4): 263-270.
Mots-clés : PREVALENCE; CLOSTRIDIUM; PREVALENCE; ENQUETE; CLOSTRIDIUM DIFFICILE; TAUX;
INTERNET; RESEAU
Background: Recent published estimates of Clostridium difficile infection (CDI) incidence have been based
on small numbers of hospitals or national hospital discharge data. These data suggest that CDI incidence is
increasing.
Methods: We conducted a point prevalence survey of C difficile in inpatients at US health care facilities. The
survey was developed, received Institutional Review Board approval, and was then distributed to all
Association for Professionals in Infection Control and Epidemiology, Inc (APIC) members. They were asked
to complete the survey on 1 day between May 7 and August 29, 2008, reporting the number of inpatients
with CDI or colonization and facility-specific information.
Results: Personnel at 648 hospitals completed the survey; this represents approximately 12.5% of all US
acute care facilities. All but 3 states and the District of Columbia were represented (mean, 14 facilities per
state; range, 2-43). Eighty-two percent reported that their CDI rate had not decreased in the past 3 years.
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Respondents reported 1443 C difficile-colonized/infected patients among 110,550 inpatients; the overall C
difficile prevalence rate was 13.1 per 1000 inpatients (94.4% infection). Detailed data were provided on 1062
(73.6%) patients. Of these, 55.5% were female, 69.2% were >60 years of age, 67.6% had selected
comorbid conditions, 79% had received antimicrobials within 30 days, and 94.4% were detected by enzyme
immunoassay. The majority of patients (54.4%) were diagnosed < or =48 hours of hospitalization, but 35%
had been admitted to a long-term care facility within 30 days, and 47% had been hospitalized within 90
days; 73% met Centers for Disease Control and Prevention criteria for health care-associated CDI. Most
facilities (>90%) used contact isolation for CDI patients. Bleach was used for environmental disinfection
more commonly during CDI outbreaks than during nonoutbreak periods.
Conclusion: Our survey documents a higher C difficile prevalence rate than previous estimates using
different methodologies. The majority of inpatient CDI appears to be health care associated. Given that not
all patients with diarrhea are tested for CDI and that most facilities use enzyme immunoassays with limited
sensitivity to detect C difficile, these are minimum estimates of the US health care facility C difficile burden.
NosoBase n° 24255
Clostridium difficile ribotypes 027 et 106 : évolutions cliniques et facteurs de risque
Sundram F; Guyot A; Carboo I; Green S; Lilaonitkul M; Scourfield A
Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors. The Journal of hospital
infection 2009/06; 72(2): 111-118.
Mots-clés : CLOSTRIDIUM DIFFICILE; FACTEUR DE RISQUE; DIARRHEE; ENVIRONNEMENT;
CONTAMINATION; APPARIEMENT; ANTIBIORESISTANCE; SURFACE
The present study investigates risk factors for onset of Clostridium difficile-associated diarrhoea, specific
ribotype and environmental spore contamination in a District General Hospital in South East England. C.
difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of C. difficile toxin from faecal
specimens by enzyme immunoassay (Health Protection Agency, Southampton). The isolates were tested for
various antimicrobial susceptibilities by E-test. Cases were assessed for prior antibiotic use and followed up
for clinical outcomes. Controls were matched for age, sex, ward, length of stay and comorbidity to identify
any antibiotic risk factors using conditional logistic regression analysis. Environmental sampling on wards
was performed with cycloserine-cefoxitin-egg yolk agar. Forty-five percent C.difficile isolates ribotyped as
027, 39% as 106 and 10% as 001. All ribotypes were resistant to ciprofloxacin, erythromycin and cefotaxime
but remained susceptible to metronidazole and vancomycin. The crude (death within 28 days) and early
(death within 72h) mortalities were 23% and 11% for the 027 strain, whereas for the 106 ribotype they were
11% and 3%, respectively. The case-control study identified ciprofloxacin usage for >7 days as a significant
risk factor (adjusted odds ratios of 3.72; 95% CI: 1.38-10.02; P=0.019). Environmental sampling revealed
the presence of spores on faecally contaminated equipment such as commodes and bedpan shells, which
persisted after cleaning. Ciprofloxacin appears to encourage C.difficile-associated diarrhoea and should be
restricted to short courses. Cleaning agents for clinical equipment must have sporicidal activity to prevent
cross-transmission.
Désinfection
NosoBase n° 24184
Liste positive désinfectants 2009
Société Française d’Hygiène Hospitalière. Hygienes 2009/06; XVII(4): 245-268.
Mots-clés : RECOMMANDATION; DESINFECTANT; DESINFECTION; THERMODESINFECTION;
DETERGENT; SPRAY; NORME; LAVAGE DES MAINS; LAVAGE CHIRURGICAL DES MAINS;
RECOMMANDATION;
SURFACE;
MOBILIER;
MATERIEL
MEDICO-CHIRURGICAL;
THERMODESINFECTION;
Ce document constitue la liste positive désinfectants établie par la Société Française d'Hygiène Hospitalière
(SFHH). Seuls les produits retenus en fonction de critères définis au préalable par les membres du Comité
de la liste figurent sur cette liste positive.
La liste positive désinfectants 2009 présente six rubriques :
A- Produits détergents-désinfectants pour sols, surfaces et mobilier
B- Dispersats dirigés pour la désinfection des surfaces (sprays). Produits donc la teneur en alcool est
inférieure ou égale à 30%.
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C- Produits détergents-désinfectants pour la pré-désinfection par immersion des dispositifs médicaux
D- Produits désinfectants pour dispositifs médicaux thermosensibles
E1- Produits pour le traitement hygiénique des mains par lavage
E2- Produits pour la désinfection chirurgicale des mains par lavage
E3- Produits pour le traitement hygiénique des mains par friction
E4- Produits pour la désinfection chirurgicale des mains par friction
F- Lingettes pour le nettoyage et la désinfection des surfaces et mobilier
Epidémie
NosoBase n° 24081
Pseudo-épidémie d’infections à Legionella pneumophila de sérogroupe 8, associée à une machine à
glace contaminée dans une salle de bronchoscopie
Schuetz AN; Hughes Rl; Howard RM; Williams TC; Nolte FS; Jackson D; et al. Pseudo-outbreak of
Legionella pneumophila serogroup 8 infection associated with a contaminated ice machine in a
bronchoscopy suite. Infection control and hospital epidemiology 2009/05; 30(5): 461-466.
Mots-clés : CONTAMINATION; LEGIONELLA PNEUMOPHILA; LEGIONELLE; GLACE; ENDOSCOPIE
BRONCHIQUE; INVESTIGATION; EPIDEMIE; EPIDEMIOLOGIE
Objective: To investigate the marked increase noted over an 8-month period in the number of Legionella
pneumophila isolates recovered from bronchoalveolar lavage fluid specimens obtained during bronchoscopy
in our healthcare system.
Setting: Bronchoscopy suite that serves a 580-bed tertiary care center and a large, multisite, faculty practice
plan with approximately 2 million outpatient visits per year.
Methods: Cultures of environmental specimens from the bronchoscopy suite were performed, including
samples from the air and water filters, bronchoscopes, and the ice machine, with the aim of identifying
Legionella species. Specimens were filtered and acid-treated and then inoculated on buffered charcoal
yeast extract agar. Serogrouping was performed on all isolates recovered from patient and environmental
samples.
Results: All L. pneumophila isolates recovered from patients were serogroup 8, a serogroup that is not
usually recovered in our facility. An epidemiologic investigation of the bronchoscopy suite revealed the ice
machine to be contaminated with L. pneumophila serogroup 8. Patients were exposed to the organism as a
result of a recently adopted practice in the bronchoscopy suite that involved directly immersing uncapped
syringes of sterile saline in contaminated ice baths during the procedures. At least 1 patient was ill as a
result of the pseudo-outbreak. Molecular typing of isolates recovered from patient and environmental
samples revealed that the isolates were indistinguishable.
Conclusions: Extensive cleaning of the ice machine and replacement of the machine's water filter ended the
pseudo-outbreak. This episode emphasizes the importance of using aseptic technique when performing
invasive procedures, such as bronchoscopies. It also demonstrates the importance of reviewing procedures
in all patient areas to ensure compliance with facility policies for providing a safe patient environment.
Environnement
NosoBase n° 24259
Est-ce vraiment propre ? Etude de l'efficacité de quatre méthodes destinées à déterminer le niveau
de propreté à l'hôpital
Sherlock O; O'connell N; Creamer E; Humphreys H. Is it really clean? an evaluation of the efficacy of four
methods for determining hospital cleanliness; The Journal of hospital infection 2009/06; 72(2): 140-146.
Mots-clés : EFFICACITE; BIONETTOYAGE; SURFACE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; PRELEVEMENT
An important component of effective cleaning in hospitals involves monitoring the efficacy of the methods
used. Generally the recommended tool for monitoring cleaning efficacy is visual assessments. In this study
four methods to determine cleaning efficacy of hospital surfaces were compared, namely visual assessment,
chemical (ATP) and microbiological methods, i.e. aerobic colony count (ACC) and the presence of meticillinresistant Staphylococcus aureus. Respectively, 93.3%, 71.5%, 92.1% and 95.0% of visual, ATP, ACC and
MRSA assessments were considered acceptable or 'clean' according to each test standard. Visual
assessment alone did not always provide a meaningful measure of surface cleanliness or cleaning efficacy.
CCLIN Sud-Est – [email protected]
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The average ATP value from 120 swabs before cleaning was 612 relative light units (RLU) (range: 72-2575)
and 375 RLU after cleaning (range: 106-1071); the accepted standard is 500 RLU. In a hospital setting with
low microbiological counts, the use of chemical tests such as ATP may provide additional information of
cleaning efficacy and ATP trends allow identification of environmental surfaces that require additional
cleaning or cleaning schedule amendments.
NosoBase n° 24358
Contamination bactérienne des stéthoscopes dans une unité de réanimation
Whittington AM; Whitlow G; Hewson D; Thomas C; Brett SJ. Bacterial contamination of stethoscopes on the
intensive care unit. Anaesthesia 2009/06; 64(6): 620-624.
Mots-clés : CONTAMINATION; STETHOSCOPE; SOIN INTENSIF; PERSONNEL; COLONISATION
We assessed how often bedside stethoscopes in our intensive care unit were cleaned and whether they
became colonised with potentially pathogenic bacteria. On two separate days the 12 nurses attending the
bedspaces were questioned about frequency of stethoscope cleaning on the unit and the bedside
stethoscopes were swabbed before and after cleaning to identify colonising organisms. Twenty-two health
care providers entering the unit were asked the same questions and had their personal stethoscopes
swabbed. All 32 non-medical staff cleaned their stethoscopes at least every day; however only three out of
the 12 medical staff cleaned this often. Out of 24 intensive care unit bedside stethoscopes tested, two
diaphragms and five earpieces were colonised with pathogenic bacteria. MRSA cultured from one earpiece
persisted after cleaning. Three out of the 22 personal stethoscope diaphragms and five earpieces were
colonised with pathogens. After cleaning, two diaphragms and two earpieces were still colonised,
demonstrating the importance of regular cleaning.
Grippe
NosoBase n° 24277
Préparation et réponses à une pandémie grippale
Organisation Mondiale de la Santé. Pandemic influenza preparedness and response. A who guidance
document 2009/04: 1-71.
Mots-clés : VIRUS; GRIPPE; EPIDEMIE; RECOMMANDATION; PREVENTION; INFORMATION; H1N1;
H2N2; H3N2; H5N1
Ce document actualise celui publié par l'OMS en mars 2005 sur le plan global de préparation à la grippe. Il
porte sur le développement des virus de la grippe, des rôles et des responsabilités dans la préparation à
une pandémie grippale du secteur de la santé, des communautés, des familles, de l'OMS. Il présente les
phases de pandémie de l'OMS et les actions recommandées avant, pendant, et après une pandémie dans
les phases 1-3, phase 4 ; phases 5-6. Ce document rappelle les caractéristiques des trois pandémies du
20ème siècle (H1N1, H2N2, H3N2).
NosoBase n° 23695
Evaluation de la préparation à une pandémie grippale par un exercice de terrain au centre hospitalier
universitaire de Nîmes
Minchella A; Onde O; Vernes E; Perrat G; De la Coussaye J; Sotto A. Médecine et maladies infectieuses
2009/02; 39(2): 116-124.
Mots-clés : FORMATION; EVALUATION; GRIPPE; ISOLEMENT; MASQUE; PEDIATRIE; CENTRE
HOSPITALIER UNIVERSITAIRE; PANDEMIE GRIPPALE; EQUIPEMENT DE PROTECTION
INDIVIDUELLE; MESURES BARRIERES; EXERCICE
Objectif : Tester l'application des mesures barrières et l'organisation de l'établissement lors d'une pandémie
grippale, dans une démarche éducative, en application du programme national de « formations pandémie
grippale » et de l'annexe « Grippe » du Plan Blanc d'établissement. Méthode : Un exercice de terrain a été
réalisé le 18 décembre 2007 dans deux secteurs de haute densité virale et un secteur de basse densité. Il
s'appliquait à toute personne dans ces secteurs, sans perturber l'activité normale de soins.
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Résultats : Deux cent quarante-cinq personnes ont été évaluées. Soixante-quinze pour cent du personnel
avaient suivi la formation dispensée dans l'établissement. L'hygiène des mains était conforme aux
procédures dans 32 % des cas, correcte dans 44 %, insuffisante dans 24 %. L'application du masque était
incorrecte dans 21 % des cas. Ces mesures ont été perçues facilement supportables pour 36 % du
personnel, pénibles pour 54 % et difficilement supportables pour 10 %. La mauvaise étanchéité du masque
FFP2 (dotation nationale), selon la morphologie du visage, sa mauvaise tolérance, le manque de points
d'eau et le regroupement de personnes ont été notés.
Conclusion : L'exercice a été satisfaisant avec une bonne participation des différents acteurs. Cependant, il
a mis en évidence des dysfonctionnements inattendus comme l'application des mesures barrières. Aussi, le
masque FFP2 coqué n'était pas efficace pour tout le personnel, ce qui posera problème en période
pandémique. Il n'existe pas de masque adapté aux enfants. Enfin, cet exercice a permis d'orienter les
actions correctives à mener et complète les différents « exercices sur table » réalisés dans d'autres
établissements de soins.
NosoBase n° 24319
Etude des mesures de lutte contre le risque infectieux en cas de pandémie de grippe
Wein LM; Atkinson MP. Assessing infection control measures for pandemic influenza. Risk analysis 2009
in press: 1-14.
Mots-clés : EPIDEMIE; GRIPPE; VIRUS; STATISTIQUE; TRANSMISSION AERIENNE; MASQUE;
PREVENTION; INFECTION COMMUNAUTAIRE; PANDEMIE
We construct a mathematical model of aerosol (i.e., droplet-nuclei) transmission of influenza within a
household containing one infected and embed it into an epidemic households model in which infecteds
occasionally infect someone from another household; in a companion paper, we argue that the contribution
from contact transmission is trivial for influenza and the contribution from droplet transmission is likely to be
small. Our model predicts that the key infection control measure is the use of N95 respirators, and that the
combination of respirators, humidifiers, and ventilation reduces the threshold parameter (which dictates
whether or not an epidemic breaks out) by approximately 20% if 70% of households comply, and by
approximately 40% if 70% of households and workplaces comply (approximately 28% reduction would have
been required to control the 1918 pandemic). However, only approximately 30% of the benefits in the
household are achieved if these interventions are used only after the infected develops symptoms. It is also
important for people to sleep in separate bedrooms throughout the pandemic, space permitting. Surgical
masks with a device (e.g., nylon hosiery) to reduce face-seal leakage are a reasonable alternative to N95
respirators if the latter are in short supply.
Hygiène des mains
NosoBase n° 24224
Mesure de l'adhésion aux recommandations pour l'hygiène des mains : étude de terrain pour des
exemples de pratiques efficaces
Braun Bi; Kusek L; Larson E; Terrace O. Measuring adherence to hand hygiene guidelines: a field survey for
examples of effective practices. American journal of infection control 2009/05; 37(4): 282-288.
Mots-clés : LAVAGE DES MAINS; OBSERVANCE; RECOMMANDATION; LAVAGE DES MAINS; ETUDE
TRANSVERSALE; INFORMATIQUE; PERSONNEL; GANT; SAVON; SOLUTION HYDRO-ALCOOLIQUE
Background: Measuring adherence to hand hygiene guidelines is resource intensive and complicated by
lack of standardized methodology. The multiplicity of approaches in use makes it difficult to meaningfully
compare performance across health care organizations. The goal of this project was to identify promising
and effective practices for measuring adherence with hand hygiene guidelines across a variety of settings.
Methods: A cross-sectional survey was conducted electronically in February 2007 to collect information on
aspects of hand hygiene measured (eg, frequency, thoroughness of technique, glove use, product
consumption), data collection approaches, training and resources, reports, and others. Invitations to respond
were widely distributed through Web site announcements and list-serve messages of The Joint Commission
and collaborating organizations. A panel of national experts developed and applied criteria for evaluating the
methods.
Results: Two hundred forty-two responses were submitted from a variety of settings and countries. Most
(approximately 75%) measured frequency of hand hygiene; approximately 50% measured thoroughness,
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glove use, product usage, patient and provider satisfaction, or other aspects. Seventy-two percent relied
exclusively on manual data collection, and most methods (80%) had been in use for less than 3 years. Most
(65%) spent less than 1 hour in training data collectors, and few had evidence of reliability or validity. Forty
submissions met most criteria for inclusion in an educational monograph.
Conclusion: Among respondents who considered their approach to be an example of an effective practice,
there was substantial variation in methods and little evidence of reliability. Standardization of methods is
needed to compare performance across organizations or within an organization over time.
NosoBase n° 24076
L’impact des bagues sur la transmission des bactéries lors d’un contact manuel
Fagernes M; Lingaas E. Impact of finger rings on transmission of bacteria during hand contact. Infection
control and hospital epidemiology 2009/05; 30(5): 427-432.
Mots-clés : TRANSMISSION; BACTERIE; BIJOU; PERONNEL; MAIN; STAPHYLOCOCCUS AUREUS;
ENTEROBACTERIE
Objective: To investigate the impact of finger rings on the transmission of bacteria from the hands of
healthcare workers and the impact on the microflora on the hands of healthcare workers in clinical practice.
Design: Our study had a nonequivalent control group posttest-only design (pre-experimental). Healthcare
workers who wore finger ring(s) on 1 hand and no ring on the other hand and a control group of healthcare
workers who did not wear any rings exchanged standardized hand shakes with an investigator wearing
sterile gloves. Samples from the gloved hands of the investigators and the bare hands of the healthcare
workers were thereafter obtained by the glove juice technique.
Setting: Two Norwegian acute care hospitals.
Participants: Healthcare workers during ordinary clinical work.
Results: A significantly higher bacterial load (odds ratio, 2.63 [95% confidence interval, 1.28-5.43]; [Formula:
see text]) and a significantly higher number of bacteria transmitted (odds ratio, 2.43 [95% confidence
interval, 1.44-4.13]; were associated with ringed hands, compared with control hands. However, a multiple
analysis of covariance revealed no statistically significant effect of rings alone. The prevalence of
nonfermentative gram-negative bacteria (42% vs 26%) and Enterobacteriaceae (26% vs 13%) was also
significantly higher among persons who wore rings than among persons who did not wear rings. However,
no statistically significant differences in the incidence of transmission of these pathogens were detected after
hand contact. The prevalence of Staphylococcus aureus and incidence of transmission of S. aureus were
the same in both groups.
Conclusions: Wearing finger rings increases the carriage rate of nonfermentative gram-negative bacteria
and Enterobacteriaceae on the hands of healthcare workers. However, no statistically significant differences
in the incidence of transmission of nonfermentative gram-negative bacteria or Enterobacteriaceae were
detected between the healthcare workers who wore rings and those who did not.
NosoBase n° 24231
Comparaison de l'efficacité antibactérienne et de cytotoxicité envers des cellules cutanées
humaines cultivées de sept produits du commerce pour la friction des mains et de X-gel, un
nouveau biocide à base de cuivre pour la friction des mains
Hall TJ; Wren M; Jeanes A; Gant VA. A comparison of the antibacterial efficacy and cytotoxicity to cultured
human skin cells of 7 commercial hand rubs and Xgel, a new copper-based biocidal hand rub. American
journal of infection control 2009/05; 37(4): 322-326.
Mots-clés : PEAU; EFFICACITE; BACTERICIDIE; SOLUTION HYDRO-ALCOOLIQUE; NORME; ALCOOL
Background: Hand cleanliness is important in hospital infection control, but skin irritation from frequent
alcohol-based hand rub use reduces compliance. We have compared a new copper biocide/Aloe verabased biocidal hand rub (Xgel) with 7 commercially available hand rubs.
Methods: Hand rubs were cultured with human skin cells for 24 hours after which cytotoxicity was assessed
using the sulforhodamine B assay. The EN 12054 bacterial suspension test protocol was used to assess
biocidal activity of 2 of the least cytotoxic hand rubs (Xgel and Purell).
Results: Hand rubs had 50% cytotoxic concentrations ranging from >10% to <0.1% vol/vol. In the EN12054
assay, Xgel reduced colony forming units (CFU) by >10(8) with methicillin-resistant Staphylococcus aureus
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(MRSA) and Acinetobacter in 1 minute, whereas Purell only reduced CFU by 10(4) and 10(5), respectively.
Purell was ineffective against C difficile spores, whereas Xgel produced a 3 x 10(3) reduction in CFU.
Conclusion: The hand rubs had a wide range of cytotoxicity values for human skin cells, with Xgel being the
least cytotoxic to human skin cells. In the EN 12054 bacterial suspension test, Xgel was more effective than
Purell against all organisms tested. It should be noted that these in vitro results may not translate into clinical
differences.
NosoBase n° 24229
Association entre l'usage de produits pour l'hygiène des mains et les taux d'infections associées
aux soins dans un grand centre hospitalier universitaire en Norvège
Herud T; Nilsen Rm; Svendheim K; Harthug S. Association between use of hand hygiene products and rates
of health care-associated infections in a large university hospital in Norway. American journal of infection
control 2009/05; 37(4): 311-317.
Mots-clés : LAVAGE DES MAINS; CENTRE HOSPITALIER UNIVERSITAIRE; TAUX; PREVALENCE;
INFORMATION; SAVON; SOLUTION HYDRO-ALCOOLIQUE; INDICATEUR
Background: An association between use of hand hygiene products and health care-associated infection
rates was investigated in a large Norwegian university hospital.
Methods: We conducted an ecologic study by combining data from purchasing and admission systems with
data from 32 point prevalence surveys (27,248 patients) in 1998-2005. Data on purchase of hand
disinfectants and soap, and patient-days, were collected for 20 bed wards similar to those of the prevalence
surveys.
Results: The prevalence of infections was 7.1%. We found no significant decline in overall infections (P =
.19), but use of hand hygiene products significantly increased from 28.5 L per 1000 patients-days in 1998 to
43.3 L per 1000 patient-days in 2005 (P < .001). After examining a linear dose-response relation between
use and infection rates, we observed a borderline significant decline in infections from 8% to 6% with
increased use of hand hygiene products (P = .05). This association appeared stronger for wards that were
registered with infections >9% at study start in 1998 (P < .001).
Conclusion: These data suggests that infection rates may be reflected by amount of hand hygiene products
used. Quantification of such products over time may serve as an indicator for hand hygiene performance in
hospitals.
NosoBase n° 24258
Efficacité bactéricide d'un protocole chirurgical de friction des mains de 1 min 30 sec. dans les
conditions d'utilisation
Kac G; Masmejean E; Gueneret M; Rodi A; Peyrard S; Podglajen I. Bactericidal efficacy of a 1.5 min
surgical hand-rubbing protocol under in-use conditions. The Journal of hospital infection 2009/06; 72(2):
135-139.
Mots-clés : BACTERICIDIE; SOLUTION HYDRO-ALCOOLIQUE; TEST; HYGIENE DES MAINS;
DESINFECTION CHIRURGICALE DES MAINS PAR FRICTION
In healthy volunteers, surgical hand rubbing with Sterillium for 1.5 min has been shown to be as effective as
a 3 min procedure. The aim of this study was to assess whether this result was reproducible under in-use
conditions. During nine weeks in the ambulatory surgery theatre of a 750-bed tertiary care university
hospital, the two surgical hand-rubbing procedures were compared with each other, and with a handscrubbing procedure using a povidone-iodine (4%) scrub prior to and after 25 different surgical operations
for each. Imprints of the surgeon.s dominant hand were taken on culture plates before and within 1 min
following the end of the hand-rubbing/scrubbing procedures (immediate effect) and at the end of surgery
(sustained effect). Plates were incubated aerobically at 37° C for 48 h. Colonies were counted at 24 h and
48 h. Results were expressed as the number of colony-forming units per hand. No significant difference in
baseline hand bacterial load was found before the hand-rubbing/scrubbing procedures among the three
groups (P = 0.19). With respect to immediate and sustained antimicrobial effects, a significantly greater
reduction in microbial loads on the hands was achieved with the 3 min hand-rubbing protocol as opposed to
hand-scrubbing protocol (P = 0.04 and P = 0.02, respectively), but there was no difference between the
reductions obtained with 1.5 and 3 min rubbing protocols (P = 0.41 and P = 0.36, respectively). Surgical
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hand rubbing with Sterillium using a 1.5 min protocol should be considered as an attractive alternative
method for surgical hand disinfection.
NosoBase n° 24230
Sécurité de l'usage des gels à base d'alcool pour la friction des mains parmi des enfants et le
personnel d'un centre de jour de soins en pédiatrie
Kinnula S; Tapiainen T; Renko M; Uhari M. Safety of alcohol hand gel use among children and personnel at
a child day care center. American journal of infection control 2009/05; 37(4): 318-321.
Mots-clés : PEDIATRIE; SOLUTION HYDRO-ALCOOLIQUE; PERSONNEL; AMBULATOIRE;
TOLERANCE; PREVENTION; TRANSMISSION
Background: Alcohol hand gels (AHG) have been used by children in child day care centers (CDCCs) to
prevent the transmission of microbes. Because parents and personnel have been concerned about the
safety of AHGs, we conducted a trial to assess this.
Methods: A total of 82 children age 3.5 to 7.2 years (mean, 5.7 years) at 2 CDCCs rubbed their hands with
AHG. Alcohol concentrations in expiratory air were measured using an official police alcometer after 15 and
60 minutes. We also conducted a questionnaire survey asking how commonly AHGs were used in CDCCs,
obtaining 128 answers from 68 CDCCs (with more than 1 person responding in 6 CDCCs).
Results: All of the alcometer readings were < 0.01 per thousand, although up to 30 contacts with the mucous
membranes (mean, 2.4) occurred during the first 15 minutes. An AHG was used in all 68 CDCCs, but only
by adults at 11 of them. The most common occasions for using an AHG were before serving food and after
cleaning secretions. One case of fire occurred when a worker lit a fire while his hands were covered with
AHG. Personnel were most concerned about situations in which children put their fingers into their mouth or
eyes after using an AHG.
Conclusion: The use of an AHG in CDCCs is safe. Even though children tend to put their hands into their
mouth after disinfection, no significant amount of alcohol is absorbed.
NosoBase n° 24301
Recommandations de l'OMS pour l'hygiène des mains dans les soins en santé. Premier défi global
pour la sécurité des patients. Un soin propre est un soin plus sûr
Organisation Mondiale de la Santé. WHO guidelines on hand hygiene in health care. First global patient
safety challenge clean care is safer care 2009/04: 1-262.
Mots-clés : TRANSMISSION MANUPORTEE; SAVON; SOLUTION HYDRO-ALCOOLIQUE; EAU;
CHLORHEXIDINE; ANTISEPTIQUE; TOLERANCE; PERSONNEL; OBSERVANCE; FORMATION;
INFORMATION; GANT; BIJOU; RECOMMANDATION; INDICATEUR; QUALITE; COUT; COUTEFFICACITE; HYGIENE DES MAINS; TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION;
DESINFECTION CHIRURGICALE DES MAINS PAR FRICTION; COMPORTEMENT; ONGLE
Ce document présente une synthèse des données scientifiques liées à l'hygiène des mains : poids des
infections associées aux soins, flore bactérienne normale, transmission manuportée, produits utilisés pour
l'hygiène des mains, désinfection chirurgicale des mains, réactions cutanées liées à l'hygiène des mains,
pratiques du personnel participant aux soins et observance des recommandations, aspects religieux et
culturels liés à l'hygiène des mains, comportement, formation et stratégies destinées à la promotion de
l'hygiène des mains, stratégies de l'OMS pour l'amélioration de l'hygiène des mains, barrières potentielles à
des pratiques optimales telles que les gants, les bijoux, les ongles et faux-ongles. Ce document présente
des recommandations pour l'hygiène des mains et le port de gants, présente l'hygiène des mains comme un
indicateur de performance, un indicateur de qualité pour la sécurité des patients et étudie son impact
économique. Ce document traite des campagnes nationales et de l'implication des patients dans la
promotion de l'hygiène des mains.
NosoBase n° 24226
Efficacité de nouveaux gants antimicrobiens imprégnés de colorants antiseptiques pour la
prévention de l'adhérence de pathogènes nosocomiaux multirésistants aux antibiotiques
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Reitzel RA; Dvorak Tl; Hachem RY Fang X; Jiang Y; Raad I. Efficacy of novel antimicrobial gloves
impregnated with antiseptic dyes in preventing the adherences of multidrug-resistant nosocomial pathogens.
American journal of infection control 2009/05; 37(4): 294-300.
Mots-clés : ANTISEPTIQUE; GANT; PREVENTION; ANTISEPTIQUE; GANT; PREVENTION;
MULTIRESISTANCE;
CHLORHEXIDINE;
STAPHYLOCOCCUS
AUREUS;
ENTEROCOCCUS;
ESCHERICHIA COLI; ACINETOBACTER; CANDIDA; CONTAMINATION
Background: Contaminated gloves are a major source of transmission of bacteria in the hospital and food
industry. We investigated the efficacy of gloves impregnated with a combination of antiseptics consisting of
brilliant green dye and chlorhexidine (Gardine).
Methods: Gardine-coated and uncoated 1-cm(2) segments of latex examination and nitrile examination
gloves (Spontex, Columbia, TN) were exposed to 1.5 x 10(8) colony-forming units (CFU)/mL methicillinresistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, multidrug resistant (MDR)
Escherichia coli, MDR-Acinetobacter baumannii, or Candida albicans as indicated by our brief exposure
method. At least 3 glove segments were tested in each group, and growth was scored as mean CFU/cm(2).
Segments were dried for various time periods (30 seconds, 10 minutes, 30 minutes, and 1 hour) and
streaked face down on agar plates. Plates were incubated overnight at 37 degrees C, and growth was
quantitated.
Results: Gardine-coated latex and nitrile gloves showed significant reduction, an average of 6 logs and 5
logs, respectively, within 30 seconds or 10 minutes when tested against MRSA, vancomycin-resistant
enterococci, MDR-E coli, MDR-Acientobacter, and C albicans. Complete kill, 8-log reduction, was seen
within 30 seconds for MRSA and E coli in both Gardine-coated latex and nitrile gloves.
Conclusion: Gloves impregnated with Gardine antiseptic dye were highly efficacious in preventing
contamination of nosocomial-resistant pathogens on the outer surface of glove and may be useful in the
food industry or clinical setting.
NosoBase n° 24225
Désinfection chirurgicale des mains par friction. Influence de la durée d'application du n-propanol et
de l'isopropanol sur les effets immédiats et à trois heures
Suchomel M; Koller W; Kundi M; Rotter Ml. Surgical hand rub: influence of duration of application on the
immediate and 3-hours effects of n-propanol and isopropanol. American journal of infection control 2009/05;
37(4): 289-293.
Mots-clés : SOLUTION HYDRO-ALCOOLIQUE; CHIRURGIE; ANTISEPSIE DES MAINS; ALCOOL;
EFFICACITE; CENTRE HOSPITALIER UNIVERSITAIRE
Background: The recommended duration for surgical hand treatment has been changed from 10 over 5 to 3
minutes and even shorter.
Objectives: Our objective was to study the impact of the length of surgical hand antisepsis with n-propanol
60% (vol/vol) or isopropanol 70% (vol/vol) applied for 1, 3, or 5 minutes on the reduction of resident hand
flora in the setting of the microbiologic laboratory for experimental and applied testing of disinfectants and
antiseptics at the Medical University Vienna, Austria, using a Latin Square design.
Methods: Our methods were according to the Austrian Guidelines for Testing Products for Surgical Hand
Antisepsis. The release of bacterial hand flora of 21 subjects is assessed before and immediately after
disinfection from one hand and 3 hours later from the other, meanwhile gloved, hand. Mean reduction
factors (RF) are calculated.
Results: The immediate mean log(10) RFs with n-propanol or isopropanol were 1.05, 2.03, and 2.30 and
0.74, 1.48, and 2.12, respectively, when applied for 1, 3, or 5 minutes, respectively. After 3 hours, the
respective mean log(10) RFs were 0.45, 1.01, and 1.60 and 0.19, 0.79, and 1.03. Thus, with increasing
length of application, a highly significant trend (P < .001) toward higher log(10) reductions was
demonstrated. At both sampling times, n-propanol was more effective than isopropanol at the corresponding
treatments. Furthermore, a highly significant (P < .001) association was found between the individual
volunteers and the effect of the antiseptics on their hands.
Conclusion: The efficacy of surgical antisepsis is significantly associated with the length of application.
NosoBase n°24517
Recommandations pour l’hygiène des mains
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Société Française d’Hygiène Hospitalière. Hygienes 20009/06; XVII(3): 141-240.
Mots-clés : RECOMMANDATION; HYGIENE DES MAINS; LAVAGE SIMPLE; TRAITEMENT HYGIENIQUE
DES MAINS PAR FRICTION; NORME; DEFINITION; BIJOU; GANT; LAVAGE CHIRURGICAL DES MAINS;
COUT; TOLERANCE; OBSERVANCE; PEAU; SAVON; SOLUTION HYDRO-ALCOOLIQUE; ONGLE;
EVALUATION; BIBLIOGRAPHIE
Ce document aborde tous les points indispensables à une meilleure connaissance des normes pour un
choix éclairé des produits hydro-alcooliques (PHA) disponibles sur le marché, à une plus grande maîtrise
des techniques adaptées aux situations de soins (friction désinfectante et friction chirurgicale), à la
reconnaissance et à la gestion de situations à l’origine d’intolérance. Il n’omet pas d’aborder certaines
difficultés auxquels les professionnels sont confrontés, notamment la réglementation incendie sur le
stockage des produits inflammables, l’utilisation des PHA dans les secteurs où son usage peut être
détourné volontairement ou accidentellement, ni les interrogations comme celle sur l’absorption cutanée du
principe actif de ces produits.
NosoBase n° 24455
Emplacement visible versus emplacement habituel des distributeurs de produits pour l'hygiène des
mains et impact sur l'utilisation des solutions hydro-alcooliques dans une unité de réanimation
Thomas BW; Berg-Copas GM; Vasquez DG; Jackson BL; Wetta-Hall R. Conspicuous vs customary location
of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.
JAOA 2009/05; 109(5): 263-267.
Mots-clés : SOLUTION HYDRO-ALCOOLIQUE; SOIN INTENSIF; OBSERVANCE; ETUDE PROSPECTIVE;
DISTRIBUTEUR; HYGIENE DES MAINS; ETUDE D'OBSERVATION
Context: Hand washing is considered the single most important nosocomial infection-control strategy, yet
compliance rarely meets levels recommended by infection control authorities.
Objectives: To determine whether placement of hand hygiene foam dispensers in more conspicuous
positions and closer proximity to patients would increase use of infection control agents as measured by
volume of product used. Further, to ascertain the influence of dispenser placement vs the number of
dispensers available on usage by volume.
Methods: This prospective, observational study conducted in an intensive care unit was composed of three
observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by
two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers)
and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). Results:
Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a
statistically significant increase in daily consumption after conspicuous and proximate positioning of
dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196).
Conclusion: More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie,
immediate proximity to patients) resulted in statistically and clinically significant increases in product usage.
An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on
usage by volume for these highly effective products should be considered when planning and implementing
intensive care unit infection-control policies.
NosoBase n° 24075
Antisepsie chirurgicale des mains avec des solutions hydro-alcooliques pour la friction des mains :
comparaison de l'efficacité après 1,5 et 3 minutes d'application
Weber WP; Reck S; Neff U; Saccilotto R; Dangel M; Rotter Ml; et al. Surgical hand antisepsis with alcoholbased hand rub: comparison of effectiveness after 1.5 and 3 minutes of application. Infection control and
hospital epidemiology 2009/05; 30(5): 420-426.
Mots-clés : ANTISEPTIQUE; SOLUTION HYDRO-ALCOOLIQUE; LAVAGE CHIRUGICAL DES MAINS;
ETUDE PROSPECTIVE; MESURE; STATISTIQUE; NORME; CHIRURGIEN; MICROBIOLOGIE; CENTRE
HOSPITALIER UNIVERSITAIRE
Objective: Research has shown 1.5 minutes of surgical hand antisepsis with alcohol-based hand rub to be at
least as effective under experimental conditions as the 3-minute reference disinfection recommended by
European Norm 12791. The aim of the present study was to validate the effectiveness of 1.5 minutes of
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surgical hand antisepsis in a clinical setting by comparing the effectiveness of 1.5- and 3-minute applications
of alcohol-based hand rub (45% vol/vol 2-propanol, 30% vol/vol 1-propanol, and 0.2% mecetronium
ethylsulphate).
Design: Prospective crossover trial in which each surgeon served as his or her own control, with individual
randomization to the 1.5- or the 3-minute group during the first part of the trial.
Setting: Basel University Hospital, Switzerland.
Participants: Thirty-two surgeons with different levels of postdoctoral training.
Methods: We measured the bactericidal effectiveness of 1.5 minutes and 3 minutes of surgical hand
antisepsis with alcohol-based hand rub by assessing the mean (+/-SD) log10 number of colony-forming units
before the application of hand rub (baseline), after the application of hand rub (immediate effect), and after
surgery (sustained effect) so as to follow European Norm 12791 as closely as possible.
Results: The immediate mean (+/-SD) log10 reduction in colony-forming units (cfu) was 2.26 +/- 1.13 log10
cfu for the 1.5-minute group and 3.01 +/- 1.06 log10 cfu for the 3-minute group (P = .204). Similarly, there
was no statistically significant difference between the 2 groups with respect to the sustained effect; the mean
(+/-SD) log10 increase in bacterial density during surgery was 1.08 +/- 1.13 log10 cfu for the 1.5-minute
group and 0.95 +/- 1.27 log10 cfu for the 3-minute group (P = .708). No adverse effects were recorded.
Conclusion: In this clinical trial, surgical hand antisepsis with alcohol-based hand rub resulted in a similar
bacterial reduction, regardless of whether it was applied for 3 or 1.5 minutes, which confirms experimental
data generated with healthy volunteers.
Odontologie
NosoBase n° 24361
Périodontite et infections respiratoires basses nosocomiales : résultats préliminaires
Gomes-Filho G; Santos C; Cruz Ss; Passos J; Cerqueira E; Costa M; et al. Periodontitis and nosocomial
lower respiratory tract infection: preliminary findings. Journal of clinical periodontology 2009/05; 36(5): 380387.
Mots-clés : ODONTOLOGIE; INFECTION RESPIRATOIRE BASSE; CAS TEMOIN; VENTILATION
ASSISTEE; TABAGISME; EPIDEMIOLOGIE
Aim: To evaluate the possible association between periodontitis and nosocomial lower respiratory tract
infection (LRTI).
Material and Methods: A case-control study was conducted at a General Hospital in Feira de Santana,
Bahia, Brazil. The sample consisted of 103 individuals: 22 cases (presence of nosocomial LRTI) and 81
controls (absence of nosocomial LRTI). The diagnosis of periodontitis was based on probing depth, gingival
recession, clinical attachment loss and bleeding on probing. The diagnosis of nosocomial LRTI was made in
accordance with established medical criteria.
Results: Invasive ventilation was much more frequent in cases (95.5%) than in controls (7.4%). An
orotracheal tube was used in 81.8% of cases and in 7.4% of controls; bronchoaspiration was suspected in
81.8% of cases and in 6.2% of controls. There was no statistically significant difference in any of the clinical
periodontal parameters between cases and controls. The crude odds ratio (OR) value for individuals with
periodontitis having LRTI was not statistically significant [ORcrude = 1.70; 95% confidence interval:(0.604.87)]. After including age, smoking and duration of hospitalization in the logistic regression, the adjusted
OR for individuals with periodontitis having LRTI was statistically significant [ORadjusted = 3.67 (1.0113.53); p = 0.049].
Conclusions: A marginal association between periodontitis and LRTI was found when smoking, age and
length of hospitalization were included as covariates. Patients with LRTI had a high frequency of suspected
bronchoaspiration and this could explain the possible association of periodontal disease and LRTI found in
this and other studies. Additional studies are needed to further clarify the possible relationship between
periodontal disease and LRTI.
NosoBase n° 24254
Synthèse sur les implants dentaires et l'infection
Pye AD; Lockhart D; Dawson Mp; Murray CA; Smith AJ. A review of dental implants and infection. The
Journal of hospital infection 2009/06; 72(2): 104-110.
Mots-clés : ODONTOLOGIE; FACTEUR DE RISQUE; BACILLE GRAM NEGATIF; COCCI GRAM
NEGATIF; TREPONEMA; TRAITEMENT; MICROBIOLOGIE; RECOMMANDATION; ANTIBIOTIQUE
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Dental implants have become increasingly common for the management of tooth loss. Despite their
placement in a contaminated surgical field, success rates are relatively high. This article reviews dental
implants and highlights factors leading to infection and potential implant failure. A literature search identified
studies analysing the microbial composition of peri-implant infections. The microflora of dental periimplantitis resembles that found in chronic periodontitis, featuring predominantly anaerobic Gram-negative
bacilli, in particular Porphyromonas gingivalis and Prevotella intermedia, anaerobic Gram-negative cocci
such as Veillonella spp. and spirochaetes including Treponema denticola. The role of Staphylococcus
aureus and coagulase-negative staphylococci that are typically encountered in orthopaedic infections is
debatable, although they undoubtedly play a role when isolated from clinically infected sites. Likewise, the
aetiological involvement of coliforms and Candida spp. requires further longitudinal studies. Currently, there
are neither standardised antibiotic prophylactic regimens for dental implant placement nor universally
accepted treatment for peri-implantitis. The treatment of infected implants is difficult and usually requires
removal. In the UK there is no systematic post-surgical implant surveillance programme. Therefore, the
development of such a project would be advisable and provide valuable epidemiological data.
Personnel
NosoBase n° 24323
Transmission d'agents infectieux des soignants à leurs patients
Institut de Veille Sanitaire. Bulletin épidémiologique hebdomadaire 2009/05/05; 18-19: 177-192.
Mots-clés : TRANSMISSION; INVESTIGATION; TUBERCULOSE; PERSONNEL; ENQUETE;
BORDETELLA; EPIDEMIE; MATERNITE; VACCIN; HEPATITE B; PRECAUTION STANDARD;
STREPTOCOCCUS; GRIPPE; GALE; INFECTION RESPIRATOIRE BASSE; TRANSMISSION
SOIGNANT/SOIGNE; BORDETELLA PERTUSSIS; STREPTOCOCCUS PYOGENES
Extrait de sommaire :
- Poujol I. Signalements d'infection nosocomiale suggérant des transmissions d'agents infectieux de
soignant à patient, France, 2001-2002 (NosoBase n° 24324).
- Floret N. Transmission nosocomiale du virus de l'hépatite B d'un soignant à un patient, France, 2005.
(NosoBase n° 24325).
- Merrer J. Gestion d'une épidémie de coqueluche touchant des personnels de santé d'une maternité,
France, 2006. (NosoBase n° 24326).
- Noel D, Antoine D. Investigations autour d'un cas de tuberculose chez un professionnel en milieu de soin,
France, 2004-2007. (NosoBase n° 24327).
- Calatayud L, Six D. Episodes de grippe dans deux établissements d'hébergement pour personnes âgées
dans les Bouches-du-Rhône, France, mars-avril 2008. (Référence NosoBase n° 24328).
NosoBase n° 24433
Coûts associés aux accidents exposant au sang par piqûre dans des établissements de santé
suédois et économies potentielles avec le matériel de sécurité pour les aiguilles et seringues
Glenngard AH; Persson U. Costs associated with sharps injuries in the Swedish health care setting and
potential cost savings from needle-stick prevention devices with needle and syringe. Scandinavian journal of
infectious diseases 2009/04; 41(4): 296-302.
Mots-clés : COUT; EXPOSITION AU SANG; PIQURE; MATERIEL DE SECURITE; ETUDE
MULTICENTRIQUE
The number and costs associated with reported sharps injuries in Swedish hospitals and the potential cost
offset by introducing safety devices with needle and syringe was estimated from a health care perspective.
Data about reported sharps injuries were collected from infection control nurses at 18 Swedish hospitals and
information about the procedures following such injuries from doctors at Swedish hospitals and published
articles. Unit costs were derived from the Southern Regional Health Care Board, SEK 2007. On average,
3.14 injuries per 100 full-time equivalent positions are reported annually in Swedish health care.
Approximately 60% involves hollow-bore needles. The cost of occupational sharps injuries in Sweden was
estimated at euro 1.8 million (SEK 16.3 million) or euro 272 (SEK 2513) per reported injury, of which euro1
million was for hollow-bore sharps injuries. The expected number of injuries that could be avoided by
introducing safety devices was estimated at 3125 injuries and the corresponding expected cost offset at
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euro 850,000. Most costs are associated with investigation as opposed to treatment. The cost per reported
injury in Sweden seems to be lower than in other EU countries and the US, due to more thorough
investigation and treatment procedures in countries with confirmed transmission of pathogens to healthcare
workers.
NosoBase n° 24223
Rapport sur l'état de l'art de l'APIC : rôle des professionnels de la prévention du risque infectieux
dans la gestion de l'urgence
Rebmann T. APIC state-of-the-art report: the role of the infection preventionist in emergency management.
American journal of infection control 2009/05; 37(4): 271-281.
Mots-clés : PREVENTION; URGENCE; TRANSMISSION; PERSONNEL; BIBLIOGRAPHIE; PROTOCOLE;
SURVEILLANCE; FORMATION; INFIRMIER HYGIENISTE; MEDECIN HYGIENISTE; RISQUE
Background: This report summarizes the scope and role of infection preventionists in emergency
management for all types of disasters. Preventing the transmission of infectious agents during a disaster is
an essential component of emergency management. Previous disasters have illustrated the need for better
infection prevention and the involvement of an infection prevention professional in planning for and
responding to such events.
Methods: An evidence-based approach was used, consisting of a literature review and review by members
of the Association for Professionals in Infection Control and Epidemiology, Inc, Emergency Preparedness
Committee.
Results: Nine domains were identified that describe the role of the infection preventionist in emergency
management: knowledge of disasters and emergency management, assessing readiness and emergency
management plans, infection prevention coverage, participation in disaster response and recovery, health
care policy development, surveillance, patient management, physical plant issues, and infection
preventionist as educator. Details for each domain are provided.
Conclusion: Infection preventionists need to become more involved in emergency management at the
personal, facility, and community level. This report outlines the infection preventionist's responsibilities
related to emergency management.
Radiologie
NosoBase n° 24281
Précautions d'hygiène et transmission des infections en radiologie
Bibbolino C; Pittalis S; Schinina V; Busi Rizzi E; Puro V. Hygiene precautions and the transmission of
infections in radiology. Radiology and medicine 2009; 114(1): 111-120.
Mots-clés : PREVENTION; TRANSMISSION; RADIOLOGIE; PRECAUTION STANDARD; OBSERVANCE;
SOLUTION HYDRO-ALCOOLIQUE; RECOMMANDATION; LAVAGE DES MAINS; HYGIENE DES MAINS;
DESINFECTION CHIRURGICALE DES MAINS PAR LAVAGE; DESINFECTION CHIRURGICALE DES
MAINS PAR FRICTION
Healthcare-associated infections are a critical challenge for the public health sector. Most are acquired
through contact, predominantly with the hands of health care personnel. Hand hygiene, therefore, is the
single most effective measure for preventing and controlling infectious diseases. Recently, cases of acute
hepatitis C occurred in patients who had undergone contrast-enhanced computed tomography. This was
probably related to inadequate handling by health care staff. Rigorous compliance with standard precautions
is therefore compulsory even in radiology, a setting traditionally considered at low risk for the transmission of
pathogens. Adherence to standard precautions is still poor and the persistence of inappropriate practices
responsible for preventable incidents is very common in radiology, often owing to underestimation of risk.
Radiology units must promote compliance with correct hand hygiene through appropriate education
programmes and provision of adequate areas and hand hygiene products. The evidence base to support the
use of alcohol-based hand rub is demonstrating that these formulations are effective in improving hand
hygiene compliance and preventing infections.
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Réanimation
NosoBase n° 24233
L'isolement des nouveaux-nés transférés d'autres unités de néonatologie est-il nécessaire à
l'admission dans l'unité de réanimation néonatale ?
Al Reyami E; Al Zoabi K; Rahmani A; Tamim M; Chedid F; Dhabi A. Is isolation of outborn infants required at
admission to the neonatal intensive care unit? American journal of infection control 2009/05; 37(4): 335-337.
Mots-clés
:
ISOLEMENT;
NEONATALOGIE;
SOIN
INTENSIF;
TAUX;
COLONISATION;
STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PEDIATRIE; PRECAUTION STANDARD
Background: To measure the rate of colonization of outborn infants with methicillin-resistant Staphylococcus
aureus (MRSA) to evaluate the need for Contact Precautions (including isolation) at the time of admission to
the neonatal intensive care unit (NICU).
Methods: All 239 consecutive infants referred from the neonatal units of other hospitals to a tertiary NICU in
Al Ain, United Arab Emirates, between January 2000 and December 2007 were screened for MRSA
colonization. Swabs from the ear, nose, rectum, axillae, and groin were obtained from each patient, and the
rates of colonization were calculated retrospectively.
Results: Some 72% of newborns were admitted to our NICU in the first week. Only 1 patient, admitted from
Oman, grew MRSA from the ear swab (rate, 0.4%; 95% confidence interval = 0.01% approximately 2.3%).
Conclusion: This study from a tertiary NICU in a developing country shows that outborn infants are unlikely
to harbor MRSA, and thus their routine admission in a single-bed isolation room is not justified. MRSA
screening on admission has a very low yield and does not appear to be cost-effective. Contact precautions
should be reserved for those newborns transferred from general pediatric wards and those admitted from
home.
NosoBase n° 24363
Acquisition et dissémination d'Acinetobacter baumannii et de Stenotrophomonas maltophilia chez
des patients de réanimation
Barchitta M; Cipresso R; Giaquinta L; Romeo MA; Denaro C; Pennisi C; et al. Acquisition and spread of
Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. International journal
of hygiene and environmental health 2009/05; 212(3): 330-337.
Mots-clés : SOIN INTENSIF; ACINETOBACTER BAUMANNII; STENOTROPHOMONAS MALTOPHILIA;
XANTHOMONAS; COLONISATION; TRANSMISSION; EPIDEMIE; FACTEUR DE RISQUE; VENTILATION
ASSISTEE; ENQUETE; BIOLOGIE MOLECULAIRE; CAS TEMOIN; ANTIBIORESISTANCE;
SURVEILLANCE
Acinetobacter baumannii and Stenotrophomonas maltophilia are increasingly important pathogens,
especially in the intensive care units (ICUs). This study was designed to investigate the clonality, the mode
of transmission and the patients' risk profile for acquisition of A. baumannii and S. maltophilia at the ICU of
an Italian Hospital. Patterns of A. baumannii and S. maltophilia acquisition in the ICU during the period of the
survey were carriage, colonization and infection. Characterization of A. baumannii was performed by
ARDRA and genotyping of both pathogens by PFGE. Our study provided evidence for the occurrence of an
outbreak sustained by the two organisms in study involving 27.3% of patients enrolled into the surveillance.
The spread of a unique A. baumannii epidemic clone was demonstrated. A major clone of S. maltophilia was
responsible for the epidemic spread of S. maltophilia (55.5% of isolates), thus confirming A. baumannii
cross-transmission and showing--among few published reports--the clonal spread of S. maltophilia. Outliers
analysis suggested colonized patients as the probable epidemic sources. Mechanical ventilation was
confirmed as risk factor for infection (OR 8.4; 95%C.I.: 2.6-27.5). A multimodal intervention program was
introduced, followed in later months with a drastic restriction of infection and colonization due to A.
baumannii and S. maltophilia and subsequently with the successful control of the outbreak. Active
surveillance of infection and colonization by high-risk clones, together with implementation of control
strategies, including strict hand hygiene, proved to be effective to reduce the epidemic spread of both alert
pathogens in our ICU.
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
juin 2009
Surveillance
NosoBase n° 24257
Réduction de l'incidence des infections du site opératoire par l'intermédiaire d'un réseau : résultats
du réseau de surveillance français RAISIN-ISO
Astagneau P; L'heriteau F; Daniel F; Parneix P; Venier AG; Malavaud S; et al. Reducing surgical site
infection incidence through a network: results from the french ISO-RAISIN surveillance system. The Journal
of hospital infection 2009/06; 72(2): 127-134.
Mots-clés : RESEAU; SITE OPERATOIRE; INCIDENCE; SURVEILLANCE; CHIRURGIE; DIAGNOSTIC;
FACTEUR DE RISQUE; ETUDE MULTICENTRIQUE
Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated
the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire
- Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were
enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised
form was completed for each patient including SSI diagnosis according to standard criteria, and several risk
factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration,
elective/emergency surgery, and type of surgery. From 1999 to 2006, 14,845 SSIs were identified in
964,128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude
overall SSI incidence decreased from 2.04% to 1.26% (P<0.001; relative reduction: -38%) and the National
Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% (P<0.001;
relative reduction: -33%). The most significant SSI incidence reduction was observed for hernia repair and
caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy.
Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI
incidence.
NosoBase n° 24261
Analyse des taux d'infections nosocomiales néonatales dans le réseau néonatal d'Australie et de
Nouvelle Zélande
Gill AW. Analysis of neonatal nosocomial infection rates across the Austalian and New Zealand neonatal
network. The Journal of hospital infection 2009/06; 72(2): 155-162.
Mots-clés : NEONATALOGIE; TAUX; RESEAU; PREMATURE; ETUDE MULTRICENTRIQUE
This paper describes the variation in neonatal nosocomial infection rates across 26 contributing units of the
Australian and New Zealand Neonatal Network. Data collected during the years 2002-2004 have been
analysed comprising a total of 3180 infants of <1000 g birthweight and 260 694 hospital-days. Overall
infection rates of 5.02 [95% confidence interval (CI): 4.75, 5.30] infections per 1000 days total admission for
infants of <1000 g birthweight are comparable with other published data. Censoring data to the first 35 days
of admission demonstrated an infection rate of 13.88 (95% CI: 13.14, 14.65) infections per 1000 days. A
standardised, expected, infection rate for each unit was calculated by correcting for gestational age and
gender. Analysis of the difference between observed and expected infection rates demonstrated
considerable variation in nosocomial infection rates between participating units. Three units demonstrated a
nosocomial infection rate significantly (P < 0.005) below the population value. Further analysis of clinical
practice variations within these units may uncover potential beneficial practices for the network.
Transmission croisée
NosoBase n° 24184
Recommandations nationales. Prévention de la transmission croisée : precautions complémentaires
contact.
Société Française d’Hygiène Hospitalière. Hygiènes 2009/04; XVII(2): 81-138.
Mots-clés : RECOMMANDATION; PREVENTION; TRANSMISSION; PRECAUTION STANDARD;
CONSENSUS; MICRO-ORGANISME; DEPISTAGE; MULTIRESISTANCE;
STAPHYLOCOCCUS
AUREUS; PSEUDOMONAS; ENTEROBACTERIE; LAVAGE DES MAINS; GANT; TENUE
VESTIMENTAIRE; MASQUE; BIBLIOGRAPHIE
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
juin 2009
Ces recommandations ont pour objet d’actualiser d’une part les précautions standard, au vu de la place
réservée maintenant aux produits hydro-alcooliques dans l’hygiène des mains et d’autre part les précautions
complémentaires de type contact (y compris la politique de dépistage et la stratégie de décontamination).
Un des points majeurs qui marque un tournant dans le concept de la prévention de la transmission croisée
réside dans la possibilité offerte au CLIN ou à la sous-commission spécialisée de la commission médicale
d’établissement de définir la stratégie de prévention entre « précautions standard » uniquement et «
précautions standard associées aux précautions complémentaires de type contact » si un ensemble de
conditions sont remplies. Le périmètre de ces recommandations exclut les recommandations spécifiques
pour les modes de transmission « gouttelettes » et « air » et celles pour la maîtrise de l’environnement qui
vont faire l’objet de documents ultérieurs produits par la SFHH et dont la rédaction vient de débuter. Les
secteurs interventionnels ont été exclus puisque des recommandations leur ont été consacrées (Conférence
de consensus Gestion préopératoire du risque infectieux, SFHH, 2004 et Conférence formalisé d’experts
Qualité de l’air au bloc opératoire, SFHH 2004). Il en est de même lorsque des micro-organismes font l’objet
de recommandations nationales publiées ou en cours et pour d’autres pathogènes comme Clostridium
difficile.
CCLIN Sud-Est – [email protected]
24 / 24