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NosoVeille – Bulletin de veille
septembre 2010
NosoVeille n°9
Septembre 2010
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.
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Abonnement / Désabonnement
Sommaire de ce numéro
Antibiorésistance
Bactériémie
Candida
Cathéter
Chirurgie
Coût
Désinfection
EHPAD
Environnement
Epidémie
Escherichia coli
Gestion des risques/qualité
Grippe
Hygiène des mains
Klebsiella pneumoniae
Législation
Mortalité
Personnel
Pneumonie
Prévention
Prion
Soins intensifs
Staphylococcus aureus
Surveillance
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
septembre 2010
Antibiorésistance
NosoBase n° 28033
Escherichia coli producteur de BLSE dans des infections urinaires en secteur ambulatoire. Options
de traitement par voie orale ?
Auer S; Wojna A; Hell M. ESBL producing Escherichia coli in ambulatory urinary tract infections - oral
treatment options? Antimicrobial agents and chemotherapy 2010; in press: 9 pages.
Mots-clés : ESCHERICHIA COLI; INFECTION URINAIRE; BETA-LACTAMASE A SPECTRE ELARGI;
ANTIBIORESISTANCE;
ANTIBIOTIQUE;
TRAITEMENT;
FOSFOMYCINE;
CARBAPENEME;
NITROFURANE; BETALACTAMINE
An increase in Extended-Spectrum-Beta-Lactamases (ESBL)-producing Escherichia coli has been observed
in outpatient settings. Consequently 100 ESBL-positive E. coli isolates were collected from clinically
confirmed, ambulatory UTIs by a single laboratory between October 2004 and January 2008. Antimicrobial
susceptibility testing was carried out using the oral antibiotics fosfomycin, mecillinam, nitrofurantoin and the
parenteral antibiotic ertapenem, Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%) and
mecillinam (85%) could be considered as important oral treatment options.
NosoBase n° 28156
La prescription d'antibiotiques le samedi est-elle plus élevée que celle de n'importe quel autre jour
de la semaine ?
Behar P; Wagner MB; Petersen LC; Vilas Boas MR. Is antibiotic prescribing on saturdays higher than any
other day of the week? The Journal of hospital infection 2010/09; 76(1): 84-85.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION
NosoBase n° 28208
Surveillance de la consommation des antibiotiques. Réseau ATB-Raisin. Résultats 2008
CCLIN Sud-Ouest; RAISIN; INVS; 2010/07; 68 pages.
Mots-clés : ANTIBIOTIQUE; SURVEILLANCE; DDJ; ANTIBIORESISTANCE;
MEDECINE; CHIRURGIE; SOIN INTENSIF; PSYCHIATRIE
CONSOMMATION;
La surveillance de la consommation des antibiotiques (ATB) est un élément des programmes de bon usage
des antibiotiques et de maîtrise des résistances bactériennes. Afin de décrire la consommation des ATB, et
de permettre à chaque établissement de santé (ES) d’analyser ses consommations par rapport à un
ensemble comparable et de confronter ces données avec celles de la résistance bactérienne, les
antibiotiques à visée systémique de la classe J01 de la classification Anatomical Therapeutic Chemical
(ATC), la rifampicine et les imidazolés per os, dispensés en hospitalisation complète, ont été exprimés en
nombre de doses définies journalières (DDJ) et rapportés à l’activité pour 1 000 journées d’hospitalisation
(JH) selon les recommandations nationales et de l’Organisation mondialde la santé (système ATC-DDD,
2008). Des données de résistance ont été collectées pour des couples bactérie/antibiotique ciblés. Les 861
ES participants en 2008 représentaient 42% des lits d’hospitalisation et avaient consommé 369 DDJ/1 000
JH. Les antibiotiques les plus utilisés étaient l’association amoxicilline-acide clavulanique (32 %),
l’amoxicilline (17 %) et l’ofloxacine (5,5 %). La consommation médiane d’ATB variait de 52 DDJ/1 000 JH
dans les hôpitaux psychiatriques à 794 DDJ/1 000 JH dans les hôpitaux militaires. Des variations étaient
observées selon les secteurs d’activité, de 59 DDJ/1 000 JH en psychiatrie (n=114) à 1 465 en réanimation
(n=132). Les données de résistance étaient en cohérence avec celles issues de réseaux spécifiques. Cette
surveillance en réseau des consommations d’AB détaillées constitue un référentiel permettant à chaque ES
de se situer par rapport aux autres, dans un objectif de benchmarking, en échangeant sur les pratiques et
organisations. L’analyse des consommations d’ATB est à compléter d’évaluation des pratiques utilisant les
outils des sociétés savantes.
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NosoBase n° 28069
Recommandations pour un dépistage phénotypique et une confirmation de carbapénémases parmi
des entérobactéries
Cohen Stuart J; Leverstein-Van Hall MA. Guideline for phenotypic screening and confirmation of
carbapenemases in enterobacteriaceae. International journal of antimicrobial agents 2010/09; 3(36): 205210.
Mots-clés:
RECOMMANDATION;
DEPISTAGE;
ENTEROBACTERIE;
ANTIBIORESISTANCE;
CARBAPENEME;
IMIPENEME;
PCR;
ESCHERICHIA
COLI;
KLEBSIELLA;
SALMONELLA;
ENTEROBACTER; CITROBACTER; CMI; MEROPENEME
Adequate detection of carbapenemase-producing Enterobacteriaceae is crucial for infection control
measures and appropriate choice of antimicrobial therapy. This guideline aims to improve the detection of
carbapenemase-producing Enterobacteriaceae in the routine setting of clinical microbiology laboratories.
Detection of carbapenemases in Enterobacteriaceae includes a screening step followed by a genotypic and
optional phenotypic confirmatory step. For all Enterobacteriaceae, the meropenem screening breakpoint to
detect carbapenemases is set at >or=0.5mg/L or a zone diameter of <or=23 mm (10 microg disk loading).
For Escherichia coli, Klebsiella spp., Salmonella spp., Enterobacter spp. and Citrobacter spp., the imipenem
screening breakpoint is set at >or=2mg/L or a zone diameter <or=21 mm. Ertapenem is not advised as an
indicator carbapenem as it has a lower specificity compared with imipenem and meropenem. On the first
isolate from a patient with a positive carbapenemase screen test, a polymerase chain reaction (PCR)-based
test should be performed to detect carbapenemase genes. However, if genotypic confirmation is not
immediately available, phenotypic confirmation tests should be performed to avoid delayed reporting of
carbapenemase-producers to the clinic. Recommended phenotypic confirmation tests are the modified
Hodge test as well as carbapenemase inhibition tests with boronic acid for Ambler class A carbapenemases
and with ethylene diamine tetra-acetic acid (EDTA) or dipicolinic acid for metallo-carbapenemases.
NosoBase n° 28085
Usage des antibiotiques dans 530 hôpitaux français. Résultats d'un réseau de surveillance au niveau
de l'établissement hospitalier et des services en 2007
Dumartin C; L'Heriteau F; Pefau M; Bertrand X; Jarno P; Boussat S; et al. Antibiotic use in 530 french
hospitals: results from a surveillance network at hospital and ward levels in 2007. The Journal of
antimicrobial chemotherapy 2010/09; 65(9): 2026-2036.
Mots-clés : ANTIBIOTIQUE; CONSOMMATION; SURVEILLANCE; RESEAU; ETUDE RETROSPECTIVE;
DDJ; STRUCTURE DE SOINS; UNITE DE SOIN
Objectives Antibiotic use in French hospitals is among the highest in Europe. A study was carried out to
describe antibiotic consumption for inpatients at hospital and at ward levels.
Methods Data were voluntarily collected retrospectively by 530 hospitals accounting for approximately 40
million patient-days (PD) on the following: antibacterials for systemic use [J01 class of the WHO Anatomical
Therapeutic Chemical (ATC) classification, defined daily doses (DDD) system, 2007], rifampicin and oral
imidazole derivatives, expressed in number of DDD and number of PD in 2007. Consumption was
expressed in DDD/1000 PD.
Results Median antibiotic use ranged from 60 DDD/1000 PD in long-term care (LTC) and psychiatric
hospitals to 633 DDD/1000 PD in teaching hospitals. Penicillins and beta-lactamase inhibitors combinations
were the most frequently used antibiotics, accounting for 26% of total use in cancer hospitals to 40% in
LTC/psychiatric hospitals. Glycopeptides and carbapenems were mostly used in cancer and teaching
hospitals. Level of consumption and pattern of use differed according to clinical ward from 60 DDD/1000 PD
in psychiatric wards up to 1466 DDD/1000 PD in intensive care units (ICUs). In medicine, surgery, ICU and
rehabilitation wards, fluoroquinolones accounted for 13%-19% of the total use. Conclusions This multicentre
survey provided detailed information on antibiotic use in a large sample of hospitals and wards, allowing
relevant comparisons and benchmarking. Analysis of consumption at the ward level should help hospitals to
target practice audits to improve antibiotic use.
NosoBase n° 27769
Emergence d'Escherichia coli et de Klebsiella pneumoniae produisant des bêta-lactamases à
spectre élargi au cours des années 2000-2004 à Helsinki, Finlande
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Forssten SD; Kolho E; Lauhio A; Lehtola L; Mero S; Oksaharju A; et al. Emergence of extended-spectrum
beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae during the years 2000 and 2004 in
Helsinki, Finland. Clinical microbiology and infection 2010/08; 8(16): 1158-1161.
Mots-clés : KLEBSIELLA PNEUMONIAE; BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI;
EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; GENOTYPE; ANTIBIORESISTANCE; PFGE; CMI; PCR;
ENTEROBACTERIE
The molecular epidemiology of 33 Escherichia coli and 81 Klebsiella pneumoniae extended-spectrum betalactamase-producing healthcare-associated and community-acquired isolates collected in the Helsinki
district during 2000-2004 was investigated. Clonality studies, antimicrobial susceptibility and genotyping of
the isolates were performed. Newly emerging CTX-M-producing E. coli and bla(SHV-12)-producing K.
pneumoniae isolates were detected. Clonal clusters of both species persisted throughout the study period.
NosoBase n° 28202
Dépistage du portage digestif des bactéries commensales multirésistantes aux antibiotiques
importées en France à l'occasion du rapatriement de patients en provenance de l'étranger et maîtrise
de leur diffusion
HCSP; Haut conseil de la santé publique 2010/05; 37 pages.
Mots-clés : ANTIBIORESISTANCE;
CARBAPENEME; SIGNALEMENT
DEPISTAGE;
PORTAGE
DIGESTIF;
EPIDEMIOLOGIE;
ERG;
NosoBase n° 28034
Facteurs de risque d'acquisition et évolutions des traitements des bactériémies d'origine
communautaire à Escherichia coli producteur de bêta-lactamase à spectre élargi
Kang CI; Song JH; Chung DR; Peck KR; Ko KS; Yeom JS; et al. Risk factors and treatment outcomes of
community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli.
International journal of antimicrobial agents 2010; in press: 4 pages.
Mots-clés : FACTEUR DE RISQUE; ESCHERICHIA COLI; TRAITEMENT; BACTERIEMIE; INFECTION
COMMUNAUTAIRE;
BETA-LACTAMASE
A
SPECTRE
ELARGI;
ANTIBIORESISTANCE;
CEPHALOSPORINE; SURVEILLANCE; MORTALITE
The purpose of this study was to identify risk factors for extended-spectrum beta-lactamase (ESBL)producing Escherichia coli amongst community-onset bacteraemia and to evaluate treatment outcomes.
From the database of a nationwide surveillance programme for bacteraemia, data from patients with
community-onset E. coli bacteraemia were analysed. Patients with ESBL-producing E. coli bacteraemia
were compared with those with non-ESBL-producing bacteraemia. The overall proportion of ESBLproducers was 9.5% (82/865) amongst community-onset E. coli bacteraemia cases. Healthcare-associated
infection, underlying liver disease and primary bacteraemia were significant independent factors associated
with ESBL-producing E. coli bacteraemia (P<0.05). There was a trend toward mortality being higher in the
ESBL group compared with the non-ESBL group (15.0% vs. 7.6%; P=0.096). ESBL production was found to
be an independent factor associated with mortality after adjusting for confounding variables (odds
ratio=2.99, 95% confidence interval 1.01-8.84; P=0.048), along with severe sepsis, higher Pitt bacteraemia
score, primary bacteraemia, pneumonia and underlying liver disease (P<0.05). ESBL-producing E. coli is a
significant cause of bacteraemia, even in patients with community-onset infections, predicting higher
mortality, particularly in patients with primary bacteraemia, underlying liver disease or healthcare-associated
infection.
NosoBase n° 28409
Emergence d'un nouveau mécanisme de résistance aux antibiotiques en Inde, au Pakistan et au
Royaume-Uni : une étude moléculaire, biologique et épidémiologique
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Kumarasamy KK; Toleman MA; Walsh TR; Bagaria J; Butt F; Balakrishnan R; et al. Emergence of a new
antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological
study. The Lancet infectious diseases 2010/09/01; 10(9): 597-602.
Mots-clés : ANTIBIORESISTANCE; ENTEROBACTERIE; ESCHERICHIA
CARBAPENEME; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; PREVALENCE
COLI;
KLEBSIELLA;
Background: Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi
metallo-beta-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the
prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.
Methods: Enterobacteriaceae isolates were studied from two major centres in India-Chennai (south India),
Haryana (north India)-and those referred to the UK's national reference laboratory. Antibiotic susceptibilities
were assessed, and the presence of the carbapenem resistance gene bla(NDM-1) was established by PCR.
Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were
analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence
of travel and recent admission to hospitals in India or Pakistan.
Findings: We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other
sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella
pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K
pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were
clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were
readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive
patients had travelled to India or Pakistan within the past year, or had links with these countries.
Interpretation: The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated
international surveillance is needed.
NosoBase n° 28036
Emergence d'infections à Staphylocoque à coagulase négative résistant au linezolide liées à une
augmentation de l'utilisation du linezolide dans un centre de lutte contre le cancer
Mulanovich VE; Huband MD; Mccurdy SP; Lemmon MM; Lescoe M; Jiang Y; et al. Emergence of linezolidresistant coagulase-negative Staphylococcus in a cancer centre linked to increased linezolid utilization. The
Journal of antimicrobial chemotherapy 2010; In press: 4 pages.
Mots-clés
:
STAPHYLOCOQUE
A
COAGULASE
NEGATIVE;
CANCER;
LINEZOLIDE;
ANTIBIORESISTANCE; CENTRE DE LUTTE CONTRE LE CANCER; PREVALENCE; EPIDEMIE; ETUDE
RETROSPECTIVE; HEMATOLOGIE; CONSOMMATION; DDJ
Objectives: The prevalence of linezolid-resistant coagulase-negative Staphylococcus (CoNS) in the MD
Anderson Cancer Center rose from 0.6% in 2007 to 5.5% in 2009. The aim of our study was to analyse the
relationship between linezolid use and an outbreak of linezolid-resistant CoNS.
Patients and methods: We retrospectively identified 27 infection or colonization events. Eleven isolates were
available for supplemental investigation; species identification, clonal relatedness and linezolid resistance
mutation analysis. The medical records of the affected patients were reviewed and linezolid utilization data
were obtained from the pharmacy.
Results: Available isolates were confirmed as clonally related Staphylococcus epidermidis. Partial 23S rRNA
gene sequencing found a G2576T mutation in all of the isolates tested. All patients received linezolid within
3 months prior to an event. Patients without a prior hospitalization had a longer time from admission to
event; 29 versus 3.5 days (P = 0.002). The outbreak was preceded by a 51% increase in inpatient linezolid
utilization and 64% of affected patients belonged to the leukaemia service, which had a utilization rate 3.1
times that of the other services (95% confidence interval: 2.96-3.23).
Conclusions: Increased linezolid utilization preceded the appearance of a linezolid-resistant CoNS clone.
Patients probably acquired the clonal strain nosocomially, given the longer time from admission to event
among patients with no previous admission to the MD Anderson Cancer Center. Linezolid administration
then selected this strain, since all patients received linezolid prior to an event. A linezolid utilization rate of
>/=13 defined daily doses/100 patient-days was similar to that reported in two other outbreaks and may be
the threshold required to generate an outbreak.
NosoBase n° 28408
La dernière menace en date dans la guerre contre l'antibiorésistance
CCLIN Sud-Est – [email protected]
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Pitout JD. The latest threat in the war on antimicrobial resistance. The Lancet infectious diseases
2010/09/01; 10(9): 578-579.
Mots-clés : ANTIBIORESISTANCE;
CARBAPENEME
ENTEROBACTERIE;
ESCHERICHIA
COLI;
KLEBSIELLA;
Bactériémie
NosoBase n° 28405
Prévenir les bactériémies liées aux cathéters hors réanimation : étendre la prévention aux autres
services
Lautenbach E; Metlay JP; Mao X; Han X; Fishman NO; Bilker WB; et al. Preventing catheter-related
bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clinical
infectious diseases 2010/08/01; 51(3): 335-341.
Mots-clés : CATHETER VEINEUX
AMBULATOIRE; EPIDEMIOLOGIE
CENTRAL;
PREVENTION;
BACTERIEMIE;
HEMODIALYSE;
With the growing recognition of the preventability of catheter-related bloodstream infections (CRBSIs),
reducing the number of CRBSIs acquired in health care facilities has become an important patient safety
goal. To date, most prevention efforts have been conducted in intensive care units (ICUs); however, many
central venous catheters (CVCs) are found outside the ICU, and rates of catheter-associated bloodstream
infections in these settings appear to be similar to rates of these infections in ICUs. CVCs are also used in
patients who primarily receive their care as outpatients, including those requiring hemodialysis, undergoing
treatment for malignancies, and receiving parenteral nutrition. In some of these patients, CVCs might be
used for extended periods, prolonging the patient's time at risk for CRBSIs and highlighting the potential
need to look beyond insertion-based interventions to prevent infections. To meet the goal of reducing the
number of all CRBSIs associated with health care, further attention on CRBSIs occurring outside the ICU is
needed; however, this effort will require a better understanding of the epidemiology and prevention of these
infections.
NosoBase n° 27920
Prédire les bactériémies chez des patients hospitalisés pour des infections de la peau et des
structures cutanées : dérivation et validation d’un score de risque
Lipsky BA; Kollef MH; Miller LG; SunX; Johannes RS; Tabak YP. Predicting bacteremia among patients
hospitalized for skin and skin-structure infections: derivation and validation of a risk score. Infection control
and hospital epidemiology 2010/08; 31(8): 828-837.
Mots-clés : PEAU; VALIDITE; BACTERIEMIE; TAUX; COHORTE; SCORE; FACTEUR DE RISQUE;
PRELEVEMENT SANGUIN; ANTIBIOTIQUE; DISPOSITIF; MEDICAL; MATERIEL ETRANGER
Objective: Bacteremia is relatively common in patients with skin and skin-structure infection (SSSI) severe
enough to require hospitalization. We used selected demographic and clinical characteristics easily
assessable at initial evaluation to develop a model for the early identification of patients with SSSI who are
at higher risk for bacteremia.
Participants: A large database of adults hospitalized with SSSI at 97 hospitals in the United States during
the period from 2003 through 2007 and from whom blood samples were obtained for culture at admission.
Methods: We compared selected candidate predictor variables for patients shown to have bacteremia and
patients with no demonstrated bacteremia. Using stepwise logistic regression to identify independent risk
factors for bacteremia, we derived a model by using 75% of a randomly split cohort, converted the model
coefficients into a risk score system, and then we validated it by using the remaining 25% of the cohort.
Results: Bacteremia was documented in 1,021 (11.7%) of the 8,747 eligible patients. Independent predictors
of bacteremia (P<.001) were infected device or prosthesis, respiratory rate less than 10 or more than 29
breaths per minute, pulse rate less than 49 or more than 125 beats per minute, temperature less than 35.6
degrees C or at least 38.0 degrees C, white blood cell band percentage of 7% or more, white blood cell
count greater than 11x10(9)/L, healthcare-associated infection, male sex, and older age. The bacteremia
CCLIN Sud-Est – [email protected]
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NosoVeille – Bulletin de veille
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rates ranged from 3.7% (lowest decile) to 30.6% (highest decile) (P<.001). The model C statistic was 0.71;
the Hosmer-Lemeshow test P value was .36, indicating excellent model calibration.
Conclusions: Using data available at hospital admission, we developed a risk score that differentiated SSSI
patients at low risk for bacteremia from patients at high risk. This score may help clinicians identify patients
who require more intensive monitoring or antimicrobial regimens appropriate for treating bacteremia.
Candida
NosoBase n° 28404
L'ablation précoce des cathéters veineux centraux n'améliore pas l'issue des patients présentant
une candidémie : analyse de 842 patients de 2 essais cliniques randomisés
Nucci M; Anaissie E; Betts RF; Dupont BF; Wu C; Buell DN; et al. Early removal of central venous catheter
in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical
trials. Clinical infectious diseases 2010/08/01; 51(3): 295-303.
Mots-clés : CATHETER VEINEUX CENTRAL; CANDIDA; SURVEILLANCE; MORTALITE; ANALYSE
MULTIVARIEE; CANDIDEMIE; ETUDE PROSPECTIVE
Background: Patients with candidemia frequently have a central venous catheter (CVC) in place, and its
early removal is considered the standard of care.
Methods: We performed a subgroup analysis of 2 phase III, multicenter, double-blind, randomized,
controlled trials of candidemia to examine the effects of early CVC removal (within 24 or 48 h after treatment
initiation) on the outcomes of 842 patients with candidemia. Inclusion criteria were candidemia, age >16
years, CVC at diagnosis, and receipt of 1 dose of the study drug. Six outcomes were evaluated: treatment
success, rates of persistent and recurrent candidemia, time to mycological eradication, and survival at 28
and 42 days. Univariate and multivariate analyses were performed, controlling for potential confounders.
Results: In univariate analysis, early CVC removal did not improve time to mycological eradication or rates
of persistent or recurrent candidemia but was associated with better treatment success and survival. These
benefits were lost in multivariate analysis, which failed to show any beneficial effect of early CVC removal on
all 6 outcomes and identified Acute Physiology and Chronic Health Evaluation II score, older age, and
persistent neutropenia as the most significant variables. Our findings were consistent across all outcomes
and time points (removal within 24 or 48 h and survival at 28 and 42 days). The median time to eradication
of candidemia was similar between the 2 study groups.
Conclusions: In this cohort of 842 adults with candidemia followed up prospectively, early CVC removal was
not associated with any clinical benefit. These findings suggest an evidence-based re-evaluation of current
treatment recommendations.
NosoBase n° 28148
Augmentation de l'incidence des candidémies : tendances épidémiologiques à long terme au
Queensland, en Australie, 1999-2008
Playford EG; Nimmo GR; Tilse M; Sorrell TC. Increasing incidence of candidaemia: long-term
epidemiological trends, Queensland, Australia, 1999-2008. The Journal of hospital infection 2010/09; 76(1):
46-51.
Mots-clés : INCIDENCE; CANDIDA; EPIDEMIOLOGIE; SURVEILLANCE; CANDIDA PARAPSILOSIS
Given variability in the epidemiology of candidaemia and a relative paucity of contemporary longitudinal
data, a passive laboratory-based surveillance study was performed to assess the epidemiology of
candidaemia in all public healthcare facilities in Queensland, Australia over the period 1999-2008.
Demographic and microbiological data on all candidaemia episodes, together with appropriate denominators
(admissions and patient-days), were collected from laboratory and administrative information systems. From
1999 to 2008, 1137 episodes occurred (overall incidence-density: 0.45 per 10 000 patient-days) with a 3.5fold increase in density (P<0.0001 for trend). Candidaemia episodes originating in traditional high-risk areas
either decreased (haemato-oncology and paediatric wards) or remained stable (intensive care units).
Episodes on adult medical/surgical wards increased significantly over time, accounting for 60% of the total
by 2008. The relative proportion caused by Candida albicans decreased and Candida parapsilosis increased
(both P<0.01). The proportion of fluconazole-resistant isolates did not change. The increasing occurrence of
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candidaemia outside traditional high-risk areas and the emergence of C. parapsilosis present new
challenges for preventive and early intervention strategies.
NosoBase n° 28178
Reconnaître et prévenir les infections nosocomiales fungiques invasives en réanimation
Smith JA; Kauffman CA. Recognition and prevention of nosocomial invasive fungal infections in the
intensive care unit. Critical care medicine 2010/08; 38 (Supplément 8): S380-S387.
Mots-clés : PREVENTION; SOIN INTENSIF; MYCOLOGIE; EPIDEMIOLOGIE; CANDIDA; TRAITEMENT;
ANTIFONGIQUE; CHIMIOPROPHYLAXIE; DIAGNOSTIC; RISQUE; PREVENTION; BIBLIOGRAPHIE
Despite recent advances in antifungal treatments, the morbidity and mortality of fungal infections, especially
invasive candidiasis, in patients in the intensive care unit setting remain high. Because of this, there has
been a great interest in improving the evaluation, risk assessment, and prevention of fungal infections in the
intensive care unit. Some important advances in the diagnosis of invasive candidiasis include rapid species
identification and improvements in antigen testing. The introduction of several prediction rules has helped to
guide clinicians in the use of prophylaxis or preemptive antifungal therapy in high-risk patients. However, the
most immediate benefit has been realized with the introduction of new antifungal agents that have proved to
be safer than those available in the past.
Cathéter
NosoBase n° 28192
Bonnes pratiques pour les soins aux cathéters urinaires
Herter R; Kazer MW. Best practices in urinary catheter. Home healthcare nurse 2010/06; 28(6): 342-319.
Mots-clés : PRATIQUE; SONDAGE URINAIRE; CATHETER; INFECTION URINAIRE; SONDAGE
EVACUATEUR; SONDAGE A DEMEURE; FORMATION; RECOMMANDATION; HYGIENE DES MAINS;
GANT
Urinary catheterization is a common healthcare intervention used to manage urinary dysfunction that poses
serious associated risks and complications. This article discusses methods of urinary catheterization and
their indications, catheter-associated complications, and assessment and management strategies that home
healthcare practitioners can employ to ensure best patient outcomes and minimize complications.
NosoBase n° 28236
Programme destiné à limiter l'usage des sondes urinaires dans un centre hospitalier
Rothfeld AF; Stickley A. A programm to limit urinary catheter use at an acute care hospital. American journal
of infection control 2010/09; 38(7): 568-571.
Mots-clés : SONDAGE URINAIRE; CATHETER; INFECTION URINAIRE; PREVENTION; INFIRMIER;
FORMATION; QUALITE
Background: Urinary catheters are the major cause of catheter-associated urinary tract infections (CAUTIs)
and often may be unnecessary. We attempted to reduce the number of CAUTIs by limiting the use of urinary
catheters.
Methods: The number of catheters and CAUTIs were recorded during a control period of 7 months. A
program was implemented limiting these catheters to patients who had urinary tract obstruction, orders for
hourly output measurements, breakdown of skin in areas exposed to urine in patients with documented
urinary tract infections, or urine- associated skin irritation that was unresponsive to barrier measures. In
patients who did not meet these criteria, the physician was asked for a catheter removal order, and
superabsorbent pads or diapers were used. Urinary catheter use and CAUTIs were then recorded during a
subsequent 5-month intervention period. Nursing personnel were queried regarding their experience after 4
months of the intervention period.
Results: Urinary catheter use decreased by 42% (P < .01), and the incidence of CAUTIs decreased by 57%
(P < .05). There was some improvement in nursing satisfaction.
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Conclusion: Limiting urinary catheter use can reduce the incidence of CAUTI with no deterioration in nursing
satisfaction.
NosoBase n° 28140
Efficacité de différents cathéters veineux centraux pour la prévention des infections liées aux
cathéters : méta-analyse en réseau
Wang H; Huang T; Jing J; Jin J; Wang P; Yang M; et al. Effectiveness of different central venous catheters
for catheter-related infections: a network meta-analysis. The Journal of hospital infection 2010/09;
76(1): 1-11.
Mots-clés : CATHETER VEINEUX CENTRAL; EFFICACITE; PREVENTION; COLONISATION; METAANALYSE; BIBLIOGRAPHIE; ANTIBIOTIQUE; CHLORHEXIDINE; BACTERIEMIE; CATHETER
IMPREGNE; INCIDENCE
We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and
to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We
identified randomised, controlled trials that compared different types of central venous catheter (CVC),
evaluating catheter-related infections in a systematic search of articles published from January 1996 to
November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled
Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain
Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect
trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to
the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58;
95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64),
chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters
(0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly
lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted
heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were
associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated
catheters seem to be better for prevention of catheter-related infection compared with the other catheters.
Chirurgie
NosoBase n° 27919
Incidence des infections du site opératoire associées à la chirurgie robotique
Hermsen ED; Hinze T; Sayles H; Sholtz L; Rupp ME. Incidence of surgical site infection associated with
robotic surgery. Infection control and hospital epidemiology 2010/08; 31(8): 822-827.
Mots-clés : INCIDENCE; SITE OPERATOIRE; ETUDE RETROSPECTIVE; APPAREIL URINAIRE;
APPAREIL GENITAL; APPAREIL DIGESTIF
Objective: Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter
recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures
and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI
incidence for open procedures according to national data.
Design: Retrospective cohort study.
Setting: A 689-bed academic medical center.
Patients: All patients who underwent a surgical procedure with use of a robotic surgical system during the
period from 2000-2007.
Methods: SSIs were defined and procedure types were classified according to National Healthcare Safety
Network criteria. National data for comparison were from 1992-2004. Because of small sample size,
procedures were grouped according to surgical site or wound classification.
Results: Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration
was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who
did not (558 vs 318 minutes; P<.001). The prostate and genitourinary group had 5.74 SSIs per 100 robotassisted procedures (95% confidence interval [CI], 2.81-11.37), compared with 0.85 SSIs per 100 open
procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.7930.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33
SSIs per 100 procedures (95% CI, 9.68-70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68-69.43),
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respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a
clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5-10.3), compared with 2.59
SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups.
Conclusions: Increased incidence of SSI after some types of robot-assisted surgery compared with
traditional open surgery may be related to the learning curve associated with use of the robot.
NosoBase n° 28181
Infections du site opératoire dans un centre hospitalier. Etude de cohorte prospective
Suljagic V; Jevtic M; Djordjevic B; Jovelic A. Surgical site infections in a tertiary health care center:
prospective cohort study. Surgery today 2010/08; 40(8): 763-771.
Mots-clés : FACTEUR DE RISQUE; SITE OPERATOIRE; COHORTE; ETUDE PROSPECTIVE;
INCIDENCE; EOH; TAUX; DUREE DE SEJOUR; ANTIBIOPROPHYLAXIE; STAPHYLOCOCCUS
AUREUS; ENQUETE; ENTEROCOCCUS; KLEBSIELLA
Purpose: To investigate the incidence and risk factors associated with the development of surgical site
infections (SSIs) using the National Nosocomial Infection Surveillance (NNIS).
Methods: A prospective cohort study was conducted at a tertiary health care center. Infection control
personnel collected general and health care related data about patients. The NNIS risk index was calculated
on the basis of data relating to the operation: wound contamination class, duration of surgery, and the
American Society of Anesthesiologists (ASA) score.
Results: A total of 5109 surgical procedures were included in the study. The overall cumulative incidence
rate was 6.3%. The incidence of SSIs was 2.3% (63.5% of operative procedures), 8.3% (29.7%), 34.6%
(6.2%), and 43.3% (0.6%), in patients with 0, 1, 2, and 3 risk index, respectively. The length of hospital stay
(OR: 1.0; 95% CI: 1.053-1.075), preoperative length of stay (odds ratio [OR]: 1.9; 95% confidence interval
[CI]: 1.953-1.981), antibiotic prophylaxis (OR: 2.5; 95% CI: 1.421-4.628), drainage (OR: 1.7; 95% CI: 1.3602.353), ASA score (OR: 1.5; 95% CI: 1.235-1.946), class of wound contamination (OR: 2.0; 95% CI: 1.7452.003), and NNIS risk index (OR: 1.3; 95% CI: 1.063-1.7) were independently associated with an increased
risk for SSIs. Staphylococcus aureus was the most frequently isolated microorganism, 64% of them being
methicillin-resistant.
Conclusion: The aim of this study was to investigate the most important risk factors associated with the
development of surgical site infections (SSIs). Therefore, greater attention has been given to adherence to
recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocols.
Coût
NosoBase n° 28185
Estimation de l'impact des infections associées aux soins sur la durée de séjour et les coûts
De Angelis G; Murthy A; Beyersmann J; Harbarth S. Estimating the impact of healthcare-associated
infections on length of stay and costs. Clinical microbiology and infection 2010; in press: 20 pages.
Mots-clés : COUT; DUREE DE SEJOUR; METHODOLOGIE
Healthcare associated infections (HAIs) unquestionably have substantial effects on morbidity and mortality.
However, quantifying the exact economic burden attributable to HAIs still remains a challenging issue.
Inaccurate estimations may arise from two major sources of bias. First, factors other than infection may
affect patients' length of stay (LoS) and health care utilization. Second, HAI is a time-varying exposure, as
the infection can impact on LoS and costs only after the infection has started. The most frequent mistake of
previously published evidence is introducing time-dependent information as time-fixed, assuming that the
impact of such exposure on the outcome was already present on admission. Longitudinal and multistate
models avoid time-dependent bias and address the time-dependent complexity of the data. Appropriate
statistical methods are important in analysis of excess costs and LoS associated with HAI, because
informed decisions and policy developments may depend on them.
NosoBase n° 27932
Comparaison, à partir des données du dossier médical et des demandes d’indemnisation, des coûts
des infections du site opératoire et des endométrites après césarienne
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Olsen MA; Butler AM; Willers DM; Gross GA; Fraser VJ. Comparison of costs of surgical site infection and
endometritis after cesarean delivery using claims and medical record data. Infection control and hospital
epidemiology 2010/08; 31(8): 872-875.
Mots-clés : CESARIENNE; SITE OPERATOIRE; COUT; ENDOMETRE; STATISTIQUE
We used administrative and clinical data from a case-control study to calculate the costs of surgical site
infection and endometritis after cesarean delivery. Attributable costs determined by multivariate generalized
least-squares regression models with the 2 data sets were similar, suggesting that administrative data can
be used to calculate infection costs.
Désinfection
NosoBase n° 27931
Efficacité des solutions hydro-alcooliques dans la désinfection des stéthoscopes
Mehta AK; Halvosa JS; Gould CV; Steinberg JP. Efficacy of alcohol-based hand rubs in the disinfection of
stethoscopes. Infection control and hospital epidemiology 2010/08; 31(8): 870-872.
Mots-clés : DESINFECTION; STETHOSCOPE; CONTAMINATION; SOLUTION HYDROALCOOLIQUE;
HYGIENE DES MAINS; ALCOOL
EHPAD
NosoBase n° 28146
Essai groupé contrôlé randomisé sur la formation en hygiène hospitalière et un programme de
formation centré à des interventions sur Staphylococcus aureus méticillino-résistant dans des
établissements pour personnes âgées (EHPAD)
Baldwin NS; Gilpin DF; Tunney MM; Kearney MP; Crymble L; Cardwell C; et al. Cluster randomised
controlled trial of an infection control education and training intervention programme focusing on
meticillin-resistant Staphylococcus aureus in nursing homes for older people. The Journal of hospital
infection 2010/09; 76(1): 36-41.
Mots-clés : RANDOMISATION; FORMATION;
STAPHYLOCOCCUS
AUREUS; METICILLINORESISTANCE; PERSONNE AGEE; AUDIT; PRATIQUE; PREVALENCE; PERSONNEL; EHPAD;
APPARIEMENT; RISQUE
The aim of this cluster randomised controlled trial was to test the impact of an infection control education
and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing
homes. Nursing homes were randomised to intervention (infection control education and training
programme; N=16) or control (usual practice continued; N=16). Staff in intervention homes were educated
and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with
infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good
practice. Audit scores were fed back to nursing home managers in intervention homes, together with a
written report indicating where practice could be improved. Nasal swabs were taken from all consenting
residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and
staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and
338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff.
The relative risk of a resident being colonised with MRSA in an intervention home compared with a control
home at 12 months was 0.99 (95% confidence interval: 0.69, 1.42) after adjustment for clustering. Mean
infection control audit scores were significantly higher in the intervention homes (82%) compared with the
control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which
may help to reduce MRSA in this setting.
NosoBase n° 28141
Etude de l'incidence des gastro-entérites parmi des personnes âgées résidant dans les
établissements de séjour de longue durée
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Kirk MD; HallGV; Veitch M; Becker N. Assessing the incidence of gastroenteritis among elderly
people living in long term care facilities. The Journal of hospital infection 2010/09; 76(1): 12-17.
Mots-clés : INCIDENCE; GASTRO-ENTERITE; PERSONNE AGEE; SOIN DE LONGUE DUREE; METAANALYSE; MAISON DE RETRAITE; EHPAD; TAUX
We conducted a systematic review and meta-analysis of the literature in order to estimate the incidence of
gastroenteritis in long term care facility (LTCF) residents from published accounts of infection surveillance.
PubMed, Web of Science and Google Scholar were searched using keywords 'long-term care facility',
'nursing home', 'gastroenteritis', 'surveillance', and 'incidence'. We manually searched reference lists of all
articles included. The number of cases of gastroenteritis and bed-days under surveillance was recorded so
as to calculate incidence and assess the influence of the study country and case definition using random
effects meta-analysis and regression. We included one trial and 14 surveillance studies in the analysis, with
47% (7/15) conducted after 1995. One study focused only on gastroenteritis in residents; the remainder
considered a range of infections. There were 2 071 330 combined bed-days under surveillance and 717
cases of gastroenteritis. In all, 194 cases were associated with 10 outbreaks during these studies. We
observed heterogeneity between studies, which may have been due to unreported clustering of
gastroenteritis cases. The mean incidence of gastroenteritis in LTCF residents was 0.40 (95% confidence
interval: 0.27-0.56) episodes per 1000 bed-days. Investigators conducting studies in the USA reported
incidence three times lower than investigators in other countries. Use of a case definition developed
specifically for LTCFs was not associated with a higher incidence of gastroenteritis. From our analysis,
residents could expect to experience gastroenteritis once every 5-10 years, which is a lower rate than that
estimated from point prevalence surveys. New studies are needed to better assess the incidence and
causes of gastroenteritis in LTCF residents.
Environnement
NosoBase n° 27572
L'introduction de l'air en salle propre
Bertin D. Salles propres et maîtrise de la contamination 2010/06; (68): 27-31.
Mots-clés : AIR; BLOC OPERATOIRE; CHOIX
Eléments de base de la gestion du flux aéraulique, les dispositifs d'injection de l'air doivent faire l'objet d'un
choix précis en fonction de la salle propre à laquelle ils se destinent. Il est donc important de maîtriser les
caractéristiques aérauliques (concepts de jets, d'unidirectionnalité, de turbulence...) ainsi que celles des
systèmes eux-mêmes (FFU, plafonds soufflants...).
NosoBase n° 27924
Une approche quantitative de la définition des surfaces à «contacts répétés» dans les hôpitaux
Huslage K; Rutala WA; Sickbert-Bennett E; Weber DJ. A quantitative approach to defining "high-touch"
surfaces in hospitals. Infection control and hospital epidemiology 2010/08; 31(8): 850-853.
Mots-clés : SURFACE; DEFINITION; LIT; MOBILIER; DISPOSITIF MEDICAL; CATHETER VEINEUX;
CONTAMINATION; BIONETTOYAGE; DESINFECTION
Fifty interactions between healthcare workers and patients were observed to obtain a quantifiable definition
of "high-touch" (ie, frequently touched) surfaces based on frequency of contact. Five surfaces were defined
as high-touch surfaces: the bed rails, the bed surface, the supply cart, the over-bed table, and the
intravenous pump.
NosoBase n° 28150
Méthode de filtration au point d'usage pour la prévention de la contamination fungique de l'eau à
l'hôpital
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Warris A; Onken A; Gaustad P; Janssen W; Van Der Lee H; Verweij PE; et al. Point-of-use filtration method
for the prevention of fungal contamination of hospital water. The Journal of hospital infection 2010/09; 76(1):
56-59.
Mots-clés : EAU; PREVENTION; CONTAMINATION; MYCOLOGIE; EFFICACITE; FILTRATION;
ASPERGILLUS FUMIGATUS; CHAMPIGNON FILAMENTEUX; FUSARIUM; PEDIATRIE; SANITAIRE;
ROBINET D'EAU
Published data implicate hospital water as a potential source of opportunistic fungi that may cause lifethreatening infections in immunocompromised patients. Point-of-care filters are known to retain bacteria, but
little is known about their efficacy in reducing exposure to moulds. We investigated the effect of point-of-use
filters (Pall-Aquasafe((R))) on the level of contamination of Aspergillus fumigatus and other filamentous
fungi. The point-of-use filters were applied to several outlets (taps and showers) on the paediatric bone
marrow transplantation (BMT) unit of the National Hospital in Oslo, Norway. In addition the efficacy was
investigated using a test rig. The laboratory experiments showed that the filters were highly effective in
reducing the number of colony-forming units for a period of at least 15 days. In the BMT unit the filters
eliminated the fungi from the water on day 1 but due to particles present in the water the filters occluded,
which prevented further evaluations. Our results show that point-of-use filtration might be an effective
preventive measure to eliminate filamentous fungi at individual points of water use, thereby reducing
patients' exposure.
Epidémie
NosoBase n° 28137
Epidémie d'infections à enterovirus 71 dans une pouponnière
Huang FL; Chen CH; Huang SK; Chen PY. An outbreak of enterovirus 71 in a nursery. Scandinavian journal
of infectious diseases 2010/08; 42(8): 609-612.
Mots-clés : ENTEROVIRUS; EPIDEMIE; NEONATALOGIE; VIRUS; DIARRHEE; RT-PCR; CONTROLE
In this article we report a nosocomial outbreak of enterovirus 71 (EV71) in a newborn nursery and describe
the clinical presentations of infected infants. Community outbreaks of EV71 are quite common in epidemic
areas, but a nosocomial outbreak of EV71 is a rare occurrence. A total of 7 out of 19 infants (37%) had
symptoms. All infants had poor activity, 6 (86%) had fever, 4 (57%) had drowsiness, 3 (43%) had diarrhoea,
and 2 (29%) had oral ulcers. Four infants (57%) suffered from encephalitis. There were no deaths. EV71
was isolated from 3 (43%) of the young infants, while all were positive when tested for EV71 using a reverse
transcription polymerase chain reaction. A sequence analysis of the EV71 partial gene revealed a 98.6100% nucleotide similarity. Control measures included staff hand washing, disinfecting all materials exposed
to potentially infected biological fluid, increasing staff hygiene precautions in the kitchen, and using a
different basin for bathing each baby. We conclude that it is difficult to diagnose EV71 infection in young
infants by clinical presentation alone and, similar to other enteroviruses, EV71 can spread efficiently
amongst young infants in a nursery unit.
NosoBase n° 28144
Le contrôle d'une épidémie hospitalière nécessite les efforts conjugués de l'encadrement, de la
microbiologie et de l'équipe opérationnelle d'hygiène de l'hôpital
Ransjo U; Lytsy B; Melhus A; Aspevall O; Artinger C; Eriksson BM; et al. Hospital outbreak control requires
joint efforts from hospital management, microbiology and infection control. The Journal of hospital infection
2010/09; 76(1): 26-31.
Mots-clés : KLEBSIELLA PNEUMONIAE; EPIDEMIE; CONTROLE; BETA-LACTAMASE A SPECTRE
ELARGI; DEPISTAGE; TRANSMISSION; PROTOCOLE; OBSERVANCE; COUT; HYGIENE DES MAINS;
AUDIT; MICROBIOLOGIE; PERSONNEL; EOH; CENTRE HOSPITALIER UNIVERSITAIRE; PFGE;
MULTIRESISTANCE
An outbreak of multidrug-resistant Klebsiella pneumoniae producing the extended-spectrum beta-lactamase
CTX-M15 affected 247 mainly elderly patients in more than 30 wards in a 1000-bedded swedish teaching
hospital between May 2005 and August 2007. A manual search of the hospital administrative records for
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possible contacts between cases in wards and outpatient settings revealed a complex chain of transmission.
Faecal screening identified twice as many cases as cultures from clinical samples. Transmission occurred
by direct and indirect patient-to-patient contact, facilitated by patient overcrowding. Interventions included
formation of a steering group with economic power, increased bed numbers, better compliance with alcohol
hand disinfection and hospital dress code, better hand hygiene for patients and improved cleaning. The cost
of the interventions was estimated to be euro3 million. Special infection control policies were not necessary,
but resources were needed to make existing policies possible to follow, and for educational efforts to
improve compliance.
Escherichia coli
NosoBase n° 28403
Prévalence des mécanismes de résistance aux fluoroquinolones d'isolats colonisant d'Escherichia
coli de patients hospitalisés
Lautenbach E; Metlay JP; Mao X; Han X; Fishman NO; Bilker WB; et al. The prevalence of fluoroquinolone
resistance mechanisms in colonizing Escherichia coli isolates recovered from hospitalized patients. Clinical
infectious diseases 2010/08/01; 51(3): 280-285.
Mots-clés : ESCHERICHIA COLI; FLUOROQUINOLONE; ANTIBIORESISTANCE; PREVALENCE
Background: Fluoroquinolones are the most commonly prescribed antimicrobials. The epidemiology of fecal
colonization with Escherichia coli demonstrating reduced susceptibility to fluoroquinolones remains unclear.
Methods: During a 3-year period (15 September 2004 through 19 October 2007), all patients hospitalized for
>3 days were approached for fecal sampling. All E. coli isolates with reduced susceptibility to
fluoroquinolones (minimum inhibitory concentration [MIC] of levofloxacin, 0.125 microg/mL) were identified.
We characterized gyrA and parC mutations and organic solvent tolerance. Isolates were compared using
pulsed-field gel electrophoresis.
Results: Of 353 patients colonized with E. coli demonstrating reduced fluoroquinolone susceptibility, 300
(85.0%) had 1 gyrA mutation, 161 (45.6%) had 1 parC mutation, and 171 (48.6%) demonstrated organic
solvent tolerance. The mean numbers of total mutations (ie, gyrA and parC) for E. coli isolates with a
levofloxacin MIC of 8 microg/mL versus <8.0 microg/mL were 2.70 and 0.82 (P < .001). Of the 136 E. coli
isolates with a levofloxacin MIC of 8 microg/mL, 90 (66.2%) demonstrated a nalidixic acid MIC of 16
microg/mL. Significant differences were found over time in the proportion of E. coli isolates demonstrating
gyrA mutation, parC mutation, and organic solvent tolerance. There was little evidence of clonal spread of
isolates.
Conclusions. Gastrointestinal tract colonization with E. coli demonstrating reduced susceptibility to
levofloxacin is common. Although 40% of study isolates exhibited a levofloxacin MIC of <8 microg/mL (and
would thus be missed by current Clinical and Laboratory Standards Institute breakpoints), nalidixic acid
resistance may be a useful marker for detection of such isolates. Significant temporal changes occurred in
the proportion of isolates exhibiting various resistance mechanisms.
Gestion des risques/qualité
NosoBase n° 28088
Une équipe Lean Six Sigma augmente l'observance de l'hygiène des mains et réduit les infections
nosocomiales à SARM de 51 %
Carboneau C; Benge E; Jaco MT; Robinson M. A lean six sigma team increases hand hygiene compliance
and reduces hospital-acquired MRSA infections by 51%. The Journal for healthcare quality 2010; 4(32): 6170.
Mots-clés : STAPHYLOCOCCUS AUREUS; HYGIENE DES MAINS; OBSERVANCE; PREVENTION;
QUALITE; METICILLINO-RESISTANCE; TAUX; METHODOLOGIE; PERSONNEL; CONNAISSANCE;
ENVIRONNEMENT; SURVEILLANCE; PRATIQUE; FORMATION; AUDIT; COUT; GESTION DES
RISQUES
A low hand hygiene compliance rate by healthcare workers increases hospital-acquired infections to
patients. At Presbyterian Healthcare Services in Albuquerque, New Mexico a Lean Six Sigma team
identified the reasons for noncompliance were multifaceted. The team followed the DMAIC process and
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completed the methodology in 12 months. They implemented multiple solutions in the three areas:
Education, Culture, and Environment. Based on methicillin-resistant Staphylococcus aureus (MRSA)
mortality research the team's results included an estimated 2.5 lives saved by reducing MRSA infections by
51%. Subsequently this 51% decrease in MRSA saved the hospital US$276,500. For those readers tasked
with increasing hand hygiene compliance this article will provide the knowledge and insight needed to
overcome multifaceted barriers to noncompliance.
NosoBase n° 28210
Projet COMPAQH 2ème phase (2006-2009). Rapport final
HAS; Haute autorité de santé; INSERM; Institut national de la santé et de la recherche médicale. 2010/06;
72 pages.
Mots-clés : INDICATEUR; GESTION DES RISQUES; MORTALITE; USAGER; QUALITE; TRACABILITE;
ESCARRE
Le présent rapport développe les travaux menés dans le cadre du projet de Coordination de la Mesure et
Amélioration de la Performance Hospitalière (COMPAQH) durant la période 2006-2009. L'objectif général de
COMPAQH est d'apporter aux pouvoirs publics et aux professionnels travaillant au sein des établissements
de santé des outils de mesure, et un éclairage sur de nouvelles formes d'amélioration de la qualité des soins
fondées sur ces mesures.
NosoBase n° 27839
Evaluation de la préparation des systèmes de santé vis-à-vis des maladies infectieuses émergentes :
un nouveau dispositif conceptuel et analytique
Krumkamp R; Mounier-Jack S; Ahmad A; Reintjes R; Coker R. Evaluating health systems' preparedness
for emerging infectious diseases: a novel conceptual and analytic framework. Health policy 2010; in press:
7 pages.
Mots-clés : GESTION DES RISQUES;
PREVENTION; QUALITE
GRIPPE; EPIDEMIE; HACCP; METHODOLOGIE; CONTROLE;
In this article we present a novel conceptual framework for systematically assessing the national health
system capacity to respond to pandemic influenza. This framework helps to determine how health systems
and pandemic programmes interact, whether, where and which weak points exist, and how and where
pandemic response health programmes can be improved effectively. This new conceptual framework draws
upon two existing approaches for assessment and evaluation, the Systemic Rapid Assessment Toolkit
(SYSRA) and the Hazard Analysis of Critical Control Points (HACCP). SYSRA is a systematic approach to
analyse the interplay between communicable disease programmes and the broader health systems context
within which they operate and the HACCP methodology builds upon a systematic analysis of process steps
within a programme in order to identify likely hazards and to develop control measures to address them. The
analytical framework that we have developed from the novel conceptualisation is simple, can be applied
rapidly, and should, we believe, be low cost to implement. Thus, this provides a means for developing a
contextual understanding of the broader health system in which a pandemic infectious disease programme
operates, and for identifying frailties in programmes that need to be responded to.
Grippe
NosoBase n° 21685
Prévention et contrôle de la grippe par la vaccination : recommandations de l'Advisory Committee
on Immunization Practices (ACIP), 2010
CDC; Centers for disease control and prevention. Prevention and Control of Influenza with Vaccines:
Recommendations of the Advisory Committee on Immunization. Practices (ACIP), 2010. MMWR Morbidity
and mortality weekly report 2010/08/06; 59(RR-8): 1-62.
Mots-clés : GRIPPE; VACCIN; RECOMMANDATION; PREVENTION; EPIDEMIOLOGIE
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This report updates 2009 recommendations by CDC.s Advisory Committee on Immunization Practices
(ACIP) regarding the use of influenza vaccine for the prevention and control of influenza. Highlights of the
2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons
aged >or= 6 months for the 2010.11 influenza season; 2) a recommendation that children aged 6 months.8
years whose vaccination status is unknown or who have never received seasonal influenza vaccine before
(or who received seasonal vaccine for the first time in 2009.10 but received only 1 dose in their first year of
vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009
monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010.11
seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010.11 season; 3) a recommendation
that vaccines containing the 2010.11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the
same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and
B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved
vaccine for persons aged >or= 65 years; and 5) information about other standard-dose newly approved
influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts
should begin as soon as the 2010.11 seasonal influenza vaccine is available and continue through the
influenza season.
Hygiène des mains
NosoBase n° 28145
Influence de l'ancienneté dans le poste, de la formation sur l'hygiène des mains et des ratio patientinfirmier sur l'observance de l'hygiène des mains
Buffet-Bataillon S; Leray E; Poisson M; Michelet C; Bonnaure-Mallet M; Cormier M. Influence of job
seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance. The Journal
of hospital infection 2010/09; 76(1): 32-35.
Mots-clés : HYGIENE DES MAINS; FORMATION; PERSONNEL;
MULTIVARIEE; CENTRE HOSPITALIER UNIVERSITAIRE; AUDIT
OBSERVANCE;
ANALYSE
Hand hygiene compliance was evaluated by direct observation in 2006 and 2007. In 2007, data on
characteristics such as job seniority, hand hygiene education, and patient-to-nurse ratio during direct
observations were collected. A hand hygiene promotional programme was performed between the two
evaluations. Univariate and multivariate analysis identified factors associated with improved hand hygiene
compliance. Between 2006 and 2007, from 761 hand hygiene opportunities, overall and partial compliance
improved from 44.9% to 58% (P<0.001) and from 73.5% to 88.4% (P<0.001), respectively. In 2007,
improvements in hand hygiene overall or partial compliance were seen when senior healthcare workers
(HCWs) were present in the clinical area under investigation (P=0.04 or P=0.08, respectively). Partial hand
hygiene compliance was significantly better in 2007 after a hand hygiene educational programme had been
presented (P<0.015). Similar rates of compliance were observed whatever the patient-to-nurse ratio during
the observation. Multivariate analysis identified job seniority as an independent predictor of hand hygiene
compliance. Our results suggest that hand hygiene compliance is influenced by education on hand hygiene
and that a senior HCW could act as a role model for other HCWs. These data should be considered when
developing future hygiene interventions.
NosoBase n° 28233
Les sessions de formation de courte durée sur l'hygiène des mains sont-elles efficaces dans la
prévention des infections nosocomiales à SARM ? Analyse de séries temporelles
Conrad A; Kaier K; Frank U; Dettenkofer M. Are short training sessions on hand hygiene effective in
preventing hospital-acquired MRSA? A time-series analysis. American journal of infection control 2010/09;
38(7): 559-561.
Mots-clés : HYGIENE DES MAINS; PREVENTION; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; EFFICACITE; ANALYSE; FORMATION; INCIDENCE; SOLUTION HYDROALCOOLIQUE;
PRODUIT DE FRICTION POUR LES MAINS
We tested the impact of short hand hygiene training sessions and bed occupancy rates on the spread of
hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a multivariate time-series)
analysis. According to our model, bed occupancy rates within general ward and intensive care unit settings
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correlated positively with the incidence of hospital-acquired MRSA, whereas alcohol-based hand rub use
and MRSA showed a negative correlation. Furthermore, our model shows that 2 hand hygiene campaigns
based on short training sessions effected a long-run reduction in the incidence of hospital-acquired MRSA.
NosoBase n° 27934
Taux d’observance aux pratiques d’hygiène des mains et au port de gants dans 2 centres de
rééducation en faisant la distinction entre des contacts uniques et des séries de contacts successifs
avec les patients ou l’environnement
Eveillard M; Rabjeau A; Pradelle MT; Raymond F; Joly-Guillou ML; Brunel P. Rates of adherence to hand
hygiene and gloving practices in 2 french rehabilitation hospitals by differentiation between single contacts
and series of successive contacts with patients or the environment. Infection control and hospital
epidemiology 2010/08; 31(8): 878-879.
Mots-clés : GANT; ENVIRONNEMENT; OBSERVANCE; TAUX; ETUDE PROSPECTIVE; HYGIENE DES
MAINS; REEDUCATION; AUDIT
NosoBase n° 27915
Les taux d’observance à l’hygiène des mains mesurés dans un service de soins intensifs : une étude
comparative par observation directe, consommation de produits et dispositifs électroniques de
comptage
Marra AR; Moura DF; Tavares Paes A; Pavao dos Santos OF; Edmond MB. Measuring rates of hand
hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage,
and electronic counting devices. Infection control and hospital epidemiology 2010/08; 31(8): 796-801.
Mots-clés : SOIN INTENSIF; OBSERVANCE; HYGIENE DES MAINS; AUDIT; TAUX; CONSOMMATION;
PRODUIT HYDROALCOOLIQUE
Objective: To compare 3 measures of hand hygiene adherence-direct observation, product usage, and
electronic counting devices-in an intensive care unit.
Design: A 12-week observational study.
Setting: A 40-bed medical-surgical intensive care unit at a private tertiary care hospital.
Methods: Over a 12-week period, we assessed hand hygiene adherence by 3 different methods: direct
observation of practice, collection of data from electronic counters for dispensers of alcohol-based hand rub,
and measurement of the amount of product used (alcohol-based hand rub and chlorhexidine).
Results: There were 2,249 opportunities for hand hygiene observed, and the overall rate of hand hygiene
adherence was 62.3% (representing 1,402 cleansing episodes). A total of 76,389 dispensing episodes were
recorded by the electronic devices. The mean number of dispensing episodes per patient-day was 53.8.
There was 64.1 mL of alcohol-based hand rub used per patient-day (representing 65.5% of total product
used) and 33.8 mL of chlorhexidine used per patient-day (representing 34.5%). There was no significant
correlation between observed hand hygiene adherence and total product used per patient-day (r=0.18;
P=.59).
Conclusions: Direct observation cannot be considered the gold standard for assessing hand hygiene,
because there was no relationship between the observed adherence and the number of dispensing
episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as
electronic devices and measurement of product usage, should be considered.
NosoBase n° 28228
Variation diurne de l'observance de l'hygiène des mains dans une unité de réanimation
multidisciplinaire d'un centre hospitalier universitaire
Sahay S; Panja S; Ray S; Rao BK. Diurnal variation in hand hygiene compliance in a tertiary level
multidisciplinary intensive care unit. American journal of infection control 2010/09; 38(7): 535-539.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; SOIN INTENSIF; PERSONNEL; ETUDE
PROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE; TAUX; LAVAGE DES MAINS; LAVAGE
HYGIENIQUE DES MAINS; INFIRMIER; MEDECIN; TECHNICIEN
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Background: Hand hygiene compliance among health care providers is considered to be the single most
effective factor to reduce hospital acquired infections. Despite continuous education and awareness,
compliance with hand hygiene guidelines has remained low, particularly during evening shifts.
Objective: Our objective was to determine the compliance with hand hygiene guidelines among doctors,
nurses, and paramedical staff during day and night duties in a multidisciplinary intensive care unit (ICU).
Methods: We used a prospective, observational, 6-month study conducted in a 34-bed ICU within a tertiary
care teaching hospital. All doctors, nurses, and paramedical staff in the ICU were included. An investigator,
placed within the ICU setting, observed the hand hygiene practices during day and night. Day and night shift
change times were 08:00 and 20:00 hours, respectively.
Results: Of the 5639 opportunities for hand hygiene, 3383 (59.9%) were properly performed. Overall rates of
compliance were 66.1% for doctors, 60.7% for nurses, and 38.6% for paramedical staff. Hand hygiene
compliance dropped during the night for doctors (81%vs 46%, respectively, P < .001), for nurses (64% vs
55%, respectively, P = .02), and for paramedical staff (44% vs 31%, respectively, P = .01). Characterization
of noncompliance is as follows: Nohandwashing after procedure in 41%, improperduration of handwashing
in 32%, and no handwashing done at all.. in 27%of the events...No handwashing done at all occurred in
55% of the time at night with doctors having the highest rate of noncompliance, making 163 (34%) contacts
without handwashing.
Conclusion: Whereas compliance with hand hygiene guidelines was lower at night compared with day,
irrespective of discipline in all 3 groups of health care providers, both periods of compliance would benefit
from additional training focusing on the importance of hand hygiene around the clock.
NosoBase n° 28173
L'hygiène des mains en réanimation
Tschudin-Sutter S; Pargger H; Widmer AF. Hand hygiene in the intensive care unit. Critical care medicine
2010/08; 38 (Supplément 8): S299-S305.
Mots-clés : HYGIENE DES MAINS; SOIN INTENSIF; SOLUTION HYDROALCOOLIQUE; OBSERVANCE;
PERSONNEL; PRODUIT DE FRICTION POUR LES MAINS; TRANSMISSION; CLOSTRIDIUM DIFFICILE;
NOROVIRUS; BACILLUS ANTHRACIS; TOLERANCE; ATTITUDE; BIBLIOGRAPHIE
Healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the World
Health Organization. In intensive care units, the burden of healthcare-associated infections is greatly
increased, causing additional morbidity and mortality. Multidrug-resistant pathogens are commonly involved
in such infections and render effective treatment challenging. Proper hand hygiene is the single most
important, simplest, and least expensive means of preventing healthcare-associated infections. In addition, it
is equally important to stop transmission of multidrug-resistant pathogens. According to the Centers for
Disease Control and Prevention and World Health Organization guidelines on hand hygiene in health care,
alcohol-based handrub should be used as the preferred means for routine hand antisepsis. Alcohols have
excellent in vitro activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant
pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci,
Mycobacterium tuberculosis, a variety of fungi, and most viruses. Some pathogens, however, such as
Clostridium difficile, Bacillus anthracis, and noroviruses, may require special hand hygiene measures.
Failure to provide user friendliness of hand hygiene equipment and shortage of staff are predictors for
noncompliance, especially in the intensive care unit setting. Therefore, practical approaches to promote
hand hygiene in the intensive care unit include provision of a minimal number of handrub dispensers per
bed, monitoring of compliance, and choice of the most attractive product. Lack of knowledge of guidelines
for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of
awareness of the risk of cross-transmission of pathogens are barriers to good hand hygiene practices.
Multidisciplinary programs to promote increased use of alcoholic handrub lead to an increased compliance
of healthcare workers with the recommended hand hygiene practices and a reduced prevalence of
nosocomial infections.
Klebsiella pneumoniae
NosoBase n° 28153
Epidémie hospitalière à Klebsiella pneumoniae productrices de bêta-lactamase KPC-2 résistant à la
colistine
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Kontopoulou K; Protonotariou E; Vasilakos K; Kriti M; Koteli A; Antoniadou E; et al. Hospital outbreak
caused by Klebsiella pneumoniae producing HPC-2 beta-lactamase resistant to colistin. The Journal of
hospital infection 2010/09; 76(1): 70-73.
Mots-clés : KLEBSIELLA PNEUMONIAE; EPIDEMIE; BETA-LACTAMASE A SPECTRE ELARGI;
COLISTINE; PCR; CARBAPENEME
We describe a hospital outbreak caused by colistin-resistant Klebsiella pneumoniae producing KPC-2 blactamase in two distinct medical centres. Seven clinical isolates of K. pneumoniae exhibiting resistance to
carbapenems were collected from patients with hospital-acquired infection. All isolates were phenotypically
positive for carbapenemase activity but negative for metallo-b-lactamase production. PCR analysis using
specific primers for blaKPC, blaSHV, blaTEM and blaCTX-M demonstrated that all clinical strains of K.
pneumoniae from hospital A and one isolate from hospital B were genetically related and carried blaKPC-2
in addition to blaSHV-12. In contrast, the remaining isolate carried blaSHV-5 with blaKPC-2 and yielded a
different profile. These results indicate the clonal spread of KPC producers between hospitals as well as the
acquisition of KPC genes by different K. pneumoniae strains. All isolates were resistant to carbapenems, blactams, ciprofloxacin, aminoglycosides and colistin, but intermediately susceptible to tigecycline and
susceptible to gentamicin. The infection was fatal in five cases. The emergence of colistinresistant K.
pneumoniae possessing blaKPC-2 underscores the implementation of strict control measures to prevent
their dissemination of these organisms in hospitals.
NosoBase n° 28152
Colonisation à Klebsiella spp produisant des bêta-lactamases à spectre élargi dans une unité de
réanimation pédiatrique
Levy SS; Mello M; Gusmao-Filho F; Correia JB. Colonisation by extended-spectrum beta-lactamaseproducing Klebsiella spp. in a paediatric intensive care unit. The Journal of hospital infection 2010/09;
76(1): 66-69.
Mots-clés : PEDIATRIE; SOIN INTENSIF; COLONISATION; BETA-LACTAMASE A SPECTRE ELARGI;
KLEBSIELLA; COHORTE; ETUDE PROSPECTIVE; INCIDENCE; FACTEUR DE RISQUE; TAUX;
ANALYSE MULTIVARIEE; CEPHALOSPORINE TROISIEME GENERATION; COLONISATION DIGESTIVE
A prospective cohort study was performed in order to study the incidence and risk factors for bacterial
colonisation with extended-spectrum producing beta-lactamase (ESBL) Klebsiella spp. in children. The study
took place in a paediatric intensive care unit (PICU) in Recife, Brazil over a five-month period in 2008. Rectal
swabs were collected during the first 24h of admission and on the 2nd, 5th, 7th and 14th days of PICU stay.
ESBL-producing strains of Klebsiella spp. were detected by Kirby-Bauer disc diffusion and confirmed by
double disc synergy testing. A total of 186 children were enrolled with a median age of three years. The
overall colonisation rate with ESBL-producing Klebsiella spp. was 14%, but 13 (7%) children were already
colonised upon admission. The incidence density of colonisation during PICU admission was 14.2 per 1000
patient-days. On multivariable analysis, the use of third generation cephalosporins (P=0.008) was a risk
factor for colonisation. Survival analysis revealed an increase in the accumulated risk of colonisation with an
increase in length of stay in the PICU. The present study provides baseline information to guide improved
practices in similar settings and direct future studies in relation to the magnitude of cross-infection and
effectiveness of infection control interventions.
Législation
NosoBase n° 28018
Décret n° 2010-805 du 13/07/2010 relatif aux missions, à l'autorisation et aux conditions techniques
d'organisation et de fonctionnement des lactariums
Ministère de la santé et des sports. Journal officiel 2010/07/16; 4 pages.
Mots-clés : LEGISLATION; LAIT; BANQUE DE LAIT; MEDECIN; SAGE-FEMME
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NosoBase n° 27984
Circulaire DGS/RI1/n°2010-163 du 17/05/2010 relative aux modalités de mise en oeuvre du plan antidissémination du chikungunya et de la dengue en métropole
Santé publique; Ministère du travail, de la solidarité et de la fonction publique; Ministère de la santé et des
sports. BO Santé 2010/07/15; 250-296.
Mots-clés : LEGISLATION; CHIKUNGUNYA; DECLARATION;
BIOLOGIQUE; RISQUE; PREVENTION; INFORMATION
SURVEILLANCE;
DIAGNOSTIC
La présente circulaire définit les mesures à mettre en oeuvre dans le but de limiter le risque de circulation
des virus chikungunya et dengue en métropole.
Mortalité
NosoBase n° 27928
Caractéristiques des infections associées aux soins responsables de décès hospitaliers imprévus
Morgan DJ; Lomotan LL; Agnes K; Mcgrail L; Roghmann MC. Characteristics of healthcare-associated
infections contributing to unexpected in-hospital deaths. Infection control and hospital epidemiology
2010/08; 31(8): 864-866.
Mots-clés : MORTALITE; ETUDE RETROSPECTIVE; BACTERIEMIE; CATHETER VEINEUX CENTRAL;
ENTEROBACTERIE; MULTIRESISTANCE
We reviewed the medical records of all the patients who died in our hospital during the period from 2004
through 2008 to determine the contribution of healthcare-associated infections to mortality. Of the 179
unexpected in-hospital deaths during that period, 55 (31%) were related to 69 healthcare-associated
infections. The most common healthcare-associated infection was central line-associated bloodstream
infection, and the most common organisms identified were members of the Enterobacteriaceae family.
Overall, 45% of bacterial isolates were multidrug resistant.
NosoBase n° 28078
Facteurs de risque d'acquisition et mortalité dûe aux infections nosocomiales à Staphylococcus
aureus méticillino-résistant (SARM) dans une unité de réanimation
Wang FD; Chen YY; Chen TL; Lin YT; Fung CP. Risk factors and mortality of nosocomial infections of
methicillin-resistant Staphylococcus aureus in an intensive care unit. Journal of critical care 2010; in press :
7 pages.
Mots-clés : FACTEUR DE RISQUE; MORTALITE; STAPHYLOCOCCUS AUREUS; METICILLINORESISTANCE; SOIN INTENSIF; COHORTE; ETUDE PROSPECTIVE; APPAREIL RESPIRATOIRE;
BACTERIEMIE; DUREE DE SEJOUR; VENTILATION ASSISTEE; CATHETER VEINEUX CENTRAL;
ANALYSE
Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) infections are an increasing worldwide
problem. We determined risk factors and predictors of mortality of MRSA nosocomial infections (NIs).
Materials and methods: A prospective cohort study was performed in an adult mixed medical and surgical
intensive care unit from 2003 to 2007. Stratified analyses and generalized linear modeling were used to
assess risk factors and predictors of infection and mortality.
Results: A total of 184 infections (3.6% of all infections) were due to S aureus, and 97.8% of these were
methicillin resistant. The most common infection sites were respiratory tract (35.6%) and bloodstream
(30.6%). Stratified analyses of length of stay (LOS) before onset of MRSA NI and death indicated that
MRSA infection (odds ratio [OR], 38.49; 95% confidence interval [CI], 25.53-58.09) and mortality (OR, 4.72;
95% CI, 1.92-11.99) were more likely for LOS more than 15 days than for LOS less than 7 days. After
controlling for potentially confounding factors by use of generalized linear modeling analysis, we identified
the following as independent risk factors: LOS before onset of MRSA infection (OR, 1.03; 95% CI, 0.011.04), serum creatinine (OR, 5.87; 95% CI, 1.37-9.21) level, use of mechanical ventilator (OR, 6.71; 95% CI,
1.58-8.5), and central venous catheter (OR, 1.13; 95% CI, 1.05-1.31).
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Conclusions: Methicillin resistance is very common with S aureus infection. In our intensive care unit, use of
invasive devices/procedures and LOS were the most important risk factors for infection.
Personnel
NosoBase n° 28143
Etude pilote contrôlée randomisée destinée à comparer le facteur de filtration d'un nouveau masque
HEPA testé non ajusté et celui d'un masque N95 testé ajusté
Au SS; Gomersall CD; Leung P; Li PT. A randomised controlled pilot study to compare filtration factor of a
novel non-fit-tested high-efficiency particulate air (HEPA) filtering facemask with a fit-tested N95 mask. The
Journal of hospital infection 2010/09; 76(1): 23-25.
Mots-clés : MASQUE; RANDOMISATION;
EFFICACITE; ETUDE PROSPECTIVE
AIR;
FILTRATION;
PREVENTION;
TRANSMISSION;
Use of a fit-tested N95 or FFP2 mask is recommended to protect against transmission of airborne
pathogens. This poses considerable logistic problems when preparing for, or dealing with, an epidemic.
Some of these problems might be overcome by use of a compact reusable high-efficiency particulate air
filtering mask that can be cut to size. We carried out a randomised controlled cross-over study to compare
the efficacy of such a mask (Totobobo, Dream Lab One Pte Ltd, Singapore) with fit-tested N95 masks (1860
or 1860s or 1862; 3M, St Paul, MN, USA) in 22 healthy volunteers. The median (interquartile range)
reduction in airborne particle counts was significantly higher [193-fold (145-200)] for N95 masks than for
Totobobo masks [135-fold (83-184)] (P<0.05). There was no statistically significant difference between the
proportion of subjects achieving a reduction of >/=100-fold between N95 (19/22) and Totobobo (16/22)
masks. We conclude that use of the Totobobo mask without fit testing cannot be recommended, but its
performance is sufficiently promising to warrant further investigation.
NosoBase n° 28138
Epidémie de varicelle parmi le personnel infirmier exposé à un patient présentant un zona localisé
Saidel-Odes L; Borer A; Riesenberg K; Frenkel A; Sherlis R; Bouhnick L; et al. An outbreak of varicella in
staff nurses exposed to a patient with localized herpes zoster. Scandinavian journal of infectious diseases
2010/08; 42(8): 620-622.
Mots-clés : VARICELLE; EPIDEMIE; PERSONNEL; HERPES ZOSTER VIRUS; TRANSMISSION; RISQUE
PROFESSIONNEL; DIAGNOSTIC; ZONA
An outbreak of varicella occurred in an internal medicine ward. The outbreak comprised 3 nurses, 2 of whom
were directly exposed to an immunocompetent patient with localized herpes zoster. Our observation
provides an argument for airborne precautions in hospitalized patients with localized herpes zoster.
NosoBase n° 28174
Protection du personnel soignant vis-à-vis des risques de maladies infectieuses
Weber DJ; Rutala WA; Schaffner W. Lessons learned: protection of heatlhcare workers from infectious
disease risks. Critical care medicine 2010/08; 38 (Supplément 8): S306-S314.
Mots-clés : PERSONNEL; RISQUE PROFESSIONNEL; PREVENTION; BIBLIOGRAPHIE; SOIN INTENSIF;
VACCIN; IMMUNITE; PRECAUTION STANDARD; PRECAUTION COMPLEMENTAIRE; HYGIENE DES
MAINS; TUBERCULOSE; HERPES ZOSTER VIRUS; GRIPPE; BORDETELLA PERTUSSIS; NEISSERIA
MENINGITIDIS; ROUGEOLE; RUBEOLE; OREILLONS; HEPATITE B
Objective: To summarize current concepts on preventing occupationally acquired infections in healthcare
workers.
Design: Review of the pertinent medical literature.
Settings: Focus on healthcare workers practicing in acute care hospitals, especially intensive care units.
Subjects: Healthcare workers.
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Measurements and main results: Key components of an effective infection control program include the
following: 1) pre-exposure immunization with vaccines to prevent mumps, measles, rubella, varicella,
pertussis, hepatitis B, and viral influenza; 2) adherence to standard precautions when providing patient care,
especially the performance of hand hygiene before and after patient care; 3) rapid evaluation and initiation of
appropriate isolation precautions for patients with potentially communicable diseases; 4) proper use of
personal protective equipment such as masks, N95 respirators, eye protection, and gowns when caring for
patients with potentially communicable diseases; and 5) evaluation of personnel with exposure to
communicable diseases for receipt of postexposure prophylaxis.
Conclusions: Risks of acquisition of infectious diseases by healthcare workers can be minimized by
adherence to current infection control guidelines.
Pneumonie
NosoBase n° 28231
Diminution des pneumonies acquises sous ventilation dans des unités de réanimation pour adultes
à l'aide du faisceau de mesures de l'Institut pour l'amélioration des soins de santé
Al-Tawfiq JA; Abed MS. Decreasing ventilator-associated pneumonia in adult intensive care units using the
institute for healthcare improvement bundle. American journal of infection control 2010/09; 38(7): 552-556.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; SOIN INTENSIF; PREVENTION; CENTRE
HOSPITALIER GENERAL; TAUX; COUT; DUREE DE SEJOUR; QUALITE; CHIMIOPROPHYLAXIE;
PERSONNEL; FORMATION; AGE; OBSERVANCE; PROTOCOLE
Background: Ventilator-associated pneumonia (VAP) increases in-hospital mortality of ventilated patients to
46%, compared with 32% for ventilated patients who do not develop VAP. In addition, VAP prolongs time
spent on the ventilator, length of intensive care unit (ICU) stay, and length of hospital stay.
Methods: In this study, we implemented VAP bundle to decrease the rate of VAP infection. This is a pre- and
postintervention trial beginning in 2006 to decrease the rate of VAP in adult ICUs after initiation of the
Institute for Healthcare Improvement (IHI) VAP bundle compared with the VAP rate for the preceding 12
months. The study was conducted at a private general hospital in Saudi Arabia. The study included all adult
patients who were on mechanical ventilation from 2006 to 2008. An interdisciplinary performance
improvement team was formed. The team implemented an evidence-based VAP bundle adopted from the
IHI.
Results: The implementation of the VAP prevention bundle resulted in the reduction of VAP rates from a
mean of 9.3 cases per 1000 ventilator-days in fiscal year 2006 to 2.3 cases per 1000 ventilator-days in 2007
and to 2.2 in 2008 (P < .001). It is estimated that each VAP case increases the hospital length of stay
attributable by 10 days and the mean hospital cost by $40,000. Thus, the potential decrease in hospital cost
is $780,000 annually. Conclusion: Implementing the IHI VAP bundle significantly resulted in the reduction of
the VAP rate with potential great cost avoidance.
NosoBase n° 28132
Prévention des pneumonies acquises sous ventilation
Klompas M. Prevention of ventilator-associated pneumonia Expert review of anti-infective therapy 2010/07;
8(7): 791-800.
Mots-clés : PREVENTION; BIBLIOGRAPHIE; PNEUMONIE; VENTILATION ASSISTEE; SURVEILLANCE;
QUALITE; INTUBATION; DECUBITUS
Ventilator-associated pneumonia (VAP) is an important source of morbidity and mortality in critically ill
patients. Many interventions are touted to prevent VAP but studies supporting these interventions are
difficult to interpret owing to an exceedingly poor correlation between clinical diagnosis of VAP and the
presence of an invasive pneumonia. There is consequently a risk that purported decreases in VAP rates
may reflect decreases in oropharyngeal colonization rates more than reductions in invasive disease. To
circumvent this source of error, it is critical to assess the impact of intervention measures on patient
outcomes rather than on VAP rates alone. This article will review selected VAP prevention methods using
this framework and advocate for the development of a new surveillance definition that will more reliably
predict patient outcomes.
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Prévention
NosoBase n° 28172
Utiliser l'ingéniérie des facteurs humains pour améliorer l'efficacité de la prévention et du contrôle
du risque infectieux
Anderson J; Gosbee LL; Bessesen M; Williams L. Using human factors engineering to improve the
effectiveness of infection prevention and control. Critical care medicine 2010/08; 38 (Supplément 8): S269S281.
Mots-clés : PREVENTION; CONTROLE; EFFICACITE; PERSONNEL; OBSERVANCE; SURVEILLANCE;
RECOMMANDATION; HYGIENE DES MAINS; DISPOSITIF MEDICAL; CHAMBRE; SURFACE; GESTION
DES RISQUES
Human factors engineering is a discipline that studies the capabilities and limitations of humans and the
design of devices and systems for improved performance. The principles of human factors engineering can
be applied to infection prevention and control to study the interaction between the healthcare worker and the
system that he or she is working with, including the use of devices, the built environment, and the demands
and complexities of patient care. Some key challenges in infection prevention, such as delayed feedback to
healthcare workers, high cognitive workload, and poor ergonomic design, are explained, as is how human
factors engineering can be used for improvement and increased compliance with practices to prevent
hospital-acquired infections.
Prion
NosoBase n° 28180
Surveillance de la maladie de Creutzfeldt-Jakob en Australie : mise à jour 2010
Klug GM; Boyd A; Mcglade A; Stehmann C; Masters CL; Collins SJ. Surveillance of Creutzfeldt-Jakob
disease in Australia: 2010 update. Communicable diseases intelligence 2010/06; 34(2): 96-101.
Mots-clés : SURVEILLANCE; MALADIE DE CREUTZFELDT-JAKOB; AGENT TRANSMISSIBLE NON
CONVENTIONNEL; DIAGNOSTIC
Surveillance of all human prion diseases in Australia has been the responsibility of the Australian National
Creutzfeldt-Jakob Disease Registry (ANCJDR) on behalf of the Australian Government Department of
Health and Ageing since the Registry's inception in October 1993. The ANCJDR was established in
response to the identification of 4 CJD deaths in recipients of human-derived pituitary hormone. The initial
brief was to perform focused surveillance for any further iatrogenic cases of CJD; however the scope of
surveillance was soon expanded to include all cases of CJD occurring in Australia both prospectively and
retrospectively to 1970. The activities of the ANCJDR have evolved from: routine surveillance
responsibilities to detailed epidemiological analysis at both national and international levels; expert advice in
relation to, and management of, infection control issues; and the provision of a number of tests to aid the
diagnosis and classification of CJD in suspect cases. In this brief report, surveillance outcomes are
examined with the inclusion of figures from the reporting period of 1 April 2009 to 31 March 2010 and the
diagnostic services offered by the ANCJDR are outlined to provide a greater insight into this aspect of the
Registry.
NosoBase n° 28154
Décontamination automatisée des prions qui adhérent sur des surfaces
Schmitt A; Westner IM; Resnicek L; Michels W; Mitteregger G; Kretzchmar HA. Automated decontamination
of surface-adherent prions. The Journal of hospital infection 2010/09; 76(1): 74-79.
Mots-clés : SURFACE; AGENT TRANSMISSIBLE NON CONVENTIONNEL; REUTILISABLE; DISPOSITIF
MEDICAL; DECONTAMINATION; PREVENTION; LAVEUR-DESINFECTEUR
At present there is no routinely available decontamination procedure in washer-disinfectors to allow the
reliable inactivation and/or elimination of prions present on reusable surgical instruments. This means that is
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not possible to provide assurance for preventing iatrogenic transmission of prion diseases. We need
effective procedures in prion decontamination that can be integrated into the usual routine of reprocessing
surgical instruments. This article reports on the evaluation of an automated process designed to
decontaminate prions in washer-disinfectors using a quantitative, highly sensitive in vivo assay for surfaceadherent 22L prions. The automated process showed great advantages when compared with conventional
alkaline cleaning. In contrast, the new process was as effective as autoclaving at 134 degrees C for 2h and
left no detectable prion infectivity, even for heavily contaminated surfaces. This indicates a reduction of
surface-adherent prion infectivity of >7log units. Due to its compatibility with even delicate surgical
instruments, the process can be integrated into the large scale reprocessing of instruments in a central
sterile supply department. The system could potentially make an important contribution to the prevention of
iatrogenic transmission of prions.
Soins intensifs
NosoBase n° 28175
Reconnaître et prévenir les pneumonies nosocomiales en réanimation et contrôle du risque
infectieux lors de la ventilation assistée
Morrow LE; Kollef MH. Recognition and prevention of nosocomial pneumonia in the intensive care unit and
infection control in mechanical ventilation. Critical care medicine 2010/08; 38 (Supplément 8): S352-S362.
Mots-clés : PREVENTION; PNEUMONIE; SOIN INTENSIF; DIAGNOSTIC; CONTROLE; VENTILATION
ASSISTEE; MULTIRESISTANCE; PROTOCOLE; INFORMATIQUE; ANTIBIOTIQUE; TRAITEMENT
Nosocomial pneumonia (NP) is a difficult diagnosis to establish in the critically ill patient due to the presence
of underlying cardiopulmonary disorders (e.g., pulmonary contusion, acute respiratory distress syndrome,
atelectasis) and the nonspecific radiographic and clinical signs associated with this infection. Additionally,
the classification of NP in the intensive care unit setting has become increasingly complex, as the types of
patients who develop NP become more diverse. The occurrence of NP is especially problematic as it is
associated with a greater risk of hospital mortality, longer lengths of stay on mechanical ventilation and in
the intensive care unit, a greater need for tracheostomy, and significantly increased medical care costs. The
adverse effects of NP on healthcare outcomes has increased pressure on clinicians and healthcare systems
to prevent this infection, as well as other nosocomial infections that complicate the hospital course of
patients with respiratory failure. This manuscript will provide a brief overview of the current approaches for
the diagnosis of NP and focus on strategies for prevention. Finally, we will provide some guidance on how
standardized or protocolized care of mechanically ventilated patients can reduce the occurrence of and
morbidity associated with complications like NP.
NosoBase n° 28177
Reconnaître et prévenir les infections urinaires associées aux soins en réanimation
Shuman EK; Chenoweth CE. Recognition and prevention of healthcare-associated urinary tract infections in
the intensive care unit. Critical care medicine 2010/08; 38 (Supplément 8): S373-S379.
Mots-clés : PREVENTION; SOIN INTENSIF; INFECTION URINAIRE; BIBLIOGRAPHIE; CATHETER;
SONDAGE URINAIRE; DIAGNOSTIC; PREVENTION; EPIDEMIOLOGIE; SURVEILLANCE; TRAITEMENT;
ENTEROCOCCUS; CANDIDA; BACILLE GRAM NEGATIF; STAPHYLOCOCCUS AUREUS
Urinary tract infection is the most common healthcare-associated infection in the intensive care unit and
predominantly occurs in patients with indwelling urinary catheters. The predominant microorganisms causing
catheter-associated urinary tract infection (CAUTI) in the intensive care unit are enteric Gram-negative
bacilli, enterococci, Candida species, and Pseudomonas aeruginosa. Multidrug resistance is a significant
problem in urinary pathogens. Duration of catheterization is the most important risk factor for development of
CAUTI. Diagnosis, particularly in the intensive care unit setting, is very difficult, as asymptomatic bacteriuria
may be difficult to differentiate from symptomatic CAUTI. In general, asymptomatic bacteriuria should not be
treated, and treatment of CAUTI often requires removal of the catheter along with systemic antimicrobial
therapy. General strategies for prevention of CAUTI apply to all healthcare-associated infections and include
measures such as adherence to hand hygiene. Targeted strategies for prevention of CAUTI include limiting
the use and duration of urinary catheterization, using aseptic technique for catheter insertion, and adhering
to proper catheter care.
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NosoBase n° 27923
Utilisation de la chlorhexidine dans une unité de réanimation néonatale : résultats d’une étude
nationale
Tamma PD; Aucott SW; Milstone AM. Chlorhexidine use in the neonatal intensive care unit: results from a
natinal survey. Infection control and hospital epidemiology 2010/08; 31(8): 846-849.
Mots-clés :
CHLORHEXIDINE;
RECOMMANDATION
NEONATALOGIE;
SOIN
INTENSIF;
QUESTIONNAIRE;
Infection prevention guidelines do not endorse chlorhexidine gluconate (CHG) use in neonates who are less
than 2 months old. A survey of US neonatology program directors revealed that most neonatal intensive
care units use CHG, often with some restrictions. Prospective studies are needed to further address
concerns regarding the safety of CHG in patients in the neonatal intensive care unit.
Staphylococcus aureus
NosoBase n° 27912
Diminution du nombre de colonisations et d’infections associées aux soins à Staphylococcus
aureus dans une unité de réanimation médicale après la mise en place d’un programme actif de
surveillance et de décolonisation
Fraser TG; Fatica C; Scarpelli M; Arroliga AC; Guzman J; Shrestha NK; et al. Decrease in Staphylococcus
aureus colononization and hospital-acquired infection in a medical intensive care unit after institution of an
active surveillance and decolonization program. Infection control and hospital epidemiology 2010/08; 31(8):
779-783.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
SOIN
INTENSIF;
COLONISATION; SURVEILLANCE; INCIDENCE; ETUDE RETROSPECTIVE; CHLORHEXIDINE; NEZ
Objective: To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a
decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due
to S. aureus.
Design: Retrospective quasi-experimental study.
Setting: An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio.
Methods: From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit
were screened for S. aureus nasal carriage at admission and weekly thereafter. During the preintervention
period, January 1 through September 30, 2006, only surveillance occurred. During the intervention period,
January 1 through December 31, 2007, S. aureus carriers received mupirocin intranasally. Beginning in
February 2007, carriers also received chlorhexidine gluconate baths.
Results: During the preintervention period, 604 (73.7%) of 819 patients were screened for S. aureus nasal
carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients
were screened, yielding 276 carriers (28.8%). The incidence of S. aureus carriage decreased from 25 cases
in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patientdays (3.32 cases per 1,000 patient-days) (P=.04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.280.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P=.02; RR, 0.50 [95% CI, 0.27-0.91]). The
incidence of S. aureus hospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11
cases per 1,000 patient-days, respectively (P=.28). The incidence of S. aureus ventilator-associated
pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P=.03; RR, 0.12 [95% CI, 0.010.83]). The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per
1,000 patient-days (P=.03; RR, 0.37 [95% CI, 0.14-0.90]).
Conclusions: Active surveillance for S. aureus nasal carriage combined with decolonization was associated
with a decreased incidence of S. aureus colonization and hospital-acquired infection.
NosoBase n° 27914
Maîtrise à long terme des Staphylococcus aureus résistants à la méticilline (SARM) endémiques sur
l’ensemble de l’hôpital : impact d’une surveillance active ciblée des SARM pour les patients et le
personnel soignant
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Rodriguez-Bano J; Garcia L; Ramirez E; Lupion C; Muniain MA; Velasco C; et al. Long-term control of
endemic of endemic hospital-wide methicillin-resistant Staphylococcus aureus (MRSA): the impact of
targeted active surveillance for MRSA in patients and healthcare workers. Infection control and hospital
epidemiology 2010/08; 31(8): 786-795.
Mots-clés: STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SURVEILLANCE
Objective: To evaluate the long-term impact of successive interventions on rates of methicillin-resistant
Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide
situation.
Design: Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed
by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel
electrophoresis.
Setting: A 950-bed teaching hospital in Seville, Spain.
Patients: All patients admitted to the hospital during the period from 1995 through 2008.
Methods: Three successive interventions were studied: (1) contact precautions, with no active surveillance
for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards,
prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients
admitted from other medical centers.
Results: Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patientdays [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of
MRSA colonization or infection changed significantly after the first intervention. The rate decreased
significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the
second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patientdays) after the third intervention, and the rate remained at a similar level for 8 years.The MRSA bacteremia
rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not
change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates
obtained from healthcare workers were clonally related to those recovered from patients who were in their
care.
Conclusion: Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers.
The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards
(identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the
success of the program.
Surveillance
NosoBase n° 28090
Renacoq : surveillance de la coqueluche à l'hôpital en 2008
Bonmarin I; GUISO N; ROSSO ML; Les participants du réseau Renacoq; Levy-Bruhl D. Renacoq: hospital
surveillanceof pertussis in 2008. Bulletin épidémiologique hebdomadaire 2010/07/27; (31-32): 336-338.
Mots-clés : SURVEILLANCE;
EPIDEMIOLOGIE
BORDETELLA
PERTUSSIS;
RESEAU;
PEDIATRIE;
VACCIN;
Le réseau Renacoq permet de suivre depuis 1996 les coqueluches identifiées en milieu pédiatrique
hospitalier et l’impact des stratégies vaccinales. Dans 42 hôpitaux, les bactériologistes listent les résultats
des recherches de la bactérie chez les enfants de moins de 16 ans. Les pédiatres remplissent une fiche
pour les cas de moins de 6 mois. En 2008, 39 hôpitaux ont participé. Les bactériologistes ont recensé 138
cas confirmés au laboratoire, reflétant la faible incidence observée généralement entre deux pics
épidémiques. Parmi les 56 cas documentés par une fiche pédiatrique, le sexe ratio M/F est de 1,1 et 54%
des cas ont moins de 3 mois. Tous, hormis un cas clinique, ont été confirmés biologiquement. Tous les
enfants ont été hospitalisés dont 21% en réanimation, proportion particulièrement élevée. Aucun décès n’a
été signalé. Le statut vaccinal, défini à partir du carnet de santé de 88% des cas, montre que 73% n’ont pas
été vaccinés. Un contaminateur a été retrouvé chez 54% des enfants, essentiellement un des deux parents.
Les caractéristiques épidémiologiques des cas sont en 2008 très similaires à celles des dernières années
avec une majorité de cas confirmés biologiquement et une baisse globale du nombre de cas chez les moins
de 6 mois. Une attention particulière doit être portée à la participation des membres du réseau.
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NosoBase n° 28025
Tendances et orientations de la surveillance globale de la santé publique
Castillo-Salgado C. Trends and directions of global public health surveillance. Epidemiologic reviews
2010/06; 32(1): 93-109.
Mots-clés : SURVEILLANCE; GESTION DES RISQUES; CDC; INFORMATION; INTERNET;
BIOTERRORISME; RESEAU; OMS; RECOMMANDATION; PROTOCOLE; GRIPPE; APPAREIL
RESPIRATOIRE; INFECTION; SRAS; SANTE PUBLIQUE; BIBLIOGRAPHIE
Recently, global health and global health surveillance have received unprecedented recognition of their
importance because of the newly emerging and reemerging infectious diseases, new cycles of pandemics,
and the threats of bioterrorism. The aim of this review is to provide an update of the current state of
knowledge on health surveillance in a globalized world. Three key areas will be highlighted in this review: 1)
the role of the new International Health Regulations, 2) the emergence of new global health networks for
surveillance and bioterrorism, and 3) the reshaping of guidelines for the collection, dissemination, and
interventions in global surveillance. A discussion is also presented of the more important challenges of
global health surveillance. Global surveillance has been reshaped by important changes in the new
International Health Regulations and the rapid development of new global networks for disease surveillance
and bioterrorism. These networks provide for the first time at the global scale real-time information about
potential outbreaks and epidemics of newly emerging and reemerging infectious diseases. The recent
outbreaks of severe acute respiratory syndrome (SARS) and the influenza A (H1N1) pandemic provide
evidence of the benefits of the new global monitoring and of the importance of the World Health
Organization in its coordinating role in the multilateral response of the global public health community.
NosoBase n° 28223
Systèmes de surveillance électronique dans la prévention du risque infectieux : support
organisationnel, caractéristiques du programme et satisfaction des utilisateurs
Grota PG; Stone PW; Jordan S; Pogorzelska M; Larson E. Electronic surveillance systems in infection
prevention: organizational support, program characteristics, and user satisfaction. American journal of
infection control 2010/09; 38(7): 509-514.
Mots-clés: SURVEILLANCE; INFORMATIQUE; PREVENTION; INTERNET; PERSONNEL
Background: The use of electronic surveillance systems (ESSs) is gradually increasing in infection
prevention and control programs. Little is known about the characteristics of hospitals that have a ESS, user
satisfaction with ESSs, and organizational support for implementation of ESSs.
Methods: A total of 350 acute care hospitals in California were invited to participate in a Web-based survey;
207 hospitals (59%) agreed to participate. The survey included a description of infection prevention and
control department staff, where and how they spent their time, a measure of organizational support for
infection prevention and control, and reported experience with ESSs. Results: Only 23% (44/192) of
responding infection prevention and control departments had an ESS. No statistically significant difference
was seen in how and where infection preventionists (IPs) who used an ESS and those who did not spend
their time. The 2 significant predictors of whether an ESS was present were score on the Organizational
Support Scale (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.18) and hospital bed size (OR,
1.004; 95% CI, 1.00-1.007). Organizational support also was positively correlated with IP satisfaction with
the ESS, as measured on the Computer Usability Scale (P = .02).
Conclusion: Despite evidence that such systems may improve efficiency of data collection and potentially
improve patient outcomes, ESSs remain relatively uncommon in infection prevention and control programs.
Based on our findings, organizational support appears to be a major predictor of the presence, use, and
satisfaction with ESSs in infection prevention and control programs.
NosoBase n° 28188
Conception de l'environnement des soins pour la sécurité des patients et du personnel : la forme
doit-elle suivre la fonction en réanimation ou vice versa ?
Bartley J; Streifel AJ. Design of the environment of care for safety of patients and personnel: does form
follow function or vice versa in the intensive care unit? Critical care medicine 2010/08; 38 (Supplément8):
S388-S398.
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Mots-clés : SOIN INTENSIF; PERSONNEL; ENVIRONNEMENT; SECURITE; USAGER; QUALITE;
ARCHITECTURE; PREVENTION; GESTION DES RISQUES; EAU; LAVABO; DECHET; SURFACE;
CHAMBRE; HYGIENE DES MAINS; DIALYSE RENALE; SANITAIRE; AIR; BIBLIOGRAPHIE
We review the context of the environment of care in the intensive care unit setting in relation to patient safety
and quality, specifically addressing healthcare-associated infection issues and solutions involving
interdisciplinary teams. Issues addressed include current and future architectural design and layout trends,
construction trends affecting intensive care units, and prevention of construction-associated healthcareassociated infections related to airborne and waterborne risks and design solutions. Specific elements
include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene,
such as water risks, sink design/location, human waste management, surface selection (floor covering,
countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet
germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and
water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective
design and operational use of the intensive care unit environment of care must engage critical care
personnel from initial planning and design through occupancy of the new/renovated intensive care unit as
part of the infection control risk assessment team. The interdisciplinary infection control risk assessment
team can address key environment of care design features to enhance the safety of intensive care unit
patients, personnel, and visitors. This perspective will ensure the environment of care supports human
factors and behavioral aspects of the interaction between the environment of care and its occupants.
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