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NosoVeille – Bulletin de veille Octobre 2016 NosoVeille n°10 Octobre 2016 Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé. Il est disponible sur le site de NosoBase à l’adresse suivante : http://www.cclin-arlin.fr/nosobase Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Désabonnement Sommaire de ce numéro : Acinetobacter baumannii Antibiotique Architecture Bactériémie Cathéter / Cathétérisme Chirurgie Clostridium difficile Coût EHPAD Endoscopie Environnement Epidémie Grippe Hygiène des mains Infection urinaire Maternité Odontologie Pédiatrie Personnel Prévention Responsabilité Soin intensif Staphylococcus aureus Stérilisation Usager Vaccination 1 / 40 NosoVeille – Bulletin de veille Octobre 2016 Acinetobacter baumannii NosoBase ID notice : 418199 La validation clinique d'un test par RT-PCR pour la détection rapide de la colonisation à Acinetobacter baumannii Blanco-Lobo P; González-Galán V; García-Quintanilla M; Valencia R; Cazalla A; Martin C; et al. Clinical validation of a real-time polymerase chain reaction assay for rapid detection of Acinetobacter baumannii colonization. The journal of hospital infection 2016/09; 94(1): 68-71. Mots-clés : ACINETOBACTER BAUMANNII; COLONISATION; PCR; ETUDE PROSPECTIVE; SOIN INTENSIF; CARBAPENEME; SURVEILLANCE; INFECTION NOSOCOMIALE Real-time polymerase chain reaction (PCR)-based approaches have not been assessed in terms of their ability to detect patients colonized by Acinetobacter baumannii during active surveillance. This prospective, double-blind study demonstrated that a real-time PCR assay had high sensitivity (100%) and specificity (91.2%) compared with conventional culture for detecting A. baumannii in 397 active surveillance samples, and provided results within 3h. Receiver-operator curve analyses demonstrated that the technique has diagnostic accuracy of 97.7% (95% confidence interval 96.0-99.3%). This method could facilitate the rapid implementation of infection control measures for preventing the transmission of A. baumannii. DOI: https://doi.org/10.1016/j.jhin.2016.04.008 Antibiotique NosoBase ID notice : 418943 Transmission d'entérobactéries résistantes aux carbapénèmes dans des établissements de santé, Wisconsin, Février-mai 2015 Centers for disease control and prevention (CDC); Elbadawi LI; Borlaug G; Gundlach KM; Monson T; Warshauer D. Carbapenem-resistant Enterobacteriaceae transmission in health care facilities - Wisconsin, february-may 2015. MMWR Morbidity and mortality weekly report 2016/09/02; 65(34): 906-909. Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE ANTIBIORESISTANCE; INVESTIGATION; EPIDEMIE A SPECTRE ELARGI; CARBAPENEME; What is already known about this topic? Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant gram-negative bacilli that can cause infections associated with high case fatality rates, and are emerging as epidemiologically important health care–associated pathogens in the United States. Prevention of CRE transmission in health care settings is dependent on recognition of cases, isolation of colonized and infected patients, effective use of infection control measures, and the correct use of antibiotics. What is added by this report? Through the Wisconsin State Laboratory of Hygiene laboratory-based CRE surveillance program, which requests all clinical microbiology laboratories to submit carbapenem-nonsusceptible Enterobacteriaceae isolates for molecular testing by one or more methods (e.g., polymerase chain reaction [PCR], pulsed-field gel electrophoresis [PFGE], and whole genome sequencing [WGS]), a cluster of CRE infections among four hospital inpatients at two southeastern Wisconsin hospitals was discovered. At the time, personnel at the two implicated hospitals were not previously aware of the possibility of transmission of CRE among their patients. What are the implications for public health practice? The use of molecular technologies, including PCR testing, PFGE, and WGS, can lead to detection of transmission events and interruption of transmission by uncommon and multidrug-resistant organisms. Public health and other programs that include antibiotic stewardship and antimicrobial resistance monitoring might benefit from data generated by molecular testing of multidrug-resistant organisms to enhance detection of intra- and interfacility transmission events. DOI: https://doi.org/10.15585/mmwr.mm6534a5 NosoBase ID notice : 419475 Les progrès de la prévention et le traitement d'infections à Enterococcus résistant à la vancomycine Isenman H; Fisher D. Advances in prevention and treatment of vancomycin-resistant Enterococcus infection. Current opinion in infectious diseases 2016/08/31; in press: 1-6. 2 / 40 NosoVeille – Bulletin de veille Octobre 2016 Mots-clés : PREVENTION; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; INFECTION NOSOCOMIALE; EPIDEMIOLOGIE; COLONISATION; DAPTOMYCINE; ANTIBIORESISTANCE Purpose of review: This article reviews data, particularly from the last 2 years, addressing the prevention and treatment of vancomycin-resistant Enterococcus (VRE). We focus on infection control, particularly active screening, use of contact precautions as well as pharmacologic options for therapy. This is timely given the evolving priorities in efforts towards the prevention and treatment of multidrug-resistant organisms globally. Recent findings: Key findings include new data regarding the impact of contact precautions on the incidence of VRE colonization and bloodstream infection, new laboratory screening methods, and novel decolonization strategies and treatments. Summary: Additional and specific measures beyond standard precautions for infection prevention of VRE remain controversial. Horizontal measures such as chlorhexidine bathing appear beneficial, as are nontouch environmental cleaning methods. Treatment options for invasive disease have improved considerably in the last decade. Decolonization strategies require further research. Overall, the threat of VRE seems exaggerated. DOI: https://doi.org/10.1097/QCO.0000000000000311 NosoBase ID notice : 418354 Combinaisons d'antibiotiques contre Acinetobacter baumannii pan-résistant avec des isolats présentant des mécanismes de résistance différents Leite GC; Oliveira MS; Vieira Perdigão-Neto L; Kamia Dias Rocha C; Guimarães T; Rizek C; et al. Antimicrobial combinations against pan-resistant Acinetobacter baumannii isolates with different resistance mechanisms. PLoS One 2016/03/21; 11(3): 1-16. Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; MULTIRESISTANCE; ANTIBIOTIQUE; CMI; PCR; PFGE; BIOLOGIE MOLECULAIRE; TRAITEMENT; MORTALITE; COLISTINE; RIFAMPICINE; VANCOMYCINE; FOSFOMYCINE; AMIKACINE; REVUE DE LA LITTERATURE The study investigated the effect of antibiotic combinations against 20 clinical isolates of A. baumannii (seven colistin-resistant and 13 colistin-susceptible) with different resistance mechanisms. Clinical data, treatment, and patient mortality were evaluated. The following methods were used: MIC, PCRs, and outer membrane protein (OMP) analysis. Synergy was investigated using the checkerboard and time-kill methods. Clonality was evaluated by PFGE. Based on clonality, the whole genome sequence of six A. baumannii isolates was analyzed. All isolates were resistant to meropenem, rifampicin, and fosfomycin. OXA-23 and OXA-143 were the most frequent carbapenemases found. Four isolates showed loss of a 43kDa OMP. The colistinsusceptible isolates belonged to different clones and showed the highest synergistic effect with fosfomycinamikacin. Among colistin-resistant isolates, the highest synergistic effect was observed with the combinations of colistin-rifampicin followed by colistin-vancomycin. All colistin-resistant isolates harbored blaOXA-23-like and belonged to CC113. Clinical and demographic data were available for 18 of 20 patients. Fourteen received treatment and eight patients died during treatment. The most frequent site of infection was the blood in 13 of 14 patients. Seven patients received vancomycin plus an active drug against A. baumannii; however, mortality did not differ in this group. The synergistic effect was similar for colistin-susceptible isolates of distinct clonal origin presenting with the same resistance mechanism. Overall mortality and death during treatment was high, and despite the high synergism in vitro with vancomycin, death did not differ comparing the use or not of vancomycin plus an active drug against A. baumannii. DOI: https://doi.org/10.1371/journal.pone.0151270 NosoBase ID notice : 418687 Recommandations sur la gestion des antibiotiques destinées au praticien hygiéniste Nagel JL; Kaye KS; LaPlante KL; Pogue JM. Antimicrobial stewardship for the infection control practitioner. Infectious disease clinics of North America 2016/09; 30(3): 771-784. Mots-clés : ANTIBIOTIQUE; GESTION DES RISQUES; ANTIBIORESISTANCE; MULTIRESISTANCE; FORMATION; PERSONNEL; TRAVAIL EN EQUIPE; REVUE DE LA LITTERATURE The continued increase in the rates of antimicrobial-resistant organisms, the devastating impact of infections due to these pathogens on patient outcomes, and the lean antibiotic pipeline has created a health care industry in desperate need of enhanced antimicrobial stewardship strategies to both optimize outcomes in 3 / 40 NosoVeille – Bulletin de veille Octobre 2016 patients infected with these pathogens and to decrease their development and spread. These common goals lead to a natural alliance between antimicrobial stewardship clinicians and infection control practitioners. Antimicrobial stewardship and infection control within an institution should convene and develop collaborative goals and strategies for decreasing the development and spread of problematic pathogens, as well as defining optimal evidence-based strategies for management of patients infected with these pathogens. These strategies could include targeting high-risk antimicrobials and enhanced hand hygiene and contact precaution compliance due to increased C difficile rates, and screening for problematic MDROs within an institution to ensure both rapid isolation of colonized patients as well as communication to stewardship personnel so that future empiric therapies can be tailored accordingly. Furthermore, infection control and stewardship teams can work together to tailor educational strategies throughout the institution using existing relationships to ensure that the message of each discipline reaches the widest possible audience. Finally, stewardship and infection control personnel should determine the best metrics for measuring the success (or failures) of their combined efforts. These could include outcomes in patients infected with target pathogens (including time to appropriate or optimal antimicrobial therapy and time until a patient is placed in contact isolation), trends in C difficile rates within hospitalized patients, and/or antimicrobial use metrics. Ideally, institutions will develop a multifaceted dashboard of several such metrics to most appropriately measure the success of these complementary programs. DOI: https://doi.org/10.1016/j.idc.2016.04.012 NosoBase ID notice : 419096 AGORA : une alliance mondiale pour optimiser le bon usage des antibiotiques face aux infections intra-abdominales Sartelli M; Weber DG; Ruppé E; Bassetti M; Wright BJ; Ansaloni L; et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World Journal of Emergency Surgery 2016/07/15; 11(33): 1-32. Mots-clés : ANTIBIOTIQUE; ANTIBIORESISTANCE; MULTIRESISTANCE; ABDOMEN; INFECTION; TRAITEMENT; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs. DOI: https://doi.org/10.1186/s13017-016-0089-y NosoBase ID notice : 418284 Enquête téléphonique sur les pratiques de contrôle du risque infectieux et le bon usage des antibiotiques dans les établissements de soins de longue durée au Maryland Yang M; Vleck K; Bellantoni M; Sood G. Telephone survey of infection-control and antibiotic stewardship practices in long-term care facilities in Maryland. Journal of the american medical directors association 2016/06/01; 17(6): 491-494. Mots-clés : ANTIBIOTIQUE; PRATIQUE; PRESCRIPTION; PROTOCOLE; SOIN DE LONGUE DUREE; EHPAD; ENQUETE; PERSONNEL; MEDECIN HYGIENISTE; INFIRMIER HYGIENISTE; SONDAGE URINAIRE; CATHETER IMPREGNE; SIGNALEMENT; ISOLEMENT SEPTIQUE Background: Multidrug-resistant organisms are an emerging and serious threat to the care of patients. Longterm care facilities are considered a reservoir of these organisms partly because of the over-prescribing of 4 / 40 NosoVeille – Bulletin de veille Octobre 2016 antibiotics. Antibiotic use is common in long-term care facilities. Antibiotic stewardship programs have been shown to reduce antibiotic consumption in acute-care facilities. The purpose of our study is to investigate existing infection-control practices and antibiotic stewardship programs in long-term care facilities in Maryland. Methods: We telephoned the infection-control personnel in 231 long-term care facilities in Maryland between February 2014 and July 2015 and reached 124 facilities (59%). Results: Among the 124 facilities surveyed, there were 14,371 beds and 337 infection-control personnel with basic infection-control training. Close to 20% of facilities use silver- or antimicrobial-impregnated urinary catheters. Most facilities (97%) track urinary tract infections. Although all report to the health department in the case of an outbreak, only 63 (50.8 %) report directly to the Centers for Disease Control and Prevention. About 80% of facilities isolate patients with Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococci with acute infections only. Eighty percent of facilities have basic guidance on choice of antibiotic, and 27% have a restricted formulary. Only 25% of facilities have an antibiotic approval process. Thirty-five percent of facilities have training for antibiotics prescribing. However, 17% of facilities did not know whether such training existed. Conclusions: Antibiotic stewardship programs in long-term care facilities are still in early development stages, but our results demonstrate that the majority of facilities are collecting data on prescribing antibiotics, and a surprising number have antibiotic approval and antibiotics prescribing training. DOI: https://doi.org/10.1016/j.jamda.2015.12.018 Architecture NosoBase ID notice : 418678 Prévention par conception "du design" : construction et rénovation des établissements de santé pour la sécurité des patients et la prévention des infections Olmsted RN. Prevention by design. Construction and renovation of health care facilities for patient safety and infection prevention. Infectious disease clinics of North America 2016/09; 30(3): 713-728. Mots-clés : PREVENTION; ARCHITECTURE; TRAVAUX HOSPITALIERS; BATIMENT ET CONSTRUCTION; SECURITE SANITAIRE; HYGIENE HOSPITALIERE; EAU; AIR; ENVIRONNEMENT; BLOC OPERATOIRE; GESTION DES RISQUES; RECOMMANDATIONS DE BONNE PRATIQUE Infection prevention and control is an essential component of the built environment. When absent or when there are disruptions, risk of exposure of patients and disease outbreaks often result. However, there are well-established, evidence-based guidelines to assist infection preventionists and health care epidemiologists with identifying strategies for prevention in collaboration with the multiple disciplines involved in construction and renovation (EIC 2003, FGI 2014). The ICRA remains the keystone of designing in prevention at the inception of a project through the completion and commissioning phases. Future trends in care delivery in the United States are going to have a significant impact on construction and renovation of health care facilities; however, involvement and subject matter expertise provided by infection preventionists/ health care epidemiologists will remain a core component into the future. DOI: https://doi.org/10.1016/j.idc.2016.04.005 Bactériémie NosoBase ID notice : 418273 Epidémiologie de l'antibiorésistance dans les bactériémies Akova M. Epidemiology of antimicrobial resistance in bloodstream infections. Virulence 2016/04/02; 7(3): 252266. Mots-clés : EPIDEMIOLOGIE; MULTIRESISTANCE; ANTIBIOTIQUE; PRESCRIPTION; BACTERIEMIE; TRAITEMENT; PREVALENCE ANTIBIORESISTANCE; Antimicrobial resistance in bacterial pathogens is a worldwide challenge leading high morbidity and mortality in clinical settings. Multidrug resistant patterns in gram-positive and -negative bacteria have resulted in difficult-to-treat or even untreatable infections with conventional antimicrobials. Since the early identification of causative microorganisms and their antimicrobial susceptibility patterns in patients with bacteremia and other serious infections is lacking in many healthcare institutions, broad spectrum antibiotics are liberally and mostly unnecessarily used. Such practice has, in turn, caused dramatic increases in emerging resistance and 5 / 40 NosoVeille – Bulletin de veille Octobre 2016 when coupled with poor practice of infection control, resistant bacteria can easily be disseminated to the other patients and the environment. Thus, availability of updated epidemiological data on antimicrobial resistance in frequently encountered bacterial pathogens will be useful not only for deciding on empirical treatment strategies, but also devising an effective antimicrobial stewardship program in hospitals. DOI: https://doi.org/10.1080/21505594.2016.1159366 NosoBase ID notice : 418357 Acinetobacter spp. associée à une mortalité plus élevée chez les patients de soins intensifs présentant une bactériémie : analyse de survie Leão AC; Menezes PR; Oliveira MS; Levin AS. Acinetobacter spp. are associated with a higher mortality in intensive care patients with bacteremia: a survival analysis. BMC infectious diseases 2016/08/09; 16(386): 18. Mots-clés : ACINETOBACTER; BACTERIEMIE; SOIN INTENSIF; PRONOSTIC; MORTALITE; ANALYSE MULTIVARIEE; ETUDE RETROSPECTIVE; KLEBSIELLA PNEUMONIAE; STAPHYLOCOCCUS AUREUS; ENTEROBACTER; ENTEROCOCCUS; PSEUDOMONAS AERUGINOSA Background: It has been challenging to determine the true clinical impact of Acinetobacter spp., due to the predilection of this pathogen to colonize and infect critically ill patients, who often have a poor prognosis. The aim of this study was to assess whether Acinetobacter spp. bacteremia is associated with lower survival compared with bacteremia caused by other pathogens in critically ill patients. Methods: This study was performed at Hospital das Clínicas, University of São Paulo, Brazil. There are 12 intensive care units (ICUs) in the hospital: five Internal Medicine ICUs (emergency, nephrology, infectious diseases and respiratory critical care), three surgical ICU (for general surgery and liver transplantion), an Emergency Department ICU for trauma patients, an ICU for burned patients, a neurosurgical ICU and a postoperative ICU. A retrospective review of medical records was conducted for all patients admitted to any of the ICUs, who developed bacteremia from January 2010 through December 2011. Patients with Acinetobacter spp. were compared with those with other pathogens (Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter spp., Enterococcus spp., Pseudomonas aeruginosa). We did a 30-day survival analysis. The Kaplan-Meier method and log-rank test were used to determine the overall survival. Potential prognostic factors were identified by bivariate and multivariate Cox regression analysis. Results: One hundred forty-one patients were evaluated. No differences between patients with Acinetobacter spp. and other pathogens were observed with regard to age, sex, APACHE II score, Charlson Comorbidity Score and type of infection. Initial inappropriate antimicrobial treatment was more frequent in Acinetobacter bacteremia (88% vs 51%). Bivariate analysis showed that age > 60 years, diabetes mellitus, and Acinetobacter spp. infection were significantly associated with a poor prognosis. Multivariate model showed that Acinetobacter spp. infection (HR = 1.93, 95% CI: 1.25-2.97) and age > 60 years were independent prognostic factors. Conclusion: Acinetobacter is associated with lower survival compared with other pathogens in critically ill patients with bacteremia, and is not merely a marker of disease severity. DOI: https://doi.org/10.1186/s12879-016-1695-8 NosoBase ID notice : 418960 Impact d’un bundle pour prévenir les infections sur voie centrale chez les nouveau-nés McMullan R; Gordon A. Impact of a central line infection prevention bundle in newborn infants. Infection control and hospital epidemiology 2016/09; 37(9): 1029-1036. Mots-clés : BACTERIEMIE; CATHETER VEINEUX CENTRAL; INFECTION NOSOCOMIALE; NOUVEAUNE; NEONATOLOGIE; SOIN INTENSIF; ETUDE RETROSPECTIVE Objective: To compare central line use and central line-associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement. Design: Retrospective cohort analysis of prospectively collected data. Setting: Level 5 neonatal intensive care unit in Sydney, Australia. Patients: Newborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted. 6 / 40 NosoVeille – Bulletin de veille Octobre 2016 Methods: Data regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback. Results: Baseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0-11.8 days] vs 7.3 days [4.0-10.4 days], P=.0004). Central line-associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVCrelated bloodstream infections (1.2/1,000 central line-days vs 11.5/1,000 central line-days, P<.0001). Conclusion: This central line infection bundle was effective in reducing CVC use, dwell time, and central lineassociated bloodstream infections. DOI: https://doi.org/10.1017/ice.2016.127 NosoBase ID notice : 418208 Réduction des bactériémies à Staphylococcus aureus associées à des cannules périphériques intraveineuses : mise en œuvre réussie d’un bouquet d’interventions de soins dans un grand service de santé australien Rhodes D; Cheng AC; McLellan S; Guerra P; Karanfilovska D; Aitchison S; et al. Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service. The journal of hospital infection 2016/09; 94(1): 86-91. Mots-clés : STAPHYLOCOCCUS AUREUS; BACTERIEMIE; CATHETER VEINEUX PERIPHERIQUE; SOIN INFIRMIER; INFECTION NOSOCOMIALE Background: Healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) results in morbidity, mortality, and increased healthcare costs, and these infections are frequently regarded as preventable. Aim: To implement a multi-modal prevention programme for improved processes regarding peripheral intravenous cannula (PIVC) insertion and maintenance, in order to reduce PIVC-associated HA-SAB events in a large Australian health service. Methods: Baseline clinical practice was evaluated for a 12-month pre-intervention period. Measures to reduce HA-SAB risk were introduced between January and September 2013: staff education, improved documentation (including phlebitis scoring), and availability of standardized equipment. Post-intervention auditing was performed during the 27 months following intervention. Baseline and post-intervention HA-SAB and PIVC-associated infection rates were compared. Interrupted time-series and Bayesian change-point analyses were applied to determine the impact of interventions and timing of change. Findings: Significantly improved documentation regarding PIVC insertion and management was observed in the post-intervention period, with fewer PIVCs left in situ for ≥4 days (2.6 vs 6.9%, P<0.05). During the baseline period a total of 68 HA-SAB events occurred [1.01/10,000 occupied bed-days (OBDs)] and 24 were PIVC-associated (35% of total, rate 0.39 per 10,000 OBDs). In the post-intervention period, a total of 83 HASAB events occurred (0.99 per 10,000 OBDs) and 12 were PIVC-associated (14.4% of total, rate 0.14 per 10,000 OBDs). PIVC-associated SAB rates were 63% lower in the post-intervention period compared to baseline (P=0.018) with a change point observed following full bundle implementation in October 2013. Conclusion: A successful multi-modal hospital-wide campaign was introduced to reduce PIVC-associated SAB rates. Evaluation of cost-effectiveness and sustainability is required. DOI: https://doi.org/10.1016/j.jhin.2016.05.020 NosoBase ID notice : 418630 Influence de l'utilisation de cathéters centraux insérés périphériquement imprégnés d'antibiotiques sur la réduction du risque de bactériémies associées aux voies centrales Yousif A; Chaftari AM; Michael M; Jordan M; Al Hamal Z; Hussain A; et al. The influence of using antibioticcoated peripherally inserted central catheters on decreasing the risk of central line-associated bloodstream infections. American journal of infection control 2016/09; 44(9): 1037-1040. Mots-clés : ANTIBIOTIQUE; RISQUE; CATHETER VEINEUX CENTRAL; CATHETER IMPREGNE; ANTIBIOTIQUE; BACTERIEMIE; EFFICACITE; MINOCYCLINE; RIFAMPICINE; CHLORHEXIDINE; ARGENT SULFADIAZINE; CANCEROLOGIE; PICC The use of peripherally inserted central catheters (PICCs) has increased over the past few years due to their less serious insertion complications. The purpose of the present study was to determine whether patients 7 / 40 NosoVeille – Bulletin de veille Octobre 2016 receiving PICCs impregnated with minocycline and rifampin had a lower rate of CLABSI compared with a concurrent control group of patients receiving uncoated PICCs. DOI: https://doi.org/10.1016/j.ajic.2015.12.015 Cathéter / Cathétérisme NosoBase ID notice : 419374 Document de consensus 2016 sur la prévention, le diagnostic et le traitement des infections liées aux cathéters veineux périphériques chez l’adulte Capdevila JA; Guembe M; Barberán J; de Alarcón A; Bouza E; Fariñas M; et al. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult. Revista española de quimioterapia 2016/08; 29(4): 230-238. Mots-clés : PREVENTION; BACTERIEMIE; CATHETER VEINEUX PERIPHERIQUE; INFECTION NOSOCOMIALE; DIAGNOSTIC CLINIQUE; TRAITEMENT; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications. DOI: https://doi.org/10.1016/j.circv.2016.06.001 NosoBase ID notice : 419287 Risques d'infections associées aux cathéters vasculaires périphériques Zhang L; Cao S; Marsh N; Ray-Barruel G; Flynn J; Larsen E; et al. Infection risks associated with peripheral vascular catheters. Journal of infection prevention 2016/09; 17(5): 207-213. Mots-clés : RISQUE; CATHETER VEINEUX PERIPHERIQUE; BACTERIEMIE; COMPLICATION; CONTAMINATION; FORMATION; PANSEMENT; PREVENTION; HYGIENE DES MAINS; DESINFECTION; REVUE DE LA LITTERATURE Background: Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey. Method: A narrative review of studies describing the infection risks associated with PVCs. Results: It is estimated that 30-80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment. Discussion: This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies. DOI: https://doi.org/10.1177/1757177416655472 8 / 40 NosoVeille – Bulletin de veille Octobre 2016 Chirurgie NosoBase ID notice : 418624 Sécurité et tolérance du gluconate de chlorhexidine 2 % en préparation peropératoire à application vaginale chez les patients bénéficiant de chirurgie gynécologique Al-Niaimi A; Rice LW; Shitanshu U; Garvens B; Fitzgerald M; Zerbel S; et al. Safety and tolerability of chlorhexidine gluconate (2%) as a vaginal operative preparation in patients undergoing gynecologic surgery. American journal of infection control 2016/09; 44(9): 996-998. Mots-clés : CHLORHEXIDINE; TOLERANCE CHIRURGIE GYNECOLOGIQUE; VAGIN; SECURITE SANITAIRE; Background: The use of chlorhexidine gluconate (CHG) as an intraoperative vaginal preparation has been shown to be more effective than vaginal povidone-iodine (PI) in decreasing vaginal bacterial colony counts. However, PI remains the standard vaginal preparation because of concerns of CHG's potential for vaginal irritation. The primary outcome of this study is a comparison of the rate of patient-reported vaginal irritation between 2% CHG and PI. Methods: Consecutive patients were enrolled in a pre-post study. Group 1 consisted of consecutive patients who received PI as a vaginal preparation. Group 2 consisted of consecutive patients who received 2% CHG as a vaginal preparation. Patients used a standardized instrument to report irritation to trained nurse practitioners 1 day after surgery. Results: A total of 117 patients received vaginal operative preparation during the course of the study, with 64 patients in group 1 and 53 patients in group 2. Of the patients in group 1, 60 (93.7%) reported no vaginal irritation, 3 (4.69%) reported mild irritation, and 1 (1.56%) reported moderate irritation. In group 2 (2% CHG vaginal preparation), all of the patients (100%) reported no vaginal irritation (P=.38). Conclusions: The use of 2% CHG as a vaginal operative preparation is not associated with increased vaginal irritation compared with PI in gynecologic surgery. It can safely be used, taking advantage of its efficacy in reducing vaginal bacterial colony counts. DOI: https://doi.org/10.1016/j.ajic.2016.02.036 NosoBase ID notice : 418206 La survie des patients subissant une chirurgie pour des tumeurs vertébrales métastatiques et l’impact des infections du site opératoire Atkinson RA; Davies B; Jones A; van Popta D; Ousey K; Stephenson J. Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection. The journal of hospital infection 2016/09; 94(1): 80-85. Mots-clés : USAGER DE LA SANTE; CHIRURGIE ORTHOPEDIQUE; TUMEUR; COLONNE VERTEBRALE Background: Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim: To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods: Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings: Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190-334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76-0.89; P<0.001) and ASA grade (1.37; 1.03-1.82; P=0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (P=0.075). Conclusion: Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significant. DOI: https://doi.org/10.1016/j.jhin.2016.06.009 9 / 40 NosoVeille – Bulletin de veille Octobre 2016 NosoBase ID notice : 418622 Influence d'une intervention de contrôle du risque infectieux et du bon usage des antibiotiques pendant 5 ans sur les infections du site opératoire cardiaque Frenette C; Sperlea D;Tesolin J; Patterson C; Thirion DJG. Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections. American journal of infection control 2016/09; 44(9): 977-982. Mots-clés : ANTIBIOTIQUE; CHIRURGIE CARDIO-VASCULAIRE; ANTIBIOPROPHYLAXIE; PRESCRIPTION; CONSOMMATION; PREVENTION; QUALITE; INTERVENTION; AMINOSIDE Background: Surgical site infections (SSIs) complicate surgery, resulting in higher morbidity and mortality. Infection control bundles and antibiotic stewardship can be effective at reducing SSIs. The influence of longterm serial interventions is unclear. Objective: The goal of this retrospective quasiexperimental study was to assess the influence of a 5-year serial infection control and antibiotic stewardship intervention on SSIs. Methods: The multidisciplinary program actively implemented pre-, intra-, and postoperative strategies over a 5-year period from 2009-2014 for all patients undergoing coronary artery bypass graft (CABG), valve replacement, or both at a tertiary care public institution. Outcomes are compared with a 2-year preinterventions period (2007-2009) and 1-year postinterventions period (2014-2015). Results: A total of 6,518 procedures were included. After interventions, the overall combined infection rate for CABG, CABG and valve, and valve procedures decreased by 66.3%, from 11.9%-4.0% (odds ratio, 0.34; 95% confidence interval, 0.23-0.49; P<.001). A significant decrease of >50% (P<.001) relative rate was observed in overall, sternum, leg, CABG, and combined CABG and valve infection rates when comparing preand postinterventions groups. The antibiotic stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 46.8%, from 39.8%-86.6% (95% confidence interval, 41.0-52.4; P<.001). Conclusion: Long-term, serial comprehensive infection control and antibiotic stewardship interventions decrease overall SSIs in patients undergoing CABG and valve replacement procedures. DOI: https://doi.org/10.1016/j.ajic.2016.02.029 NosoBase ID notice : 418203 Evaluation in-vitro de casques chirurgicaux afin de protéger les chirurgiens des gouttelettes générées lors d’interventions orthopédiques Wendlandt R; Thomas M; Kienast B; Schulz AP. In-vitro evaluation of surgical helmet systems for protecting surgeons from droplets generated during orthopaedic procedures. The journal of hospital infection 2016/09; 94(1): 75-79. Mots-clés : EVALUATION; TENUE VESTIMENTAIRE; CHIRURGIEN; TRANSMISSION AERIENNE; CONTAMINATION; RISQUE PROFESSIONNEL; CHIRURGIE ORTHOPEDIQUE; INFECTION NOSOCOMIALE Background: Operating theatres and surgical clothing are designed to protect the patient from surgical site infections. However, there is still a risk of infection of the surgical team with blood-borne pathogens via ocular or mucocutaneous exposure. Whereas conventional surgical clothing provides some protection against contamination, surgical helmet systems (SHS) are intended to provide a high level of protection by forming a barrier for particles, aerosols and fluids between surgeon and surgical field of work. Aim: The aim of this study was to quantify the contamination of the surgeon by droplets during orthopaedic procedures by an in-vitro simulation of hip and knee arthroplasty while wearing SHS versus conventional surgical clothing. Methods: Hip and knee arthroplasty procedures were performed on artificial foam bone, which was continuously kept wet with a marker fluid. Each of the procedures was carried out by ten subjects wearing conventional surgical clothing or wearing SHS with integrated toga. After the simulated operation, pictures of the subjects were taken under ultraviolet illumination. Images wearing the full gown, and after removal of the gown, were evaluated for stained areas. Findings: The contamination risk was 30% while wearing conventional clothing. In none of the 20 subjects using the SHS stains could staining be detected after removal of the protective clothing. Conclusion: This study has demonstrated that the protective properties of the SHS are superior to conventional surgical clothing. Using SHS in high-risk procedures could reduce occupational exposure to blood-borne infections in surgeons. DOI: https://doi.org/10.1016/j.jhin.2016.05.002 10 / 40 NosoVeille – Bulletin de veille Octobre 2016 Clostridium difficile NosoBase ID notice : 418966 Infections à Clostridium difficile chez les enfants : impact de la méthode de diagnostic sur les taux d’infection AlGhounaim M; Longtin Y; Gonzales M; Merckx J; Winters N; Quach C. Clostridium difficile infections in children: impact of the diagnostic method on infection rates. Infection control and hospital epidemiology 2016/09; 37(9): 1087-1093. Mots-clés : CLOSTRIDIUM DIFFICILE; PEDIATRIE; INFECTION; TECHNIQUE DE DIAGNOSTIC; PCR; ELISA; TAUX Background: Polymerase chain reaction (PCR) assays based on the detection of the toxin B gene are replacing enzyme-linked immunosorbent assay (ELISA)-based toxin production detection or cell cytotoxicity assay in most laboratories. Objective: To determine the proportion of pediatric patients diagnosed with Clostridium difficile infection by PCR who would have also been diagnosed by ELISA and to compare the clinical characteristics of PCR+/ELISA+ vs PCR+/ELISA- patients. Methods: Using the microbiology laboratory information system, stool samples positive for C. difficile by PCR between October 2010 and July 2014 were identified. Using frozen stool specimens, an ELISA for toxin A and B was performed. A retrospective medical chart review was conducted to obtain demographic and clinical data. Duplicate samples were excluded. Results: A total of 136 PCR-positive samples underwent ELISA testing: 54 (40%) were positive for toxin A or B. The mean (SD) age of the entire cohort was 8.5 (6.2) years. There was no difference in age, gender, clinical manifestation, previous medical problems, and management between patients positive or negative by ELISA. However, patients positive by ELISA were more likely to have had a recent exposure to antibiotics (67.9% vs 50%; crude odds ratio, 2.1 [95% CI, 1.03-4.28]). Conclusion: In our pediatric population, 60% of patients with C. difficile diagnosed by PCR had no toxin detectable by ELISA. ELISA-negative patients were less likely to have received an antibiotic recently compared with ELISA-positive patients. These results highlight the need to standardize laboratory criteria for the diagnosis of C. difficile infections in children. DOI: https://doi.org/10.1017/ice.2016.123 NosoBase ID notice : 418628 Facteurs de risque associés aux transferts entre établissements chez les patients avec une infection à Clostridium difficile Awali RA; Kandipalli D; Pervaiz A; Narukonda S; Qazi U; Trehan N; et al. Risk factors associated with interfacility transfers among patients with Clostridium difficile infection. American journal of infection control 2016/09; 44(9): 1027-1031. Mots-clés : FACTEUR DE RISQUE; SOIN DE LONGUE DUREE; EHPAD; CENTRE HOSPITALIER; TRANSFERT; CLOSTRIDIUM DIFFICILE; TRANSMISSION; INFECTION COMMUNAUTAIRE; ETUDE PROSPECTIVE Background: Preventing the transmission of Clostridium difficile infection (CDI) over the continuum of care presents an important challenge for infection control. Methods: A prospective case-control study was conducted on patients admitted with CDI to a tertiary care hospital in Detroit between August 2012 and September 2013. Patients were then followed for 1 year by telephone interviews and the hospital administrative database. Cases, patients with interfacility transfers (IFTs), were patients admitted to our facility from another health care facility and discharged to long-term care (LTC) facilities. Controls were patients admitted from and discharged to home. Results: There were 143 patients included in the study. Thirty-six (30%) cases were compared with 84 (70%) controls. Independent risk factors of CDI patients with IFTs (compared with CDI patients without IFTs) included Charlson Comorbidity Index score ≥6 (odds ratio [OR], 5.30; P=.016) and hospital-acquired CDI (OR, 4.92; P=.023). Patients with IFTs were more likely to be readmitted within 90 days of discharge than patients without IFTs (OR, 2.24; P=.046). One-year mortality rate was significantly higher among patients with IFTs than among patients without IFTs (OR, 4.33; P=.01). 11 / 40 NosoVeille – Bulletin de veille Octobre 2016 Conclusions: With the growing number of alternate health care centers, it is highly critical to establish better collaboration between acute care and LTC facilities to tackle the increasing burden of CDI across the health care system. DOI: https://doi.org/10.1016/j.ajic.2016.03.037 NosoBase ID notice : 418965 Analyse coût-efficacité de l’utilisation de probiotiques pour la prévention des diarrhées associées à Clostridium difficile dans un réseau d’établissements hospitaliers de province Leal JR; Heitman SJ; Conly JM; Henderson EA; Manns BJ. Cost-effectiveness analysis of the use of probiotics for the prevention of Clostridium difficile-associated diarrhea in a provincial healthcare system. Infection control and hospital epidemiology 2016/09; 37(9): 1079-1086. Mots-clés : CLOSTRIDIUM DIFFICILE; PROBIOTIQUE; INFECTION NOSOCOMIALE; DIARRHEE; COUTEFFICACITE Objective: To conduct a full economic evaluation assessing the costs and consequences related to probiotic use for the primary prevention of Clostridium difficile-associated diarrhea (CDAD). Design: Cost-effectiveness analysis using decision analytic modeling. Methods: A cost-effectiveness analysis was used to evaluate the risk of CDAD and the costs of receiving oral probiotics versus not over a time horizon of 30 days. The target population modeled was all adult inpatients receiving any therapeutic course of antibiotics from a publicly funded healthcare system perspective. Effectiveness estimates were based on a recent systematic review of probiotics for the primary prevention of CDAD. Additional estimates came from local data and the literature. Sensitivity analyses were conducted to assess how plausible changes in variables impacted the results. Results: Treatment with oral probiotics led to direct costs of CDN $24 per course of treatment per patient. On average, patients treated with oral probiotics had a lower overall cost compared with usual care (CDN $327 vs $845). The risk of CDAD was reduced from 5.5% in those not receiving oral probiotics to 2% in those receiving oral probiotics. These results were robust to plausible variation in all estimates. Conclusions: Oral probiotics as a preventive strategy for CDAD resulted in a lower risk of CDAD as well as cost-savings. The cost-savings may be greater in other healthcare systems that experience a higher incidence and cost associated with CDAD. DOI: https://doi.org/10.1017/ice.2016.134 NosoBase ID notice : 419827 Infections communautaires à Clostridium difficile dans les services d’urgence Lefevre-Tantet-Etchebarne D; Sivadon-Tardy V; Davido B; Bouchand F; Grenet J; Farfour E; et al. Community-acquired Clostridium difficile infections in emergency departments. Médecine et maladies infectieuses 2016/10; 46(7): 372–379. Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION COMMUNAUTAIRE; URGENCES HOSPITALIERES; DIARRHEE; FACTEUR DE RISQUE; INFECTION NOSOCOMIALE; ANTIBIOTIQUE; PREVALENCE; ETUDE RETROSPECTIVE Objectif : Depuis une dizaine d’années, les infections à Clostridium difficile (ICD) sont émergentes en particulier en milieu communautaire. Peu de données sont disponibles sur leur fréquence et leurs caractéristiques en France. Nous nous sommes intéressés aux cas d’ICD consultant au service d’accueil des urgences (SAU) adulte et avons comparé les cas d’ICD communautaires aux cas d’ICD nosocomiales. Patients et méthodes : Étude rétrospective multicentrique sur trois ans des cas d’ICD communautaires et nosocomiales se présentant au SAU et comparaison de leurs caractéristiques. Résultats : Parmi les 2055 patients ayant consulté au SAU pour des diarrhées et ayant bénéficié d’une coproculture, 66 (3,2 %) présentaient une ICD dont 28 d’origine communautaire et 26 d’origine nosocomiale. Les cas d’ICD communautaires avaient un âge moyen de 57,7 ans (18–91) et le sex-ratio était de 0,65. On retrouvait la présence d’au moins un facteur de risque dans 24 cas (85,7 %), dont 22 cas (78,6 %) avaient reçu une antibiothérapie inductrice. En comparaison, les patients présentant une ICD nosocomiale avaient plus souvent un diabète et une insuffisance rénale. Leur prise en charge nécessitait plus souvent un remplissage vasculaire et une nouvelle hospitalisation. Conclusion : Les ICD communautaires au SAU représentent environ 1,4 % des patients consultant pour diarrhée. Un facteur de risque est présent dans 85,7 % des cas. Dans notre étude, leur présentation clinicobiologique et leur évolution étaient moins sévères que celles des ICD nosocomiales. DOI: https://doi.org/10.1016/j.medmal.2016.06.002 12 / 40 NosoVeille – Bulletin de veille Octobre 2016 Coût NosoBase ID notice : 418623 Tendances de mortalité, durée de séjour et coûts hospitaliers associées aux infections nosocomiales Glied S; Cohen B; Liu J; Neidell M; Larson E. Trends in mortality, length of stay, and hospital charges associated with health care-associated infections, 2006-2012. American journal of infection control 2016/09; 44(9): 983-989. Mots-clés : MORTALITE; DUREE RETROSPECTIVE; INCIDENCE DE SEJOUR; COUT; INFECTION NOSOCOMIALE; ETUDE Background: Many factors associated with hospital-acquired infections (HAIs), including reimbursement policies, drug prices, practice patterns, and the distribution of organisms causing infections, change over time. We examined whether outcomes, including mortality, length of stay (LOS), daily charges, and total charges associated with HAIs, changed during 2006-2012. Methods: Electronic data on adults discharged from 2 tertiary-quaternary hospitals and 1 community hospital during 2006-2012 were collected retrospectively. Computerized algorithms identified infections using laboratory and administrative codes. Propensity scores were used to match cases with uninfected controls. Differences in mortality, LOS, daily charges, and total charges were modeled against infection status and time period (2006-2008 vs 2009-2012), including interaction for infection status by time period. Results: Among 352,077 discharges, 24,466 HAIs were detected. There was no significant change in mortality. LOS declined only for bloodstream infections (3-day reduction; P<0.01). Daily charges rose 4% for urinary tract infections but did not change significantly for other HAIs. Total charges declined by 11% for bloodstream infections and 13% for pneumonia. Conclusions: We found no appreciable or consistent improvement in HAI mortality or LOS during 2006-2012. Costs of bloodstream infections and pneumonia have declined, with most of the change occurring before 2008. DOI: https://doi.org/10.1016/j.ajic.2016.03.010 EHPAD NosoBase ID notice : 419470 Infections associées aux soins chez les personnes âgées : quoi de neuf ? Katz MJ; Roghmann MC. Healthcare-associated infections in the elderly: what's new. Current opinion in infectious diseases 2016/08; 29(4): 388-393. Mots-clés : ANTIBIORESISTANCE; PERSONNE AGEE; INFECTION NOSOCOMIALE; PREVENTION; EHPAD; MAISON DE RETRAITE Purpose of review: The high-risk population and current lack of knowledge regarding appropriate infection prevention in the long-term care (LTC) setting has contributed to substantial rates of resistance and healthcare-associated infections in this arena. More evidence-based research on LTC is necessary, particularly now that the elderly population is increasing. recent findings: Proposed government mandates highlight the urgent need to combat antimicrobial resistance in the LTC setting. Recent studies focusing on unique strategies for the prevention of transmission and infection with multidrug-resistant organisms in nursing homes are discussed, as well as attempts to formulate clear antimicrobial stewardship programs. Summary: The long-term setting has unique challenges to instituting effective infection control precautions, therefore current accepted methods used in acute-care facilities need to be modified. Recent data suggest that prevention of transmission in LTC may be achieved with focus on high-risk patients or specific carebased activities rather than colonization status. Antimicrobial stewardship and consultation with specialized physicians may be important measures to combat resistance and adverse events in LTC. The prevention of unnecessary antibiotic use in palliative care may reduce rates of resistance as well as discomfort for terminal patients. DOI: https://doi.org/10.1097/QCO.0000000000000283 13 / 40 NosoVeille – Bulletin de veille Octobre 2016 Endoscopie NosoBase ID notice : 418629 Entérobactéries résistantes aux carbapénèmes et endoscopie : une menace en constante évolution O'Horo JC; Farrell AM; Sohail R; Safdar N. Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat. American journal of infection control 2016/09; 44(9): 1032-1036. Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; CARBAPENEME; ENDOSCOPIE; ENDOSCOPIE DIGESTIVE; DUODENUM; CHOLANGIOSCOPIE; CYSTOSCOPIE; URETEROSCOPIE; CONTAMINATION; INVESTIGATION; EPIDEMIOLOGIE; DESINFECTION; NETTOYAGE Background: Several clusters of Carbapenem-resistant Enterobacteriaceae (CRE) infections associated with contaminated endoscopes have recently been reported. Interim guidelines for mitigating endoscopeassociated transmission have been proposed, but there has not been a systematic appraisal of CRE prevention practices. Methods: We conducted a systematic review of endoscope-associated CRE infection episodes, abstracting information on outbreak detection, mitigation, outcomes, and corrective steps taken to prevent recurrence. Results: Seven distinct outbreaks were identified in the published literature, and 5 of these were associated with duodenal endoscopy, with the remaining 2 associated with cystoscopy and ureteroscopy. Several investigators noted difficulties in cleaning protocols surrounding difficult to access components, such as the elevator on duodenoscopes. The published investigations did not report any failures of sterilization. It is unclear if routine reprocessing was ineffective, or difficult to execute properly. Conclusions: Meticulous cleaning protocols and increased surveillance are necessary to prevent and detect future outbreaks of CRE and to determine whether more stringent measures, such as sterilization, are needed for duodenoscopes. DOI: https://doi.org/10.1016/j.ajic.2016.03.029 NosoBase ID notice : 419473 Epidémies associées aux duodénoscopes : nouveaux défis et controverses Rubin ZA; Murthy RK. Outbreaks associated with duodenoscopes: new challenges and controversies. Current opinion in infectious diseases 2016/08; 29(4): 407-414. Mots-clés : ENDOSCOPE DIGESTIVE; DUODENUM; ENTEROBACTERIE; CARBAPENEME; EPIDEMIE; DESINFECTION; STERILISATION ANTIBIORESISTANCE; Purpose of review: Recent outbreaks of carbapenem-resistant enterobacteriaceae related to duodenoscopes in the United States and Europe have gained international attention and resulted in new regulations, especially in the United States, affecting healthcare facilities. In this review, we summarize findings from recent duodenoscope-related outbreaks, highlight what is known about the risk of transmission from these devices and discuss controversies about current recommendations to prevent transmission. Recent findings: Between 2013 and 2015, several US and European healthcare facilities reported outbreaks of carbapenem-resistant enterobacteriaceae associated with endoscopic retrograde cholangiopancreatography procedures. Unlike prior outbreaks (attributed to lapses in cleaning and reprocessing), the recent outbreaks occurred in spite of adherence to current reprocessing guidelines. Factors associated with infection transmission include a low margin of safety for gastrointestinal endoscopic procedures and complex design features of duodenoscopes. Outbreaks were halted with enhanced cleaning and surveillance measures or by adopting gas sterilization methods. New guidance from manufacturers and federal agencies has been issued as a result of these recent outbreaks; however, concerns remain that the new measures may not eliminate risks to patients. Summary: Recent duodenoscope-related outbreaks have highlighted the need for a reassessment of current guidelines for endoscope reprocessing and for new design of duodenoscope components. Although we summarize the US experience, this review has global implications for the safe cleaning and disinfection of these instruments. DOI: https://doi.org/10.1097/QCO.0000000000000290 14 / 40 NosoVeille – Bulletin de veille Octobre 2016 Environnement NosoBase ID notice : 419664 Décret n° 2016-1275 du 29 septembre 2016 relatif aux déchets d'activités de soins à risques infectieux produits par les utilisateurs d'autotests mentionnés à l'article L. 3121-2-2 du code de la santé publique Ministère des affaires sociales et de la santé. Décret n° 2016-1275 du 29 septembre 2016 relatif aux déchets d'activités de soins à risques infectieux produits par les utilisateurs d'autotests mentionnés à l'article L. 31212-2 du code de la santé publique. Journal officiel de la République française Lois et décrets 2016/09/30; 228: 2 pages. Mots-clés : DECHET D'ACTIVITE DE SOINS A RISQUE INFECTIEUX; GESTION DES DECHETS; TRAITEMENT DES DECHETS; DISPOSITIF MEDICAL; SECURITE SANITAIRE; LEGISLATION; INFECTION NOSOCOMIALE; TRAITEMENT; USAGER DE LA SANTE; TEST; SOIN AUTOGERE; DASRI Le décret étend le champ des contributeurs à la filière à responsabilité élargie, mise en place pour les déchets d’activités de soins (DASRI) perforants des patients en auto-traitement, aux DASRI perforants produits par les utilisateurs d’autotests de dépistage de maladies infectieuses transmissibles. NosoBase ID notice : 418649 Aérobiologie dans l'environnement bâti : synergie entre Legionella et champignons Alum A; Isaacs GZ. Aerobiology of the built environment: Synergy between Legionella and fungi. American journal of infection control 2016/09/02; 44(9 Suppl.): S138-S143. Mots-clés : LEGIONELLA; MYCOLOGIE; CHAMPIGNON FILAMENTEUX; BIOFILM; ASPERGILLUS; ENVIRONNEMENT; ARCHITECTURE; AIR; AEROSOL; AEROBIOCONTAMINATION; REVUE DE LA LITTERATURE Background: The modern built environment (BE) design creates unique ecological niches ideal for the survival and mutual interaction of microbial communities. This investigation focused on the synergistic relations between Legionella and the fungal species commonly found in BEs and the impact of these synergistic relationships on the survival and transmission of Legionella. Methods: A field study was conducted to identify the types and concentrations of fungi in BEs. The fungal isolates purified from BEs were cocultured with Legionella to study their synergistic association. Cocultured Legionella cells were aerosolized in an air-tight chamber to evaluate the efficacy of ultraviolet (UV) to inactivate these cells. Results: Aspergillus, Alternaria, and Cladosporium were the most common fungi detected in samples that tested positive for Legionella. After coculturing, Legionella cells were detected inside fungal hyphae. The microscopic observations of Legionella internalization in fungal hyphae were confirmed by molecular analyses. UV disinfection of the aerosolized Legionella cells that were cocultured with fungi indicated that fungal spores and propagules act as a shield against UV radiation. The shield effect of fungal spores on Legionella cells was quantified at >2.5 log10. Conclusions: This study provides the first evidence, to our knowledge, of Legionella cell presence inside fungi detected in an indoor environment. This symbiotic relationship with fungi results in longer survival of Legionella under ambient conditions and provides protection against UV rays. DOI: https://doi.org/10.1016/j.ajic.2016.06.004 NosoBase ID notice : 418690 Optimisation de l'hygiène dans l'environnement des soins Carling PC. Optimizing health care environmental hygiene. Infectious disease clinics of North America 2016/09; 30(3): 639-660. Mots-clés : HYGIENE; HYGIENE DES MAINS; HYGIENE HOSPITALIERE; ENVIRONNEMENT; SURFACE; NETTOYAGE; BIONETTOYAGE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of 15 / 40 NosoVeille – Bulletin de veille Octobre 2016 cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. DOI: https://doi.org/10.1016/j.idc.2016.04.010 NosoBase ID notice : 419474 Nettoyage de l'environnement hospitalier : choses à faire et à ne pas faire Dancer SJ. Dos and don'ts for hospital cleaning. Current opinion in infectious diseases 2016/08; 29(4): 415423. Mots-clés : NETTOYAGE; BIONETTOYAGE; DECONTAMINATION; DESINFECTION; DETERGENT; DESINFECTANT; ENVIRONNEMENT; RECOMMANDATIONS DE BONNE PRATIQUE; SURFACE; REVUE DE LA LITTERATURE Purpose of review: More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. Recent findings: Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs. Summary: As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments. DOI: https://doi.org/10.1097/QCO.0000000000000289 NosoBase ID notice : 418639 Utilisation d'un marqueur fluorescent pour évaluer la propreté des salles de bains dans un hôpital Fattorini M; Ceriale E; Nante N; Lenzi D; Manzi P; Basagni C; et al. Use of a fluorescent marker for assessing hospital bathroom cleanliness. American journal of infection control 2016/09; 44(9): 1066-1068. Mots-clés : CHAMBRE DU MALADE; NETTOYAGE; BIONETTOYAGE; AUDIT; ENVIRONNEMENT; SURFACE; HYGIENE HOSPITALIERE; FLUORESCENCE; SANITAIRE QUALITE; A fluorescent marker was used to assess the efficacy of daily cleaning in hospital en suite bathrooms. We applied the marker on 218 surfaces and we assigned a score according how completely the mark had been removed. We found significant statistical differences among different surfaces and wards (P<.05). Microbiologic contamination and marker removal score did not seem to be correlated. Differences in cleanliness may indicate discrepancies in cleaning procedures. Fluorescent marker proved to be a practical and effective method and it could be adopted as a first-level control system to assess hospital cleanliness. DOI: https://doi.org/10.1016/j.ajic.2016.03.030 NosoBase ID notice : 418676 Salubrité de l'eau et Legionella dans les établissements de santé : les priorités, la politique et la pratique Gamage SD; Ambrose M; Kralovic SM; Roselle GA. Water safety and Legionella in health care: Priorities, policy, and practice. Infectious disease clinics of North America 2016/09; 30(3): 689-712. Mots-clés : LEGIONELLA; EAU; PREVENTION; ENVIRONNEMENT; DISTRIBUTION D'EAU; EAU POTABLE; PLOMBERIE; GESTION DES RISQUES; INFECTION NOSOCOMIALE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE 16 / 40 NosoVeille – Bulletin de veille Octobre 2016 Although there are many gaps in knowledge regarding water safety in premise plumbing, it is clear that more active approaches to water safety in US health care settings will continue to evolve with regard to microbial pathogens. The WHO and ASHRAE publications and the international efforts to address Legionella prevention in the health care setting show the increasing importance of this topic. To promote the development of evidence-based recommendations, more research and reporting on opportunistic premise plumbing pathogens and disease incidence will be necessary. Consensus on risk assessment and prevention of these pathogens, while balancing the different water system priorities in the health care setting, can bolster actions. In the interim, protection of patients and residents from water-based pathogens must still be prioritized; the unique nature of each individual building and its water distribution systems necessitates that a knowledgeable, multidisciplinary cadre of personnel in health care settings do risk evaluations and assessments to best identify strategies for risk mitigation. DOI: https://doi.org/10.1016/j.idc.2016.04.004 NosoBase ID notice : 418643 Evaluation d'un dispositif de rayonnement ultra-violet de xénon pulsé pour la désinfection des chambres d'isolement dans un hôpital au Royaume-Uni Hosein I; Madeloso R; Nagaratnam W; Villamaria F; Stock E; Jinadatha C. Evaluation of a pulsed xenon ultraviolet light device for isolation room disinfection in a United Kingdom hospital. American journal of infection control 2016/09; 44(9): e157-e161. Mots-clés : DESINFECTION; ULTRA-VIOLET; DECONTAMINATION; D'ISOLEMENT; ENVIRONNEMENT; SURFACE; HYGIENE HOSPITALIERE EFFICACITE; CHAMBRE Background: Pathogen transmission from contaminated surfaces can cause hospital-associated infections. Although pulsed xenon ultraviolet (PX-UV) light devices have been shown to decrease hospital room bioburden in the United States, their effectiveness in United Kingdom (UK) hospitals is less understood. Methods: Forty isolation rooms at the Queens Hospital (700 beds) in North London, UK, were sampled for aerobic bacteria after patient discharge, after manual cleaning with a hypochlorous acid-troclosene sodium solution, and after PX-UV disinfection. PX-UV device efficacy on known organisms was tested by exposing inoculated agar plates in a nonpatient care area. Turnaround times for device usage were recorded, and a survey of hospital staff for perceptions of the device was undertaken. Results: After PX-UV disinfection, the bacterial contamination measured in colony forming units (CFU) decreased by 78.4%, a 91% reduction from initial bioburden levels prior to terminal cleaning. PX-UV exposure resulted in a 5-log CFU reduction for multidrug-resistant organisms (MDROs) on spiked plates. The average device turnaround time was 1 hour, with minimal impact on patient throughput. Ward staff were enthusiastic about device deployment, and device operators reported physical comfort in usage. Conclusions: PX-UV use decreased bioburden in patient discharge rooms and on agar plates spiked with MDROs. The implementation of the PX-UV device was well received by hospital cleaning and ward staff, with minimal disruption to patient flow. DOI: https://doi.org/10.1016/j.ajic.2016.01.044 NosoBase ID notice : 418648 Transmission aérienne d'agents infectieux dans l'environnement intérieur Wei J; Li Y. Airborne spread of infectious agents in the indoor environment. American journal of infection control 2016/09/02; 44(9 Suppl.): S102-S108. Mots-clés : TRANSMISSION; AEROSOL; AIR; ENVIRONNEMENT; AMENAGEMENT INTERIEUR; INTERIEUR; VENTILATION; TOUX; PRECAUTION GOUTTELETTE; MASQUE; RESPIRATEUR; INGENIERIE; AEROBIOCONTAMINATION; REVUE DE LA LITTERATURE Background: Since the 2003 severe acute respiratory syndrome epidemic, scientific exploration of infection control is no longer restricted to microbiologists or medical scientists. Many studies have reported on the release, transport, and exposure of expiratory droplets because of respiratory activities. This review focuses on the airborne spread of infectious agents from mucus to mucus in the indoor environment and their spread as governed by airflows in the respiratory system, around people, and in buildings at different transport stages. 17 / 40 NosoVeille – Bulletin de veille Octobre 2016 Methods: We critically review the literature on the release of respiratory droplets, their transport and dispersion in the indoor environment, and the ultimate exposure of a susceptible host, as influenced by airflows. Results: These droplets or droplet nuclei are transported by expired airflows, which are sometimes affected by the human body plume and use of a face mask, as well as room airflow. Room airflow is affected by human activities such as walking and door opening, and some droplets are eventually captured by a susceptible individual because of his or her inspired flows; such exposure can eventually lead to long-range spread of airborne pathogens. Direct exposure to the expired fine droplets or droplet nuclei results in shortrange airborne transmission. Deposition of droplets and direct personal exposure to expired large droplets can lead to the fomite route and the droplet-borne route, respectively. We have shown the opportunities for infection control at different stages of the spread. We propose that the short-range airborne route may be important in close contact, and its control may be achieved by face masks for the source patients and use of personalized ventilation. Our discussion of the effect of thermal stratification and expiratory delivery of droplets leads to the suggestion that displacement ventilation may not be applicable to hospital rooms where respiratory infection is a concern. DOI: https://doi.org/10.1016/j.ajic.2016.06.003 Epidémie NosoBase ID notice : 418692 Epidémies dans les établissements de soins Sood G; Perl TM. Outbreaks in health care settings. Infectious disease clinics of North America 2016/09; 30(3): 661-687. Mots-clés : EPIDEMIE; STRUCTURE DE SOINS; EPIDEMIOLOGIE; EVALUATION; PERSONNEL; ENVIRONNEMENT; DEPISTAGE; MYCOBACTERIE; ACINETOBACTER; PSEUDOMONAS; STAPHYLOCOCCUS AUREUS; ENTEROBACTERIE; CHAMPIGNON FILAMENTEUX; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE Outbreaks should be considered in any health care delivery site and can encompass a variety of pathogens and vectors of transmission. Epidemiologic and laboratory diagnostic tools can help guide a systematic investigation; however, often multiple steps occur simultaneously in the complex situations. Many interventions have been used to abort an ongoing outbreak. Most significantly, it is important to ensure that basic infection prevention practices, such as hand hygiene and isolation, are in place and that health care personnel are compliant with these practices. Beyond this, prevention strategies need to be tailored to the epidemiologic findings, the organism, and the patients. The goal is to remove the offending source and protect patients and health care personnel. Enhanced patient screening and surveillance are implemented 54% of the time, personnel screening in 38% of outbreaks, isolation or cohorting in 32%, enhanced or revised sterilization or disinfection practices in 24%, modification of care or equipment in 23%, increased use of protective clothing in 19%, and ward closure in 11%. In most situations, these interventions are applied in combination and simultaneously, as there are limited data to empirically guide management. Epidemiologic data are important tools in identifying potential sources and guiding additional testing. It is important to quickly implement reasonable prevention strategies, and communicate to leadership and public health authorities while refining further investigations. The goal is to abort further transmission or harm and provide a safe atmosphere for patient care while protecting the health care personnel and the institution. This harmonious balance requires engagement of all of the vested parties and access to necessary resources. DOI: https://doi.org/10.1016/j.idc.2016.04.003 NosoBase ID notice : 418185 L’acide acétique en tant que méthode de décontamination des siphons de lavabo dans une épidémie nosocomiale à Pseudomonas aeruginosa productrice de métallo-bêta-lactamase Stjärne Aspelund A; Sjöström K; Olsson-Liljequist B; Mörgelin M; Melander E; Påhlman LI. Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-β-lactamase-producing Pseudomonas aeruginosa. The journal of hospital infection 2016/09; 94(1): 13-20. Mots-clés : SIPHON; LAVABO; DECONTAMINATION; PSEUDOMONAS PERACETIQUE; BIOFILM; EPIDEMIE; INFECTION NOSOCOMIALE AERUGINOSA; ACIDE 18 / 40 NosoVeille – Bulletin de veille Octobre 2016 Background: Pseudomonas aeruginosa may colonize water systems via biofilm formation. In hospital environments, contaminated sinks have been associated with nosocomial transmission. Here we describe a prolonged outbreak of a metallo-β-lactamase-producing P. aeruginosa (Pae-MBL) associated with sink drains, and propose a previously unreported decontamination method with acetic acid. Aim: To describe a nosocomial outbreak of Pae-MBL associated with hospital sink drains and to evaluate acetic acid as a decontamination method. Methods: The outbreak was investigated by searching the microbiology database, microbiological sampling and strain typing. Antibacterial and antibiofilm properties of acetic acid were evaluated in vitro. Pae-MBLpositive sinks were treated with 24% acetic acid once weekly and monitored with repeated cultures. Findings: Fourteen patients with positive cultures for Pae-MBL were identified from 2008 to 2014. The patients had been admitted to three wards, where screening discovered Pae-MBL in 12 sink drains located in the patient bathrooms. Typing of clinical and sink drain isolates revealed identical or closely related strains. Pae-MBL biofilm was highly sensitive to acetic acid with a minimum biofilm eradication concentration of 0.75% (range: 0.19-1.5). Weekly treatment of colonized sink drains with acetic acid resulted in negative cultures and terminated transmission. Conclusion: Acetic acid is highly effective against Pae-MBL biofilms, and may be used as a simple method to decontaminate sink drains and to prevent nosocomial transmission. DOI: https://doi.org/10.1016/j.jhin.2016.05.009 NosoBase ID notice : 418182 Une nouvelle méthode de génotypage a permis l'éradication d'une épidémie nosocomiale persistante à Pseudomonas aeruginosa dans une unité de réanimation pour brûlés Tissot F; Blanc DS; Basset P; Zanetti G; Berger MM; Que YA; et al. New genotyping method discovers sustained nosocomial Pseudomonas aeruginosa outbreak in an intensive care burn unit. The journal of hospital infection 2016/09; 94(1): 2-7. Mots-clés : PSEUDOMONAS AERUGINOSA; SOIN INTENSIF; BRULE; GENOTYPE; ENVIRONNEMENT; CONTAMINATION; IDENTIFICATION DE L'AGENT INFECTIEUX; EPIDEMIE; INFECTION NOSOCOMIALE Background: Pseudomonas aeruginosa is a leading cause of healthcare-associated infections in the intensive care unit (ICU). Aim: To investigate an unexplained increase in the incidence of P. aeruginosa recovered from clinical samples in the ICU over a two-year period. Methods: After unsuccessful epidemiological investigation by conventional tools, P. aeruginosa clinical isolates of all patients hospitalized between January 2010 and July 2012 were typed by a novel double-locus sequence typing (DLST) method and compared to environmental isolates recovered during the investigation period. Findings: In total, 509 clinical isolates from 218 patients and 91 environmental isolates were typed. Thirty-five different genotypic clusters were found in 154 out of 218 patients (71%). The largest cluster, DLST 1-18, included 23 patients who were mostly hospitalized during overlapping periods in the burn unit. Genotype DLST 1-18 was also recovered from floor traps, shower trolleys and the shower mattress in the hydrotherapy rooms, suggesting environmental contamination of the burn unit as the source of the outbreak. After implementation of appropriate infection control measures, this genotype was recovered only once in a clinical sample from a burned patient and twice in the environment, but never thereafter during a 12-month follow-up period. Conclusion: The use of a novel DLST method allowed the genotyping of a large number of clinical and environmental isolates, leading to the identification of the environmental source of a large unrecognized outbreak in the burn unit. Eradication of the outbreak was confirmed after implementation of a continuous epidemiological surveillance of P. aeruginosa clones in the ICU. DOI: https://doi.org/10.1016/j.jhin.2016.05.011 Grippe NosoBase ID notice : 419771 Couvertures de la vaccination contre la grippe chez les sujets à haut risque et le personnel de santé en Espagne. Résultats de deux enquêtes nationales de santé consécutives Astray-Mochales J; López de Andres A; Hernandez-Barrera V; Rodríguez-Rieiro C; Carrasco Garrido P; Esteban-Vasallo MD; et al. Influenza vaccination coverages among high risk subjects and health care 19 / 40 NosoVeille – Bulletin de veille Octobre 2016 workers in Spain. Results of two consecutive National Health Surveys (2011-2014). Vaccine 2016/09/22; 34(41): 4898-4904. Mots-clés : VACCINATION; GRIPPE; PERSONNEL; ENQUETE; COUVERTURE VACCINALE Objectives: We aim to describe influenza vaccination coverage for the Spanish population using data from two consecutive nation-wide representative health surveys. The data was analysed by high risk groups, health care workers (HCWs) and immigrants. Also, coverage trends were analysed. Material and methods: The 2011/12 Spanish National Health Survey (N=21,007) and the 2014 European Health Interview Survey for Spain (N=22,842) were analysed. Influenza vaccination status was self-reported. Time trends for were estimated by a multivariate logistic regression model. Results: Overall vaccination uptake was similar in 2011/12 and 2014, 19.1% and 18.9%, respectively, (p>0.05). 47% of the subjects surveyed were in the groups for which vaccination was recommended with coverages of 41.1% in 2011/12 and 40% in 2014 (p>0.05). In both surveys, uptake among subjects with a chronic disease was three times higher than uptake in subjects who did not have these diseases. In 2011/12 and 2014, 20% and 27.6% of health workers were vaccinated. Subjects born outside Spain were vaccinated less frequently than Spanish-born subjects (9.3% vs 20.4% and 8.9% vs 20%). Within the diseases studied, the best uptake was for patients with heart disease (52.5% in 2011/12 and 51.1% in 2014) and patients with diabetes (50.5% and 51.8%). Multivariate analysis showed that older age, having a chronic disease or being a HCW increases the possibility of being vaccinated whereas being born outside Spain decreased it. Conclusions: Seasonal influenza vaccine uptake rates in the recommended target groups, patients with chronic conditions and health care workers, in Spain are unacceptably low and seem to be stable in the post pandemic seasons. This finding should alert health authorities to the need to work directly with health care providers on the indications for this vaccine and to study strategies that make it possible to increase vaccination uptake. DOI: https://doi.org/10.1016/j.vaccine.2016.08.065 NosoBase ID notice : 419769 Efficacité du vaccin contre la grippe saisonnière en Australie, 2015 : évaluation épidémiologique, antigénique et phylogénique Fielding JE; Levy A; Chilver MB; Deng YM; Regan AK; Grant KA; et al. Effectiveness of seasonal influenza vaccine in Australia, 2015: An epidemiological, antigenic and phylogenetic assessment. Vaccine 2016/09/22; 34(41): 4905-4912. Mots-clés : GRIPPE; VACCINATION; EFFICACITE; SURVEILLANCE Background: A record number of laboratory-confirmed influenza cases were notified in Australia in 2015, during which type A(H3) and type B Victoria and Yamagata lineages co-circulated. We estimated effectiveness of the 2015 inactivated seasonal influenza vaccine against specific virus lineages and clades. Methods: Three sentinel general practitioner networks conduct surveillance for laboratory-confirmed influenza amongst patients presenting with influenza-like illness in Australia. Data from the networks were pooled to estimate vaccine effectiveness (VE) for seasonal trivalent influenza vaccine in Australia in 2015 using the case test-negative study design. Results: There were 2443 eligible patients included in the study, of which 857 (35%) were influenza-positive. Thirty-three and 19% of controls and cases respectively were reported as vaccinated. Adjusted VE against all influenza was 54% (95% CI: 42, 63). Antigenic characterisation data suggested good match between vaccine and circulating strains of A(H3); however VE for A(H3) was low at 44% (95% CI: 21, 60). Phylogenetic analysis indicated most circulating viruses were from clade 3C.2a, rather than the clade included in the vaccine (3C.3a). VE point estimates were higher against B/Yamagata lineage influenza (71%; 95% CI: 57, 80) than B/Victoria (42%, 95% CI: 13, 61), and in younger people. Conclusions: Overall seasonal vaccine was protective against influenza infection in Australia in 2015. Higher VE against the B/Yamagata lineage included in the trivalent vaccine suggests that more widespread use of quadrivalent vaccine could have improved overall effectiveness of influenza vaccine. Genetic characterisation suggested lower VE against A(H3) influenza was due to clade mismatch of vaccine and circulating viruses. DOI : https://doi.org/10.1016/j.vaccine.2016.08.067 NosoBase ID notice : 418627 Association entre l'augmentation du taux de vaccination contre la grippe chez les professionnels de santé et la réduction des infections nosocomiales grippales chez les patients cancéreux 20 / 40 NosoVeille – Bulletin de veille Octobre 2016 Frenzel E; Chemaly RF; Ariza-Heredia E; Jiang Y; Shah DP; Thomas G; et al. Association of increased influenza vaccination in health care workers with a reduction in nosocomial influenza infections in cancer patients. American journal of infection control 2016/09; 44(9): 1016-1021. Mots-clés : VACCINATION; GRIPPE; PERSONNEL; INFECTION NOSOCOMIALE; CANCEROLOGIE; PREVENTION; SURVEILLANCE; TAUX Background: Vaccination of health care workers (HCWs) remains a key strategy to reduce the burden of influenza infections in cancer patients. Methods: In this 8-year study, we evaluated the effect of a multifaceted approach, including a mandatory influenza vaccination program, on HCW vaccination rates and its effect on nosocomial influenza infections in cancer patients. Results: The influenza vaccination rate of all employees significantly increased from 56% (8,762/15,693) in 2006-2007 to 94% (17,927/19,114) in 2013-2014 (P<.0001). The 2009 mandatory participation program increased HCW vaccination rates in the targeted groups (P<.0001), and the addition of an institutional policy in 2012 requiring influenza vaccination or surgical mask use with each patient contact further increased vaccination rates by 10%-18% for all groups in 1 year. The proportion of nosocomial influenza infections significantly decreased (P=.045) during the study period and was significantly associated with increased HCW vaccination rates in the nursing staff (P=.043) and in personnel working in high-risk areas (P=.0497). Conclusions: Multifaceted influenza vaccination programs supported by institutional policy effectively increased HCW vaccination rates. Increased HCW vaccination rates were associated with a reduction in the proportion of nosocomial influenza infections in immunocompromised cancer patients. DOI: https://doi.org/10.1016/j.ajic.2016.03.024 NosoBase ID notice : 419778 Vaccination contre la grippe pour le personnel de santé au Royaume-Uni : évaluation de revues systématiques et options politiques Kliner M; Keenan A; Sinclair D; Ghebrehewet S; Garner P. Influenza vaccination for healthcare workers in the UK: appraisal of systematic reviews and policy options. BMJ Open 2016/09/13; 6(9): 1-12. Mots-clés : VACCINATION;GRIPPE; PERSONNEL; REVUE DE LA LITTERATURE Background: The UK Department of Health recommends annual influenza vaccination for healthcare workers, but uptake remains low. For staff, there is uncertainty about the rationale for vaccination and evidence underpinning the recommendation. Objectives: To clarify the rationale, and evidence base, for influenza vaccination of healthcare workers from the occupational health, employer and patient safety perspectives. Design: Systematic appraisal of published systematic reviews. Results: The quality of the 11 included reviews was variable; some included exactly the same trials but made conflicting recommendations. 3 reviews assessed vaccine effects in healthcare workers and found 1 trial reporting a vaccine efficacy (VE) of 88%. 6 reviews assessed vaccine effects in healthy adults, and VE was consistent with a median of 62% (95% CI 56 to 67). 2 reviews assessed effects on working days lost in healthcare workers (3 trials), and 3 reported effects in healthy adults (4 trials). The meta-analyses presented by the most recent reviews do not reach standard levels of statistical significance, but may be misleading as individual trials suggest benefit with wide variation in size of effect. The 2013 Cochrane review reported absolute effects close to 0 for laboratory-confirmed influenza, and hospitalisation for patients, but excluded data on clinically suspected influenza and all-cause mortality, which had shown potentially important effects in previous editions. A more recent systematic review reports these effects as a 42% reduction in clinically suspected influenza (95% CI 27 to 54) and a 29% reduction in all-cause mortality (95% CI 15 to 41). Conclusions: The evidence for employer and patient safety benefits of influenza vaccination is not straightforward and has been interpreted differently by different systematic review authors. Future uptake of influenza vaccination among healthcare workers may benefit from a fully transparent guideline process by a panel representing all relevant stakeholders, which clearly communicates the underlying rationale, evidence base and judgements made. DOI: https://doi.org/10.1136/bmjopen-2016-012149 NosoBase ID notice : 418636 Facteurs associés à la vaccination contre la grippe chez les résidents des EHPAD dans un échantillon national 21 / 40 NosoVeille – Bulletin de veille Octobre 2016 Travers JL; Stone PW; Bjarnadottir RI; Pogorzelska-Maziarz M; Castle N; Herzig CT. Factors associated with resident influenza vaccination in a national sample of nursing homes. American journal of infection control 2016/09; 44(9): 1055-1057. Mots-clés : VACCINATION; GRIPPE; MAISON DE RETRAITE; EHPAD; PERSONNE AGEE; PERSONNEL; ENQUETE; PREVALENCE; FACTEUR DE RISQUE Influenza vaccination remains the cornerstone of influenza prevention, yet national goals for nursing home residents and staff vaccination have not been met. Few studies have examined associations between facility and resident characteristics; employee processes, such as staff vaccination policies; and resident influenza vaccination. In this national survey of nursing homes, employee processes were not associated with resident influenza vaccination; however, various facility and resident characteristics were. DOI: https://doi.org/10.1016/j.ajic.2016.01.019 NosoBase ID notice : 419466 Grippe nosocomiale : aperçus encourageant et défis à venir Vanhems P; Bénet T; Munier-Marion E. Nosocomial influenza: encouraging insights and future challenges. Current opinion in infectious diseases 2016/08; 29(4): 366-372. Mots-clés : GRIPPE; INFECTION NOSOCOMIALE; EPIDEMIE; PREVENTION; DIAGNOSTIC; TYPAGE; VACCINATION; VACCIN; PERSONNEL; TRANSMISSION TECHNIQUE DE Purpose of review: The prevalence and incidence of viral nosocomial influenza infections in healthcare settings are underestimated. Nosocomial influenza outbreaks are frequent, and control remains challenging in acute care and long-term healthcare settings. This review examines recent publications on the determinants of nosocomial influenza prevention and control. Recent findings: Nosocomial influenza outbreaks occur in various healthcare settings, especially among the frail and elderly. The correct diagnosis is commonly missed because a substantial proportion of asymptomatic cases can transmit infections. Rapid diagnosis will facilitate rapid identification of cases and the implementation of control measures but needs confirmation in some circumstances, such as the description of transmission chains. Links between patients and healthcare personnel (HCP) have been well explored by phylogenetic virus characterization and need additional refinement and study. The preventive role of HCP vaccination in influenza incidence among patients should be investigated further in various settings to take into account different strategies for vaccination (i.e. voluntary or mandatory vaccination policies). Indeed, in Europe, influenza vaccination remains modest, whereas in North America hospitals and some states and provinces are now mandating influenza vaccination among HCP. The variability of vaccine effectiveness by seasonal epidemics is also an important consideration for control strategies. Summary: When influenza cases occur in the community, the risk of transmission and nosocomial cases increase in healthcare settings requiring vigilance among staff. Surveillance and early warning systems should be encouraged. Outbreak control needs appropriate identification of cases and transmission chains, and rapid implementation of control measures. Vaccination policies in conjunction with appropriate infection control measures could reduce virus spreading in hospitals. HCP vaccination coverage must be improved. DOI: https://doi.org/10.1097/QCO.0000000000000287 Hygiène des mains NosoBase ID notice : 418363 Rôle de l'hygiène des mains dans la lutte contre la dissémination du norovirus dans les maisons de retraite Assab R; Temime L. The role of hand hygiene in controlling norovirus spread in nursing homes. BMC infectious diseases 2016/08/09; 16(395): 1-10. Mots-clés : HYGIENE DES MAINS; NOROVIRUS; TRANSMISSION; MAISON DE RETRAITE; EHPAD; PERSONNE AGEE; GASTRO-ENTERITE; DIARRHEE; STATISTIQUE Background: Norovirus, the leading cause of gastroenteritis, causes higher morbidity and mortality in nursing homes (NHs) than in the community. Hence, implementing infection control measures is crucial. However, the evidence on the effectiveness of these measures in NH settings is lacking. Using an innovative data-driven modeling approach, we assess various interventions to control norovirus spread in NHs. 22 / 40 NosoVeille – Bulletin de veille Octobre 2016 Methods: We collected data on resident and staff characteristics and inter-human contacts in a French NH. Based on this data, we developed a stochastic compartmental model of norovirus transmission among the residents and staff of a 100-bed NH. Using this model, we investigated how the size of a 100-day norovirus outbreak changed following three interventions: increasing hand hygiene (HH) among the staff or residents and isolating symptomatic residents. Results: Assuming a baseline staff HH compliance rate of 15%, the model predicted on average 19 gastroenteritis cases over 100 days among the residents, which is consistent with published incidence data in NHs. Isolating symptomatic residents was highly effective, leading to an 88% reduction in the predicted number of cases. The number of expected cases could also be reduced significantly by increasing HH compliance among the staff; for instance, by 75% when assuming a 60% HH compliance rate. While there was a linear reduction in the predicted number of cases when HH practices among residents increased, the achieved impact was less important. Conclusions: This study shows that simple interventions can help control the spread of norovirus in NHs. Modeling, which has seldom been used in these settings, may be a useful tool for decision makers to design optimal and cost-effective control strategies. DOI: https://doi.org/10.1186/s12879-016-1702-0 NosoBase ID notice : 418677 Hygiène des mains : une mise à jour Bolon MK. Hand hygiene: An update. Infectious disease clinics of North America 2016/09; 30(3): 591-607. Mots-clés : HYGIENE DES MAINS; LAVAGE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; GEL HYDROALCOOLIQUE; INFECTIONS NOSOCOMIALES; PERSONNEL; OBSERVANCE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE Despite the abundance of hand hygiene literature, there remain numerous unanswered questions that should engage future researchers. As an example: what is the optimal level of hand hygiene adherence necessary to improve infectious outcomes? Several modeling studies have explored this issue and seem to reach consensus that there exists a level of adherence beyond which incremental improvements will achieve no further reduction in the transmission of infection, yet it is not clear what the threshold adherence might be and whether it might vary for different organisms or different levels of colonization pressure. A further question: what is the most appropriate metric of infection to use as the outcome for hand hygiene intervention studies? Is the failure to establish conclusively improvements in health care-associated infection associated with hand hygiene simply an issue of selecting the wrong outcome? Finally, which intervention or interventions can sustain improvements over time and are cost effective enough to be applied widely? The patients who place themselves in our care deserve answers to these important questions. DOI: https://doi.org/10.1016/j.idc.2016.04.007 NosoBase ID notice : 418625 Concentration d'éthanol et d'éthyl glucuronide dans l'urine après antisepsie des mains avec un produit à base d'éthanol, avec et sans consommation de boissons alcoolisées Gessner S; Below E; Diedrich S; Wegner C; Gessner W; Kohlmann T; et al. Ethanol and ethyl glucuronide urine concentrations after ethanol-based hand antisepsis with and without permitted alcohol consumption. American journal of infection control 2016/09; 44(9): 999-1003. Mots-clés : PRODUIT DE FRICTION POUR LES MAINS; GEL HYDROALCOOLIQUE; ETHANOL; URINE; HYGIENE DES MAINS; PERSONNEL; TOLERANCE; ALCOOL; GROSSESSE; ALCOOL DEHYDROGENASE Background: During hand antisepsis, health care workers (HCWs) are exposed to alcohol by dermal contact and by inhalation. Concerns have been raised that high alcohol absorptions may adversely affect HCWs, particularly certain vulnerable individuals such as pregnant women or individuals with genetic deficiencies of aldehyde dehydrogenase. Methods: We investigated the kinetics of HCWs' urinary concentrations of ethanol and its metabolite ethyl glucuronide (EtG) during clinical work with and without previous consumption of alcoholic beverages by HCWs. Results: The median ethanol concentration was 0.7 mg/L (interquartile range [IQR], 0.5-1.9 mg/L; maximum, 9.2 mg/L) during abstinence and 12.2 mg/L (IQR, 1.5-139.6 mg/L; maximum, 1,020.1 mg/L) during alcohol consumption. During abstinence, EtG reached concentrations of up to 958 ng/mL. When alcohol consumption 23 / 40 NosoVeille – Bulletin de veille Octobre 2016 was permitted, the median EtG concentration of all samples was 2,593 ng/mL (IQR, 890.8-3,576 ng/mL; maximum, 5,043 ng/mL). Although alcohol consumption was strongly correlated with both EtG and ethanol in urine, no significant correlation for the frequency of alcoholic hand antisepsis was observed in the linear mixed models. Conclusions: The use of ethanol-based handrub induces measurable ethanol and EtG concentrations in urine. Compared with consumption of alcoholic beverages or use of consumer products containing ethanol, the amount of ethanol absorption resulting from handrub applications is negligible. In practice, there is no evidence of any harmful effect of using ethanol-based handrubs as much as it is clinically necessary. DOI: https://doi.org/10.1016/j.ajic.2016.02.021 NosoBase ID notice : 419149 Taux de perforation des gants utilisés en chirurgie : étude contrôlée randomisée pour évaluer l'efficacité du double gantage Makama JG; Okeme IM; Makama EJ; Ameh EA. Glove perforation rate in surgery: A randomized, controlled study to evaluate the efficacy of double gloving. Surgical infections 2016/08; 17(4): 436-442. Mots-clés : GANT; PREVENTION; CHIRURGIE; EFFICACITE; TAUX; ETUDE RANDOMISATION; PERSONNEL; BLOC OPERATOIRE; RISQUE PROFESSIONNEL PROSPECTIVE; Background: The risk of exposure of either the patient or the surgeon to communicable disease when the surgical glove is perforated is important. Both patients and the surgical team need to be protected from this risk. Therefore, we intended to determine the efficacy of double gloving in our center. Methods: This was a prospective cohort study, involving (randomly selected) surgeons, who wore single or double latex surgical gloves during procedures. Gloves were collected and evaluated for perforations (using air insufflation and water leak methods). Results: A total of 1,536 gloves were collected (512 single gloves and 1,024 double gloves), with 78 of 512 gloves perforated, giving a rate of 15.2%. Perforation rate was 15.2% in single gloves, 14.4% in double gloves, 15.5% in emergency operations, and 14.3% in elective surgery. It was highest (30.8%) among registrars in training, particularly when doing any deep (16.0%) surgery. Glove perforation rate was highest (17.4%) among general surgery procedures as opposed to pediatric surgery (14.6%), urology (13.9%), neurosurgery (11.7%), and plastic surgery (10.6%), with (42.1%) index finger injury. In unused (control group) gloves, the rate of perforation was (0.8%). There was a substantial difference in the overall perforation rate between single and double glove sets (15.2% versus 14.4%) (X 2 = 1748, p<0.0001). However, among the double set, total gloves [outer and inner set] analysis revealed a perforation rate of 27.5% (141 of 512). Of this set, the number of inner gloves that perforated as a result of a through and through puncture from outer to the inner gloves gave a rate of 1.17% (six of 512). Thus, the protection offered by double gloves was 98.83% (X2=280.9, p<0.0001) even if the outer gloves were perforated. Conclusion: The use of double gloves has more than 90% protection to patient and the surgeon. Therefore, wearing double gloves should be encouraged in surgery. DOI: https://doi.org/10.1089/sur.2015.165 NosoBase ID notice : 418189 Interventions visant à améliorer l’hygiène des mains des patients : une revue systématique Srigley JA; Furness CD; Gardam M. Interventions to improve patient hand hygiene: a systematic review. The journal of hospital infection 2016/09; 94(1): 23-29. Mots-clés : HYGIENE DES MAINS; CLOSTRIDIUM DIFFICILE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; REVUE DE LA LITTERATURE; EFFICACITE; USAGER DE LA SANTE; TRANSMISSION; PREVENTION Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with 24 / 40 NosoVeille – Bulletin de veille Octobre 2016 components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes. DOI: https://doi.org/10.1016/j.jhin.2016.04.018 Infection urinaire NosoBase ID notice : 418963 Evaluer une formation organisée par des pharmaciens hospitaliers pour réduire les antibiothérapies inappropriées à des patients ayant une bactériurie asymptomatique Hartley SE; Kuhn L; Valley S; Washer LL; Gandhi T; Meddings J; et al. Evaluating a hospitalist-based intervention to decrease unnecessary antimicrobial use in patients with asymptomatic bacteriuria. Infection control and hospital epidemiology 2016/09; 37(9): 1044-1051. Mots-clés : ANTIBIOTIQUE; FORMATION; BACTERIURIE; PHARMACIEN; QUALITE; EVALUATION; TRAITEMENT; TAUX Objective: Inappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention. Design: Prospective, interventional trial. Setting: Two community hospitals and a tertiary-care academic center. Patients: Adult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection. Interventions: An educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians. Results: Treatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; P<.001) or urinary catheters (31.2%; P<.001). The pharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients. Conclusions: A hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful. DOI: https://doi.org/10.1017/ice.2016.119 Maternité NosoBase ID notice : 419407 Réseau "MATER : le contrôle d'infection est efficace pour l'endométrite mais pas pour l'infection urinaire après accouchement par voie basse Ayzac L; Caillat-Vallet E; Girard R; Berland M. The "RESEAU MATER": An efficient infection control for endometritis, but not for urinary tract infection after vaginal delivery. Journal of infection and public health 2016/09/01; in press: 1-13. Mots-clés : MATERNITE; ACCOUCHEMENT PAR VOIE BASSE; ENDOMETRE; INFECTION URINAIRE; SURVEILLANCE; FACTEUR DE RISQUE "RESEAU MATER" is useful to monitor nosocomial infections in maternity and contributes to the decreasing trend of it, since its implementation. Specifically, this network demonstrates its efficiency in the control of endometritis following vaginal deliveries, but not in the control of urinary tract infections. The aim of this study is to determine whether the difference between the control of endometritis and of urinary tract infection could be explained by an unsuitable regression model or by an unsuitable care policy concerning urinary cares. 25 / 40 NosoVeille – Bulletin de veille Octobre 2016 This study includes (1) the analysis of historic data of the network and (2) the description of French guidelines for maternity cares and available evaluations, concerning endometritis and urinary tract infection prevention. Univariate and multivariate odds ratios (ORs) were calculated for the total study period of 1999-2013, for these infections and their risk factors. The endometritis frequency is decreasing, in association with no significant evolution of associated risk factors, but urinary tract infection frequency is constant, in association with a increasing trend of its risk factors such as intermittent catheterization and epidural analgesia. In French guidelines, all preventive measures against endometritis are clearly broadcasted by all field operators, and repeated audits have reinforced the control of their application. But preventive measures against urinary tract infection seem to be broadcasted exclusively in the circle of infection prevention agencies and not in the obstetrics societies or in the Health Ministry communication. Urinary tract infection prevention requires a clearer public and professional policy in favor of a more efficient urinary cares, with a specific target to maternity. DOI: https://doi.org/10.1016/j.jiph.2016.08.002 NosoBase ID notice : 419182 Essai contrôlé randomisé évaluant les pansements imprégnés de chlorure de dialkyl carbamoyl pour la prévention des infections du site opératoire chez des femmes bénéficiant d'une césarienne Stanirowski PJ; Bizoń M; Cendrowski K; Sawicki W. Randomized controlled trial evaluating dialkylcarbamoyl chloride impregnated dressings for the prevention of surgical site infections in adult women undergoing cesarean section. Surgical infections 2016/08; 17(4): 427-435. Mots-clés : PREVENTION; OBSTETRIQUE; CESARIENNE; PANSEMENT; MATERNITE; EFFICACITE; COUT Background: Surgical site infections (SSI) occur in 1.8%-9.2% of women undergoing cesarean section (CS) and lead to greater morbidity rates and increased treatment costs. The aim of the study was to evaluate the efficacy and cost-effectiveness of dialkylcarbamoyl chloride (DACC) impregnated dressings to prevent SSI in women subject to CS. Methods: Randomized, controlled trial was conducted at the Mazovian Bródno Hospital, a tertiary care center performing approximately 1300 deliveries per year, between June 2014 and April 2015. Patients were randomly allocated to receive either DACC impregnated dressing or standard surgical dressing (SSD) following skin closure. In order to analyze cost-effectiveness of the selected dressings in the group of patients who developed SSI, the costs of ambulatory visits, additional hospitalization, nursing care, and systemic antibiotic therapy were assessed. Independent risk factors for SSI were determined by multivariable logistic regression. Results: Five hundred and forty-three women undergoing elective or emergency CS were enrolled. The SSI rates in the DACC and SSD groups were 1.8% and 5.2%, respectively (p=0.04). The total cost of SSI prophylaxis and treatment was greater in the control group as compared with the study group (5775 EUR vs. 1065 EUR, respectively). Independent risk factors for SSI included higher pre-pregnancy body mass index (adjusted odds ratio [aOR]=1.08; [95% confidence interval [CI]: 1.0-1.2]; p<0.05), smoking in pregnancy (aOR=5.34; [95% CI: 1.6-15.4]; p<0.01), and SSD application (aOR=2.94; [95% CI: 1.1-9.3]; p<0.05). Conclusion: The study confirmed the efficacy and cost-effectiveness of DACC impregnated dressings in SSI prevention among women undergoing CS. DOI: https://doi.org/10.1089/sur.2015.223 Odontologie NosoBase ID notice : 418111 Contamination des gants pendant le traitement endodontique est l’une des sources d’infection endodontique nosocomiale à Propionibacterium acnes Niazi SA; Vincer L; Mannocci F. Glove contamination during endodontic treatment is one of the sources of nosocomial endodontic Propionibacterium acnes infections. Journal of endodontics 2016/08; 42(8): 12021211. Mots-clés : GANT; CONTAMINATION; DENT; ODONTOLOGIE; CHIRURGIE DENTAIRE; PROPIONIBACTERIUM; STAPHYLOCOCCUS EPIDERMIDIS; INFECTION NOSOCOMIALE; PRELEVEMENT; MICROBIOLOGIE; BIOLOGIE MOLECULAIRE; PREVALENCE; TYPAGE; MICROBIOTE 26 / 40 NosoVeille – Bulletin de veille Octobre 2016 Introduction: The opportunistic Propionibacterium acnes recovered frequently from failed endodontic treatments might be the result of nosocomial endodontic infections. The study was aimed to determine if gloves worn by dentists could be one of the sources of these nosocomial infections and to investigate the P. acnes phylotypes involved. Methods: The cultivable microbiota of gloves (n=8) at 4 time points (T1, immediately after wearing gloves; T2, after access cavity preparation; T3, after taking a working length/master cone radiograph; and T4, before sealing the cavity) were identified using 16S ribosomal RNA gene sequencing. recA gene sequencing of P. acnes isolates was done. The phylogenetic relationship was determined using MEGA 6 (http://www.megasoftware.net/fixedbugs.html; Megasoftware, Tempe, AZ). Data distributions were compared using the Fisher exact test; means were compared using the Mann-Whitney U test in SPSSPC (version 21; IBM, Armonk, NY). Results: The quantitative viable counts at T4 (aerobically [2.93±0.57], anaerobically [3.35±0.43]) were greater (P<.001) than at T1 [(aerobically [0.48±0.73], anaerobically [0.66±0.86]) and T2 (aerobically [1.80±0.54], anaerobically [2.41±0.71]). Eighty cultivable bacterial taxa (5 phyla) were identified. The most prevalent ones were P. acnes and Staphylococcus epidermidis (100%). recA gene sequencing (n=88) revealed 2 phylogenetic lineages with type I split into type IA and type IB. Type II was prevalent on gloves. Conclusions: Contamination of the gloves was detected at the final stages of the treatment. P. acnes and S. epidermidis are the prevalent taxa on gloves and are opportunistic endodontic pathogens. Changing gloves frequently, after gaining access into the pulp space and also after taking the working length/master guttapercha point radiographs, is likely to reduce the risk of root canal reinfection. DOI: https://doi.org/10.1016/j.joen.2016.05.016 Pédiatrie NosoBase ID notice : 418275 Infections à Enterococcus résistant à la vancomycine en augmentation chez les enfants hospitalisés aux Etats-Unis Adams DJ; Eberly MD; Goudie A; Nylund CM. Rising vancomycin-resistant Enterococcus infections in hospitalized children in the United States. Hospital pediatrics 2016/07; 6(7): 404-411. Mots-clés : PEDIATRIE; ENTEROCOCCUS; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; ENFANT; ETUDE RETROSPECTIVE; ANTIBIORESISTANCE; FACTEUR DE RISQUE; MORTALITE; DUREE DE SEJOUR; COUT; CLOSTRIDIUM DIFFICILE; DEFICIT IMMUNITAIRE Objective: Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. Methods: A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a highdimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. Results: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizations per million in 1997 to 120 in 2012 (P<.001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P<.001) and higher hospitalization costs (AD $8233, P=.004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47). Conclusions: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations. DOI: https://doi.org/10.1542/hpeds.2015-0196 NosoBase ID notice : 418210 Sepsis d'apparition tardive à Staphylococcus capitis "neonatalis" chez des nourrissons de faible poids : une nouvelle entité ? 27 / 40 NosoVeille – Bulletin de veille Octobre 2016 Ben Saïd M; Hays S; Bonfils M; Jourdes E; Rasigade JP; Laurent F; et al. Late-onset sepsis due to Staphylococcus capitis 'neonatalis' in low-birthweight infants: a new entity? The journal of hospital infection 2016/09; 94(1): 95-98. Mots-clés : STAPHYLOCOCCUS; NOUVEAU-NE; POIDS DE NAISSANCE; PREMATURE; SYNDROME SEPTIQUE; STAPHYLOCOQUE A COAGULASE NEGATIVE; STAPHYLOCOCCUS CAPITIS During hospitalization, sepsis occurs in one of every five very-low-birthweight infants. The emergence of Staphylococcus capitis (SC)-related sepsis in preterm infants was observed recently. This study aimed to evaluate the clinical severity of SC-related sepsis in preterm infants. Of the 105 infants who presented with sepsis related to coagulase-negative staphylococci, 74 were SC. Severe morbidity was more common in the SC group (55.4%) than in the non-SC coagulase-negative staphylococci group (32.0%) (P=0.03). Multivariate analysis identified SC-related sepsis as an independent risk factor for severe morbidity. DOI: https://doi.org/10.1016/j.jhin.2016.06.008 NosoBase ID notice : 418271 Réduction des taux d'infections associées aux voies centrales chez les enfants atteints de leucémie après la formation des aidants familiaux. Une étude d'amélioration de la qualité Lo Vecchio A; Schaffzin JK; Ruberto E; Caiazzo MA; Saggiomo L; Mambretti D; et al. Reduced central line infection rates in children with leukemia following caregiver training. A quality improvement study. Medicine 2016/06; 95(25): 1-6. Mots-clés : BACTERIEMIE; CATHETER VEINEUX CENTRAL; PEDIATRIE; ENFANT; LEUCEMIE; USAGER DE LA SANTE; AIDANT; FORMATION; PREVENTION; EFFICACITE Infections are a leading cause of morbidity and mortality in children with acute leukemia. Central-line (CL) devices increase this population's risk of serious infections.Within the context of a quality improvement (QI) project, we tested the effect of caregiver education on CL management on the CL-associated bloodstream infection (CLABSI) rate among children with acute leukemia seen at a large referral center in Italy. The intervention consisted of 9 in-person sessions for education and practice using mannequins and children.One hundred and twenty caregivers agreed to participate in the initiative. One hundred and five (87.5%) completed the training, 5 (4.1%) withdrew after the first session, and 10 (8.3%) withdrew during practical sessions. After educational intervention, the overall CLABSI rate was reduced by 46% (from 6.86 to 3.70/1000 CL-days). CLABSI rate was lower in children whose caregivers completed the training (1.74/1000 CL-days, 95% CI 0.43-6.94) compared with those who did not receive any training (12.2/1000 CL-days, 95% CI 7.08-21.0, P < 0.05) or were in-training (3.96/1000 CL-days, 95% CI 1.98-7.91) at the time of infection.Caregiver training in CL management, applied within a multifaceted QI approach, reduced the rate of CLABSI in children with acute leukemia. Specific training and active involvement of caregivers in CL management may be effective to reduce CLABSI in high-risk children. DOI: https://doi.org/10.1097/MD.0000000000003946 Personnel NosoBase ID notice : 419289 Caractérisation des accidents d'exposition au sang et aux liquides biologiques au-delà de la législation sur la prévention des piqûres et coupures "Needlestick Safety and Prevention Act" Green-McKenzie J; McCarthy RB; Shofer FS. Characterisation of occupational blood and body fluid exposures beyond the Needlestick Safety and Prevention Act. Journal of infection prevention 2016/09; 17(5): 226-232. Mots-clés : ENQUETE; ACCIDENT D'EXPOSITION AU SANG; RISQUE PROFESSIONNEL; COUPURE; PIQURE; PERSONNEL; PREVENTION; MATERIEL DE SECURITE; INCIDENCE; PRECAUTION STANDARD; FORMATION Objective: To describe the use of mandated safety engineered sharps devices (SESDs) and personal protective equipment in healthcare workers (HCWs) with occupational body fluid exposures (BFE) since the Needlestick Safety and Prevention Act. Methods: Two questionnaires were administered, over 3 years, to HCWs who reported sharps or splash BFEs. Descriptive statistics and chi-square analysis were used. 28 / 40 NosoVeille – Bulletin de veille Octobre 2016 Results: Of the 498 questionnaires completed, nurses completed 262 (53%), house staff 155 (32%), technicians 63 (13%) and phlebotomists 11 (2%). Four (1%) completers reported ‘other’ and three (1%) reported unknown. Sharps injuries accounted for 349 (70%) of the BFEs. SESDs were utilised 43% (128/299) of the time with a 54% (70/130) activation rate. Phlebotomists (80%; 8/10) and nurses (59%; 79/267) used SESDs more than doctors (27%; 31/86) and technicians (26%; 10/39) (P<0.0001). Fifty-four percent (185/207) of HCWs reported having had training on SESD use; nurses (64%; 98/154) and phlebotomists (70%; 7/8) significantly more so than house staff (44%; 59/133) and technicians (44%; 21/48) (P<0.05). Most splash BFEs were to the eyes 73% (91/149). Five percent (4/79) of HCWs used protective eyewear. Conclusions: Systematic regular training, appropriate protocols and iteratively providing the safest SESDs based on HCW experience and technological advances will further reduce the physical and emotional toll of BFEs. DOI: https://doi.org/10.1177/1757177416645339 NosoBase ID notice : 418209 La contamination bactérienne des blouses blanches des infirmières à base de tissus en polyester et coton/polyester mélangés Gupta P; Bairagi N; Priyadarshini R; Singh A; Chauhan D; Gupta D. Bacterial contamination of nurses' white coats made from polyester and polyester cotton blend fabrics. The journal of hospital infection 2016/09; 94(1): 92-94. Mots-clés : CONTAMINATION; BLOUSE; INFIRMIER; POLYESTER; COTON In India, nurses wear white coats over their uniform. In this small study, patches of polyester and polyester cotton blend fabrics were attached to the white coats of nurses and sampled for contamination after one shift. Results showed that microbial adhesion is influenced by fabric type, with the microbial load on the polyester cotton blend fabric being 60% higher than that on the polyester fabric. Further studies need to be conducted to establish the correlation between fabric properties and microbial contamination. DOI: https://doi.org/10.1016/j.jhin.2016.05.016 NosoBase ID notice : 418967 Réservoir caché : une épidémie de tuberculose parmi le personnel hospitalier n’ayant pas de contact avec les patients Hazard R; Enfield KB; Low DJ; Giannetta ET; Sifri CD. Hidden reservoir: an outbreak of tuberculosis in hospital employees with no patient contact. Infection control and hospital epidemiology 2016/09; 37(9): 11111113. Mots-clés : TUBERCULOSE; EPIDEMIE; TRANSMISSION AERIENNE; AIR PERSONNEL; ALIMENTATION; CUISINE; RISQUE; We describe an outbreak of tuberculosis (TB) in the food preparation area of a hospital, which demonstrates that employees in healthcare settings may serve as potential risks for spread of TB even if they have no direct patient contact. DOI: https://doi.org/10.1017/ice.2016.126 NosoBase ID notice : 418959 Equipement de protection individuel (EPI) pour la préparation face à des maladies infectieuses : une évaluation des facteurs humains Herlihey TA; Gelmi S; Flewwelling CJ; Hall TN; Bañez C; Morita PP; et al. Personal protective equipment for infectious disease preparedness: a human factors evaluation. Infection control and hospital epidemiology 2016/09; 37(9): 1022-1028. Mots-clés : TENUE VESTIMENTAIRE; MASQUE; GANT; FORMATION; PERSONNEL; RISQUE; EPI; EQUIPEMENT DE PROTECTION INDIVIDUELLE Objective: To identify issues during donning and doffing of personal protective equipment (PPE) for infectious diseases and to inform PPE procurement criteria and design. 29 / 40 NosoVeille – Bulletin de veille Octobre 2016 Design: A mixed methods approach was used. Usability testing assessed the appropriateness, potential for errors, and ease of use of various combinations of PPE. A qualitative constructivist approach was used to analyze participant feedback. Setting: Four academic health sciences centers: 2 adult hospitals, 1 trauma center, and 1 pediatric hospital, in Toronto, Canada. Participants: Participants (n=82) were representative of the potential users of PPE within Western healthcare institutions. Results: None of the tested combinations provided a complete solution for PPE. Environmental factors, such as anteroom layout, and the design of protocols and instructional material were also found to impact safety. The study identified the need to design PPE as a complete system, rather than mixing and matching components. Conclusions: Healthcare institutions are encouraged to use human factors methods to identify risk and failure points with the usage of their selected PPE, and to modify on the basis of iterative evaluations with representative end users. Manufacturers of PPE should consider usability when designing the next generation of PPE. DOI: https://doi.org/10.1017/ice.2016.124 NosoBase ID notice : 418641 Epidémie à parvovirus B19 parmi des anesthésistes et chirurgiens en formation post-doctorale Lara-Medrano R; Martínez Reséndez MF; Garza-González E; Medina-Torres AG; Camacho-Ortiz A. Outbreak of parvovirus B19 infection among anesthesiology and surgical fellows. American journal of infection control 2016/09; 44(9): 1069-1070. Mots-clés : EPIDEMIE; VIRUS; PARVOVIRUS; PERSONNEL; ANESTHESIE; SOIGNANT-SOIGNANT; RISQUE PROFESSIONNEL; INFECTION NOSOCOMIALE TRANSMISSION A human parvovirus B19 outbreak was detected in personnel assigned to a surgical area (anesthesiology fellows and an otorhinolaryngology fellow) in a university hospital. The attack rate between susceptible members was higher than previous reports. Diagnosis was determined by polymerase chain reaction for human parvovirus B19 in serum of 1 subject and immunoglobulin M/immunoglobulin G antibody titer in the remaining subjects. Medical personnel were put on leave of absence until resolution of symptoms and laboratory confirmation of health. No cases of infection were detected in hospitalized patients or other health care workers on follow-up. DOI: https://doi.org/10.1016/j.ajic.2015.12.004 Prévention NosoBase ID notice : 409461 Etude qualitative des points de vue et des expériences dans la gestion de la performance en matière d'infections nosocomiales Brewster L; Tarrant C; Dixon-Woods M. Qualitative study of views and experiences of performance management for healthcare-associated infections. The journal of hospital infection 2016/09; 94(1): 41-47. Mots-clés : INFECTION NOSOCOMIALE; PREVENTION; HOSPITALIERE; CONTROLE; PERSONNE AGEE QUALITE DES SOINS; GESTION Background: Centrally led performance management regimes using standard setting, monitoring, and incentives have become a prominent feature of infection prevention and control (IPC) in health systems. Aim: To characterize views and experiences of regulation and performance management relating to IPC in English hospitals. Methods: Two qualitative datasets containing 139 interviews with healthcare workers and managers were analysed. Data directly relevant to performance management and IPC were extracted. Data analysis was based on the constant comparative method. Findings: Participants reported that performance management regimes had mobilized action around specific infections. The benefits of establishing organizational structures of accountability were seen in empirical evidence of decreasing infection rates. Performance management was not, however, experienced as wholly benign, and setting targets in one area was seen to involve risks of ‘tunnel vision’ and the marginalization of other potentially important issues. Financial sanctions were viewed especially negatively; performance 30 / 40 NosoVeille – Bulletin de veille Octobre 2016 management was associated with risks of creating a culture of fearfulness, suppressing learning and disrupting inter-professional relationships. Conclusion: Centrally led performance management may have some important roles in IPC, but identifying where it is appropriate and determining its limits is critical. Persisting with harsh regimes may affect relationships and increase resistance to continued improvement efforts, but leaving all improvement to local teams may also be a flawed strategy. DOI: https://doi.org/10.1016/j.jhin.2016.01.021 NosoBase ID notice : 418191 Evolution d’un audit et d’un outil de surveillance dans un processus de contrôle et de prévention des infections Denton A; Topping A; Humphreys P. Evolution of an audit and monitoring tool into an infection prevention and control process. The journal of hospital infection 2016/09; 94(1): 32-40. Mots-clés : AUDIT; CLOSTRIDIUM DIFFICILE; INTERVIEW; CONNAISSANCE; FORMATION; RELATION DE TRAVAIL; PERSONNEL; INFECTION NOSOCOMIALE; PREVENTION Background: In 2010, an infection prevention and control team in an acute hospital trust integrated an audit and monitoring tool (AMT) into the management regime for patients with Clostridium difficile infection (CDI). Aim: To examine the mechanisms through which the implementation of an AMT influenced the care and management of patients with CDI. Methods: A constructivist grounded theory approach was used, employing semi-structured interviews with ward staff (N=8), infection prevention and control practitioners (IPCPs) (N=7) and matrons (N=8), and subsequently a theoretical sample of senior managers (N=4). All interviews were transcribed verbatim and analysed using a constant comparison approach until explanatory categories emerged. Findings: The AMT evolved into a daily review process (DRP) that became an essential aspect of the management of all patients with CDI. Participants recognized that the DRP had positively influenced the care received by patients with CDI. Two main explanatory themes emerged to offer a framework for understanding the influence of the DRP on care management: education and learning, and the development and maintenance of relationships. Conclusion: The use of auditing and monitoring tools as part of a daily review process may enable ward staff, matrons, and IPCPs to improve patient outcomes and achieve the required levels of environmental hygiene if they act as a focal point for interaction, education, and collaboration. The findings offer insights into the behavioural changes and improved patient outcomes that ensue from the implementation of a DRP. DOI: https://doi.org/10.1016/j.jhin.2016.04.017 NosoBase ID notice : 418686 Construire un programme de prévention des infections réussi : composants clés, processus et économie Dhar S; Cook E; Oden M; Kaye KS. Building a successful infection prevention program. Key components, processes, and economics. Infectious disease clinics of North America 2016/09; 30(3): 567-589. Mots-clés : PREVENTION; INFECTION NOSOCOMIALE; EPIDEMIOLOGIE; GESTION DES RISQUES; SURVEILLANCE; TRAVAIL EN EQUIPE; PERSONNEL; ECONOMIE DE LA SANTE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE IPPs have seen much evolution in terms of scope of activities and complexity since their inception in the 1970s. They play the lead role in HAI surveillance, reporting, and prevention. Successful programs consist of a multidisciplinary team led by a hospital epidemiologist and managed by infection preventionists. Knowledge of the economics of HAIs and the ability to make a business plan is now essential to the success of programs. Although the landscape of payers and consumers continues to evolve, increasing regulatory and reimbursement demands pertaining to HAIs are aligning with many of the core values and priorities of infection prevention. DOI: https://doi.org/10.1016/j.idc.2016.04.009 NosoBase ID notice : 418689 Prévention du risque infectieux dans les structures délivrant les soins de suite : une mise à jour 31 / 40 NosoVeille – Bulletin de veille Octobre 2016 Flanagan E; Cassone M; Montoya A; Mody L. Infection control in alternative health care settings: An Update. Infectious disease clinics of North America 2016/09; 30(3): 785-804. Mots-clés : PREVENTION; INFECTION NOSOCOMIALE; SOIN AMBULATOIRE; EHPAD; SOIN DE LONGUE DUREE; HYGIENE DES MAINS; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE Outpatient services are continually increasing and changing with expansion of new technologies. Increased use of invasive devices and procedures provides new and challenging risks for infection. Risks associated with contaminated equipment can be decreased by knowledge and maintenance of aseptic technique and disinfection practices. The challenge to IPs and ambulatory staff is to remain updated and familiar with emerging technologies to increase the likelihood of preventing health careassociated infection and providing safe patient care. More patients with a high acuity of illness are now being seen in ambulatory instead of inpatient settings, and these patients often spend prolonged periods in waiting rooms, in close proximity to others. The risk of communicable disease transmission and the relatively high prevalence of some MDROs in health care and community settings necessitate standard and transmission-based precautions for all patient care settings, including ambulatory settings. The health care worker, patient, and family members of patients need to be provided education to support patient safety and minimize infection risk. The IP has unique challenges in providing the ambulatory clinic both infection prevention and regulatory strategies. DOI: https://doi.org/10.1016/j.idc.2016.05.001 NosoBase ID notice : 418958 Analyse coût-efficacité de matériels de sécurité Fukuda H; Moriwaki K. Cost-effectiveness analysis of safety-engineered devices. Infection control and hospital epidemiology 2016/09; 37(9): 1012-1021. Mots-clés : MATERIEL DE SECURITE; COUT-EFFICACITE; ACCIDENT D'EXPOSITION AU SANG; PREVENTION; AIGUILLE; COUT; HEPATITE B; HEPATITE C; PERSONNEL; COHORTE Objective: To estimate the cost-effectiveness of safety-engineered devices (SEDs) relative to non-SEDs for winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles. Design: Decision analysis modeling. Participants: Hypothetical cohort of healthcare workers who utilized needle devices. Methods: We developed a decision-analytic model to estimate and compare the life-cycle costs and benefits for SED and non-SED needle devices. For this cost-effectiveness analysis, we quantified the total direct medical cost per needlestick injury, number of needlestick injuries avoided, and incremental costeffectiveness ratio. Sensitivity analyses were performed to examine the robustness of the base-case analysis. Results: In the base-case analysis, we calculated the incremental cost-effectiveness ratios of SED winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles to be $2,633, $13,943, $1,792, and $1,269 per needlestick injury avoided, respectively. Sensitivity analyses showed that the calculated incremental cost-effectiveness ratio values for using SEDs did not fall below zero even after adjusting the values of each parameter. Conclusion: The use of SED needle devices would not produce cost savings for hospitals. Government intervention may be needed to systematically protect healthcare workers in Japan from the risk of bloodborne pathogen infections. DOI: https://doi.org/10.1017/ice.2016.110 NosoBase ID notice : 418964 Utilité de l’e-learning dans la prévention des infections associées aux soins Labeau SO; Rello J; Dimopoulos G; Lipman J; Sarikaya A; Oztürk C; et al. The value of e-learning for the prevention of healthcare-associated infections. Infection control and hospital epidemiology 2016/09; 37(9): 1052-1059. Mots-clés : INFECTION NOSOCOMIALE; FORMATION; RECOMMANDATIONS DE BONNE PRATIQUE; CONNAISSANCE PERSONNEL; INFORMATIQUE; Background: Healthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help 32 / 40 NosoVeille – Bulletin de veille Octobre 2016 to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines. Methods: We developed an electronic course (e-course) and tested its usability and content validity. An international sample of voluntary learners submitted to a pretest (T0) that determined their baseline knowledge of guidelines, and they subsequently studied the e-course. Immediately after studying the course, posttest 1 (T1) assessed the immediate learning effect. After 3 months, during which participants had no access to the course, a second posttest (T2) evaluated the residual learning effect. Results: A total of 3,587 HCWs representing 79 nationalities enrolled: 2,590 HCWs (72%) completed T0; 1,410 HCWs (39%) completed T1; and 1,011 HCWs (28%) completed T2. The median study time was 193 minutes (interquartile range [IQR], 96-306 minutes) The median scores were 52% (IQR, 44%-62%) for T0, 80% (IQR, 68%-88%) for T1, and 74% (IQR, 64%-84%) for T2. The immediate learning effect (T0 vs T1) was +24% (IQR, 12%-34%; P300 minutes yielded the greatest residual effect (24%). Conclusions: Moderate time invested in e-learning yielded significant immediate and residual learning effects. Decision makers could consider promoting e-learning as a supporting tool in HAI prevention. DOI: https://doi.org/10.1017/ice.2016.107 NosoBase ID notice : 418688 Informatique et la lutte contre le risque infectieux Lin MY; Trick WE. Informatics in infection control. Infectious disease clinics of North America 2016/09; 30(3): 759-770. Mots-clés : INFORMATIQUE; PREVENTION; SURVEILLANCE; INFECTION NOSOCOMIALE; SANTE PUBLIQUE Infection control personnel benefit most from computer technology when they recognize the strengths and limitations of software systems in carrying out everyday infection control tasks. Computer programs excel in applying surveillance rules when little or no judgement is needed. However, computers are only as valid as the data fed into the programs, and thus periodic validation of data inputs is required. As surveillance becomes more efficient, the challenge for infection preventionists is in translating the knowledge gained from electronic surveillance systems into action. The ability of informatics tools to motivate behavior change by hospital personnel to prevent infections is a key determinant in how well informatics can ultimately improve patient safety. DOI: https://doi.org/10.1016/j.idc.2016.04.011 NosoBase ID notice : 409287 Estimations révisées concernant le nombre de cellules humaines et de cellules bactériennes dans un corps humain Sender R; Fuchs S; Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS biology 2016/08/19; 14(8): 1-14. Mots-clés : CELLULE; BACTERIE; CORPS; BIOLOGIE HUMAINE; ESTIMATION We critically revisit the "common knowledge" that bacteria outnumber human cells by a ratio of at least 10:1 in the human body. We found the total number of bacteria in the "reference man" to be 3.9.10 13, with an uncertainty (SEM) of 25%, and a variation over the population (CV) of 52%. For human cells we identify the dominant role of the hematopoietic lineage to the total count of body cells (≈90%), and revise past estimates to reach a total of 3.0.1013 human cells in the 70 kg “reference man” with 2% uncertainty and 14% CV. Our analysis updates the widely-cited 10:1 ratio, showing that the number of bacteria in our bodies is actually of the same order as the number of human cells. Indeed, the numbers are similar enough that each defecation event may flip the ratio to favor human cells over bacteria. DOI : https://doi.org/10.1371/journal.pbio.1002533 NosoBase ID notice : 418304 Pratiques de transfusion et risques infectieux associés Shander A; Lobel GP; Javidroozi M. Transfusion practices and infectious risks. Expert review of hematology 2016/06; 9(6): 597-605. 33 / 40 NosoVeille – Bulletin de veille Octobre 2016 Mots-clés : TRANSFUSION SANGUINE; FACTEUR DE RISQUE; DON DE SANG; TRANSMISSION; INFECTION NOSOCOMIALE; RECOMMANDATIONS DE BONNE PRATIQUE; PREVENTION; REVUE DE LA LITTERATURE Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks. DOI: https://doi.org/10.1586/17474086.2016.1164593 NosoBase ID notice : 418685 Santé au travail : une mise à jour ciblée sur la prévention de l'acquisition des infections avec des prophylaxies pré-exposition et post-exposition Weber DJ; Rutala WA. Occupational health update: Focus on preventing the acquisition of infections with preexposure prophylaxis and postexposure prophylaxis. Infectious disease clinics of North America 2016/09; 30(3): 729-757. Mots-clés : PREVENTION; RISQUE PROFESSIONNEL; PERSONNEL; VACCIN; VACCINATION; ACCIDENT D'EXPOSITION AU SANG; HEPATITE B; HEPATITE C; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE Health care personnel are commonly exposed to infectious agents via sharp injuries (eg, human immunodeficiency virus, hepatitis B virus, and hepatitis C virus), direct patient care (eg, pertussis and meningococcus), and the contaminated environment (eg, Clostridium difficile). An effective occupational program is a key aspect of preventing acquisition of an infection by offering the following: (1) education of health care personnel regarding proper handling of sharps, early identification and isolation of potentially infectious patients, and hand hygiene; (2) assuring immunity to vaccine-preventable diseases; and, (3) immediate availability of a medical evaluation after a nonprotected exposure to an infectious disease. DOI: https://doi.org/10.1016/j.idc.2016.04.008 Responsabilité NosoBase ID notice : 419557 Responsabilité et infections nosocomiales Safar H. Responsabilité et infections nosocomiales. Droit déontologie & soin 2016/09; 16(3): 332-336. Mots-clés : INFECTION NOSOCOMIALE; RESPONSABILITE; JURISPRUDENCE; COUR ADMINISTRATIVE D'APPEL; COUR DE CASSATION; DROIT DE LA SANTE; STAPHYLOCOCCUS EPIDERMIDIS; CANDIDA ALBICANS; ENTEROCOCCUS Décisions de jurisprudence du deuxième trimestre 2016 en matière de responsabilité pour infections nosocomiales : notion d'infections nosocomiales, régime jurisprudentiel antérieur à la loi du 4 mars 2002. DOI: https://doi.org/10.1016/j.ddes.2016.07.020 Soin intensif NosoBase ID notice : 418962 Evaluer la fiabilité des stratégies d’échantillonnage pour estimer les taux d’observance des mesures de lutte contre l’acquisition de pneumonies sous ventilation 34 / 40 NosoVeille – Bulletin de veille Octobre 2016 Diehl A; Yang T; Speck K; Battles J; Cosgrove SE; Berenholtz S; et al. Evaluating the accuracy of sampling strategies for estimation of compliance rate for ventilator-associated pneumonia process measures. Infection control and hospital epidemiology 2016/09; 37(9): 1037-1043. Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; SOIN INTENSIF; INFECTION NOSOCOMIALE; OBSERVANCE; TAUX Background: Measuring processes of care performance rates is an invaluable tool for quality improvement; however, collecting daily process measure data is time-consuming and burdensome. Objective: To evaluate the accuracy of sampling strategies to estimate monthly compliance rates with ventilator-associated pneumonia prevention measures. Setting and participants: A total of 37 intensive care units affiliated with 29 hospitals participating in a 2-state 35-month ventilator-associated pneumonia prevention collaborative. Analysis was limited to 325 unit-months with complete data entry rates. Methods: We calculated unit-month level actual and sample monthly compliance rates for 6 ventilatorassociated pneumonia prevention measures, using 4 sampling strategies: sample 1 day per month, sample 1 day per week, sample 7 consecutive days per month, and sample 7 consecutive days per month plus additional consecutive days as necessary to obtain at least 30 ventilator-days for that month whenever possible. We compared sample versus actual rates using paired t test and χ 2 test. Results: Mean sampling accuracy ranged 84%-97% for 1 day per month, 91%-98% for 1 day per week, 92%98% for 7 consecutive days per month, and 96%-99% for 7 consecutive days with at least 30 days per month if possible. The most accurate sampling strategy was to sample 7 consecutive days with at least 30 ventilatordays per month if possible. With this strategy, sample rates were within 10% of actual rates in 88%-99% of unit-months and within 5% of actual rates in 74%-97% of unit-months. Conclusion: Sampling process measures intermittently rather than continually can yield accurate estimates of process measure performance rates. DOI: https://doi.org/10.1017/ice.2016.136 NosoBase ID notice : 418183 Transmission continue de Pseudomonas aeruginosa d’un robinet de lave-main dans une unité de soins intensifs Garvey MI; Bradley CW; Tracey J; Oppenheim B. Continued transmission of Pseudomonas aeruginosa from a wash hand basin tap in a critical care unit. The journal of hospital infection 2016/09; 94(1): 8-12. Mots-clés : PSEUDOMONAS AERUGINOSA; TRANSMISSION; ROBINET D'EAU; SOIN INTENSIF; EAU; PRELEVEMENT; INFECTION NOSOCOMIALE Pseudomonas aeruginosa is an important nosocomial pathogen, colonizing hospital water supplies including taps and sinks. We report a cluster of P. aeruginosa acquisitions during a period of five months from tap water to patients occupying the same burns single room in a critical care unit. Pseudomonas aeruginosa cultured from clinical isolates from four different patients was indistinguishable from water strains by pulsedfield gel electrophoresis. Water outlets in critical care may be a source of P. aeruginosa despite following the national guidance, and updated guidance and improved control measures are needed to reduce the risks of transmission to patients. DOI: https://doi.org/10.1016/j.jhin.2016.05.004 NosoBase ID notice : 419037 Impact d'un bain de bouche à base de peroxyde d'hydrogène sur la prevention de la pneumonie associée à la ventilation chez des patients en unité de soins intensifs Nobahar M; Razavi MR; Malek F; Ghorbani R. Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit. The Brazilian journal of infectious diseases 2016/09; 20(5):444-450. Mots-clés : PREVENTION; PNEUMONIE; SOIN INTENSIF; VENTILATION ASSISTEE; INFECTION NOSOCOMIALE; PEROXYDE D'HYDROGENE; SOIN DE BOUCHE; INCIDENCE; RANDOMISATION; EFFICACITE Aims: The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU). 35 / 40 NosoVeille – Bulletin de veille Octobre 2016 Methods: This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0-2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data. Results: In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR=2.60, 95% CI: 1.04-6.49, p=0.0279). The mean±SD MCPIS was calculated as 3.91±1.35 in the HP group and 4.65±1.55 in the NS group, a difference statistically significant (p=0.042). There were no significant differences in the risk factors for VAP between the two groups. Conclusion: HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP. DOI: https://doi.org/10.1016/j.bjid.2016.06.005 NosoBase ID notice : 419045 Prise en charge des pneumonies associées à la ventilation dans les unités de soins intensifs : une étude de méthodes mixtes évaluant les obstacles et les facilitateurs liés à l'observance des recommandations Safdar N; Musuuza JS; Xie A; Schoofs Hundt A; Hall M; Wood KE; et al. Management of ventilatorassociated pneumonia in intensive care units: a mixed methods study assessing barriers and facilitators to guideline adherence. BMC infectious diseases 2016/07/22; 16(349): 1-9. Mots-clés : PNEUMONIE; SOIN INTENSIF; VENTILATION ASSISTEE; RECOMMANDATIONS DE BONNE PRATIQUE; ENQUETE; OBSERVANCE; PERSONNEL; FORMATION; TRAVAIL EN EQUIPE Background: Guidelines from the Infectious Diseases Society of America/The American Thoracic Society (IDSA/ATS) provide recommendations for diagnosis and treatment of ventilator-associated pneumonia (VAP). However, the mere presence of guidelines is rarely sufficient to promote widespread adoption and uptake. Using the Systems Engineering Initiative for Patient Safety (SEIPS) model framework, we undertook a study to understand barriers and facilitators to the adoption of the IDSA/ATS guidelines. Methods: We conducted surveys and focus group discussions of different health care providers involved in the management of VAP. The setting was medical-surgical ICUs at a tertiary academic hospital and a large multispecialty rural hospital in Wisconsin, USA. Results: Overall, we found that 55 % of participants indicated that they were aware of the IDSA/ATS guideline. The top ranked barriers to VAP management included: 1) having multiple physician groups managing VAP, 2) variation in VAP management by differing ICU services, 3) physicians and level of training, and 4) renal failure complicating doses of antibiotics. Facilitators to VAP management included presence of multidisciplinary rounds that include nurses, pharmacist and respiratory therapists, and awareness of the IDSA/ATS guideline. This awareness was associated with receiving effective training on management of VAP, keeping up to date on nosocomial infection literature, and belief that performing a bronchoscopy to diagnose VAP would help with expeditious diagnosis of VAP. Conclusions: Findings from our study complement existing studies by identifying perceptions of the many different types of healthcare workers in ICU settings. These findings have implications for antibiotic stewardship teams, clinicians, and organizational leaders. DOI: https://doi.org/10.1186/s12879-016-1665-1 Staphylococcus aureus NosoBase ID notice : 417344 Staphylococcus aureus méticillino-résistant isolé sur les surfaces et le personnel dans un service de blanchisserie hospitalière Michael KE; No D; Roberts MC. Methicillin-resistant Staphylococcus aureus isolates from surfaces and personnel at a hospital laundry facility. Journal of applied microbiology 2016/09; 121(3): 846-854. Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SURFACE; PERSONNEL; LINGERIE; CONTAMINATION; COLONISATION NASALE 36 / 40 NosoVeille – Bulletin de veille Octobre 2016 Aim: Examine a clinical laundry facility for the presence of methicillin-resistant Staphylococcus aureus (MRSA) on environmental surfaces and among personnel. Methods: Nasal and face samples along with surface samples were collected four times in 2015. MRSA isolates were confirmed using standardized biochemical assays and molecular characterization. Results: MRSA was identified in 33/120 (28%) samples from the dirty and 3/120 (3%) samples from the clean environmental areas. MRSA isolates included: (dirty) ST5 SCCmec type II, ST8 SCCmec type IV, ST 231 SCCmec type II, ST239 SCCmec type III, ST239 SCCmec type IV, ST256 SCCmec type IV and (clean) ST5 SCCmec type II and ST8 SCCmec type IV. Five different employees were MRSA positive, 4/8 (50%) from the dirty: and 1/15 (6.7%) from the clean but there was a ten-fold higher MRSA carriage 6/22 (27%) dirty vs 1/38 (2.6%) clean when all 50 human samples were combined. Conclusion: MRSA prevalence was significantly higher (28% vs 3%) in dirty vs clean areas within the laundry facility suggesting a greater risk for personnel on the dirty side. Significance & impact of the study: This is the first report of isolation and characterization of MRSA from surfaces and personnel from a clinical laundry facility. DOI: https://doi.org/10.1111/jam.13202 Stérilisation NosoBase ID notice : 418691 Désinfection et stérilisation dans les établissements de santé : vue d'ensemble et enjeux actuels Rutala WA; Weber DJ. Disinfection and sterilization in health care facilities: An overview and current issues. Infectious Disease Clinics of North America 2016/09; 30(3): 609-637. Mots-clés : DESINFECTION; STERILISATION; HYGIENE HOSPITALIERE; DISPOSITIF MEDICAL; DISPOSITIF MEDICAL STERILE; ENDOSCOPIE; ENVIRONNEMENT; SURFACE; DECONTAMINATION; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede HLD and sterilization. Current disinfection and sterilization guidelines must be strictly followed. DOI: https://doi.org/10.1016/j.idc.2016.04.002 NosoBase ID notice : 413192 Résoudre des pannes de charges de stérilisation : défaillance du processus et problèmes d'humidité des emballages/charges Seavey R. Troubleshooting failed sterilization loads: Process failures and wet packs/loads. American journal of infection control 2016/05; 44(Suppl. 5): e29-e34. Mots-clés : STERILISATION; ANALYSE DES RISQUES; GESTION DES RISQUES; DISPOSITIF MEDICAL; QUALITE; RECOMMANDATIONS DE BONNE PRATIQUE Sterilization process failures may place patients at risk. It is important that IPs, managers, educators, and staff members responsible for sterilization in health care facilities understand what to do if there is a biological, chemical, or mechanical sterilization monitor failure, or a wet pack. Sterilization process failures occur for many reasons: a malfunctioning sterilizer, user error (eg, incorrect packaging or loading procedures or incorrect cycle selection), poor steam quality, and others. All process failures should be investigated and the root cause of the failure identified. Understanding the possible causes of sterilization process failures and investigating tools for failed loads can help with risk assessment and necessary corrective action. DOI: https://doi.org/10.1016/j.ajic.2016.03.001 Usager NosoBase ID notice : 419478 Décret n° 2016-1249 du 26 septembre 2016 relatif à l'action de groupe en matière de santé 37 / 40 NosoVeille – Bulletin de veille Octobre 2016 Ministère des affaires sociales et de la santé. Décret n° 2016-1249 du 26 septembre 2016 relatif à l'action de groupe en matière de santé. Journal officiel de la République française Lois et décrets 2016/09/27; 225: 4 pages. Mots-clés : USAGER DE LA SANTE; ASSOCIATION INDEMNISATION; PROCES; MEDIATEUR; LEGISLATION DE MALADES; VICTIME; PREJUDICE; Le décret précise les modalités de mise en œuvre de l'action de groupe en matière de santé. Le décret fixe la composition de la commission de médiation que le juge peut adjoindre au médiateur et précise les personnes appartenant à des professions judiciaires auxquelles l'association portant l'action de groupe peut avoir recours pour l'assister. Il précise également les règles de la procédure civile ou administrative que commandent les spécificités de l'action de groupe en matière de santé, notamment au regard de l'appréciation individuelle des dommages corporels. Vaccination NosoBase ID notice : 412532 Boîte à outil pour le stockage et la manutention des vaccins Centers for disease control and prevention (CDC). Vaccine storage & handling toolkit. CDC 2016/06: 1-82. Mots-clés : VACCIN; STOCKAGE; CHAINE DU FROID; TRANSPORT; APPROVISIONNEMENT; CONSERVATION; CDC; RECOMMANDATIONS DE BONNE PRATIQUE NosoBase ID notice : 417969 Arrêté du 12 août 2016 modifiant l'arrêté du 22 mars 2005 fixant la liste des vaccinations que les sages-femmes sont autorisées à pratiquer Ministère des affaires sociales et de la santé. Arrêté du 12 août 2016 modifiant l'arrêté du 22 mars 2005 fixant la liste des vaccinations que les sages-femmes sont autorisées à pratiquer. Journal officiel de la République française Lois et décrets 2016/08/17; 190: 1 page. Mots-clés : ROLE PROPRE; SAGE-FEMME; VACCINATION; LEGISLATION NosoBase ID notice : 419770 Hésitation vaccinale chez les personnels de santé en Europe : étude qualitative Karafillakis E; Dinca I; Apfel F; Cecconi S; Wűrz A; Takacs J; et al. Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine 2016/09/22; 34(41): 5013-5020. Mots-clés : VACCINATION; PERSONNEL; COMPORTEMENT Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants' beliefs and attitudes toward the topic. As HCWs have the potential of 38 / 40 NosoVeille – Bulletin de veille Octobre 2016 influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients. DOI: https://doi.org/10.1016/j.vaccine.2016.08.029 NosoBase ID notice : 418522 Vaccins contre les infections nosocomiales : promesse et défis Knisely J; Liu B; Ranallo RT; Zou L. Vaccines for healthcare-associated infections: Promise and challenge. Clinical infectious diseases 2016/09/01; 63(5): 657-662. Mots-clés : INFECTION NOSOCOMIALE; VACCIN; ANTIBIORESISTANCE; CLOSTRIDIUM DIFFICILE; STAPHYLOCOCCUS AUREUS As antibiotic resistance increases and the rate of antibiotic development slows, it is becoming more urgent to develop novel approaches to prevent and mitigate serious bacterial and fungal infections. Healthcareassociated infections (HAIs), including those caused by Clostridium difficile, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenem-resistant Enterobacteriaceae, and Candida species, are a major cause of morbidity, mortality, and healthcare costs. HAIs are also a key driver of antibiotic use. Vaccines directed toward these pathogens could help prevent a large number of HAIs and associated antibiotic use if administered to targeted populations. Despite numerous scientific and operational challenges, there are vaccine candidates in late-stage clinical development for C. difficile, S. aureus, and P. aeruginosa Basic, preclinical, and early clinical research to develop vaccines for other types of HAIs is also under way. In addition, other prophylactic immune interventions, such as monoclonal antibodies, for several of these pathogens are in advanced development. Here we describe the promise, challenges, and current pipeline of vaccines to prevent HAIs. DOI: https://doi.org/10.1093/cid/ciw333 NosoBase ID notice : 418307 Résurgence des maladies évitables par la vaccination aux Etats-Unis : implications pour les soins en anesthésie-réanimation Porteous GH; Hanson NA; Sueda LA; Hoaglan CD; Dahl AB; Ohlson BB; et al. Resurgence of vaccinepreventable diseases in the United States: Anesthetic and critical care implications. Anesthesia and analgesia 2016/05; 122(5): 1450-1473. Mots-clés : VACCINATION; VACCIN; PREVENTION; PERSONNEL; SOIN INTENSIF; ANESTHESIE; ANESTHESIE REANIMATION; RISQUE PROFESSIONNEL; TRANSMISSION SOIGNE-SOIGNANT; PRECAUTION STANDARD; PRECAUTION COMPLEMENTAIRE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE; EQUIPEMENT DE PROTECTION INDIVIDUELLE Vaccine-preventable diseases (VPDs) such as measles and pertussis are becoming more common in the United States. This disturbing trend is driven by several factors, including the antivaccination movement, waning efficacy of certain vaccines, pathogen adaptation, and travel of individuals to and from areas where disease is endemic. The anesthesia-related manifestations of many VPDs involve airway complications, cardiovascular and respiratory compromise, and unusual neurologic and neuromuscular symptoms. In this article, we will review the presentation and management of 9 VPDs most relevant to anesthesiologists, intensivists, and other hospital-based clinicians: measles, mumps, rubella, pertussis, diphtheria, influenza, meningococcal disease, varicella, and poliomyelitis. Because many of the pathogens causing these diseases are spread by respiratory droplets and aerosols, appropriate transmission precautions, personal protective equipment, and immunizations necessary to protect clinicians and prevent nosocomial outbreaks are described. DOI: https://doi.org/10.1213/ANE.0000000000001196 NosoBase ID notice : 418626 Vaccination des parents d'enfants clients et des employés dans les garderies d'enfants à Saint Louis : prise du vaccin et politiques comparées aux perceptions des parents Rebmann T; Arnold LD; Elliott MB; Gilbertson PG; Wakefield M. Vaccination for child clients and employees in St Louis childcare agencies: Vaccine uptake and policies versus parents' perceptions. American journal of infection control 2016/09; 44(9): 1010-1015. 39 / 40 NosoVeille – Bulletin de veille Octobre 2016 Mots-clés : VACCINATION; VACCIN; PERSONNEL; PARENT; ENFANT; CRECHE; ENQUETE; TAUX; PERCEPTION; HEPATITE A; BORDETELLA PERTUSSIS; GRIPPE; COQUELUCHE Background: Little is known about childcare agency staff vaccination requirements, parents' perceptions of these requirements, or vaccine uptake in these populations. Methods: A questionnaire was administered to St Louis parents and childcare agency staff in fall of 2014. The χ2 tests compared staff's versus parents' uptake of hepatitis A, pertussis, and seasonal influenza vaccines. Multivariate logistic regression was used to examine individuals being fully immunized (ie, having received influenza, hepatitis A, and pertussis vaccines). Results: Overall, 351 parents and staff from 23 agencies participated (response rate, 32%). One-third of staff (34.4%, n=33) and parents (37.6%, n = 96) were fully immunized. Parents and staff were equally likely to have received the influenza vaccine (48.8% and 47.3%, respectively), but more staff received the hepatitis A vaccine (85.3% vs 67.5%, χ2=11.0, P<.001), and more parents received the pertussis vaccine (66.5% vs 45.8%, χ2=12.5, P<.001). Determinants of being fully immunized included having previously received the influenza vaccine, being offered the vaccines, belief that vaccination is important, having immunization recommendation awareness, and not having vaccine misperceptions. Conclusions: Childcare agency staff vaccination can protect employees and children from disease, but their uptake of vaccines needs improvement. Future interventions should be aimed at increasing uptake to lower disease transmission in childcare settings. DOI: https://doi.org/10.1016/j.ajic.2016.03.047 Responsables de la rubrique NosoVeille : N. Sanlaville, S. Yvars, A, K. Trouilloud (CClin Sud-Est), I. Girot (CClin Ouest), K. Lebascle (CClin Paris-Nord). Secrétaire : N. Vincent (CClin Sud-Est) Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de votre inter-région : CCLIN Est Tél : 03.83.15.34.73 Fax : 03.83.15.39.73 [email protected] CCLIN Ouest Tél : 02.99.87.35.31 Fax : 02.99.87.35.32 [email protected] CCLIN Paris-Nord Tél : 01.40.27.42.00 Fax : 01.40.27.42.17 [email protected] php.fr CCLIN Sud-Est Tél : 04.78.86.49.50 Fax : 04.78.86.49.48 nathalie.vincent@chu -lyon.fr CCLIN Sud-Ouest Tél : 05.56.79.60.58 Fax : 05.56.79.60.12 [email protected] 40 / 40