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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
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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
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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.
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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
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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
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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
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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.
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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
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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
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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
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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
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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).
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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.
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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
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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
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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.
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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
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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 ?
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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.
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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.
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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
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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
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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
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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.
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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
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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).
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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
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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
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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
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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.
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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]
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