Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download NosoVeille Août 2011
Document related concepts
Sociality and disease transmission wikipedia , lookup
Staphylococcus aureus wikipedia , lookup
Hepatitis C wikipedia , lookup
Anaerobic infection wikipedia , lookup
Clostridium difficile infection wikipedia , lookup
Hepatitis B wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Urinary tract infection wikipedia , lookup
Carbapenem-resistant enterobacteriaceae wikipedia , lookup
Neonatal infection wikipedia , lookup
Transcript
NosoVeille – Bulletin de veille
Juillet 2013
NosoVeille n°7
Juillet 2013
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Secrétariat de rédaction : Nathalie Vincent
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://nosobase.chu-lyon.fr/RevuesBiblio/sommaire_biblio.html
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Antibiorésistance
Bactériémie
Chirurgie
Coronavirus
Dispositif médical
EHPAD
Entérobactérie
Epidémie
Grippe
Hygiène des mains
Infection fongique
Infection urinaire
Pédiatrie
Personnel
Pneumonie
Prévention
Réanimation
Staphylococcus aureus
Surveillance
1 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Antibiorésistance
NosoBase ID notice : 366230
Bactéries à Gram négatif productrices de carbapénémases responsables de décès attribués à une
hospitalisation récente à l’étranger
Ahmed-Bentley J; Chandran AU; Joffe AM; French D; Peirano G; Pitout J. Gram-negative bacteria that
produce carbapenemases causing death attributed to recent foreign hospitalization. Antimicrobial agents and
chemotherapy 2013/07; 57(7): 3085-3091.
Mots-clés :
BACTERIE
A
GRAM
NEGATIF;
CARBAPENEME;
ANTIBIORESISTANCE;
MULTIRESISTANCE; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; ACINETOBACTER BAUMANNII;
EPIDEMIE; BIOLOGIE MOLECULAIRE; MORTALITE; TYPAGE
Overseas travel, as a risk factor for the acquisition of infections due to antimicrobial-resistant organisms, has
recently been linked to carbapenemase-producing Gram-negative bacteria. Multiresistant Klebsiella
pneumoniae, Escherichia coli, and Acinetobacter baumannii strains were isolated from a wound of a
Canadian patient with a recent history of hospitalization in India. This resulted in the initiation of outbreak
management that included surveillance cultures. Epidemiological and molecular investigations showed that
NDM-1-producing K. pneumoniae ST16 and OXA-23-producing A. baumannii ST10 strains were transmitted
to 5 other patients, resulting in the colonization of 4 patients and the death of 1 patient due to septic shock
caused by the OXA-23-producing A. baumannii strain. The high rate of false positivity of the screening
cultures resulted in additional workloads and increased costs for infection control and clinical laboratory work.
We believe that this is the first report of an infection with carbapenemase-producing Gram-negative bacteria
resulting in death attributed to a patient with recent foreign hospitalization. We recommend routine rectal and
wound screening for colonization with multiresistant bacteria for patients who have recently been admitted to
hospitals outside Canada.
NosoBase ID notice : 365362
Micro-organismes multirésistants aux antibiotiques chez des patients dialysés
Calfee DP. Multidrug-resistant organisms in dialysis patients. Seminars in dialysis 2013; in press: 10 pages.
Mots-clés : ANTIBIORESISTANCE; MULTIRESISTANCE; DIALYSE RENALE; COLONISATION;
STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; BACILLE GRAM NEGATIF; FACTEUR DE RISQUE;
PREVENTION; CONTROLE; TRANSMISSION; PRECAUTION CONTACT; ENVIRONNEMENT;
BIBLIOGRAPHIE
Multidrug-resistant organisms (MDROs) have emerged as important causes of healthcare-associated
infections (HAIs), and these infections are associated with significant morbidity and mortality. Dialysis patients
have been particularly affected by these pathogens, with colonization and infection rates often exceeding
those seen in persons with other types of healthcare exposure. The infection control practices that are
currently recommended for use in dialysis facilities and other healthcare settings have the potential to
eliminate, or at least substantially reduce transmission of and infection with MDROs. Unfortunately, recent
data suggest that these recommended practices are not consistently implemented. Additional efforts and
research are needed to increase healthcare workers' awareness of and adherence to infection prevention
measures, to develop new and more effective prevention strategies, and to determine cost-effective
approaches to MDRO prevention to optimize the safety and quality of care provided to dialysis patients.
NosoBase ID notice : 365359
Emergence de résistance à la colistine parmi des entérobactéries après introduction d'une
désinfection digestive sélective dans une unité de réanimation
Halaby T; Al Naiemi N; Kluytmans J; van der Palen J; Vandenbroucke-Grauls C. Emergence of colistin
resistance in Enterobacteriaceae after the introduction of selective digestive tract decontamination in an
intensive care unit. Antimicrobial agents and chemotherapy 2013; in press: 25 pages.
Mots-clés :
SOIN
INTENSIF;
ENTEROBACTERIE;
COLISTINE;
ANTIBIORESISTANCE;
DECONTAMINATION DIGESTIVE SELECTIVE; ETUDE RETROSPECTIVE; EPIDEMIE; CONTROLE;
BETA-LACTAMASE A SPECTRE ELARGI; KLEBSIELLA PNEUMONIAE; BACTERIEMIE
2 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Selective decontamination of the digestive tract (SDD) selectively eradicates aerobic Gram-negative bacteria
(AGNB) by the enteral administration of oral non-absorbable antimicrobial agents, i.e. colistin and tobramycin.
We retrospectively investigated the impact of SDD, applied for the duration of 5 years as part of an infection
control programme for the control of an outbreak with extended spectrum beta lactamase-producing
Klebsiella pneumoniae (ESBL-Kp) in an intensive care unit (ICU), on resistance among AGNB. Colistin MIC's
were performed on stored ESBL-Kp isolates using the E-test. The occurrence of both tobramycin resistance
among pathogens intrinsically resistant to colistin (CIR) and bacteraemia caused by ESBL-Kp and CIR were
investigated. Of the134 retested ESBL-Kp isolates, 28 were isolated before SDD was started and all had
MIC's <1,5 mg/L. For the remaining 106 isolated after starting SDD, MIC's ranged between 0,5 and 24 mg/L.
Tobramycin-resistant CIR isolates were found sporadically before the introduction of SDD but their
prevalence increased immediately afterwards. Segmented regression analysis showed a highly significant
relation between SDD and resistance to tobramycin. 5 patients were identified with bacteraemia caused by
ESBL-Kp before SDD and 9 patients thereafter. No bacteremia caused by CIR was found before SDD, but its
occurrence increased to 26 after the introduction of SDD. In conclusion, colistin resistance among ESBL- Kp
isolates emerged rapidly after SDD. In addition, both the occurrence and the proportion of tobramycin
resistance among CIR increased under the use of SDD. SDD should not be applied in outbreak settings when
resistant bacteria are prevalent.
NosoBase ID notice : 366065
Exposition antérieure aux antibiotiques et évolution de l’antibiorésistance chez des patients sous
ventilation assistée présentant des infections nosocomiales
Hui C; Lin MC; Jao MS; Liu TC; Wu RG. Previous antibiotic exposure and evolution of antibiotic resistance in
mechanically ventilated patients with nosocomial infections. Journal of critical care 2013; in press: 6 pages.
Mots-clés : ANTIBIORESISTANCE; ANTIBIOTIQUE; TRAITEMENT; VENTILATION ASSISTEE; ETUDE
RETROSPECTIVE; BACTERIEMIE; INFECTION URINAIRE; INFECTION RESPIRATOIRE BASSE; SITE
OPERATOIRE; ENTEROBACTERIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BETALACTAMASE A SPECTRE ELARGI; ANALYSE MULTIVARIEE
Purpose: This study aimed to evaluate the impact of previous antibiotic exposure and the influence of time
interval since exposure on the evolution of antibiotic-resistant infections.
Methods: We retrospectively analyzed 167 mechanically ventilated patients with nosocomial infections over a
3-year period, with focus on infections in the bloodstream, urinary tract, lower respiratory tract, and surgical
sites.
Results: Of 167 patients, 62% were confirmed as antibiotic resistant. The most common isolated pathogen
was extended-spectrum β-lactamase Enterobacteriaceae (43.9%), followed by methicillin-resistant
Staphylococcus aureus (22.8%), and carbapenem-resistant Acinetobacter baumannii (17.5%). Multivariate
analysis revealed that the association between resistance and the time interval increased within 10 days
(odds ratio [OR], 2.45; P=.133) and peaked at 11 to 20 days (OR, 7.17; P=.012). The data were categorized
into 2 groups: when the time interval was more than 20 days, there was a 23.9% reduction in resistance rate
compared with when the time interval was 20 days or less (OR, 0.36; P=.002).
Conclusions: Although antibiotic exposure increased resistance rate in nosocomial infections, this association
decreased as time interval increased. Antibiotic stewardship should consider the significance of time interval
while investigating the evolution of subsequent antibiotic-resistant infections.
NosoBase ID notice : 365852
Prévalence, dans des hôpitaux Canadiens, de la colonisation et de l’infection à Staphylococcus
aureus résistant à la méticilline et à Enterococcus résistant à la vancomycine et prévalence des
infections à Clostridium difficile
Simor AE; Williams VR; McGeer A; Raboud J; Larios O; Weiss K; et al. Prevalence of colonization and
infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and of
Clostridium difficile infection in canadian hospitals. Infection control and hospital epidemiology 2013/07; 34(7):
687-693.
Mots-clés :
COLONISATION;
PREVALENCE;
STAPHYLOCOCCUS
AUREUS;
METICILLINORESISTANCE; ENTEROCOCCUS; ANTIBIORESISTANCE; CLOSTRIDIUM DIFFICILE; VANCOMYCINE;
TAUX; NETTOYAGE; ENVIRONNEMENT
3 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Objective: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococci (VRE), and Clostridium difficile infection (CDI) in Canadian hospitals.
Design: National point prevalence survey in November 2010.
Settingcanadian acute care hospitals with at least 50 beds.
Patients: Adult inpatients colonized or infected with MRSA or VRE or with CDI.
Methods: The prevalence (per 100 inpatients) of MRSA, VRE, and CDI was determined. Associations
between prevalence and institutional characteristics and infection control policies were evaluated.
Results: One hundred seventy-six hospitals (65% of those eligible) participated. The median (range)
prevalence rates for MRSA and VRE colonization or infection and CDI were 4.2% (0%-22.1%), 0.5% (0%13.1%), and 0.9% (0%-8.6%), respectively. Median MRSA and VRE infection rates were low (0.3% and 0%,
respectively). MRSA, VRE, and CDI were thought to have been healthcare associated in 79%, 96%, and 84%
of cases, respectively. In multivariable analysis, routine use of a private room for colonized/infected patients
was associated with lower median MRSA infection rate (prevalence ratio [PR], 0.44 [95% confidence interval
(CI), 0.22-0.88]) and VRE prevalence (PR, 0.26 [95% CI, 0.12-0.57]). Lower VRE rates were also associated
with enhanced environmental cleaning (PR, 0.52 [95% CI, 0.36-0.75]). Higher bed occupancy rates were
associated with higher rates of CDI (PR, 1.02 [95% CI, 1.01-1.03]).
Conclusion: These data provide the first national prevalence estimates for MRSA, VRE, and CDI in Canadian
hospitals. Certain infection prevention and control policies were found to be associated with prevalence and
deserve further investigation.
NosoBase ID notice : 366091
Impact des activités intensives de l’équipe d’hygiène hospitalière sur l’acquisition de Staphylococcus
aureus méticillino-résistant, Pseudomonas aeruginosa résistant aux antibiotiques et sur l’incidence
des infections associées à Clostridium difficile
Suzuki H; Senda J; Yamashita K; Tokuda Y; Kanesaka Y; Kotaki N; et al. Impact of intensive infection control
team activities on the acquisition of methicillin-resistant Staphylococcus aureus, drug-resistant Pseudomonas
aeruginosa and the incidence of Clostridium difficile-associated disease. Journal of infection and
chemotherapy 2013; in press: 6 pages.
Mots-clés : PSEUDOMONAS AERUGINOSA; CLOSTRIDIUM DIFFICILE; STAPHYLOCOCCUS AUREUS;
PERSONNEL;
INCIDENCE;
METICILLINO-RESISTANCE;
PREVENTION;
TRANSMISSION;
CARBAPENEME; CONSOMMATION; INDICATEUR; QUALITE; GANT; TENUE VESTIMENTAIRE;
EFFICACITE; MULTIRESISTANCE
The transmission of multidrug-resistant organisms (MDROs) is an emerging problem in acute healthcare
facilities. To reduce this transmission, we introduced intensive infection control team (ICT) activities and
investigated the impact of their introduction. This study was conducted at a single teaching hospital from 1
April 2010 to 31 March 2012. During the intervention period, all carbapenem use was monitored by the ICT,
and doctors using carbapenems inappropriately were individually instructed. Information related to patients
with newly identified MDROs was provided daily to the ICT and instructions on the appropriate infection
control measures for MDROs were given immediately with continuous monitoring. The medical records of
newly hospitalized patients were reviewed daily to check previous microbiological results and infection control
intervention by the ICT was also performed for patients with a previous history of MDROs. Compared with the
pre-intervention period, the antimicrobial usage density of carbapenems decreased significantly (28.5 vs 17.8
defined daily doses/1000 inpatient days; p<0.001) and the frequency of use of sanitary items, especially the
use of aprons, increased significantly (710 vs 1854 pieces/1000 inpatient days; p<0.001). The number of
cases with hospital-acquired MRSA (0.66 vs 0.29 cases/1000 inpatient days; p<0.001), hospital-acquired
drug-resistant Pseudomonas aeruginosa (0.23 vs 0.06 cases/1000 inpatient days; p=0.006) and nosocomial
Clostridium difficile-associated disease (0.47 vs 0.11 cases/1000 inpatient days; p<0.001) decreased
significantly during the intervention period. Our study showed that proactive and continuous ICT interventions
were effective for reduction of MDRO transmission.
NosoBase ID notice : 365742
Antibiorésistance mondiale : une histoire sans fin
Theuretzbacher U. Global antibacterial resistance: the never-ending story. Journal of global antimicrobial
resistance 2013/06; 1(2): 63-69.
Mots-clés : ANTIBIORESISTANCE; EPIDEMIOLOGIE; MULTIRESISTANCE;
AUREUS; ENTEROCOCCUS; ENTEROBACTERIE; BIBLIOGRAPHIE
STAPHYLOCOCCUS
4 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Bacterial resistance is undoubtedly recognised as a major medical challenge inmost healthcare systems.
Resistance-determining genes, mostly in combination, and multidrug-resistant (MDR) pathogens are
spreading with unprecedented speed. Well known resistance carriers with high clinical impact include the
Gram-positive organisms Staphylococcus aureus and Enterococcus spp. In contrast to these organisms that
are usually still treatable with newer alternative antibacterial drugs, some Gram-negative bacteria, especially
Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp., have developed
resistance to most or all available antibiotics. Such strains are already a reality in some Mediterranean and
Asian countries. According to their resistance epidemiology (based on major drivers favouring resistance),
three regions are pinpointed as high-impact resistance hot spots. Despite the clear medical need for novel
antibiotics without cross-resistance issues, antibacterial research and development pipelines are nearly dry,
thus failing to provide the flow of novel antibiotics required to match the fast emergence and spread of MDR
bacteria. In a globalised world, only concerted global actions can mitigate a future with untreatable infectious
diseases.
Bactériémie
NosoBase ID notice : 365321
Impact des PICC lines imprégnées d'antibiotique sur l'incidence des bactériémies dans un centre
régional pour brûlés
Armstrong SD; Thomas W; Neaman KC; Ford RD; Paulson J. The impact of antibiotic impregnated PICC
lines on the incidence of bacteremia in a regional burn center. Burns 2013/06; 39(4): 632-635.
Mots-clés : ANTIBIOTIQUE; BACTERIEMIE; BRULE; INCIDENCE; CATHETER; CATHETER IMPREGNE;
CATHETER VEINEUX; ETUDE RETROSPECTIVE
Introduction: Peripherally inserted central catheters (PICCs) have been used increasingly in burn patients
who often have decreased intravascular volumes and obtaining intravascular access for resuscitative efforts
can be difficult. A potentially serious complication is bloodstream infection. The purpose of our study is to
examine the impact of antibiotic impregnated PICC lines on the bacteremia rate in a regional burn center.
Methods: Consecutive patients admitted to the burn unit and receiving an antibiotic impregnated PICC line
were included in the study. Baseline demographics and bacteremia rate was recorded. A retrospective chart
review was then undertaken of the 30 consecutive patients admitted to the burn unit and receiving a PICC
line prior to the study period.
Results: Nineteen patients were enrolled over the two-year period. The bacteremia rate for the study group
was 0% compared to the 50% bacteremia rate of the retrospective control group (p=<0.001).
Conclusion: Antibiotic impregnated PICC lines decrease the bacteremia rate in our burn population. This has
potential benefits for both patient morbidity and mortality as well as potential cost savings for the healthcare
system.
NosoBase ID notice : 366229
Pertinence du traitement empirique et évolution des bactériémies à bactéries productrices de bêtalactamases à spectre étendu
Frakking FNJ; Rottier WC; Dorigo-Zetsma JW; van Hattem JM; van Hees BC; Kluytmans JA; et al.
Appropriateness of empirical treatment and outcome in bacteremia caused by extended-spectrum-βlactamase-producing bacteria. Antimicrobial agents and chemotherapy 2013/07; 57(7): 3092-3099.
Mots-clés : BACTERIEMIE; TRAITEMENT; ANTIBIOTIQUE; COHORTE; BETA-LACTAMASE A SPECTRE
ELARGI;
ETUDE
RETROSPECTIVE;
ESCHERICHIA
COLI;
KLEBSIELLA
PNEUMONIAE;
ENTEROBACTER CLOACAE; INFECTION URINAIRE; ANALYSE MULTIVARIEE; MORTALITE; ETUDE
RETROSPECTIVE
We studied clinical characteristics, appropriateness of initial antibiotic treatment, and other factors associated
with day 30 mortality in patients with bacteremia caused by extended-spectrum-β-lactamase (ESBL)producing bacteria in eight Dutch hospitals. Retrospectively, information was collected from 232 consecutive
patients with ESBL bacteremia (due to Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae)
between 2008 and 2010. In this cohort (median age of 65 years; 24 patients were <18 years of age), many
had comorbidities, such as malignancy (34%) or recurrent urinary tract infection (UTI) (15%). One hundred
forty episodes (60%) were nosocomial, 54 (23%) were otherwise health care associated, and 38 (16%) were
5 / 29
NosoVeille – Bulletin de veille
Juillet 2013
community acquired. The most frequent sources of infection were UTI (42%) and intra-abdominal infection
(28%). Appropriate therapy within 24 h after bacteremia onset was prescribed to 37% of all patients and to
54% of known ESBL carriers. The day 30 mortality rate was 20%. In a multivariable analysis, a Charlson
comorbidity index of ≥3, an age of ≥75 years, intensive care unit (ICU) stay at bacteremia onset, a non-UTI
bacteremia source, and presentation with severe sepsis, but not inappropriate therapy within <24 h (adjusted
odds ratio [OR], 1.53; 95% confidence interval [CI], 0.68 to 3.45), were associated with day 30 mortality.
Further assessment of confounding and a stratified analysis for patients with UTI and non-UTI origins of
infection did not reveal a statistically significant effect of inappropriate therapy on day 30 mortality, and these
results were insensitive to the possible misclassification of patients who had received β-lactam-β-lactamase
inhibitor combinations or ceftazidime as initial treatment. In conclusion, ESBL bacteremia occurs mostly in
patients with comorbidities requiring frequent hospitalization, and 84% of episodes were health care
associated. Factors other than inappropriate therapy within <24 h determined day 30 mortality.
NosoBase ID notice : 365915
Enterococcus sp. et définition de la surveillance des bactériémies sur voies centrales : évaluer
l’importance de la contamination des hémocultures
Freeman JT; Anderson DJ; Sexton DJ. Enterococcus species and the central line-associated bloodstream
infection surveillance definition: evaluating the importance of blood culture contamination. Infection control
and hospital epidemiology 2013/07; 34(7): 762-763.
Mots-clés : SURVEILLANCE; ENTEROCOCCUS; CATHETER VEINEUX CENTRAL; BACTERIEMIE;
HEMOCULTURE; CONTAMINATION
NosoBase ID notice : 365773
Infections associées aux dispositifs veineux centraux implantables chez des patients cancéreux :
épidémiologie et facteurs de risque
Freire MP; Pierrotti LC; Zerati AE; Araújo PH; Motta-Leal-Filho JM; Duarte LP; et al. Infection related to
implantable central venous access devices in cancer patients: epidemiology and risk factors. Infection control
and hospital epidemiology 2013/07; 34(7): 671-677.
Mots-clés : FACTEUR DE RISQUE; INFECTION; CATHETER VEINEUX CENTRAL; BACTERIEMIE;
EPIDEMIOLOGIE; INCIDENCE; TAUX; DEIFICIT IMMUNITAIRE; ANALYSE MULTIVARIEE; ONCOLOGIE;
CANCER; SITE OPERATOIRE; ETUDE PROSPECTIVE
Objective: To describe the epidemiology of infections related to the use of implantable central venous access
devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections.
Design: Prospective cohort study.
Setting: Referral hospital for cancer in São Paulo, Brazil.
Patients: We prospectively evaluated all implantable CVADs employed between January 2009 and December
2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death.
Methods: Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects
that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and
limiting CVAD insertion in neutropenic patients have on the rates of such infections.
Results: During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a
combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were
bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the
study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days (P<.001).
Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention,
implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy
indication for catheter use.
Conclusions: Establishing a multidisciplinary team specifically focused on CVAD care, together with
systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.
NosoBase ID notice : 365772
Evaluer l’utilisation de la définition de la surveillance des bactériémies associées aux voies centrales,
élaborée par le réseau NHSN (National Health Safety Network) : une enquête au sein d’unités
pédiatriques d’oncologie/hématologie et de soins intensifs
6 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Gaur AH; Miller MR; Gao C; Rosenberg C; Morrell GC; Coffin SE; et al. Evaluating application of the national
healthcare safety network central line-associated bloodstream infection surveillance definition: a survey of
pediatric intensive care and hematology/oncology units. Infection control and hospital epidemiology 2013/07;
34(7): 663-670.
Mots-clés : SURVEILLANCE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; PEAU; SOIN INTENSIF;
PEDIATRIE; ONCOLOGIE; HEMATOLOGIE; DEFINITION
Objective: To evaluate the application of the National Healthcare Safety Network (NHSN) central lineassociated bloodstream infection (CLABSI) definition in pediatric intensive care units (PICUs) and pediatric
hematology/oncology units (PHOUs) participating in a multicenter quality improvement collaborative to reduce
CLABSIs; to identify sources of variability in the application of the definition.
Design: Online survey using 18 standardized case scenarios. Each described a positive blood culture in a
patient and required a yes- or-no answer to the question "Is this a CLABSI?" NHSN staff responses were the
reference standard.
Setting: Sixty-five US PICUs and PHOUs.
Participants: Staff who routinely adjudicate CLABSIs using NHSN definitions.
Results: Sixty responses were received from 58 (89%) of 65 institutions; 78% of respondents were infection
preventionists, infection control officers, or infectious disease physicians. Responses matched those of NHSN
staff for 78% of questions. The mean (SE) percentage of concurring answers did not differ for scenarios
evaluating application of 1 of the 3 criteria ("known pathogen," 78% [1.7%]; "skin contaminant, >1 year of
age," 76% [SE, 2.5%]; "skin contaminant, ≤1 year of age," 81% [3.8%]; P=.3). The mean percentage of
concurring answers was lower for scenarios requiring respondents to determine whether a CLABSI was
present or incubating on admission (64% [4.6%]; P=.017) or to distinguish between primary and secondary
bacteremia (65% [2.5%]; P=.021).
Conclusions: The accuracy of application of the CLABSI definition was suboptimal. Efforts to reduce
variability in identifying CLABSIs that are present or incubating on admission and in distinguishing primary
from secondary bloodstream infection are needed.
NosoBase ID notice : 366607
Complications infectieuses associées à l’usage des cathéters veineux centraux chez des patients
bénéficiant de transplantation de cellules souches hématopoïétiques
Martinho GH; Romanelli RMC; Teixeira GM; Macedo AV; Chaia JMC; Nobre V. Infectious complications
associated with the use of central venous catheters in patients undergoing hematopoietic stem cell
transplantation. American journal of infection control 2013/07; 41(7): 642-644.
Mots-clés : CATHETER VEINEUX CENTRAL; TRANSPLANTATION; INCIDENCE; MOELLE OSSEUSE;
FACTEUR DE RISQUE; BACTERIEMIE; CENTRE HOSPITALIER UNIVERSITAIRE; ANALYSE
MULTIVARIEE
In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of
central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell
transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream
infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian
access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal
failure.
NosoBase ID notice : 365354
Etude nationale sur les comorbidités et le risque de réinfection après une bactériémie à
Staphylococcus aureus
Wiese L; Mejer N; Schønheyder HC; Westh H; Jensen AG; Larsen AR; et al. A nationwide study of
comorbidity and risk of reinfection after Staphylococcus aureus bacteraemia. Journal of infection 2013; in
press: 7 pages.
Mots-clés : RISQUE; STAPHYLOCOCCUS AUREUS; BACTERIEMIE; INCIDENCE; MORTALITE;
COHORTE; ANALYSE MULTIVARIEE; FACTEUR DE RISQUE; DIALYSE RENALE; DIABETE; VIRUS DE
L'IMMUNODEFICIENCE HUMAINE; INFECTION RECURRENTE; MORBIDITE
7 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Background: Data on risk factors and rates of reinfection associated with Staphylococcus aureus bacteraemia
(SAB) are sparse.
Methods: We conducted a nationwide cohort study of cases of SAB diagnosed between 1995 and 2008.
Reinfection was defined as an episode of SAB more than 90 days after the initial episode of SAB.
Comorbidity was evaluated by the Charlson Comorbidity Index (CCI). Cox proportional hazards modelling
was used to estimate hazard rates (HR).
Results: Of 10,891 eligible patients, 774 (7.1%) experienced reinfection a median of 458 days (range 90-5021
days) after their primary SAB episode corresponding to a reinfection rate of 1459 (95% confidence interval
(CI): 1357-1562) per 100,000 personyears. In multivariate analysis, sex, origin, a vascular or peritoneal
device, endocarditis and comorbidity were associated with reinfection. The association was more than twofold higher among patients in dialysis and for patients with severe comorbidity (CCI≥2). HIV infection (Hazard
ratio (HR) 6.18, 95% CI: 4.17-9.16), renal disease (HR 3.92, 95% CI: 3.22-4.78), diabetes with complications
(HR 2.11, 95% CI: 1.69-2.62), diabetes without complications (HR 1.61, 95% CI: 1.34-1.93), mild (HR: 1.94,
95% CI: 1.36-2.76) and severe liver disease (HR 2.08, 95% CI: 1.08-4.03), peptic ulcer (HR 1.33, 95% CI:
1.03-1.72), and paraplegia (HR 2.15, 95% CI: 1.02-4.54) were each associated with an increased risk of
reinfection.
Conclusions: Patients with previous SAB have a 60-fold higher risk of SAB compared to the general
population. Patients with HIV infection, renal disease, diabetes, liver disease, peptic ulcer and paraplegia had
the highest rates of reinfection.
Chirurgie
NosoBase ID notice : 366517
Caractéristiques et évolution de 16 infections périprothétiques de l’épaule
Achermann Y; Sahin F; Schwyzer HK; Kolling C; Wüst J; Vogt MP. Characteristics and outcome of 16
periprosthetic shoulder joint infections. Infection 2013/06; 41(3): 613-620.
Mots-clés :
CHIRURGIE;
CHIRURGIE
ORTHOPEDIQUE;
RETROSPECTIVE; BACILLE GRAM POSITIF
MATERIEL
ETRANGER;
ETUDE
Purpose: Shoulder arthroplasties are increasingly performed, but data on periprosthetic joint infections (PJI)
in this anatomical position are limited. We retrospectively investigated the characteristics and outcome of
shoulder PJI after primary arthroplasty from 1998 to 2010 in a single centre.
Methods: Periprosthetic joint infection was defined as periprosthetic purulence, presence of sinus tract or
microbial growth. A Kaplan-Meier survival method was used to estimate relapse-free survival of prosthesis.
Results: From 1,571 primary shoulder prostheses, we evaluated 16 patients with a PJI at different stages, i.e,
early (n=4), delayed (n=6) and late (n=6) infections. The median patient age was 67 (range 53-86) years, and
69% were females. The most commonly isolated microorganism was Propionibacterium acnes in 38% of
patients (monobacterial in four and polymicrobial in two patients). In 14 of the 16 patients, surgical
interventions consisting of debridement and implant retention (6 patients), exchange (7) and explantation (1)
were performed. Four patients had a relapse of infection with P. acnes (n=3) or Bacteroides fragilis (n=1). The
relapse-free survival of the prosthesis was 75 % (95% confidence interval 46-90%) after 1 and 2 years, 100%
in six patients following the treatment algorithm for hip and knee PJI and 60% in 10 patients not followed up.
All but one of the relapses were previously treated without exchange of the prosthesis.
Conclusions: As recommended for hip and knee PJI, we suggest treating shoulder PJI with a low-grade
infection by microorganisms such as P. acnes with an exchange of the prosthesis. Cohort studies are needed
to verify our results.
NosoBase ID notice : 366452
Sondage urinaire intermittent versus à demeure chez des patients bénéficiant de chirurgie de la
hanche : essai contrôlé randomisé avec analyse coût-efficacité
Hälleberg Nyman M; Gustafsson M; Langius-Eklöf A; Johansson JE; Norlin R; Hagberg L. Intermittent versus
indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness
analysis. International journal of nursing studies 2013; in press: 10 pages.
Mots-clés : SONDAGE URINAIRE; CHIRURGIE; CHIRURGIE ORTHOPEDIQUE; PROTHESE TOTALE DE
HANCHE; CENTRE HOSPITALIER UNIVERSITAIRE; ESSAI THERAPEUTIQUE; RANDOMISATION;
COUT-EFFICACITE; INFECTION URINAIRE
8 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Background: Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary
retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated
with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether
intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in
patients undergoing hip surgery.
Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary
catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.
Design: Randomised controlled trial with cost-effectiveness analysis.
Setting: The study was carried out at an orthopaedic department at a Swedish University Hospital.
Methods: One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were
randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four
time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.
Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in
the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the
intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans
(p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation
group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation.
Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.
Conclusions: Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods
have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary
catheterisations might be avoided in this patient group.
NosoBase ID notice : 366093
Mise à jour sur les facteurs qui peuvent être modifiés pour réduire le risque d’infections du site
opératoire en chirurgie
Savage JW; Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. The
Spine journal 2013; in press: 13 pages.
Mots-clés : PREVENTION; SITE OPERATOIRE; BIBLIOGRAPHIE; DEPISTAGE; STAPHYLOCOCCUS
AUREUS; HYGIENE DES MAINS; ANTISEPTIQUE; CHLORHEXIDINE; MUPIROCINE; CHIRURGIE
ORTHOPEDIQUE; FACTEUR DE RISQUE
Background context: Despite an increase in physician and public awareness and advances in infection control
practices, surgical site infection (SSI) remains to be one of the most common complications after an
operation. Surgical site infections have been shown to decrease health-related quality of life, double the risk
of readmission, prolong the length of hospital stay, and increase hospital costs.
Purpose: To critically evaluate the literature and identify modifiable factors to reduce the risk of SSI.
Study design/Setting: Systematic review of the literature.
Methods: A critical review of the literature was performed using OVID, Pubmed, and the Cochrane database
and focused on eight identifiable factors: preoperative screening and decolonization of methicillin-sensitive
Staphylococcus aureus and methicillin-resistant S. aureus protocols, antiseptic showers, antiseptic cloths,
perioperative skin preparation, surgeon hand hygiene, antibiotic irrigation and/or use of vancomycin powder,
closed suction drains, and antibiotic suture.
Results: Screening protocols have shown that 18% to 25% of patients undergoing elective orthopedic surgery
are nasal carriers of S. aureus and that carriers are more likely to have a nosocomial infection and SSI. The
evidence suggests that an institutionalized prescreening program, followed by an appropriate eradication
using mupirocin ointment and chlorhexidine soap/shower, will lower the rate of nosocomial S. aureus
infections. Based on the current literature, definitive conclusions cannot be made on whether preoperative
antiseptic showers effectively reduce the incidence of postoperative infection. The use of a chlorhexidine
bathing cloth before surgery may decrease the risk of SSI. There is no definitive clinical evidence that one
skin preparation solution effectively lowers the rate of postoperative infection compared with another. The use
of dilute betadine irrigation or vancomycin powder in the wound before closure likely decreases the incidence
of SSI.
Conclusions: There is strong evidence in the literature that optimizing specific preoperative, intraoperative,
and postoperative variables can significantly lower the risk of developing an SSI.
9 / 29
NosoVeille – Bulletin de veille
Juillet 2013
NosoBase ID notice : 366475
Efficacité d’un bouquet d’interventions (bundle) de décolonisation et prophylaxie destinées à
diminuer les infections du site opératoire à pathogènes à Gram positif après chirurgie cardiaque ou
chirurgie orthopédique : revue systématique et méta-analyse
Schweizer M; Perencevich E; McDanel J; Carson J; Formanek M; Hafner J; et al. Effectiveness of a bundled
intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac
or orthopedic surgery: systematic review and meta-analysis. British medical journal 2013/06/13; 346: 1-13.
Mots-clés : EFFICACITE; SITE OPERATOIRE; PREVENTION; CHIRURGIE; CHIRURGIE CARDIOVASCULAIRE;
CHIRURGIE
ORTHOPEDIQUE;
META-ANALYSE;
BIBLIOGRAPHIE;
ANTIBIOPROPHYLAXIE; COLONISATION; BACTERIE A GRAM POSITIF; STAPHYLOCOCCUS AUREUS;
GLYCOPEPTIDE; COLONISATION NASALE
Objective: To evaluate studies assessing the effectiveness of a bundle of nasal decolonization and
glycopeptide prophylaxis for preventing surgical site infections caused by Gram positive bacteria among
patients undergoing cardiac operations or total joint replacement procedures.
Design: Systematic review and meta-analysis.
Data sources: PubMed (1995 to 2011), the Cochrane database of systematic reviews, CINAHL, Embase, and
clinicaltrials.gov were searched to identify relevant studies. Pertinent journals and conference abstracts were
hand searched. Study authors were contacted if more data were needed.
Eligibility criteria: Randomized controlled trials, quasi-experimental studies, and cohort studies that assessed
nasal decolonization or glycopeptide prophylaxis, or both, for preventing Gram positive surgical site infections
compared with standard care.
Participants: Patients undergoing cardiac operations or total joint replacement procedures.
Data extraction and study appraisal: Two authors independently extracted data from each paper and a
random effects model was used to obtain summary estimates. Risk of bias was assessed using the Downs
and Black or the Cochrane scales. Heterogeneity was assessed using the Cochran Q and I(2) statistics.
Results: 39 studies were included. Pooled effects of 17 studies showed that nasal decolonization had a
significantly protective effect against surgical site infections associated with Staphylococcus aureus (pooled
relative risk 0.39, 95% confidence interval 0.31 to 0.50) when all patients underwent decolonization (0.40,
0.29 to 0.55) and when only S aureus carriers underwent decolonization (0.36, 0.22 to 0.57). Pooled effects
of 15 prophylaxis studies showed that glycopeptide prophylaxis was significantly protective against surgical
site infections related to methicillin (meticillin) resistant S aureus (MRSA) compared with prophylaxis using β
lactam antibiotics (0.40, 0.20 to 0.80), and a non-significant risk factor for methicillin susceptible S aureus
infections (1.47, 0.91 to 2.38). Seven studies assessed a bundle including decolonization and glycopeptide
prophylaxis for only patients colonized with MRSA and found a significantly protective effect against surgical
site infections with Gram positive bacteria (0.41, 0.30 to 0.56).
Conclusions: Surgical programs that implement a bundled intervention including both nasal decolonization
and glycopeptide prophylaxis for MRSA carriers may decrease rates of surgical site infections caused by S
aureus or other Gram positive bacteria.
Coronavirus
NosoBase ID notice : 366645
Epidémie hospitalière au nouveau coronavirus - Middle East Respiratory Syndrome Coronavirus
(MERS-CoV)
Assiri A; McGeer A; Perl TM; Price CS; Al-Rabeeah AA; Cummings D; et al. Hospital outbreak of middle east
respiratory syndrome coronavirus. The New England journal of medicine; in press: 1-10.
Mots-clés : EPIDEMIE; CORONAVIRUS; TRANSMISSION
Etude réalisée sur une vingtaine de personnes touchées par le coronavirus MERS-Cov en Arabie saoudite
qui révèle que plusieurs patients auraient été contaminés à l'hôpital.
Les médecins ont examiné les dossiers médicaux et échantillons de sang de 23 patients atteints par le virus,
sur quatre sites médicaux. Ils ont déterminé que la transmission du virus s'était faite entre personnes, mais il
est difficile de savoir si elle s'est faite via des gouttelettes respiratoires (toux, éternuements) ou par un contact
indirect (par exemple, une blouse qui servirait de vecteur).
10 / 29
NosoVeille – Bulletin de veille
Juillet 2013
NosoBase ID notice : 365996
Différents scénarios de transmission du coronavirus du syndrome respiratoire du Moyen-Orient
(MERS-CoV) et comment les distinguer
Cauchemez S; Van Kerkhove MD; Riley S; Donnelly CA; Fraser C; Ferguson NM. Transmission scenarios for
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and how to tell them apart. Eurosurveillance
2013/06; 18(24): 1-7.
Mots-clés : CORONAVIRUS; APPAREIL RESPIRATOIRE; TRANSMISSION AERIENNE; INVESTIGATION;
EPIDEMIOLOGIE; PREVENTION; DIAGNOSTIC; CHAMBRE; TRANSMISSION SOIGNE-SOIGNE;
INVESTIGATION; PRECAUTION AIR; PRECAUTION CONTACT
Detection of human cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection
internationally is a global public health concern. Rigorous risk assessment is particularly challenging in a
context where surveillance may be subject to under-ascertainment and a selection bias towards more severe
cases. We would like to assess whether the virus is capable of causing widespread human epidemics, and
whether self-sustaining transmission is already under way. Here we review possible transmission scenarios
for MERS-CoV and their implications for risk assessment and control. We discuss how existing data, future
investigations and analyses may help in reducing uncertainty and refining the public health risk assessment
and present analytical approaches that allow robust assessment of epidemiological characteristics, even from
partial and biased surveillance data. Finally, we urge that adequate data be collected on future cases to
permit rigorous assessment of the transmission characteristics and severity of MERS-CoV, and the public
health threat it may pose. Going beyond minimal case reporting, open international collaboration, under the
guidance of the World Health Organization and the International Health Regulations, will impact on how this
potential epidemic unfolds and prospects for control.
NosoBase ID notice : 365989
Premiers cas d’infections dues au nouveau coronavirus - Middle East Respiratory Syndrome
Coronavirus (MERS-CoV) en France, investigations et implications pour la prévention de la
transmission interhumaine, France, mai 2013
Mailles A; Blanckaert K; Chaud P; van der Werf S; Lina B; Caro V; et al. First cases of Middle East
Respiratory Syndrome Coronavirus (MERS-CoV) infections in France, investigations and implications for the
prevention of human-to-human transmission, France, May 2013. Eurosurveillance 2013/06; 18(24): 1-5.
Mots-clés : CORONAVIRUS; APPAREIL RESPIRATOIRE; TRANSMISSION AERIENNE; INVESTIGATION;
EPIDEMIOLOGIE; PREVENTION; DIAGNOSTIC; CHAMBRE; TRANSMISSION SOIGNE-SOIGNE;
INVESTIGATION; PRECAUTION AIR; PRECAUTION CONTACT
In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an
adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before
symptom onset. Contact tracing identified a secondary case in a patient hospitalised in the same hospital
room. No other cases of MERS-CoV infection were identified among the index case’s 123 contacts, nor
among 39 contacts of the secondary case, during the 10-day follow-up period.
NosoBase ID notice : 366636
Infections par le nouveau coronavirus (MERS-CoV) au sein d'une famille
Memish ZA; Zumla A; Al-Rabeeah AA; Stephens GM. Family cluster of middle east respiratory syndrome
coronavirus infections. The New England journal of medicine 2013/06/27; 368(26): 2487-2494.
Mots-clés : CORONAVIRUS; EPIDEMIE; MORTALITE
A human coronavirus, called the Middle East respiratory syndrome coronavirus (MERS-CoV), was first
identified in September 2012 in samples obtained from a Saudi Arabian businessman who died from acute
respiratory failure. Since then, 49 cases of infections caused by MERS-CoV (previously called a novel
coronavirus) with 26 deaths have been reported to date. In this report, we describe a family case cluster of
MERS-CoV infection, including the clinical presentation, treatment outcomes, and household relationships of
three young men who became ill with MERS-CoV infection after the hospitalization of an elderly male relative,
who died of the disease. Twenty-four other family members living in the same household and 124 attending
staff members at the hospitals did not become ill. MERS-CoV infection may cause a spectrum of clinical
11 / 29
NosoVeille – Bulletin de veille
Juillet 2013
illness. Although an animal reservoir is suspected, none has been discovered. Meanwhile, global concern
rests on the ability of MERS-CoV to cause major illness in close contacts of patients
Dispositif médical
NosoBase ID notice : 365837
Risques de contamination croisée et d’infection croisée liés aux têtes des otoscopes
Korkmaz H; Çetinkol Y; Korkmaz M. Cross-contamination and cross-infection risk of otoscope heads.
European archives of oto-rhino-laryngologie 2013; in press: 4 pages.
Mots-clés : CONTAMINATION; DISPOSITIF MEDICAL; OTO-RHINO-LARYNGOLOGIE; DESINFECTION;
CENTRE HOSPITALIER UNIVERSITAIRE; MICROBIOLOGIE; STAPHYLOCOCCUS; OREILLE
Adequate disinfection level of the medical equipments should be maintained to prevent cross-contamination
between patients. Otoscope specula are usually cleaned and disinfected appropriately after each use by
disinfectant solutions. However, since otoscope heads are electrical instruments with irregular inner surface
they may still harbor pathogenic microorganisms. According to manufacturers' instructions, otoscope heads
can be cleaned externally with a damp cloth and they can be disinfected with aldehydes, tensides, and
alcohols. Instrument heads should not be placed in liquids. Alcohols cannot be used on glass surfaces. How
often an otoscope head must be cleaned to limit contamination is not well established. This study aimed to
determine whether the otoscope heads harbor pathogenic microorganisms or not. A total of 53 otoscope
heads were included in the study. Swab samples were obtained from the inner parts of the otoscope heads.
For bacteriological examination, cotton swabs were inoculated onto 5% sheep blood agar, chocolate agar,
and eosine methylene blue agar plates. For fungal evaluation, cotton swabs were inoculated onto Sabouraud
dextrose agars. Cultured microorganisms were evaluated macroscopically and microscopically. Of the 53
otoscope heads, 22 were found to be contaminated with bacteria and/or fungi. Eleven of them were colonized
by one organism, 11 were colonized by more than one organism. Only one Pseudomonas species isolated as
gram-negative microorganism. Gram-positive microorganisms were isolated from the remaining 19 samples.
Staphylococcus species were the most common bacteria isolated. The most common fungal isolates were
Aspergillus species. Two cultures were positive with Candida albicans. The results show that
decontamination of the otoscope heads is usually ignored. However, they can harbor considerable amount of
pathogenic microorganisms. The probability of contamination and the risk of cross-infection is high if they are
used by otolaryngologists. In order to prevent cross-contamination between patients, guidelines indicating
appropriate methods and frequency of cleaning and disinfection of otoscope heads needed to be described.
NosoBase ID notice : 366250
Contamination bactérienne de lames de laryngoscopes réutilisables au cours de la pratique
anesthésique quotidienne
Lowman W. Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic
practice. South African medical journal 2013/06; 103(6): 386-389.
Mots-clés :
CONTAMINATION ;
DISPOSITIF
MEDICAL ;
REUTILISABLE ;
ANESTHESIE ;
LARYNGOSCOPIE; BLOC OPERATOIRE; ENTEROBACTER; ACINETOBACTER BAUMANNII
Background and objectives: Hospital-acquired infections (HAIs) are largely preventable through risk analysis
and modification of practice. Anaesthetic practice plays a limited role in the prevention of HAIs, although
laryngoscope use and decontamination is an area of concern. We aimed to assess the level of microbial
contamination of re-usable laryngoscope blades at a public hospital in South Africa.
Setting: The theatre complex of a secondary-level public hospital in Johannesburg.
Methods. Blades from two different theatres were sampled twice daily, using a standardised technique, over a
2-week period. Samples were quantitatively assessed for microbial contamination, and stratified by area on
blade, theatre and time using Fisher's exact test.
Results: A contamination rate of 57.3% (63/110) was found, with high-level contamination accounting for
22.2% of these. Common commensals were the most frequently isolated micro-organisms (79.1%), but
important hospital pathogens such as Enterobacter species and Acinetobacter baumannii were isolated from
blades with high-level contamination. No significant difference in the level of microbial contamination by area
on blade, theatre or time was found (p<0.05).
12 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Conclusions: A combination of sub-optimal decontamination and improper handling of laryngoscopes after
decontamination results in significant microbial contamination of re-usable laryngoscope blades. There is an
urgent need to review protocols and policies surrounding the use of these blades.
EHPAD
NosoBase ID notice : 366451
Bactéries multirésistantes aux antibiotiques dans des services de gériatrie, des EHPAD et en secteur
ambulatoire : prévalence et facteurs de risque
Gruber I; Heudorf U; Werner G; Pfeifer Y; Imirzalioglu C; Ackermann H; et al. Multidrug-resistant bacteria in
geriatric clinics, nursing homes, and ambulant care - Prevalence and risk factors. International journal of
medical microbiology 2013; in press: 5 pages.
Mots-clés : PREVALENCE; FACTEUR DE RISQUE; GERIATRIE; EHPAD; AMBULATOIRE;
ANTIBIORESISTANCE;
MULTIRESISTANCE;
STAPHYLOCOCCUS
AUREUS;
METICILLINORESISTANCE; ENTEROCOCCUS; VANCOMYCINE; ENTEROBACTERIE; BETA-LACTAMASE A
SPECTRE ELARGI; PERSONNE AGEE
Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus
aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL)
producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care
facilities. The aim of this study was to determine the prevalence as well as the risk factors of
colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing
homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n=46), 8
nursing homes (n=178), and 2 ambulant care facilities (n=64) as well as 64 staff members were screened for
MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%)
were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened
positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae.
Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and
15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5-4.9; p=0.002),
urinary catheter (OR: 3.1, 95% CI: 1.7-5.9; p<0.001), former hospitalization (OR: 2.1, 95% CI: 1.1-4.0;
p=0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5-4.9; p=0.03). Finally, the high level of MDRB in geriatric
clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for
dissemination.
Entérobactérie
NosoBase ID notice : 365888
Les défis que constituent les entérobactéries productrices de carbapénèmases et la gestion du risque
infectieux : protéger les patients dans la tourmente
Savard P; Carroll KC; Wilson LE; Perl TM. The challenges of carbapenemase-producing enterobacteriaceae
and infection prevention: protecting patients in the chaos. Infection control and hospital epidemiology
2013/07; 34(7): 730-739.
Mots-clés :
PREVENTION;
ENTEROBACTERIE;
CARBAPENEME;
ANTIBIORESISTANCE;
COLONISATION; TRANSMISSION; LABORATOIRE; EPIDEMIOLOGIE; TRANSMISSION; PRECAUTION
COMPLEMENTAIRE
NosoBase ID notice : 364532
Poids élevé des entérobactéries productrices de bêta-lactamase a spectre étendu au Gabon
Schaumburg F; Alabi A; Kokou C; Grobusch MP; Köck R; Kaba H; et al. High burden of extended-spectrum
β-lactamase-producing Enterobacteriaceae in Gabon. Journal of antimicrobial chemotherapy 2013; in press:
4 pages.
Mots-clés : ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; COLONISATION; FACTEUR
DE RISQUE
13 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Objectives: Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are sporadically
reported from infections in sub-Saharan Africa. Travellers returning from the tropics have a high risk of ESBLE colonization, which suggests a high prevalence of ESBL-E in Africa. Our objective was to assess the
burden of rectal ESBL-E colonization and associated risk factors in Gabon, Central Africa
Patients and methods: We performed a cross-sectional study on 200 hospitalized children in Gabon, Central
Africa, on rectal ESBL-E colonization and applied a standardized questionnaire to assess risk factors. The
antimicrobial resistance and the type of β-lactamase (SHV, TEM and CTX-M) were analysed for each isolate.
Isolates associated with nosocomial spread were further genotyped.
Results: The overall colonization rate of ESBL-E was 45% (n = 90) and increased from 33.6%(n = 37) at
admission to 94.1% (n = 16) during hospitalization. Risk factors for ESBL-E carriage were age <5 years,
hospitalization for ≥5 days and a hospital stay during the past year. All isolates were susceptible to
meropenem, but non-susceptible to ciprofloxacin in 52.8% (n = 57). CTX-M-15 was the predominant βlactamase. Genotyping revealed a polyclonal structure of nosocomial isolates.
Conclusions: ESBL colonization in hospitalized children in Gabon is high. The risk of nosocomial transmission
of ESBL-E is a challenge in rural Africa and underlines the need for sentinel surveillance in the absence of a
broad decentralized microbiology laboratory.
Epidémie
NosoBase ID notice : 366132
Déplacement de l’épidémie de rougeole 2009-2011 des enfants vers les adultes : revue d’observation
au centre hospitalier universitaire de Clermont-Ferrand, France
Corbin V; Beytout J; Auclair C; Chambon M; Mouly D; Chamoux A; et al. Shift of the 2009-2011 measles
outbreak from children to adults: an observational review at the University Hospital of Clermont-Ferrand,
France. Infection 2013; in press: 5 pages.
Mots-clés : EPIDEMIE; PERSONNEL; VIRUS;
HOSPITALIER UNIVERSITAIRE; DIAGNOSTIC
ROUGEOLE;
PEDIATRIE;
VACCIN;
CENTRE
In 2009-2011, 113 adult in- and outpatients with measles were referred to the University Hospital of ClermontFerrand (centre of France): 71 (62.8%) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver
enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred
among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients.
The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected.
NosoBase ID notice : 365920
Épidémie de kératoconjonctivite dans un service psychiatrique fermé
Nováková V; Cantero-Caballero M; Zoni AC; Plá-Mestre R; Olmedo-Lucerón M; Rodríguez-Pérez P.
Epidemic keratoconjunctivitis outbreak in a closed psychiatric ward. Infection control and hospital
epidemiology 2013/07; 34(7): 764-765.
Mots-clés : EPIDEMIE; CONJONCTIVE; PSYCHIATRIE
NosoBase ID notice : 365745
Enquête épidémiologique sur une épidémie nosocomiale d’infections à Corynebacterium striatum
multirésistant aux antibiotiques dans un centre hospitalier universitaire en Belgique
Verroken A; Bauraing C; Deplano A; Bogaerts P; Huang D; Wauters G; et al. Epidemiological investigation of
a nosocomial outbreak of multidrug-resistant Corynebacterium striatum at one Belgian university hospital.
Clinical microbiology and infection 2013; in press: 7 pages.
Mots-clés : EPIDEMIOLOGIE; ENQUETE; EPIDEMIE; CENTRE HOSPITALIER UNIVERSITAIRE;
ANTIBIORESISTANCE; MULTIRESISTANCE; CORYNEBACTERIUM; FACTEUR DE RISQUE; BIOLOGIE
MOLECULAIRE; TYPAGE; APPAREIL RESPIRATOIRE; BACILLE GRAM POSITIF
During an 8-month period, 24 Corynebacterium striatum isolates recovered from lower respiratory tract
specimens of 10 hospitalized patients were characterized. The organisms were identified by matrix-assisted
14 / 29
NosoVeille – Bulletin de veille
Juillet 2013
laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and by 16S rRNA gene
sequencing. The cluster of C. striatum exclusively affected patients who had been admitted to an intensive
care unit and/or subsequently transferred to one medium-size respiratory care unit. Prolonged duration of
hospitalization, advanced stage of chronic obstructive pulmonary disease, recent administration of antibiotics
and exposure to an invasive diagnostic procedure were the most commonly found risk factors in these
patients. Seven patients were colonized and three infected. All strains displayed a similar broad spectrum
resistance to antimicrobial agents, remaining susceptible to vancomycin only. Typing analysis by MALDI-TOF
MS and by semi-automated repetitive sequence-based PCR (DiversiLab typing) showed that all outbreakassociated C. striatum isolates clustered together in one single type while they differed markedly from
epidemiologically unrelated C. striatum isolates. Pulsed-field gel electrophoresis (PFGE) profiles revealed
three distinct PFGE types among the C. striatum isolates associated with the outbreak while all external
strains except one belonged to a distinct type. We conclude that C. striatum is an opportunistic nosocomial
pathogen in long-term hospitalized patients and can be at the origin of major outbreaks. The routine use of
MALDI-TOF MS greatly facilitated the recognition/identification of this organism in clinical samples and this
technique could also offer the potential to be used as an easy and rapid epidemiological typing tool for
outbreak investigation.
Grippe
NosoBase ID notice : 365882
Evaluation des mesures d’hygiène suite à une épidémie de grippe dans un centre de soins spécialisé
pour enfants et jeunes adultes souffrant de troubles neurologiques et de troubles de développement
neurologique
Azofeifa A; Yeung LF; Peacock G; Moore CA; Rodgers L; DiOrio M; et al. Infection control assessment after
an influenza outbreak in a residential care facility for children and young adults with neurologic and
neurodevelopmental conditions. Infection control and hospital epidemiology 2013/07; 34(7): 717-722.
Mots-clés : GRIPPE; EPIDEMIE; PEDIATRIE; SOIN DE LONGUE DUREE; CONNAISSANCE; ATTITUDE;
PRATIQUE; PERSONNEL; HYGIENE DES MAINS; PRECAUTION COMPLEMENTAIRE
Objective: To assess the knowledge, attitudes, and practices of infection control among staff in a residential
care facility for children and young adults with neurologic and neurodevelopmental conditions.
Design: Self-administered survey.
Setting: Residential care facility (facility A).
Participants: Facility A staff (N=200).
Methods: We distributed a survey to staff at facility A. We classified staff with direct care responsibilities as
clinical (ie, physicians, nurses, and therapists) or nonclinical (ie, habilitation assistants, volunteers, and
teachers) and used χ(2) tests to measure differences between staff agreement to questions.
Results: Of 248 surveys distributed, 200 (81%) were completed; median respondent age was 36 years; 85%
were female; and 151 were direct care staff (50 clinical, 101 nonclinical). Among direct care staff
respondents, 86% agreed they could identify residents with respiratory symptoms, 70% stayed home from
work when ill with respiratory infection, 64% agreed that facility administration encouraged them to stay home
when ill with respiratory infection, and 72% reported that ill residents with respiratory infections were
separated from well residents. Clinical and nonclinical staff differed in agreement about using waterless hand
gel as a substitute for handwashing (96% vs 78%; P=.005) and whether handwashing was done after
touching residents (92% vs 75%; P=.04).
Conclusions: Respondents' knowledge, attitudes, and practices regarding infection control could be improved,
especially among nonclinical staff. Facilities caring for children and young adults with neurologic and
neurodevelopmental conditions should encourage adherence to infection control best practices among all
staff having direct contact with residents.
NosoBase ID notice : 365887
Corrélation entre mesures mises en place et amélioration du taux de vaccination contre la grippe :
une étude parmi le personnel soignant des hôpitaux de Louisiane
Fricke KL; Gastañaduy MM; Klos R; Bégué RE. Correlates of improved influenza vaccination of healthcare
personnel: a survey of hospitals in Louisiana. Infection control and hospital epidemiology 2013/07; 34(7): 723729.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; TAUX; FORMATION
15 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Objective: To describe practices for influenza vaccination of healthcare personnel (HCP) with emphasis on
correlates of increased vaccination rates.
Design: Survey.
Participants: Volunteer sample of hospitals in Louisiana.
Methods : All hospitals in Louisiana were invited to participate. A 17-item questionnaire inquired about the
hospital type, patients served, characteristics of the vaccination campaign, and the resulting vaccination rate.
Results: Of 254 hospitals, 153 (60%) participated and were included in the 124 responses that were received.
Most programs (64%) required that HCP either receive the vaccine or sign a declination form, and the rest
were exclusively voluntary (36%); no program made vaccination a condition of employment. The median
vaccination rate was 67%, and the vaccination rate was higher among hospitals that were accredited by the
Joint Commission; provided acute care; served children, pregnant women, oncology patients, or intensive
care unit patients; required a signed declination form; or imposed consequences for unvaccinated HCP (the
most common of which was to require that a mask be worn on patient contact). Hospitals that provided free
vaccine, made vaccine widely available, advertised the program extensively, required a declination form, and
imposed consequences had the highest vaccination rates (median, 86%; range, 81%-91%).
Conclusions: The rate of influenza vaccination of HCP remains low among the hospitals surveyed.
Recommended practices may not be enough to reach 90% vaccination rates unless a signed declination
requirement and consequences are implemented. Wearing a mask is a strong consequence. Demanding
influenza vaccination as a condition of employment was not reported as a practice by the participating
hospitals.
NosoBase ID notice : 366567
Résultats cliniques sur 111 cas d'infections au virus de la grippe A (H7N9)
Gao HN; Lu HZ; Cao B; Du B; Shang H; Gan JH; et al. Clinical findings in 111 cases of influenza A (H7N9)
virus infection. The New England journal of medicine 13/06/2013; 368(24): 2277-2285.
Mots-clés : GRIPPE; ETUDE RETROSPECTIVE; AGE; PNEUMONIE
Background: During the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread
among humans in China. Data were lacking on the clinical characteristics of the infections caused by this
virus.
Methods: Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin
influenza A (H7N9) infection through May 10, 2013.
Results: Of the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0%
died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of
61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common
presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral
ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed
in 88.3% of patients, and thrombocytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108
patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness
and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptasepolymerase-chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4
to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the
only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95%
confidence interval, 1.21 to 9.70; P=0.02).
Conclusions: During the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia
and ARDS, with high rates of ICU admission and death.
NosoBase ID notice : 366560
Infection humaine par le nouveau virus grippal aviaire A (H7N9)
Gao R; Cao B; Hu Y; Feng Z; Wang D; Hu W; et al. Human infection with a novel avian-origin influenza A
(H7N9) virus. The New England journal of medicine 16/05/2013; 368(20): 1888-1897.
Mots-clés : GRIPPE AVIAIRE; BIOLOGIE MOLECULAIRE; PCR; ANIMAL
Background: Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of
this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of
16 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were
found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus.
Methods: We obtained and analyzed clinical, epidemiologic, and virologic data from these patients.
Respiratory specimens were tested for influenza and other respiratory viruses by means of real-time reversetranscriptase-polymerase-chain-reaction assays, viral culturing, and sequence analyses.
Results: A novel reassortant avian-origin influenza A (H7N9) virus was isolated from respiratory specimens
obtained from all three patients and was identified as H7N9. Sequencing analyses revealed that all the genes
from these three viruses were of avian origin, with six internal genes from avian influenza A (H9N2) viruses.
Substitution Q226L (H3 numbering) at the 210-loop in the hemagglutinin (HA) gene was found in the
A/Anhui/1/2013 and A/Shanghai/2/2013 virus but not in the A/Shanghai/1/2013 virus. A T160A mutation was
identified at the 150-loop in the HA gene of all three viruses. A deletion of five amino acids in the
neuraminidase (NA) stalk region was found in all three viruses. All three patients presented with fever, cough,
and dyspnea. Two of the patients had a history of recent exposure to poultry. Chest radiography revealed
diffuse opacities and consolidation. Complications included acute respiratory distress syndrome and
multiorgan failure. All three patients died.
Conclusions: Novel reassortant H7N9 viruses were associated with severe and fatal respiratory disease in
three patients. (Funded by the National Basic Research Program of China and others.)
NosoBase ID notice : 366579
Essai contrôlé randomisé sur cas groupés pour évaluer les effets d’un programme multifacettes sur
la couverture anti-grippale du personnel soignant hospitalier et sur la grippe nosocomiale aux PaysBas, de 2009 à 2011
Riphagen-Dalhuisen J, Burgerhof JG, Frijstein G, Van der Geest-Blankert AD, Danhof-Pont, De Jager HJ et
al. Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on
influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands,
2009 to 2011. Eurosurveillance. 2013/06; 18(26) : 1-10
Mots-clés : EPIDEMIE ; GRIPPE ; VACCIN ; INFORMATION ; PERSONNEL
Nosocomial influenza is a large burden in hospitals. Despite recommendations from the World Health
Organization to vaccinate healthcare workers against influenza, vaccine uptake remains low in most
European countries. We performed a pragmatic cluster randomised controlled trial in order to assess the
effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital
healthcare workers (HCWs) and on in-patient morbidity. We included hospital HCWs of three intervention and
three control University Medical Centers (UMCs), and 3,367 patients. An implementation programme was
offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and
patient morbidity. In 2009/10, the coverage of seasonal, the first and second dose of pandemic influenza
vaccine as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs (all
p<0.05). At the internal medicine departments of the intervention group with higher vaccine coverage
compared to the control group, nosocomial influenza and/or pneumonia was recorded in 3.9% and 9.7% of
patients of intervention and control UMCs, respectively (p=0.015). Though potential bias could not be
completely ruled out, an increase in vaccine coverage was associated with decreased patient in-hospital
morbidity from influenza and/or pneumonia.
NosoBase ID notice : 366557
Les préoccupations mondiales concernant les infections au nouveau virus de la grippe A (H7N9)
Uyeki TM; Cox NJ. Global concerns regarding novel influenza A (H7N9) virus infections. The New England
journal of medicine 16/05/2013; 368(20): 1862-1864.
Mots-clés : GRIPPE; EPIDEMIOLOGIE; GRIPPE A; TRANSMISSION
Hygiène des mains
NosoBase ID notice : 365903
Amélioration continue de l’hygiène des mains dans un hôpital pédiatrique
17 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Crews JD; Whaley E; Syblik D; Starke J. Sustained improvement in hand hygiene at a children's hospital.
Infection control and hospital epidemiology 2013/07; 34(7): 751-753.
Mots-clés : PEDIATRIE ; HYGIENE DES MAINS ; QUALITE ; FORMATION ; OBSERVANCE
A quality improvement project was conducted to improve hand hygiene at a children's hospital. Interventions
included education, performance feedback, an incentive program, and a marketing campaign. There were
9,322 observations performed over a 5-year period. Hospital-wide adherence increased from 39.9% to
97.9%. Adherence of 95% or greater was sustained for over 3 years.
NosoBase ID notice : 365363
Revue systématique des stratégies
comportementale
d'amélioration
de
l'hygiène
des
mains
:
approche
Huis A; van Achterberg T; de Bruin M; Grol R; Schoonhoven L; Hulscher M. A systematic review of hand
hygiene improvement strategies: a behavioural approach. Implementation science 2013; in press: 14 pages.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; TRAVAIL; CONNAISSANCE; ATTITUDE; QUALITE;
BIBLIOGRAPHIE
Background: Many strategies have been designed and evaluated to address the problem of low hand hygiene
(HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we
describe frequently used improvement strategies and related determinants of behaviour change that prompt
good HH behaviour to provide a better overview of the choice and content of such strategies.
Methods: Systematic searches of experimental and quasi-experimental research on HH improvement
strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to
November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist,
including study objectives, setting, study design, target population, outcome measures, description of the
intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to
identify targeted determinants.
Results: We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness,
action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy,
and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies
on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed
positive results. The median effect size of these strategies increased from 17.6 (relative difference)
addressing one determinant to 49.5 for the studies that addressed five determinants.
Conclusions: By focussing on determinants of behaviour change, we found hidden and valuable components
in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control,
and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants
showed better results. This indicates that we should be more creative in the application of alternative
improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.
NosoBase ID notice : 365351
Etude de la contamination croisée microbiologique de l'environnement après séchage des mains par
des essuie-mains en papier ou par un sèche-main à lame d'air (air blade)
Margas E; Maguire E; Berland CR; Welander F; Holah JT. Assessment of the environmental microbiological
cross contamination following hand drying with paper hand towels or an air blade dryer. Journal of applied
microbiology 2013; in press: 11 pages.
Mots-clés : ENVIRONNEMENT; CONTAMINATION; MICROBIOLOGIE; HYGIENE DES MAINS; ESSUIEMAINS; EQUIPEMENT; DISTRIBUTEUR
Aims: This study compared the potential for cross contamination of the surrounding environment resulting
from two different hand-drying methods: paper towels and the use of an air blade dryer.
Methods and results: One hundred volunteers for each method washed their hands and dried them using one
of the two methods. Bacterial contamination of the surrounding environment was measured using settle
plates placed on the floor in a grid pattern, air sampling and surface swabs. Both drying methods produced
ballistic droplets in the immediate vicinity of the hand-drying process. The air blade dryer produced a larger
number of droplets which were dispersed over a larger area. Settle plates showed increased microbial
contamination in the grid squares which were affected by ballistic droplets. Using the settle plates counts, it
18 / 29
NosoVeille – Bulletin de veille
Juillet 2013
was estimated that approx. 1.7 x 105 cfu more micro-organisms were left on the laboratory floor (total area
approx. 17.15 m2 ) after 100 volunteers used an air blade dryer compared to when paper towels were used.
Conclusions: The two drying methods led to different patterns of ballistic droplets and levels of microbial
contamination under heavy use conditions. Whilst the increase in microbial levels in the environment is not
significant if only nonpathogenic micro-organisms are spread, it may increase the risk of pathogen
contamination of the environment when pathogens are occasionally present on people's hands.
Significance and impact of the study: The study suggests that the risk of cross contamination from the
washroom users to the environment and subsequent users should be considered when choosing a handdrying method. The data could potentially give guidance following the selection of drying methods on
implementing measures to minimise the risk of cross contamination.
NosoBase ID notice : 366521
Maintien à long terme des améliorations de l’hygiène des mains en hémodialyse
Scheithauer S; Eitner F; Häfner H; Floege; Lemmen SW. Long-term sustainability of hand hygiene
improvements in the hemodialysis setting. Infection 2013/06; 41(3): 675-680.
Mots-clés : HYGIENE DES MAINS; HEMODIALYSE; OBSERVANCE; GANT; TRAITEMENT HYGIENIQUE
DES MAINS PAR FRICTION
Purpose: In a previous observational intervention study, we achieved a more than 100% increase in overall
hand hygiene (HH) compliance in the hemodialysis setting by increasing the number of hand rubs (HR)
performed and concomitantly optimizing HH standard operating procedures (SOPs). SOPs were mainly
aimed at reducing the number of avoidable opportunities due to a less than perfect workflow. However, the
long-term sustainability of this successful intervention was not evaluated. The present study was carried out
to evaluate the long-term effects of our previous successful intervention.
Methods: We conducted a follow-up observational study 1 year after the first intervention study in the same
hemodialysis unit to assess the sustainability. No HH-related interventions were performed in the 1 year
between studies. The main outcome was HH compliance, and the secondary outcome was opportunities per
hemodialysis procedure.
Results: A total of 1,574 opportunities for HH and 871 hand rubs (HR) were observed during the follow-up
observational study. Overall, compliance was 55%, which was significantly than that at the end of the first
study (62%; p<0.0001), but significantly higher than that at the start and mid-term phases of the first study (37
and 49%, p<0.0001). Both the decrease in HH opportunities and the increase in HR were sustained over the
course of this observational study. The number of avoidable opportunities in the present study was similar to
that at the end of the previous study. Thus, in 320 opportunities (20%), gloves were worn instead of HR
performed, representing 46% of all missed HR.
Conclusions: Despite a decrease in HH compliance compared to the last postintervention period, a
multifaceted intervention focusing on standardization and workflow optimization resulted in a sustained
improvement in HH. We therefore propose that standardization of the hemodialysis workflow aimed at
improving HH is a promising avenue for improving the quality of patient care and outcome.
Infection fongique
NosoBase ID notice : 366641
Infections fongiques associées à de la méthylprednisolone contaminée
Kauffman CA; Pappas PG; Patterson TF. Fungal infections associated with contaminated methylprednisolone
injections. The New England journal of medicine 2013/06/27; 368(26): 2495-2500.
Mots-clés : EPIDEMIE; INFECTION
RECOMMANDATION; BIBLIOGRAPHIE
FONGIQUE;
INJECTION;
CONTAMINATION;
MENINGITE;
Recently, an outbreak of serious fungal infections, including meningitis, associated with contaminated
methylprednisolone medication was identified. In this review, experts discuss key issues associated with the
care of affected patients.
NosoBase ID notice : 366519
Programme sur 6 ans de gestion des antifongiques dans un centre hospitalier universitaire
19 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Mondain V; Lieutier F; Hasseine L; Gari-Toussaint M; Poiree M; Lions C; et al. A 6-year antifungal
stewardship programme in a teaching hospital. Infection 2013/06; 41(3): 621-628.
Mots-clés : TRAITEMENT; ANTIFONGIQUE; CENTRE HOSPITALIER UNIVERSITAIRE; PRESCRIPTION;
ASPERGILLUS; CANDIDA; ETUDE PROSPECTIVE; PERSONNEL; COUT; FLUCONAZOLE; FORMATION;
RECOMMANDATION
Purpose: To describe the antifungal stewardship programme in our hospital and to assess its impact on total
antifungal prescriptions and their cost, and on the process of care measures regarding the diagnostic and
therapeutic management of invasive aspergillosis and candidaemia.
Methods: We conducted a prospective observational study describing the multifaceted antifungal stewardship
programme in place at our French teaching tertiary-care hospital since 2005. Several actions were
implemented successively, including the systematic evaluation of all costly antifungal prescriptions
(echinocandins, lipid formulations of amphotericin B, posaconazole and voriconazole).
Results: A total of 636 antifungal prescriptions were discussed by the antifungal management team from 2005
to 2010 inclusive, mainly from the haematology department (72%). In 344/636 cases (54%), a piece of advice
was fed back to the physician in charge of the patient, with an 88% compliance rate. Optimal standard of care
was achieved for galactomannan antigen testing, performance of chest computed tomography (CT) scan and
voriconazole therapeutic drug monitoring for invasive aspergillosis, with no combination therapies used since
2008. Regarding candidaemia, optimal standard of care was achieved for the timing of antifungal therapy,
recommended first-line therapy, duration of therapy and the removal of central venous catheters. Total
antifungal prescriptions (in defined daily doses, DDD) and their cost were contained between 2003 and 2010.
Conclusions: The implementation of an antifungal stewardship programme was feasible, sustainable and well
accepted. We observed an improved quality of care for some process of care measures, and antifungal use
and cost were contained in our hospital.
Infection urinaire
NosoBase ID notice : 366255
Réduction de l’usage inutile de sondes urinaires à demeure
Janzen J; Buurman BM; Spanjaard L; de Reijke TM; Goossens A; Geerlings SE. Reduction of unnecessary
use of indwelling urinary catheters. BMJ quality & safety 2013; in press: 5 pages.
Mots-clés : SONDAGE URINAIRE; SONDE; PREVENTION; QUALITE; FORMATION; DUREE DE SEJOUR;
INFECTION URINAIRE; SONDAGE A DEMEURE
Background: The most effective way to reduce catheter-associated urinary tract infections (CA-UTIs) is to
avoid unnecessary urinary catheterisation and to minimise the duration of catheterisation.
Aim: To implement and assess the effect of an intervention to reduce the duration of urinary tract
catheterisation.
Methods: This quality improvement project was set up as a before-after comparison consisting of a 2-month
pre-intervention period, a period in which the intervention was implemented and a 2-month post-intervention
period. The intervention included educational sessions to increase physicians' awareness and the daily
reassessment of catheter use. The primary endpoint was the duration of catheterisation. Secondary
endpoints were the catheter utilisation ratio, the length of hospital stay, the number of hospital-acquired
symptomatic CA-UTIs and the number of appropriate indications for catheterisation.
Results: During the total study period, 149 patients (18.3%) were catheterised at some time during their
hospital stay. There was a statistically significant decrease in the duration of catheterisation (median 7 vs 5
days; p<0.01), length of hospital stay (median 13 vs 9 days; p<0.01), and number of hospital-acquired CAUTIs (4 vs 0, p=0.04) in the pre-intervention versus post-intervention period.
Conclusions: An intervention to raise more awareness of the risks of inappropriate catheterisation can reduce
the duration of catheterisation along with the length of hospital stay and the number of hospital-acquired
symptomatic CA- UTIs, even in a short period of time.
Pédiatrie
NosoBase ID notice : 366063
Facteurs de risque et évolution des infections à virus respiratoire syncytial parmi des enfants
immunodéprimés
20 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Asner S; Stephens D; Pedulla P; Richardson SE; Robinson J; Allen U. Risk factors and outcomes for
respiratory syncytial virus-related infections in immunocompromised children. The Pediatric infectious disease
journal 2013; in press: 19 pages.
Mots-clés : FACTEUR DE RISQUE; PEDIATRIE; DEFICIT IMMUNITAIRE; VIRUS; PNEUMOVIRUS;
ETUDE RETROSPECTIVE; COHORTE; MORTALITE; INFECTION RESPIRATOIRE BASSE
Background: Respiratory syncytial virus (RSV) is associated with significant morbidity and mortality in
immunocompromised children. Data on the risk factors for acquisition and outcomes from RSV infections in
this population are limited.
Methods: This retrospective-cohort study (2006 - 2011) included RSV-positive immunocompromised pediatric
inpatients. Nasopharyngeal swabs were tested for RSV by direct immunofluorescence. Purposeful multiple
regression was used to assess risk factors associated with community-acquired RSV (CA-RSV) infections
and their outcomes compared with nosocomial (N-RSV) infections. Means and medians were compared
using Student's t test and a non-parametric test, respectively. Proportions were compared using chi-square or
Fisher's Exact test, as appropriate.
Results: There were 117 RSV-positive patients of whom 42 (35.9%) presented with (N-RSV) infection.
Overall, more than a third presented with lower respiratory tract infections (LRTI) which resulted in a 28%
admission rate to the intensive care unit (ICU) and a mortality rate of 5%, the latter solely among patients with
community-acquired infection. Subjects with CA-RSV presented with more advanced clinical evidence of
lower tract disease with respiratory distress (e.g., intercostal recession; OR 2.5; 95 % CI 1.1-5.6; p=0.03)
compared with those with N-RSV. Subjects with CA-RSV infections were less likely to have a prolonged
hospital admission (OR 0.7; 95% CI 0.5-0.8; p< 0.0001) relative to those with N-RSV infections.
Conclusions: RSV-related infections in immunocompromised children may result in poor outcomes, including
mortality. Differences in mortality rates among those with CA-RSV compared with N-RSV warrant further
study, with enhanced opportunities for prevention and early detection of infection.
NosoBase ID notice : 365900
Facteurs de risque de colonisation chronique à Staphylococcus aureus résistant à la méticilline chez
des enfants admis à plusieurs reprises en unité de soins intensifs
Popoola VO; Tamma P; Reich NG; Perl TM; Milstone AM. Risk factors for persistent methicillin-resistant
Staphylococcus aureus colonization in children with multiple intensive care unit admissions. Infection control
and hospital epidemiology 2013/07; 34(7): 748-750.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
COLONISATION;
PREVALENCE; SOIN INTENSIF; PRECAUTION STANDARD; PEDIATRIE; FACTEUR DE RISQUE
We studied methicillin-resistant Staphylococcus aureus (MRSA)-colonized children with multiple intensive
care unit (ICU) admissions to assess the persistence of MRSA colonization. Our data found that children with
more than 1 year between ICU admissions had a higher prevalence of MRSA colonization than the overall
ICU population, which supports empirical contact precautions for children with previous MRSA colonization
Personnel
NosoBase ID notice : 365838
Jeux éducatifs pour professionnels de santé (revue)
Akl EA; Kairouz VF; Sackett KM; Erdley WS; Mustafa RA; Fiander M; et al. Educational games for health
professionals (Review). Cochrane database of systematic reviews 2013/03; 3: 1-26.
Mots-clés : PERSONNEL; FORMATION; BIBLIOGRAPHIE; TRAVAIL; ATTITUDE; CONNAISSANCE
Background: The use of games as an educational strategy has the potential to improve health professionals'
performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes.
Objectives: The objective was to assess the effect of educational games on health professionals'
performance, knowledge, skills, attitude and satisfaction, and on patient outcomes.
Search methods: We searched the following databases in January 2012: MEDLINE, AMED, CINAHL,
Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations &
Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases.
21 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Database searches identified 1546 citations. We also screened the reference lists of included studies in
relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for
papers citing studies included in the review. These search methods identified an additional 62 unique
citations for a total of 1608 for this update.
Selection criteria: We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled
before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health
professionals or in postgraduate training. The intervention was an educational game with "a form of
competitive activity or sport played according to rules".
Data collection and analysis: Using a standardized data form we extracted data on methodological quality,
participants, interventions and outcomes of interest that included patient outcomes, professional behavior
(process of care outcomes), and professional's knowledge, skills, attitude and satisfaction.
Main results: The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible
citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique,
was based on the television game show "Family Feud" and focused on infection control. The study did not
assess any patient or process of care outcomes. The group that was randomized to the game had statistically
higher scores on the knowledge test (P=0.02). The second study compared game-based learning ("Snakes
and Ladders" board game) with traditional case-based learning of stroke prevention and management. The
effect on knowledge was not statistically different between the two groups immediately and 3 months after the
intervention. The level of reported enjoyment was higher in the game-based group.
Authors' conclusions: The findings of this systematic review neither confirm nor refute the utility of games as a
teaching strategy for health professionals. There is a need for additional high-quality research to explore the
impact of educational games on patient and performance outcomes.
Pneumonie
NosoBase ID notice : 366254
Prévention des pneumonies acquises sous ventilation chez les enfants : protocole reposant sur des
preuves
Cooper VB; Haut C. Preventing ventilator-associated pneumonia in children: an evidence-based protocol.
Critical care nurse 2013/06; 33(3): 21-29.
Mots-clés : PREVENTION; PNEUMONIE; PEDIATRIE; PROTOCOLE; VENTILATION ASSISTEE; SOIN
INTENSIF; SOIN DE BOUCHE; RECOMMANDATION; FACTEUR DE RISQUE; QUESTIONNAIRE
Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive
care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care
unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little
research has been done in children to identify necessary skills and strategies. Critical care nurses play an
important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care
bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia,
mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent
prevention strategies for providers caring for children in the pediatric intensive care unit. Following the
recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can
support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this
important health care problem.
NosoBase ID notice : 366092
Pneumonie associée aux soins : une maladie des Etats-Unis ou en rapport aussi avec la région AsiePacifique ?
Dobler CC; Waterer G. Healthcare-associated pneumonia: a US disease or relevant to the Asia Pacific too?
Respirology 2013; in press: 29 pages.
Mots-clés : PNEUMONIE; ANTIBIORESISTANCE; ANTIBIOTIQUE; TRAITEMENT; DEFINITION;
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
PSEUDOMONAS
AERUGINOSA;
ENTEROBACTERIE; RISQUE; BIBLIOGRAPHIE
The term 'healthcare-associated pneumonia" (HCAP) was introduced by the American Thoracic Society and
the Infectious Diseases Society of America in 2005 to describe a distinct entity of pneumonia that resembles
hospital-acquired pneumonia rather than community-acquired pneumonia in terms of occurrence of drug
22 / 29
NosoVeille – Bulletin de veille
Juillet 2013
resistant pathogens and mortality in patients that-while not hospitalised in the traditional sense- have been in
recent contact with the healthcare system. It was proposed that healthcare-associated pneumonia should be
treated empirically with therapy for drug resistant pathogens. Over the last few years there has been
increasing controversy over whether HCAP is a helpful definition, or leads to unnecessary and potentially
problematic overtreatment. The term HCAP has been extensively criticised in Europe. While most studies
have shown that HCAP is associated with more frequent drug resistant pathogens and higher mortality than
community-acquired pneumonia, there is no clear evidence that this is due to inappropriate antibiotic therapy.
Therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. Based on
current evidence, we suggest broad-spectrum antibiotic therapy to treat possible pathogens not usually
covered in community-acquired pneumonia be based on assessment of individual risk factors rather than
applying a HCAP classification system in the Asia Pacific Region.
Prévention
NosoBase ID notice : 366213
Les freins à la déclaration des événements indésirables liés aux soins : une étude transversale au
groupement hospitalier Edouard Herriot, CHU de Lyon
Bénet T; Gagnaire J; Jean-Denis M; Gerbier-Colomban S; Haesebaert J; Khanafer N; et al. Les freins à la
déclaration des événements indésirables liés aux soins : une étude transversale au groupement hospitalier
Edouard Herriot, CHU de Lyon. Bulletin épidémiologique hebdomadaire 18/06/2013; 24-25: 275-278.
Mots-clés : RECOMMANDATION ; ETUDE TRANSVERSALE; SOIN; DECLARATION; QUALITE;
PERSONNEL; MEDECIN; INFIRMIER; INFORMATION; FORMATION; SIGNALEMENt ; EVENEMENT
INDESIRABLE GRAVE; ATTITUDE
Introduction : Les évènements indésirables (EI) liés aux soins sont sous-déclarés et les freins à leur
déclaration demeurent mal connus. L’objectif de l’étude était d’identifier les freins à la déclaration des EI liés
aux soins.
Matériel - Méthodes : Une étude descriptive transversale a été réalisée par auto-questionnaire standardisé,
entre janvier et juin 2010, auprès de l’ensemble du personnel soignant médical et paramédical du
groupement hospitalier Édouard Herriot (CHU de Lyon). Les items comportaient des mises en situation de
signalement et recherchaient les raisons de nondéclaration.
Résultats : Au total, 415 soignants appartenant à 24 services de soins ont été inclus, dont 62 % (n = 255)
déclaraient connaître la définition d’un EI. Les principales raisons de non-déclaration des EI invoquées
étaient le manque de connaissance du système de déclaration (n = 342 ; 82 %), une absence de perception
de l’intérêt de la déclaration (n = 243 ; 58%), une charge de travail trop lourde (n = 161 ; 39 %) et la crainte
des sanctions (n = 103 ; 25 %).
Discussion - Conclusion : Les soignants connaissaient globalement bien les concepts d’EI et de signalement.
La méconnaissance du système et le manque de retour d’information étaient les principaux freins à la
déclaration des EI. Le renforcement des systèmes de signalement des EI doit se faire par la formation
continue et l’information aux soignants.
NosoBase ID notice : 366606
Le rôle dans les soins en santé et la perception de l’influence de l’expérience de la culture de la
sécurité sont-ils liés à la prévention du risque infectieux ?
Braun BI; Harris AD; Richards CL; Belton BM; Dembry LM; Morton DJ; et al. Does health care role and
experience influence perception of safety culture related to preventing infections? American journal of
infection control 2013/07; 41(7): 638-641.
Mots-clés : PREVENTION; SECURITE; QUALITE; PERSONNEL; TRAVAIL; PERCEPTION
Growing evidence reveals the importance of improving safety culture in efforts to eliminate health
careassociated infections. This multisite, cross-sectional survey examined the association between
professional role and health care experience on infection prevention safety culture at 5 hospitals. The findings
suggest that frontline health care technicians are less directly engaged in improvement efforts and safety
education than other staff and that infection prevention safety culture varies more by hospital than by staff
position and experience.
23 / 29
NosoVeille – Bulletin de veille
Juillet 2013
NosoBase ID notice : 365692
Recommandations sanitaires pour les voyageurs, 2013
Caumes E. Recommandations sanitaires pour les voyageurs, 2013. Bulletin épidémiologique hebdomadaire
2013/06/04; 22-23: 239-266.
Mots-clés : RECOMMANDATION; PAYS ETRANGER; USAGER; VACCIN ; RAGE; NEISSERIA
MENINGITIDIS ; GRIPPE; HEPATITE A; HEPATITE B; TUBERCULOSE; ROUGEOLE; RUBEOLE;
ALIMENTAITON; SOIN; INFECTION ;
NosoBase ID notice : 366480
Infections associées aux soins : propositions pour des indicateurs de résultats à visée de diffusion
publique
HCSP. Infections associées aux soins : propositions pour des indicateurs de résultats à visée de diffusion
publique. HCSP 2013/04: 1-43.
Mots-clés : RECOMMANDATION; INDICATEUR; USAGER; INFORMATION; TABLEAU DE BORD
La France a mis en place depuis une dizaine d’années une politique de diffusion publique d’indicateurs de
qualité/sécurité des soins dans les établissements de santé (ES) visant à répondre à une exigence de
transparence pour la population et les média sur les risques auxquels tout patient peut être exposé lors d’un
séjour dans un ES, tout spécialement quant au risque infectieux. Chaque année, les ES ont l’obligation de
fournir les données nécessaires au calcul de ces indicateurs au ministère de la santé qui édite les résultats
sous forme d’un tableau de bord pour chaque établissement.
Le présent travail s’inscrit dans la continuité d’une expérience d’indicateurs à diffusion publique entreprise
depuis plusieurs années à un moment où la réflexion sur ce sujet, tant en France qu’à l’étranger, est en
pleine évolution. L’objectif du travail confié au Haut comité de santé publique (Commission spécialisée
Sécurité des patients) était de voir si d’autres indicateurs, dits de résultats, pourraient être ajoutés et de
proposer, en s’appuyant sur une démarche scientifiquement valide, une hiérarchisation des indicateurs
éventuellement retenus afin d’aider les autorités de santé au choix final.
Les résultats produits devraient permettre d’étayer ce choix en vue de compléter les indicateurs existants du
tableau de bord.
Dans une perspective d’utilisation pour une diffusion publique, les indicateurs retenus nécessitent toutefois
d’être validés par les futurs utilisateurs, à savoir des représentants des professionnels de santé et des
usagers. Un regard par des experts étrangers reconnus dans le domaine serait également nécessaire.
NosoBase ID notice : 365862
Impact de la surveillance électronique sur la mise en place des protocoles d’isolement
Larson E; Behta M; Cohen B; Jia H; Furuya EY; Ross; et al. Impact of electronic surveillance on isolation
practices. Infection control and hospital epidemiology 2013/07; 34(7): 694-699.
Mots-clés : SURVEILLANCE; ISOLEMENT; STAPHYLOCOCCUS AUREUS; METCILLINO-RESISTANCE;
TAUX; PRECAUTION AIR; PRECAUTION GOUTELETTE; PERSONNEL; VISITE; ENTEROCOCCUS;
ANTIBIOREISTANCE; VANCOMYCINE; CLOSTRIDIUM DIFFICILE; ACINETOBACTER BAUMANNII;
INFORMATIQUE
Objective: To assess the impact of an electronic surveillance system on isolation practices and rates of
methicillin-resistant Staphylococcus aureus (MRSA).
Design: A pre-post test intervention.
Setting: Inpatient units (except psychiatry and labor and delivery) in 4 New York City hospitals.
Patients: All patients for whom isolation precautions were indicated, May 2009-December 2011.
Methods: Trained observers assessed isolation sign postings, availability of isolation carts, and staff use of
personal protective equipment (PPE). Infection rates were obtained from the infection control department.
Regression analyses were used to examine the association between the surveillance system, infection
prevention practices, and MRSA infection rates.
Results: A total of 54,159 isolation days and 7,628 staff opportunities for donning PPE were observed over a
31-month period. Odds of having an appropriate sign posted were significantly higher after intervention than
before intervention (odds ratio [OR], 1.10 [95% confidence interval {CI}, 1.01-1.20]). Relative to baseline,
postintervention sign posting improved significantly for airborne and droplet precautions but not for contact
24 / 29
NosoVeille – Bulletin de veille
Juillet 2013
precautions. Sign posting improved for vancomycin-resistant enterococci (OR, 1.51 [95% CI, 1.23-1.86];
P=.0001), Clostridium difficile (OR, 1.59 [95% CI, 1.27-2.02]; P=00005), and Acinetobacter baumannii (OR,
1.41 [95% CI, 1.21-1.64]; P=.00001) precautions but not for MRSA precautions (OR, 1.11 [95% CI, 0.891.39]; P=.36). Staff and visitor adherence to PPE remained low throughout the study but improved from
29.1% to 37.0% after the intervention (OR, 1.14 [95% CI, 1.01-1.29]). MRSA infection rates were not
significantly different after the intervention.
Conclusions: An electronic surveillance system resulted in small but statistically significant improvements in
isolation practices but no reductions in infection rates over the short term. Such innovations likely require
considerable uptake time.
NosoBase ID notice : 366753
Instruction DGOS/PF2 n° 2013-254 du 24 juin 2013 relative à l'organisation de la semaine de la
sécurité des patients 2013
Ministère des affaires sociales et de la santé. Instruction DGOS/PF2 n° 2013-254 du 24 juin 2013 relative à
l'organisation de la semaine de la sécurité des patients. Ministère des affaires sociales et de la santé 2013:
10 pages.
Mots-clés : USAGER; COMMUNICATION; INFORMATION; MEDICAMENT; SORTIE; AUDIO-VISUEL;
EHPAD; STRUCTURE DE SOINS; SECURITE; USAGER; LEGISLATION; INFORMATION
Organisation de la semaine de la sécurité des patients du 25 au 29 novembre 2013 auprès des
professionnels de santé libéraux, dans les établissements de santé et médico-sociaux, et toute structure
intéressée.
Réanimation
NosoBase ID notice : 366071
Etude des mesures d’hygiène bucco-dentaire pour des patients intubés dans des unités de
réanimation en Suisse
Gmür C; Irani S; Attin T; Menghini G; Schmidlin PR. Survey on oral hygiene measures for intubated patients
in swiss intensive care units. Schweizer Monatsschrift Zahnmedizin 2013; 123(5): 394-401.
Mots-clés : SOIN INTENSIF; SOIN DE BOUCHE; INTUBATION; PREVENTION; QUESTIONNAIRE;
PROTOCOLE; PNEUMONIE; PRATIQUE
Dans les hôpitaux, 5 à 10 % des patients sont traités dans une unité de soins intensifs. Leur séjour peut
entraîner une infection nosocomiale, notamment en cas d’intubation. L’hygiène buccodentaire joue un rôle
fondamental dans ce contexte. Dans le cadre d’une enquête menée auprès des unités suisses de soins
intensifs, nous avons voulu examiner les standards de prévention orale chez les patients intubés et évaluer
l’importance accordée à l’hygiène buccodentaire. Dans ce but, nous avons envoyé à 25 cliniques un
questionnaire constitué de questions à choix multiples ou à deux alternatives (oui/non). Parmi ces cliniques
figurent toutes les unités de soins intensifs reconnues du canton de Zurich ainsi que les unités de soins
intensifs des hôpitaux universitaires et des hôpitaux classés catégorie A par la Société Suisse de Médecine
Intensive (état 31.05.2010). Les unités de soins intensifs des cliniques pédiatriques n’étaient pas concernées
par cette enquête. Parmi les formulaires envoyés, 21 ont été entièrement remplis, renvoyés et évalués (84
%). Un quart des cliniques dispose, de protocoles sur la prévention des pneumonies acquises sous
ventilation mécanique (PAVM). Les hôpitaux n’effectuent, en aucun cas, une thérapie antibiotique
systématique de routine. Parmi les cliniques questionnées, 90 % brossent les dents mécaniquement avec
une brosse à dents, 67 % utilisent l’agent désinfectant chlorhexidine (dont 81 % sous forme de solution).
Trois quarts des hôpitaux appliquent trois fois par jour des mesures d’hygiène buccodentaire (dont 90 %
immédiatement après l’intubation). En résumé, nous avons constaté que, dans les unités de soins intensifs
suisses, l’hygiène buccodentaire n’est pas pratiquée de manière uniforme et que seules quelques cliniques
disposent de directives pour éviter les PAVM. Ce constat est en corrélation avec les résultats enregistrés par
des enquêtes similaires menées en Europe et aux Etats-Unis. D’autres mesures restent donc nécessaires,
non seulement pour confirmer l’usage ou optimiser les règles d’hygiène buccodentaire actuelles, mais surtout
pour garantir leur mise en oeuvre standardisée.
NosoBase ID notice : 366563
25 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Décolonisation globale versus ciblée pour prévenir les infections en réanimation
Huang SS; Septimus E; Kleinman K; Moody J; Hickok J; Avery TR; et al. Targeted versus universal
decolonization to prevent ICU infection. The New England journal of medicine 2013/05/16; 368(24): 22552265.
Mots-clés :
REANIMATION;
COLONISATION;
STAPHYLOCOCCUS
AUREUS;
METICILLINORESISTANCE; SARM; BACTERIEMIE; ETUDE MULTICENTRIQUE; CHLORHEXIDINE; MUPIROCINE
Background: Both targeted decolonization and universal decolonization of patients in intensive care units
(ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by
methicillin-resistant Staphylococcus aureus (MRSA).
Methods: We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of
three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented
MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization
of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all
patients). Proportional-hazards models were used to assess differences in infection reductions across the
study groups, with clustering according to hospital.
Results: A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period)
underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for
MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days),
0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization
(2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus
baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99
(crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6
vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal
decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either
targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients
who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those
of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7
patients, were mild and related to chlorhexidine.
Conclusions: In routine ICU practice, universal decolonization was more effective than targeted
decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream
infection from any pathogen.
NosoBase ID notice : 365682
La visite de risque : évaluer autrement le risque infectieux en réanimation
Lashéras-Bauduin A; Auffret A; Jeanne-Leroyer C; Binard F; Marie V; Nunes J; et al. La visite de risque :
évaluer autrement le risque infectieux en réanimation. Risques & qualité en milieu de soins 2013/06; 10(2):
85-92.
Mots-clés : RISQUE; SOIN INTENSIF; GESTION DES RISQUES; EVALUATION; HYGIENE DES MAINS;
PREVENTION; SCORE; PERSONNEL; BIJOU; PRECAUTION COMPLEMENTAIRE; DISPOSITIF
MEDICAL; TRACABILITE; QUESTIONNAIRE
La visite de risque est une approche d’analyse de risque a priori combinant à la fois entretiens, observations
de pratiques, visite sur site et utilisation d’un référentiel. Elle permet en particulier de repérer et d’évaluer des
risques latents, ainsi que d’identifier les principales défenses vis-à-vis du risque infectieux nosocomial. La
méthode consiste à : repérer les actes ou les activités les plus critiques et concevoir les outils de visite ;
réaliser la visite ; analyser les données ; formaliser le rapport et proposer un plan d’action ; restituer les
résultats de la visite de risque et contractualiser avec le service clinique sur le plan d’actions. Nous
rapportons ici les résultats de visites de risque conduites dans deux services de réanimation auprès de 23
professionnels sur 175, portant sur 69 critères d’entretien et 15 critères d’observation. Les scores les plus
élevés ont été obtenus pour la politique de prévention des infections nosocomiales et les soins de base, les
plus faibles pour la connaissance du référentiel. Les scores obtenus pour la politique d’hygiène des mains
différaient dans les deux services. Les résultats et le plan d’actions ont été présentés aux 33 professionnels :
actions à court terme (hygiène des mains, présentation du référentiel) et actions à moyen terme (accueil des
nouveaux professionnels). Aucune action à long terme n’a été retenue. Au total, le risque infectieux dans ces
deux services de réanimation a été considéré comme bien maîtrisé.
26 / 29
NosoVeille – Bulletin de veille
Juillet 2013
NosoBase ID notice : 366520
Epidémiologie des infections fongiques invasives en réanimation : résultats d’une étude
multicentrique en Italie (Projet AURORA)
Montagna MT; Caggiano G; Lovero G; De Giglio O; Coretti C; Cuna|Iatta T; et al. Epidemiology of invasive
fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project). Infection
2013/06; 41(3): 645-653.
Mots-clés : EPIDEMIOLOGIE; MYCOLOGIE; SOIN INTENSIF; SURVEILLANCE; MORTALITE; CANDIDA;
CANDIDA PARAPSILOSIS; ANALYSE MULTIVARIEE; ASPERGILLUS; RESISTANCE
Purpose: The aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in
patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of
isolates.
Methods: A surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized
form.
Results: A total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main
infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000
admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high
(42.8%), particularly for mold infections (61.5%). All yeast infections were Candida bloodstream infections.
Over half (59.8%) were caused by Candida non-albicans, with C. parapsilosis being the most common
(61.8%). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral
nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.85.2); OR 3.5, (1.02-3.5); OR 3.6, (1.28-6.99), respectively]. Among mold infections, 12 patients suffered from
invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7%). One case
of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon.
Conclusions: Candida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold
infections are associated with a high mortality rate. This study confirms the importance of the epidemiological
surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility
patterns to guide therapeutic choices.
NosoBase ID notice : 365370
Les bouquets d'interventions (bundles) pour les voies centrales et pour les patients sous ventilation
assistée sont-il efficaces en réanimation néonatale et en réanimation pédiatrique ?
Smulders CA; van Gestel JPJ; Bos AP. Are central line bundles and ventilator bundles effective in critically ill
neonates and children? Intensive care medicine 2013; in press: 7 pages.
Mots-clés : PEDIATRIE; NEONATALOGIE; SOIN INTENSIF; CATHETER; PROTOCOLE; PNEUMONIE;
VENTILATION ASSISTEE; BACTERIEMIE; EFFICACITE; BIBLIOGRAPHIE; PREVENTION
Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are
common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles
have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies
in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of
this literature review was to critically appraise the known evidence of the effectiveness of central line bundles
and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and
ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients
demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two
studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line
bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements
differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to
bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on
maintenance of a central line probably are important to prevent CLABSI in children.
NosoBase ID notice : 365770
Epidémiologie des pneumopathies acquises sous ventilation assistée dans un groupement
hospitalier : une étude prospective multicentrique
27 / 29
NosoVeille – Bulletin de veille
Juillet 2013
Suk Lee M; Walker V; Chen LF; Sexton DJ; Anderson DJ. The epidemiology of ventilator-associated
pneumonia in a network of community hospitals: a prospective multicenter study. Infection control and
hospital epidemiology 2013/07; 34(7): 657-662.
Mots-clés : EPIDEMIOLOGIE; PNEUMONIE; PNEUMOPATHIE; INCIDENCE; ETUDE PROSPECTIVE;
VENTILATION ASSISTEE; RESPIRATEUR; SOIN INTENSIF; DUREE DE SEJOUR; RESEAU
Objective: To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.
Design and setting: Prospective study in 31 community hospitals from 2007 to 2011.
Methods: VAP surveillance was performed by infection preventionists using the National Healthcare Safety
Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We
categorized hospitals into small (<30,000 patient-days/year), medium (30,000-60,000 patient-days/year), and
large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.
Results: The median VAP incidence was 1.4 (interquartile range, 0.4-2.4), and ventilator utilization ratio
(VUR) was 0.33 (0.25-0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large
(0.69) hospitals (P=.03) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively;(P=.01).
The median age of 247 VAP cases was 64 (53-73); 136 (55.1%) were female; 142 (57.5%) were Caucasian;
170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14-42) and 12
(4-21) days, respectively. The pre- and postinfection hospital stays were 8 (3-13) days and 14 (8-30) days,
respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during
hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n=70, 27.9%),
Pseudomonas species (n=40, 16.3%), and Klebsiella species (n=34, 13.3%).
Conclusions: VAP incidence was inversely associated with size of hospital. VAP in community hospitals was
frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR
may not be predictive in community hospitals with few ventilated patients.
Staphylococcus aureus
NosoBase ID notice : 366564
Dépistage des patients pour le SARM
Edmond MB; Wenzel RP. Screening inpatients for MRSA - Case closed. The New England journal of
medicine 2013/05/16; 368(24): 2314-2315.
Mots-clés :
REANIMATION;
COLONISATION;
STAPHYLOCOCCUS
AUREUS;
METICILLINORESISTANCE; SARM; BACTERIEMIE; ETUDE MULTICENTRIQUE; CHLORHEXIDINE; MUPIROCINE
NosoBase ID notice : 366094
Coût-bénéfice d’interventions de lutte contre le risque infectieux ciblant Staphylococcus aureus
méticillino-résistant dans les hôpitaux : revue systématique
Farbman L; Avni T; Rubinovitch B; Leibovici L; Paul M. Cost-benefit of infection control interventions targeting
methicillin-resistant Staphylococcus aureus in hospitals: systematic review. Clinical microbiology and infection
2013; in press: 40 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; COUT; COUT-BENEFICE;
DEPISTAGE
Infections caused by MRSA incur significant costs. We aimed to examine the cost and costbenefit of infection
control interventions against MRSA and to examine factors affecting economical estimates. We performed a
systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in
hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched Pubmed
and references of included studies with no language restrictions up to January 2012. We used the Quality of
Health Economic Studies tool to assess studies’ quality. We report cost and savings per month in 2011 US$.
We calculated the median save/cost ratio and the save-cost difference with interquartile (IQ) range. We
examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six
studies published between 1987-2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs
and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQ
range 1.37-16). The median cost across all studies reporting intervention costs (N=31) was 8,648 (IQ range
2,025-19,170) US$ per month; median savings were 38,751 (IQ range 14,206-75,842) US$ per month (23
studies). Higher save/cost ratios were observed in intermediate to high endemicity setting compared to low28 / 29
NosoVeille – Bulletin de veille
Juillet 2013
endemicity setting, in <500-bed hospitals and with >6 months’ interventions. Infection control intervention to
reduce spread of MRSA in acute-care hospitals showed a favorable cost-benefit ratio. This was true also for
high MRSA endemicity settings. Unresolved economical issues include rapid screening using molecular
techniques and universal vs. Targeted screening.
Surveillance
NosoBase ID notice : 365841
Divergences d’interprétation dans l’identification d’infections associées aux soins
Keller SC|Linkin DR|Fishman NO|Lautenbach E. Variations in identification of healthcare-associated
infections. Infection control and hospital epidemiology 2013/07; 34(7): 678-686.
Mots-clés : DEFINITION; SURVEILLANCE; RESEAU; CDC; ETUDE TRANSVERSALE; TAUX;
BACTERIEMIE; CATHETER VEINEUX CENTRAL; APPAREIL RESPIRATOIRE; CLOSTRIDIUM DIFFICILE;
SITE OPERATOIRE; PNEUMOPATHIE; VENTILATION ASSISTEE
Objective: Little is known about whether those performing healthcare-associated infection (HAI) surveillance
vary in their interpretations of HAI definitions developed by the Centers for Disease Control and Prevention's
National Healthcare Safety Network (NHSN). Our primary objective was to characterize variations in these
interpretations using clinical vignettes. We also describe predictors of variation in responses.
Design: Cross-sectional study.
Setting: United States.
Participants: A sample of US-based members of the Society for Healthcare Epidemiology of America (SHEA)
Research Network.
Methods: Respondents assessed whether each of 6 clinical vignettes met criteria for an NHSN-defined HAI.
Individual- and institutional-level data were also gathered.
Results : Surveys were distributed to 143 SHEA Research Network members from 126 hospitals. In total, 113
responses were obtained, representing at least 61 unique hospitals (30 respondents did not identify a
hospital); 79.2% (84 of 106 nonmissing responses) were infection preventionists, and 79.4% (81 of 102
nonmissing responses) worked at academic hospitals. Among the 6 vignettes, the proportion of respondents
correctly characterizing the vignettes was as low as 27.3%. Combining all 6 vignettes, the mean percentage
of correct responses was 61.1% (95% confidence interval, 57.7%-63.8%). Percentage of correct responses
was associated with presence of a clinical background (ie, nursing or physician degrees) but not with hospital
size or infection prevention and control department characteristics.
Conclusions: Substantial heterogeneity exists in the application of HAI definitions in this survey of infection
preventionists and hospital epidemiologists. Our data suggest a need to better clarify these definitions,
especially when comparing HAI rates across institutions.
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
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
29 / 29
