Download NosoVeille n° 8 - août 2009

NosoVeille – Bulletin de veille
août 2009
NosoVeille n°8
Août 2009
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications
scientifiques publiées au cours du mois écoulé.
La recherche documentaire est effectuée dans la base de données
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro
Bactériémie
Biofilm
Cathétérisme
Clostridium
Désinfection
Environnement
Epidémie
Généralités
Grippe
Hygiène des mains
Odontologie
Pédiatrie
Personnel
Pneumonie
Réanimation
Site opératoire
Staphylococcus aureus
Usager
CCLIN Sud-Est – [email protected]
1 / 23
NosoVeille – Bulletin de veille
août 2009
Bactériémie
NosoBase n° 24773
Traitement des bactériémies à Staphylococcus aureus
Cheng AC; Yong M; Athan E; Fowler V. Treatment for bacteraemia due to Staphylococcus aureus
(protocol). Cochrane database of systematic reviews 2009; (1): 1-9.
Mots-clés : BACTERIEMIE; STAPHYLOCOCCUS AUREUS; BIBLIOGRAPHIE; METHODOLOGIE;
METICILLINO-RESISTANCE
This is the protocol for a review and there is no abstract. The objectives are as follows :
We will review clinical trials evidence for patients with bacteraemia with Staphylococcus aureus. The specific
questions to be addressed are :
- For bacteraemia due to methicillin-sensitive S. aureus (MSSA), what is the most effective antibiotic?
- For bacteraemia due to methicillin-resistant S. aureus (MRSA), what is the most effective antibiotic?
- For uncomplicated bacteraemia due to S. aureus, what is the appropriate duration of therapy?
NosoBase n° 24882
Morbidité associée aux bactériémies à Pseudomonas aeruginosa
Scheetz MH; Hoffman M; Bolon MK; Schulert G; Estrellado W; Baraboutis IG; et al. Morbidity associated
with Pseudomonas aeruginosa bloodstream infections. Diagnostic microbiology and infectious disease
2009/07; 64(3): 311-319.
Mots-clés : MORBIDITE; PSEUDOMONAS AERUGINOSA; BACTERIEMIE; MICROBIOLOGIE;
MORTALITE; FACTEUR DE RISQUE
We sought to quantify patient morbidity throughout Pseudomonas aeruginosa bloodstream infection (PABSI)
as a function of patient covariates. Individuals with PABSI were included in a retrospective, observational,
cohort study. Morbidity was quantified by serial Sequential Organ Failure Assessment (SOFA) scores.
Impact of active antimicrobial treatment was assessed as a function of changes in SOFA scores as the
dependent variable. A total of 95 patients with PABSI were analyzed. Relative to baseline SOFA scores (day
-2), scores after PABSI were increased by 37% on day 0 and 22% on day +2 but returned to baseline on day
+7. Overall mortality was 37%, and mean length of hospital stay (postculture) was 16 days. Most patients
were appropriately treated, with n = 83 (87%) receiving an active agent and n = 61 (64%) receiving >1
agent. As a result, an effect of therapy on morbidity was not observed. Advanced age and elevated baseline
SOFA scores predicted increased in-hospital mortality (P = 0.01 and P < 0.001, respectively) and morbidity
at day +2 (P < 0.05 and P < 0.05, respectively) and day +7 (P < 0.05 and P < 0.001, respectively).
Neutropenia was also associated with increased morbidity at day +2 (P < 0.05). In treated PABSI, morbidity
is highest the day of the diagnostic blood cultures and slowly returns to baseline over the subsequent 7
days. Age and baseline severity of illness are the strongest predictors of morbidity and mortality. Because
neither of these factors are modifiable, efforts to minimize the negative impact of PABSI should focus on
appropriate prevention and infection control efforts.
Biofilm
NosoBase n° 24884
L'augmentation de l'importance des matériaux prévenant
antimicrobien du matériel médical contenant de l'argent
l'adhésion
microbienne :
effet
Monteiro DR; Gorup LF; Takamiya AS; Ruvollo-Filho AC; De Camargo ER; Barros Barbosa D. The growing
importance of materials that prevent microbial adhesion: antimicrobial effect of medical devices containing
silver. International journal of antimicrobial agents 2009/08; 34(2): 103-110.
Mots-clés : PREVENTION; MATERIAU; MATERIEL MEDICO-CHIRURGICAL; BIOFILM; ARGENT
Research has clarified the properties required for polymers that resist bacterial colonisation for use in
medical devices. The increase in antibiotic-resistant microorganisms has prompted interest in the use of
silver as an antimicrobial agent. Silver-based polymers can protect the inner and outer surfaces of devices
against the attachment of microorganisms. Thus, this review focuses on the mechanisms of various silver
forms as antimicrobial agents against different microorganisms and biofilms as well as the dissociation of
CCLIN Sud-Est – [email protected]
2 / 23
NosoVeille – Bulletin de veille
août 2009
silver ions and the resulting reduction in antimicrobial efficacy for medical devices. This work suggests that
the characteristics of released silver ions depend on the nature of the silver antimicrobial used and the
polymer matrix. In addition, the elementary silver, silver zeolite and silver nanoparticles, used in polymers or
as coatings could be used as antimicrobial biomaterials for a variety of promising applications.
NosoBase n° 25057
L’effet de plusieurs cycles de contamination, détergence et désinfection sur le développement de
biofilm sur les tubes d’endoscope
Vickery K; Ngo QD; Zou J; Cossart YE. The effect of multiple cycles of contamination, detergent washing,
and disinfection on the development of biofilm in endoscope tubing. American journal of infection control
2009/08; 37(6): 470-475.
Mots-clés :
CONTAMINATION;
DESINFECTION;
BIOFILM;
ENDOSCOPIE;
PSEUDOMONAS
AERUGINOSA; LAVE-ENDOSCOPE; EAU
Cathétérisme
NosoBase n° 24876
Les cultures de l'extrémité des cathéters veineux centraux sont-elles fiables après 6 jours de
réfrigération ?
Bouza E; Guembe M; Gomez H; Martin-Rabadan P; Rivera M; Alcala L. Are central venous catheter tip
cultures reliable after 6-day refrigeration? Diagnostic microbiology and infectious disease 2009/07; 64(3):
241-246
Mots-clés : CATHETER VEINEUX CENTRAL; CATHETER; PRELEVEMENT; HEMOCULTURE
Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with
suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions
are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may
be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be
refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day
refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's
roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after
24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that
the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant
colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group
A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only
61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already
positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as
culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from
patients with positive blood cultures reduce the workload in the microbiology laboratory without
misdiagnosing CR-BSI.
NosoBase n° 24820
Une stratégie efficace pour diminuer le taux des complications des cathéters veineux centraux
tunnelisés en hémodialyse
Jean G; Vanel T; Bresson E; Terrat Jc; Hurot Jm; Lorriaux C; Mayor B; Chazot C. An efficient strategy to
decrease the central venous catheter-related adverse events rate in haemodialysis patients. Nephrologie et
therapeutique 2009/07; 5(4): 280-286
Mots-clés :
CATHETER
VEINEUX
CENTRAL;
FISTULE;
BACTERIEMIE;
HEMODIALYSE;
COMPLICATION; INCIDENCE; PREVALENCE; CHLORHEXIDINE
Introduction : Les complications liées aux cathéters veineux centraux (CVC) restent une des causes
principales de morbidité et de mortalité des patients hémodialysés (HD).
Objectif : Dans une population d'HD d'un même centre à dix ans d'intervalle, comparer la prevalence des
CVC tunnelisés et l'incidence de leurs complications. Méthodes : De 1994 à 1997 (période 1) et de 2004 à
CCLIN Sud-Est – [email protected]
3 / 23
NosoVeille – Bulletin de veille
août 2009
2007 (période 2), nous avons suivi tous les CVC et leurs complications : les bactériémies (BLC), les
infections locales (ILC), les dysfonctions, la consommation de thrombolytiques et les arrachements partiels
ou totaux. Résultats : Les PermCath (PC, Quinton, n = 63) et les TwinCath (TC, MedComp, n = 76) étaient
utilisés dans la période 1 chez 95 HD, les split-cathéters (ASPC, MedComp, n = 52) et les BioFlex
(MedComp, n = 46) dans la période 2 chez 72 HD. La désinfection utilisait la povidone iodée (période 1)
puis la chlorexidine alcoolique (période 2). La prévalence des CVC a diminué de 15-18 % à 9-6 %,
l.incidence des BLC de 1,1 à 0,23 par 1000 jours-cathéter ( p < 0,001), celle des ILC de 1,1 a 0,28 par 1000
jours-cathéter ( p < 0,001), le pourcentage de dysfonctions de 12 à 1,2 % ( p < 0,001) et celui des
arrachements de 4 à 0 %. La consommation de thrombolytiques a diminué de trois à un flacon par CVC et
par an. Conclusion : En dix ans, notre stratégie a permis de diminuer la prévalence de CVC de - 50 % et
l'incidence des complications de CVC de - 200 %. Les changements de protocole de désinfection et
l'utilisation de CVC plus récents ont été efficaces pour diminuer les complications infectieuses et
mécaniques des CVC.
NosoBase n° 24632
Prévention des infections associées aux cathéters veineux centraux dans les unités de réanimation
pédiatrique : un projet collaboratif pour l'amélioration des performances
Jeffries HE; Mason W; Brewer M; Oakes KL; Munoz EI Gornick W; et al. Prevention of central venous
catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement
collaborative. Infection control and hospital epidemiology 2009/07; 30(7): 645-651.
Mots-clés : PREVENTION; CATHETER VEINEUX CENTRAL; PEDIATRIE; SOIN INTENSIF; INFECTION;
BACTERIEMIE; COUT
Objective: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream
infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based
intervention.
Methods: An observational study was conducted in 26 freestanding children's hospitals with pediatric or
cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols
were implemented using a collaborative process that included catheter insertion and maintenance bundles,
daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVCassociated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a
9-month improvement period. A 12-month sustain period followed the initial improvement period, with the
primary goal of maintaining the improvements achieved.
Results: The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per
1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end
of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated
BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost
avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain
period and prevent another 198 infections.
Conclusions: We conclude that our collaborative quality improvement project demonstrated that significant
reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based
prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and
maintenance processes, enhanced measurement, and empowerment of team members to enforce
adherence to best practices.
NosoBase n° 25122
Impact des bactériémies liées au cathéter sur la mortalité des patients en état critique : une métaanalyse
Siempos II; Kopterides P; Tsangaris I; Dimopoulou I; Armaganidis AE. Impact of catheter-related
bloodstream infections on the mortality of critically ill patients: a meta-analysis. Critical care medicine
2009/07; 37(7): 2283-2289.
Mots-clés : BACTERIEMIE; CATHETER; MORTALITE; SEPTICEMIE; PREVENTION; STAPHYLOCOCCUS
AUREUS; META-ANALYSE; DUREE DE SEJOUR
CCLIN Sud-Est – [email protected]
4 / 23
NosoVeille – Bulletin de veille
août 2009
Clostridium
NosoBase n° 24875
Clostridium difficile
Mcfee RB; Abdelsayed GG. Clostridium difficile. Disease a month 2009/07; 55(5): 439-470.
Mots-clés : CLOSTRIDIUM DIFFICILE; BIBLIOGRAPHIE; FACTEUR DE RISQUE; COLONISATION;
SOLUTION HYDRO-ALCOOLIQUE; MICROBIOLOGIE; DIAGNOSTIC; LABORATOIRE; TRAITEMENT;
ANTIBIOTIQUE; ANTIBIORESISTANCE; PREVENTION; VACCIN
NosoBase n° 25055
Analyse d'une épidémie d'infections à Clostridium difficile maîtrisée grâce à des mesures renforcées
de lutte contre le risque infectieux
Salgado CD; Mauldin PD; Fogle PJ; Bosso JA. Analysis of an outbreak of Clostridium difficile infection
controlled with enhanced infection control measures. American journal of infection control 2009/08; 37(6):
458-464.
Mots-clés : CLOSTRIDIUM DIFFICILE; EPIDEMIE; PREVENTION; ANTIBIOTIQUE
Background : In October 2004, our Clostridium difficile infection (CDI) rate increased (relative risk, 3.51; 95%
confidence interval: 2.96-4.16) from a baseline rate of 1.35 per 1000 patient-days. We describe the
outbreak, the relationship between antibiotic use and CDI, and the effect of enhanced infection control
measures (EICM) on CDI.
Methods : Rates were calculated as positive C difficile toxin A or B tests among patients with nosocomial
diarrhea per 1000 patient-days (duplicates removed). Antibiotic use was calculated as defined daily dose per
1000 patient-days. EICM consisted of (1) placing patients with diarrhea into empiric Contact Precautions, (2)
cleaning with a bleach product in areas with CDI patients, and (3) requiring soap and water hand hygiene
when caring for CDI patients. CDI rates were analyzed by chi(2) for trend. Time series methodology was
used to examine the association between CDI and antibiotic use.
Results: During the outbreak (October 2004-May 2005), we observed 144 excess cases of CDI. The CDI
rate decreased after EICM were implemented (P < .0001) and has been maintained for 36 months beyond
the outbreak. Multivariate analysis revealed positive associations between CDI rates and cefazolin use (P =
.008) and levofloxacin/gatifloxacin use (P = .015).
Conclusion: Despite an association between some antibiotic use and CDI rates, we achieved sustained
control of an outbreak using EICM without formulary changes or new antibiotic control policies. This
suggests that patient-to-patient spread may be a more important cause of increased CDI rates.
Désinfection
NosoBase n° 25082
Nouveaux procédés de désinfection contre les agents infectieux conventionnels et le prion
compatibles avec le matériel médical thermosensible
Lehmann S; Pastore M; Rogez-Kreuz C; Richard M; Belondrade M; Rauwel G; et al. New hospital
disinfection processes for both conventional and prion infectious agents compatible with thermosensitive
medical equipment. The Journal of hospital infection 2009/08; 72(4): 342-350.
Mots-clés : DESINFECTION; EQUIPEMENT; MALADIE DE CREUTZFELDT-JAKOB; AGENT
TRANSMISSIBLE NON CONVENTIONEL; NORME
NosoBase n° 24837
Désinfectants et désinfection en hygiène et salubrité : principes fondamentaux
Ministère de la santé et des services sociaux du Québec 2009/07; 1-73
Mots-clés : RECOMMANDATION; DESINFECTANT; CONTAMINATION; SURFACE; NETTOYAGE;
DESINFECTION; CHOIX; DEFINITION; BACTERIE; MICRO-ORGANISME; BIOFILM; CLOSTRIDIUM;
RESISTANCE
CCLIN Sud-Est – [email protected]
5 / 23
NosoVeille – Bulletin de veille
août 2009
Ce document s’adresse à toutes les personnes concernées par l’utilisation des désinfectants dans un
établissement de soins. Son objectif principal est de présenter et d’expliquer les principes fondamentaux qui
justifient le choix des désinfectants en tenant compte des différents facteurs pouvant moduler ce choix : les
types d’organismes pathogènes ciblés, le milieu environnant et les caractéristiques des produits
désinfectants. Un second objectif est d’établir des bases et des concepts permettant de concevoir un plan
de formation pour les travailleurs. Le document couvre les cibles de désinfection, la contamination des
surfaces et l’adhésion microbienne, le nettoyage, les désinfectants, la résistance de bactéries aux
désinfectants, le choix d’un désinfectant et leurs conditions d’utilisation.
NosoBase n° 24641
Influence de l’antécédent de l’instrument, de son degré de complexité et de différentes méthodes de
nettoyage sur la propreté d’instruments contaminés par le sang en chirurgie dentaire
Wu G; Yu X. Influence of usage history, instrument complexity, and different cleaning procedures on the
cleanliness of blood-contaminated dental surgical instruments. Infection control and hospital epidemiology
2009/07; 30(7): 702-704.
Mots-clés : CONTAMINATION; ODONTOLOGIE; CHIRURGIE; SANG; LAVEUR-DESINFECTEUR;
DESINFECTION; INSTRUMENT
Our study assessed the factors that influence the resistance of blood residues on dental surgical instruments
to washer-disinfector-based cleaning procedures in a clinical setting. The use of 2 additional cleaning
methods-presoaking and scrubbing by hand-and the use of newer and/or less structurally complex
instruments significantly increased the efficacy of washer-disinfector cleaning.
Environnement
NosoBase n° 25065
Contamination microbienne des claviers d'ordinateurs dans un centre hospitalier universitaire
Anderson G; Palombo EA. Microbial contamination of computer keyboards in a university setting. American
journal of infection control 2009/08; 37(6): 507-509.
Mots-clés : CONTAMINATION; INFORMATIQUE; ORDINATEUR; CLAVIER
The keyboards of multiple-user (student) and single-user (staff) computers located on a university campus
were sampled to assess microbial contamination. The average number of microorganisms present on
multiple-user computer keyboards was significantly greater than on single-user keyboards, and the number
of keyboards harboring potential pathogens was also greater for multiple-user computers. It is
recommended that regular cleaning and disinfection of computers be used to reduce the microbial load,
especially for multiple-user workstations.
NosoBase n° 25059
Décontamination du linge à basse température avec CuBW50, un nouveau composé biocide à base
de cuivre
Hall TJ; Wren M; Jeanes A; Gant VA. Decontamination of laundry at low temperature with CuWB50, a novel
copper-based biocidal compound. American journal of infection control 2009/08; 37(6): 478-483.
Mots-clés : LINGE; DECONTAMINATION; STAPHYLOCOCCUS AUREUS; ACINETOBACTER;
DETERGENT; TEMPERATURE; COMPOSE BIOCIDE
NosoBase n° 24978
Brûlures infectées par de l'eau contaminée : étude de cas, revue de la littérature et
recommandations pour le traitement
CCLIN Sud-Est – [email protected]
6 / 23
NosoVeille – Bulletin de veille
août 2009
Ribeiro NF; Heath H; Kierath J; Rea S; Duncan-Smith M; Wood FM. Burn wounds infected by contaminated
water: case reports, review of the literature and recommendations for treatment. Burns 2009; in press: 14
pages.
Mots-clés : BRULE; EAU; BIBLIOGRAPHIE; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS;
PSEUDOMONAS; BACILLUS; CONTAMINATION
First-aid education for the management of burns advocates cool running water over burnt skin to limit soft
tissue damage. However, the water used may itself constitute a risk. We report three cases of severe
invasive and necrotizing infection in patients who used or immersed themselves in contaminated water in an
attempt to extinguish the fire following acute major burns. Wound cultures from all patients yielded
Aeromonas hydrophila and two yielded Bacillus cereus. One patient had a complex polymicrobial infection,
including zygomycosis with Rhizomucor variabilis. All patients were treated aggressively with wound
débridement, including one patient who required bilateral lower limb amputations to control progressive
infection. All infections were successfully treated and all patients survived their burn injuries. We review the
management of burns complicated by exposure to contaminated water leading to burn wound infections. We
describe commonly reported organisms from various water sources, the appropriate initial empirical
antimicrobial chemotherapy and present the clinician with a proposed algorithm for managing these serious
infections.
Epidémie
NosoBase n° 25025
Conduite adoptée face à une épidémie à ERG (ERV) dans un établissement de santé
Hénard S; Cao-Huut; Loos-Ayav C; Chanet P; Kessler M; Rabaud C. Néphrologie et thérapeutique 2009/06;
5(Supplément 4): S265-S271.
Mots-clés : VANCOMYCINE; ENTEROCOCCUS; ANTIBIORESISTANCE; EPIDEMIE
NosoBase n° 25080
Epidémie de Listeria monocytogènes dans une unité d'oncologie due à des sandwiches consommés
à l'hôpital
Shetty A; Mclauchlin J; Grant K; O'brien D; Howard T; Davies EM. Outbreak of Listeria monocytogenes in an
oncology unit associated with sandwiches consumed in hospital. The Journal of hospital infection 2009/08;
72(4): 332-336.
Mots-clés :
EPIDEMIE;
LISTERIA
MONOCYTOGENES;
ALIMENTATION;
CANCEROLOGIE;
INVESTIGATION
In May 2003, two adult patients in an oncology unit were diagnosed with listeriosis, and sandwiches
consumed in the hospital were identified as a common risk factor. Both patients were infected by the same
strain of Listeria monocytogenes. Sandwiches collected from the hospital and external sandwich producer,
as well as sites within the manufacturing environment, were contaminated by the same strain of L.
monocytogenes. Sandwiches consumed in other hospitals have been associated with small clusters of
listeriosis patients in the UK. This report describes the investigations following diagnosis of the two
infections, and highlights a more general problem with sandwiches sold in hospitals
Généralités
NosoBase n° 24833
Les états généraux des infections nosocomiales. Compte-rendu de congrès
Bergogne-Berezin E. General meeting about nosocomial infections Antibiotiques 2009 in press :4 pages
Mots-clés : INFECTION;GENERALITE; ORGANISATION; RISQUE; EPIDEMIOLOGIE; SURVEILLANCE;
INFORMATION
La fréquence et la gravité des infections nosocomiales justifient les grandes réunions périodiques sur ce
thème.
CCLIN Sud-Est – [email protected]
7 / 23
NosoVeille – Bulletin de veille
août 2009
L’évolution. Les états généraux des infections nosocomiales tenus en février 2009 s’inscrivent dans un
contexte évolutif. Au-delà de la définition épidémiologique stricte de l’infection nosocomiale, acquise à
l’hôpital, aujourd’hui la multiplication des parcours de soins, le nombre des intervenants dans la
dispensation des soins, la diversité des structures imposent une approche élargie de la prise en charge des
infections associées aux soins (IAS). Selon ce terme dont la définition est reconnue en 2007 par le ministère
de la Santé, le critère principal définissant l’IAS est l’événement infectieux survenant « par la délivrance d’un
acte ou d’une prise en charge de soins au sens large (à visée diagnostique, thérapeutique, de dépistage ou
de prévention) par un professionnel de santé.
La lutte sur le terrain. Le risque infectieux s’est considérablement élargi et fait l’objet de présentations des
disciplines concernées, des modalités et de la diversité du risque infectieux. À cet égard, le concept
d’infection nosocomiale acquise en ville s’impose : fréquence du portage bactérien manuel, matériel en
contact avec le patient.
Conclusion. L’actualisation du cadre des IAS aura pour objectifs une surveillance épidémiologique élargie,
une information précise largement diffusée et la prévention du risque infectieux par le personnel de santé
dans tous les systèmes de soins.
NosoBase n° 24755
Bilan de 7 années de signalement dans le Sud-Est de la France. Quelle lecture des principaux
résultats ?
CCLIN Sud-Est; Bernet C. En Bref 2009/06; (41): 11-13
Mots-clés : STATISTIQUE; STAPHYLOCOCCUS AUREUS; ENTEROBACTERIE; PSEUDOMONAS;
ENTEROCOCCUS;
GLYCOPEPTIDE;
CLOSTRIDIUM;
ASPERGILLUS;
ENDOPHTALMIE ;
SIGNALEMENT; PSEUDOMONAS AERUGINOSA; ENTEROBACTER SAKAZAKII; CLOSTRIDIUM
DIFFICILE
Ce bilan de sept années de signalement dans le Sud-Est de la France présente les caractéristiques des
événements infectieux signalés, les actions mises en place par les établissements et les détections
d'infections émergentes ou récurrentes grâce au signalement.
NosoBase n° 24751
Perception du risque nosocomial. Enquête Nicolle, France, 2006
CCLIN Sud-Est; Poujol I; Gautier A; Jestin C; Jauffret-Roustide M; Coignard B. En Bref 2009/06; (41): 1-4
Mots-clés : ENQUETE; INFORMATION; MEDECIN; MEDECINE GENERALE
Cet article présente les résultats de l'enquête Nicolle dont l'objectif était d'évaluer la perception des
infections nosocomiales (IN) dans la population générale et parmi les professionnels de santé. Cette
enquête a été organisée par l'Institut national de prévention et d'éducation pour la santé (INPES) avec la
collaboration scientifique de l'Institut de veille sanitaire (InVs).
NosoBase n° 24781
Infections nosocomiales ou infections acquises à l'hôpital : revue générale
Mcfee RB. Nosocomial or hospital-acquired infections: an overview. Disease a month 2009/07; 55(7): 422438.
Mots-clés : GENERALITE; BACTERIEMIE; SITE OPERATOIRE; MORTALITE; VANCOMYCINE;
CLOSTRIDIUM DIFFICILE; ACINETOBACTER BEUMANNII; ENTEROCOCCUS; PREVENTION;
ANTIBIOTIQUE; HYGIENE DES MAINS
NosoBase n° 24963
Prévention et contrôle des infections nosocomiales. Principes généraux d'aménagement : centres
hospitaliers de soins généraux et spécialisés (CHSGS) et centres hospitaliers et instituts affiliés
universitaires (CHU, CHAU, IU)
CCLIN Sud-Est – [email protected]
8 / 23
NosoVeille – Bulletin de veille
août 2009
Ministère de la santé et des services sociaux du Québec. 2009/06: 30 pages.
Mots-clés : PREVENTION; GENERALITE; CONTROLE; DEFINITION; LAVAGE DES MAINS; TENUE
VESTIMENTAIRE; ISOLEMENT; REVETEMENT; ENVIRONNEMENT; DECHET; EAU; AIR; TRAVAUX
HOSPITALIERS; ARCHITECTURE; EQUIPEMENT; CHAMBRE; CIRCUIT
Cette publication du ministère de la Santé et des Services sociaux du Québec, réalisée grâce à la
collaboration du Comité des immobilisations en prévention des infections nosocomiales (CIPIN) et du
support technique de la Corporation d'hébergement du Québec (CHQ), énonce des principes généraux
d'aménagement tenant compte des exigences relatives à la prévention des infections nosocomiales.
Elle est destinée aux gestionnaires d'immeubles, architectes, ingénieurs et intervenants, acteurs en
prévention des infections nosocomiales et en hygiène et salubrité qui participent à la programmation, à la
conception et à la construction des Centres hospitaliers de soins généraux et spécialisés (CHSGS) y
compris les centres hospitaliers et les instituts affiliés universitaires (CHU, CHAU, et IU). Elle a pour objectif
premier de soutenir ces acteurs dans la mise en oeuvre d'un programme de prévention et de contrôle des
infections nosocomiales et a été conçue afin de les orienter, tout en respectant l'autonomie de chaque
établissement et sa responsabilité dans le choix des priorités d'action et des structures nécessaires à la
concrétisation ou à l'actualisation d'un tel programme.
Grippe
NosoBase n° 24720
Avis de l'Agence française de sécurité sanitaire de l'environnement et du travail relatif à "l'évaluation
du risque sanitaire pour l'homme lié à la présence de virus Influenza pandémique dans l'air des
bâtiments et sa diffusion éventuelle par les dispositifs de ventilation"
AFSSET. 2009/06 : 1-6
Mots-clés : RECOMMANDATION; AIR; GRIPPE; EVALUATION
L'Afsset (Agence Française de Sécurité Sanitaire de l'Environnement et du Travail) a été saisie le
05/04/2006 d'une demande d'évaluation des risques sanitaires liées à la présence de virus Influenza
pandémique dans l'air des bâtiments. Des travaux d'expertise ont eu lieu. L'Afsset rend dans ce document
son avis et émet des recommandations (mesures de gestion des systèmes de ventilation, mesures
générales de protection sanitaire des personnes, mesures générales de prévention pour les occupants de
bâtiments collectifs, mesures particulières relatives à la circulation de l'air dans les bâtiments).
NosoBase n° 25010
Vaccination contre la grippe chez le personnel hospitalier : une revue des études sur les attitudes et
les facteurs prédictifs
Hollmeyer HG; Hayden F; Poland G; Buchholz U. Influenza vaccination of heatlh care workers in hosptials a review of studies on attitudes and predictors. Vaccine 2009/06; 27(19): 3935-3944.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; BIBLIOGRAPHIE
NosoBase n° 24639
Plan factoriel en vue d'améliorer les taux de vaccination contre la grippe chez les employés d'un
vaste réseau de soins
Kent Zimmerman R; Nowalk MP; Lin CJ; Raymund M; Fox DE; Harpe JD; et al. Factorial design for
improving influenza vaccination among employees of a large health system. Infection control and hospital
epidemiology 2009/07; 30(7): 691-697.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; PREVENTION; TAUX; FORMATION
Objective: As healthcare personnel (HCP) influenza vaccination becomes a quality indicator for healthcare
facilities, effective interventions are needed. This study was designed to test a factorial design to improve
HCP vaccination rates. Design: A before-after trial with education, publicity, and free and easily accessible
influenza vaccines used a factorial design to determine the effect of mobile vaccination carts and incentives
CCLIN Sud-Est – [email protected]
9 / 23
NosoVeille – Bulletin de veille
août 2009
on vaccination rates of HCP, who were divided into groups on the basis of their level of patient contact (ie,
business and/or administrative role, indirect patient contact, and direct patient contact).
Setting: Eleven acute care facilities in a large health system.
Participants: More than 26,000 nonphysician employees.
Results: Influenza vaccination rates increased significantly in most facilities and increased system-wide from
32.4% to 39.6% (P<.001). In the baseline year, business unit employee vaccination rates were significantly
higher than among HCP with patient contact; rates did not differ significantly across groups in the
intervention year. In logistic regression that accounted for demographic characteristics, intervention year,
and other factors, the use of incentives and/or mobile carts that provided access to vaccine at the work unit
significantly increased the likelihood of vaccination among HCP with direct and indirect patient contact,
compared with control sites.
Conclusions: Interventions to improve vaccination rates are differentially effective among HCP with varying
levels of patient contact. Mobile carts appear to remove access barriers, whereas incentives may motivate
HCP to be vaccinated. Education and publicity may be sufficient for workers in business or administrative
positions. Interventions tailored by worker type are likely to be most successful for improving HCP
vaccination rates.
NosoBase n° 25060
Un partenariat avec le service de soins infirmiers augmente le taux de vaccination du personnel
contre la grippe
Nicholson MR; Hayes DM; Bennett AM. Partnering with nursing service improves health care worker
influenza vaccination rates. American journal of infection control 2009/08; 37(6): 484-489.
Mots-clés : VACCIN; GRIPPE; PERSONNEL; COUT; INFIRMIER; ENQUETE
Background : Increasing the influenza vaccination rate in health care workers (HCWs) promotes patient
safety as well as employee health. The average HCW influenza vaccination rate is approximately 35%.
Various studies have analyzed the reasons for the low vaccination rate in HCWs and developed strategies
aimed at increasing this rate.
Methods : At the study hospital, the Nursing Department was contacted to recruit influenza (flu) coordinators
from the various hospital departments to coordinate administration of influenza vaccinations in their
respective departments, with the aim of increasing HCW vaccination rates. The flu coordinators received
education about the influenza vaccine along with lists of employees, vaccination supplies, and
consent/declination forms. Each flu coordinator was responsible for contacting the employees in his or her
department/unit. Both consent and declination responses were documented.
Results : Of the hospital's 3238 employees (including physicians), a total of 2534 were contacted (78%). of
these, 2008 consented to receive the influenza vaccine and 526 declined. This represented a 37% increase
in the total number of HCWs contacted and a 20% increase in vaccine recipients over the previous influenza
season.
Conclusions : Partnering with the Nursing Department increased the accessibility to and acceptance of
influenza vaccination among HCWs. The HCWs reported positive experiences about receiving the vaccine
in the work environment.
Hygiène des mains
NosoBase n° 24638
Efficacité microbiologique et tolérance d’un nouveau produit d'hygiène des mains non-alcoolique
Agthe N; Terho K; Kurvinen T; Routama M; Peltonen R; Laitinen K; Kanerva M. Microbiological efficacy and
tolerability of a new, non-alcohol-based hand disinfectant. Infection control and hospital epidemiology
2009/07; 30(7): 685-690.
Mots-clés : DESINFECTANT; MICROBIOLOGIE; MAIN; EAU; NORME; QUESTIONNAIRE; TOLERANCE
Objective: Alcohol-based hand disinfectants are widely used in hospitals. Occasionally, there is a need for
non-alcohol-based products, but alternatives have been scarce. We studied the microbiological efficacy and
tolerability of a water-based hand disinfectant for healthcare workers.
Design: A water-based hand disinfectant was introduced as the only hand disinfectant in 5 wards in Turku
University Hospital, Finland. Ninety-nine healthcare workers participated in fingerprint sampling during the 7week study period. In another ward, 26 healthcare workers who were using alcohol-based hand disinfectant
CCLIN Sud-Est – [email protected]
10 / 23
NosoVeille – Bulletin de veille
août 2009
acted as control subjects for the skin reaction studies. The water-based product was tested in the laboratory
according to the European standard EN 12791. We obtained 292 fingerprint samples before disinfection and
302 after disinfection. The opinions of healthcare workers were collected by use of a questionnaire, and skin
reactions were assessed subjectively by use of questionnaires and objectively by measuring moisture and
transepidermal water loss.
Results: When tested in accordance with the European standard, the product met the requirements for
short-term and long-term efficacy. The results of the fingerprint test showed that there was a statistically
significant decrease in colonization of the fingertips before and after disinfection (P<.001). The users of the
water-based hand disinfectant reported dry skin more often than did control subjects, but visual inspection
and the results of the moisture measurement showed no difference between the users of the water-based
hand disinfectant and the control subjects. Transepidermal water loss measurement also showed no
deterioration of skin condition.
Conclusions: The water-based hand disinfectant was shown to be an effective hand disinfectant that caused
relatively little skin irritation and can serve as a hand hygiene alternative in situations in which alcohol-based
disinfectant cannot be used.
NosoBase n° 24628
Recommandations de l'Organisation Mondiale de la Santé pour l'hygiène des mains au cours des
soins et consensus
Pittet D; Allegranzi B; Boyce J. The world health organization guidelines on hand hygiene in health care and
their consensus recommendations. Infection control and hospital epidemiology 2009/07; 30(7): 611-622.
Mots-clés : RECOMMANDATION; MAIN; LAVAGE DES MAINS; SOLUTION HYDRO-ALCOOLIQUE;
FORMATION; TRANSMISSION MANUPORTEE; SAVON; CHLORHEXIDINE; ANTISEPTIQUE;
PERSONNEL; INFORMATION; GANT; QUALITE
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO
Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative.
The Guidelines represent the contribution of more than 100 international experts and provide a
comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensusbased recommendations, and lessons learned from testing their Advanced Draft and related implementation
tools.
NosoBase n° 24795
Guide pour la mise en oeuvre de la stratégie multimodale de promotion de l'hygiène des mains
(OMS)
WHO; OMS. Guide to implementation. A guide to the implementation of the WHO multimodal hand hygiene
improvement strategy. 2009 : 1-47
Mots-clés : LAVAGE DES MAINS; SOLUTION HYDRO-ALCOOLIQUE; DEFINITION; FORMATION;
RECOMMANDATION; INFORMATION; METHODOLOGIE
Health care-associated infection (HCAI) places a serious disease burden and has a significant economic
impact on patients and health-care systems throughout the world. Yet good hand hygiene, the simple task of
cleaning hands at the right times and in the right way, can save lives.
World Health Organization (WHO) has developed evidence-based WHO Guidelines on Hand Hygiene in
Health Care to support health-care facilities to improve hand hygiene and thus reduce HCAI.
This Guide to Implementation has been developed to assist health-care facilities to implement improvements
in hand hygiene in accordance with the WHO Guidelines on Hand Hygiene in Health Care. The strategy
described in this Guide to Implementation has been designed to be used by any health-care facility,
irrespective of the level of resources or whether the facility has already implemented any hand hygiene
initiatives. The approach focuses primarily on improving hand hygiene compliance by health-care workers
who work with patients. Through the actions proposed by the strategy, improvement of infrastructures for
hand hygiene along with enhancement of knowledge and perception about hand hygiene and HCAI and of
the patient safety climate is also meant to be achieved. The ultimate goal is to reduce both the spread of
infection and multi-resistant germs as well as the numbers of patients acquiring a preventable HCAI, and
thus to prevent waste of resources and save lives.
CCLIN Sud-Est – [email protected]
11 / 23
NosoVeille – Bulletin de veille
août 2009
Details of all of the tools supplied to support successful implementation of a hand hygiene improvement
strategy at any health-care facility are provided in this guide.
Odontologie
NosoBase n° 24754
Enquête concernant l'évaluation de la maîtrise du risque infectieux en soins dentaires et
stomatologie en Languedoc-Roussillon
CCLIN Sud-Est; ARLIN Languedoc-Roussillon; Richaud-Morel B; Bernet C; Perrin C. En Bref 2009/06; (41):
9-10.
Mots-clés : ENQUETE; STOMATOLOGIE; ODONTOLOGIE; EVALUATION; INSTRUMENT; MEDECINE
PENITENCIAIRE; AUDIT; HEPATITE B; HEPATITE C; VIRUS DE L'IMMUNODEFICIENCE HUMAINE
Cet article présente les résultats d'une enquête par autoévaluation dont l'objectif était d'évaluer le risque de
transmission virale hématogène (VHB, VHC, VIH) lors des soins dentaires réalisés dans différentes unités
de consultations et de soins ambulatoires (VCSA), rattachées à des établissements de santé dans la région
Languedoc-Roussillon.
NosoBase n° 24880
Stérilisation des dispositifs médicaux dentaires : les spécialistes sur les dents
Thiveaud D. Le moniteur hospitalier 2009/07; (217): 44-47
Mots-clés : STERILISATION; ODONTOLOGIE; MATERIEL MEDICO-CHIRURGICAL
Pédiatrie
NosoBase n° 25051
Pathogènes producteurs de bêta-lactamase à spectre élargi dans un hôpital pédiatrique : une
expérience sur 5 ans
Blaschke AJ; Korgenski EK; Daly JA; Lafleur B; Pavia AT; Byington CL. Extended-spectrum beta-lactamaseproducing pathogens in a children's hospital: a 5-year experience. American journal of infection control
2009/08; 37(6): 435-441.
Mots-clés : PEDIATRIE; BETA-LACTAMASE A SPECTRE ELARGI; ESCHERICHIA COLI; KLEBSIELLA;
ANTIBIORESISTANCE
Background: Pediatric infection with bacteria producing extended-spectrum beta-lactamases (ESBLs) has
not been well described. We sought to determine the proportion of isolates producing ESBLs and the
incidence of infection or colonization with these organisms in our tertiary care pediatric facility over 5 years.
In addition, we sought to evaluate the characteristics of children affected.
Methods: We identified all Escherichia coli or Klebsiella spp cultured from children younger than 18 years of
age at our facility between January 2003 and December 2007. Medical records were reviewed for affected
children.
Results: Of 2697 E coli, K pneumoniae, and K oxytoca cultured, 26 ESBL producers were isolated from 16
children. Rates of ESBL production among cultured isolates significantly increased, from 0.53% in the first
half of the study period to 1.4% in the second. Incidence of a primary ESBL infection also increased
significantly, from 0.14/10,000 patient encounters to 0.31/10,000. The majority of children infected or
colonized with ESBL-producing organisms were those with chronic medical conditions, frequent
hospitalizations, or a history of recurrent infection. However, 4 affected children were less than 5 months old
and evaluated in an outpatient setting.
Conclusion: Rates and incidence of ESBL infection increased over the study period. Whereas most patients
belonged to traditional risk groups for antibiotic-resistant infection, infants in the ambulatory setting were
also affected, an at-risk population not previously described
NosoBase n° 24858
Infection à adénovirus fatale chez un nouveau-né et transmission au personnel hospitalier
CCLIN Sud-Est – [email protected]
12 / 23
NosoVeille – Bulletin de veille
août 2009
Henquell C; Boeuf B; Mirand A; Bacher C; Traore O; Dechelotte P; Labbe A; Bailly JI; Peigue-Lafeuille H.
Fatal adenovirus infection in a neonate and transmission to health-care workers. Journal of clinical virology
2009/08; 45(4): 345-348.
Mots-clés :
NOUVEAU-NE ;
ADENOVIRUS;
TRANSMISSION;
NEONATALOGIE;
INFIRMIER;
PERSONNEL; MEDECIN; TRANSMISSION SOIGNE-SOIGNANT
Background: Human adenovirus (HAdV) infections, while common in infancy and childhood, occur rarely in
the neonatal period but may be fatal. Objectives: To describe a transmission of HAdV froma patient with
fatal pneumonia to heath-careworkers that could be considered as a model of respiratory virus transmission
in a care unit.
Study design : Case report with virologic studies.
Results: A 10-day-old neonate developed pneumonia with acute respiratory distress, external pulmonary
bleeding and coagulopathy and died 36 h after admission of multivisceral failure. An adenovirus was isolated
frompulmonary biopsy and detected by PCR in blood and respiratory secretions. Ten days later, three
members of medical staff in charge of this infant, who used neither masks nor glasses for close patient
contact, developed keratoconjunctivitis. Molecular analysis of the infant.s and one of the pediatrician.s
isolates identified a species D HAdv and showed 100% identity, thereby demonstrating viral transmission.
Conclusion: In view of the serious outcome, HAdV infections should be considered in the differential
diagnosis ofpneumoniain neonates. This case illustrates the epidemicpotential of viruses with respiratory
transmission and underlines the importance of complying with standard precautions to prevent viral spread
in routine practice.
NosoBase n° 24851
Infections à entérovirus chez les nouveaux-nés
Tebruegge M; Curtis N. Enterovirus infections in neonates. Seminars in fetal and neonatal medicine
2009/08; 14(4): 222-227.
Mots-clés : NOUVEAU-NE; ENTEROVIRUS; EPIDEMIOLOGIE; DIAGNOSTIC; TRAITEMENT;
TRANSMISSION
Enteroviruses, which include echoviruses, coxsackie A and B viruses, polioviruses and the .numbered.
enteroviruses, are among the most common viruses causing disease in humans. A large proportion of
enteroviral infections occur in neonates and infants. There is a wide spectrum of clinical manifestations that
can be caused by enterovirus infection with varying degrees of severity. In the neonatal age group,
enteroviral infections are associated with significant morbidity and mortality, particularly when infection
occurs antenatally. This review provides a detailed overview of the epidemiology and clinical features of
enterovirus infections in the neonatal period. In addition, laboratory features and diagnostic investigations
are discussed. A review of the currently available data for prophylactic and therapeutic interventions,
including antiviral therapy, is also presented.
NosoBase n° 25056
Hospitalisations pour gastro-entérites nosocomiales à rotavirus dans un centre hospitalier
universitaire pédiatrique
Waisbourd-Zinman O; Ben-Ziony S; Solter E; Scherf E; Samra Z; Ashkenazi S. Hospitalizations for
nosocomial rotavirus gastroenteritis in a tertiary pediatric center: a 4-year prospective study. American
journal of infection control 2009/08; 37(6): 465-469.
Mots-clés : ROTAVIRUS; GASTRO-ENTERITE; PEDIATRIE; EPIDEMIOLOGIE
Background: Although rotavirus is the most common cause of gastroenteritis worldwide, data regarding
nosocomial rotavirus gastroenteritis (NRVGE) are limited. Our objectives were to study the rates,
seasonality, epidemiology, and clinical features of NRVGE.
Methods: This was a 4-year prospective study.
Results: NRVGE occurred in 1% of all admissions (356/35,833), 0.8% of all hospitalization days
(1164/145,595) and 0.24 cases per 100 hospitalization days. Rates of NRVGE were age-dependent,
occurring in 1.8%, 1.5%, 0.3%, and 0.1% of the admissions of children age # 1, . 1 to 2, . 2 to 5, and . 5
years, respectively (P , .001). Of the children age . 5 years, 90% received immunosuppressive treatment or
CCLIN Sud-Est – [email protected]
13 / 23
NosoVeille – Bulletin de veille
août 2009
had significant underlying diseases. The number of NRVGE cases was highest in winter months, but it
occurred throughout the year, and its percentage of all hospitalizations for rotavirus gastroenteritis was
highest in the summer months. NRVGE occurred after a median hospitalization of 6 days, required a median
hospital stay of 3 days, and warranted treatment with intravenous fluids in 67% of cases.
Conclusion: NRVGE is a significant health burden, especially in children age # 2 years, although it also can
affect children age . 5 years with significant underlying disturbances. Vaccine prevention of rotavirus
gastroenteritis also could reduce NRVGE and should be considered in cost-effectiveness analyses.
Personnel
NosoBase n° 25058
Colonisation bactérienne des montres-bracelets portées par le personnel hospitalier
Bhusal Y; Laza S; Lane TW; Schultz K; Hansen C; Hill C. Bacterial colonization of wristwatches worn by
health care personnel. American journal of infection control 2009/08; 37(6): 476-477.
Mots-clés : PERSONNEL; BIJOU; STAPHYLOCOCCUS AUREUS; ENQUETE
We examined bacterial colonization of wristwatches worn by 100 health care personnel in a communityteaching hospital. Seventy-eight percent of the wristwatches were colonized with bacterial skin flora, with
only 1 of the 100 watches growing a potential pathogen, Staphylococcus aureus. Watches are unlikely to be
sources of health-care associated pathogens.
NosoBase n° 24855
Transmission soignant-soigné du virus de l'hépatite C en établissement de santé : beaucoup de
questions, peu de réponses
Raggam RB; Rossmann AM; Salzer HJ; Stauber RE; Kessler HH. Health care worker-to-patient
transmission of hepatitis C virus in the health care setting: many questions and few answers. Journal of
clinical virology 2009/08; 45(4): 272-275.
Mots-clés : HEPATITE C; TRANSMISSION; PERSONNEL; PREVENTION; DEPISTAGE; BIBLIOGRAPHIE
Hepatitis C virus (HCV) infection represents a substantial risk to both, health care workers and patients. It is
of major importance to detect health care workers with HCV infection and to establish regulations how to
deal with infected individuals working in specific health care settings. Currently, there are no consistent
recommendations, regulations or guidelines concerning prevention of health care worker-to-patient
transmission of HCV. Questions arising include: Should health care workers be screened or tested
individually on HCV infection and what kind of assay(s) should be used? When and how often should health
care workers be tested? How should health care workers with HCV infection be managed? Based on these
questions, this article reviews the most relevant published literature. Furthermore, suggestions for
establishing a future common regulatory framework are provided.
NosoBase n° 25000
Accidents d'exposition au sang en réanimation et lors des procédures de circulation extracorporelle
Sornicle G; Pereira G; Guery A; Landre C; Boulain T. Healthcare workers exposure to blood and body fluids
in intensive care units and during extracorporeal blood circulation. Réanimation 2009/07; 18 (5): 459-465.
Mots-clés : EXPOSITION AU SANG; REANIMATION; HEMODIALYSE; PERSONNEL; PREVENTION;
TENUE VESTIMENTAIRE; FORMATION
Les accidents d’exposition au sang (AES) sont plus fréquents en réanimation que dans d’autres services si
l’on rapporte leur nombre à celui des gestes à risque effectués. Le turnover rapide, et donc parfois le
manque d’expérience des soignants, les situations d’urgence et la grande diversité des actes effectués sont
autant des facteurs expliquant l’augmentation du risque d’AES en réanimation. La pratique de
l’hémodialyse, et possiblement de tout autre circulation extracorporelle (CEC), est une situation à risque
bien identifiée, en particulier lors du débranchement du circuit en fin de séance. Même si les matériels
sécurisés disponibles destinés à réduire le risque d’AES sont nombreux, aucun n’est actuellement
disponible pour couvrir le risque spécifique de projections lors des manoeuvres de débranchement des
CCLIN Sud-Est – [email protected]
14 / 23
NosoVeille – Bulletin de veille
août 2009
circuits d’hémodialyse ou de toute autre CEC. La formation, l’entraînement, le respect des précautions
standard (tablier, gants, masque, lunettes, etc.) et la mise en place de procédures opérationnelles propres à
chaque service sont donc absolument nécessaires.
Pneumonie
NosoBase n° 25094
Avancées dans la prévention et la gestion des pneumonies associées à la ventilation
Bouza E; Burillo A. Advances in the prevention and management of ventilator-associated pneumonia.
Current opinion in infectious diseases 2009/08; 22(4): 345-351.
Mots-clés : PREVENTION; PNEUMONIE; VENTILATION; DIAGNOSTIC; BOUCHE; CHLORHEXIDINE;
CIRCUIT; TRAITEMENT; ANTIBIOTIQUE; BIBLIOGRAPHIE; RECOMMANDATION
NosoBase n° 25121
Spectre des pratiques dans le diagnostic des pneumonies nosocomiales chez des patients sous
ventilation mécanique dans les services de réanimation Européens
Koulenti D; Lisboa T; Brun-Buisson C; Krueger W; Macor A; Sole-Violan J; Diaz E; et al. Spectrum of
practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in european
intensive care units. Critical care medicine 2009/08; 37(8): 2360-2368.
Mots-clés : PNEUMONIE; SOIN INTENSIF; DIAGNOSTIC; VENTILATION; STAPHYLOCOCCUS AUREUS;
PSEUDOMONAS AERUGINOSA; ACINETOBACTER BAUMANNII; MORTALITE
NosoBase n° 24981
Pneumonie dans une unité de réanimation en chirurgie cardiothoracique et facteurs de risque
Mastropierro R; Bettinzoli M; Bordonali T; Patroni A; Barni C; Manzato A. Pneumonia in a cardiothoracic
intensive care unit: incidence and risk factors. Journal of cardiothoracic and vascular anesthesia 2009; in
press: 9 pages
Mots-clés : PNEUMONIE; SOIN INTENSIF; FACTEUR DE RISQUE; INCIDENCE; VENTILATION;
BRONCHOSCOPIE; PSEUDOMONAS; STAPHYLOCOCCUS AUREUS; ANTIBIOTIQUE; CHIRURGIE
CARDIO-VASCULAIRE; CHIRURGIE THORACIQUE
Objective: The purpose of this study was to determine the incidence, risk factors, and pathogens causing
pneumonia in a cardiothoracic intensive care unit (CTICU). DESIGN: A prospective study.
Setting: "Civili Hospital," Brescia, Italy.
Participants: One hundred forty consecutive patients in the CTICU for more than 24 hours from October 1,
2006, to September 30, 2007.
Interventions: None.
Measurements and main results: Demographic variables and intrinsic and extrinsic risk factors were
analyzed with univariate and multivariate analysis. One hundred forty patients were studied, 128 (91.4%)
were surgical and 12 (8.5%) were medical. Cumulative incidence of pneumonia was 28.6% (n = 40); 62.5%
(n = 25) had ventilator-associated pneumonia (VAP) and 37.5% (n = 15) had non-VAP. The most common
isolated pathogens were Pseudomonas aeruginosa (n = 15), Staphylococcus aureus (n = 5), Escherichia
coli (n = 4), and Klebsiella pneumoniae (n = 3). Mortality was 22.2% (n = 31), with 54.8% (n = 17) of patients
with pneumonia leading to mortality during CTICU stay (p = 0.0006). On multivariate analysis, independent
risk factors for pneumonia were each point of the Sequential Organ Failure Assessment score at CTICU
admission (p = 0.006, odds ratio [OR] = 1.39, confidence interval [CI] = 1.09-1.76), every day of mechanical
ventilation (p = 0.049, OR = 1.08, CI = 1.00-1.18), noninvasive mechanical ventilation (NIMV) (p = 0.014, OR
= 4.83, CI = 1.37-17.03), and bronchoscopy (p = 0.002, OR = 8.14, CI = 2.10-31.55).
Conclusions: Pneumonia is a common complication in the CTICU, and the authors recommend the
following: the removal of the endotracheal tube as soon as possible, the minimal use of a bronchoscope and
only in cases of bronchial obstruction, and the use of NIMV.
CCLIN Sud-Est – [email protected]
15 / 23
NosoVeille – Bulletin de veille
août 2009
Réanimation
NosoBase n° 24852
Infection en réanimation
Dhillon R; Clark J. Infection in the intensive care unit (ICU). Current anaesthesia and critical care 2009/08;
20(4): 175-182.
Mots-clés : SOIN INTENSIF; PNEUMONIE; VENTILATION; DIAGNOSTIC; PREVENTION; CATHETER;
BACTERIEMIE; CANDIDA; BIOFILM; APPAREIL URINAIRE; SITE OPERATOIRE; PSEUDOMONAS
AERUGINOSA; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; CLOSTRIDIUM DIFFICILE;
BIBLIOGRAPHIE
Healthcare-associated infections (HAIs) are a hugely topical issue, attracting unprecedented public and
political interest. With regards to the ICU, both the ward environment and susceptible population make the
patients particularly vulnerable to a range of infections. The causative organisms are often different to those
causing disease in the community, or even for the rest of the hospital. Therefore management of the
infected ICU patient is complicated and requires careful consideration. In addition, the emergence of multidrug resistant organisms further complicates treating such patients as they tend to be more susceptible to
infections with less physiological reserve and therapeutic options are frequently reduced.
NosoBase n° 24999
L'eau de dialyse en réanimation
Dorez D; Soule H. Dialysis water in intensive care unit. Réanimation 2009/07; 18(5): 407-412.
Mots-clés : EAU; SOIN INTENSIF; HEMODIALYSE; BIOFILM
L’hémodialyse intermittente reste sous-utilisée en réanimation malgré des résultats cliniques équivalents à
l’hémofiltration continue en termes de tolérance hémodynamique ou de mortalité. La qualité de l’eau
osmosée produite est un facteur essentiel de la biocompatibilité de l’hémodialyse. La possibilité de
rétrodiffusion du dialysat rend impératif le respect de normes physicochimiques et microbiologiques strictes.
L’absence de norme spécifique à la réanimation conduit à se référer aux exigences décrites pour la dialyse
chronique. La norme française, parfois différente de la pharmacopée européenne, doit être appliquée. Elle
décrit également les seuils pour le dialysat ultrapur et le liquide de substitution nécessaires à l’utilisation des
techniques d’épuration avec réinjection en ligne. Les appareils de traitement d’eau peuvent être portables
ou intégrés dans une boucle d’eau osmosée. Ils comportent, tous, des étapes de préfiltration,
d’adoucissement, de filtration et d’osmose inverse. Les générateurs de dialyse modernes doivent intégrer
une filtration supplémentaire de l’eau osmosée ou du dialysat produit pour répondre à l’objectif de dialysat
ultrapur. Quels que soient les appareils utilisés, ils représentent un assemblage, en série, d’un traitement
d’eau de dialyse, d’un générateur et d’un hémodialyseur. Séparément, ces dispositifs permettent d’obtenir
les résultats voulus dans le cadre d’une norme CE et d’un usage conforme aux recommandations des
constructeurs. La prévention de la formation du biofilm repose sur les étapes successives de rinçage,
détartrage et stérilisation qui sont le plus souvent automatisées sur les appareils modernes. Les points
faibles de cet assemblage sont donc souvent dans les connexions entre ces appareils et dans le respect
des procédures d’entretien spécifiques à chacun des maillons de la chaîne. L’élaboration pluridisciplinaire
de règles rigoureuses d’usage, de désinfection, d’entretien, de maintenance et de contrôle des dispositifs
est indispensable pour la phase de qualification du traitement par dialyse. La collaboration des équipes de
réanimation, du service biomédical, de la pharmacie et d’hygiène reste indispensable pour maintenir dans le
temps les performances de l’ensemble de la chaîne aboutissant à la dialyse. Les situations de nonconformité doivent être anticipées afin de mener les actions nécessaires rapidement. Il faut insister sur
l’utilisation régulière et normalisée de l’ensemble de la chaîne de dialyse car c’est elle qui permet d’obtenir
une qualité d’eau de dialyse conforme à la biocompatibilité indispensable à l’hémodialyse en réanimation.
Site opératoire
NosoBase n° 25098
Progrès dans la prévention des infections du site opératoire
Casey AL; Elliott T. Progress in the prevention of surgical site infection. Current opinion in infectious
diseases 2009/08; 22(4): 370-375.
CCLIN Sud-Est – [email protected]
16 / 23
NosoVeille – Bulletin de veille
août 2009
Mots-clés : PREVENTION; SITE OPERATOIRE; MORTALITE; LAVAGE CHIRURGICAL DES MAINS;
STAPHYLOCOCCUS AUREUS; MUPIROCINE; ANTIBIOPROPHYLAXIE
NosoBase n° 24753
Infection de site opératoire "récidivante" en gynécologie-obstétrique. A propos d'un signalement
d'infection nosocomiale
CCLIN Sud-Est; Laprugne-Garcia E. En Bref 2009/06; (41): 7-8
Mots-clés : SITE OPERATOIRE; GYNECOLOGIE; OBSTETRIQUE; CESARIENNE; SIGNALEMENT;
OBESITE
Présentation d'un cas d'infection du site opératoire "récidivante" CISOL à la suite d'une césarienne chez une
patiente âgée de 34 ans (deuxième grossesse, obésité majeure).
NosoBase n° 25111
Le volume des interventions chirurgicales et son impact sur le résultat : étude de faisabilité basée
sur des données belges
Federal Kenniscentrum voor de Gezondheidszorg; KCE. 2009/07: 1-236.
Mots-clés : CHIRURGIE; SITE OPERATOIRE; STATISTIQUE; RECOMMANDATION; QUALITE;
CHIRURGIE CARCINOLOGIQUE; CHIRURGIE CARDIO-VASCULAIRE; CHIRURGIE ORTHOPEDIQUE;
BIBLIOGRAPHIE
Quantifier et comprendre l'association entre le volume d'une série de procédures chirurgicales et les
résultats de l'intervention a fait l'objet d'une multitude de recherches depuis les années 80. De nombreuses
études ont montré que, pour certaines procédures, les patients admis dans des hôpitaux à faible volume ou
traités par des chirurgiens à faible volume présentaient des résultats plus défavorables (taux de mortalité
supérieur, taux de complications accru, réadmissions plus nombreuses, etc.) par rapport aux patients admis
dans des hôpitaux à volume élevé ou traités par des chirurgiens ayant un volume d'activité important. A ce
jour, seule une poignée d'études belges se sont penchées sur le sujet, probablement en raison de la
difficulté d'accès aux données requises.
La présente étude est dite de faisabilité et a pour ambition de répondre à trois questions :
1/ Pour quelles procédures chirurgicales l'association entre le volume et les résultats a-t-elle été étudiée
dans la littérature ? Quels sont les constats et lesquelles parmi ces procédures peuvent-elles être étudiées
en se fondant sur les données administratives belges ?
2/ Quelles sont les méthodes statistiques utilisées pour évaluer les associations entre le volume et les
résultats ?
3/ Est-il possible d'appliquer ces méthodes sur des données belges, pour une série d'interventions
chirurgicales ? Quelles sont les embûches ?
NosoBase n° 24744
Check-list sécurité du patient au bloc opératoire
HAS.2009/06 :2 pages
Mots-clés : BLOC OPERATOIRE; RECOMMANDATION; ANTIBIOPROPHYLAXIE
La Haute autorité de santé (HAS) a adapté la check-list de l'Organisation mondiale de la santé (OMS) au
contexte français.
Cette check-list reprend 10 points essentiels devant être vérifiés pour toute intervention, avant l'anesthésie,
avant et après l'opération : de la vérification de l'identité du patient à sa prise en charge postopératoire. Les
dix points figurant sur cette check-list devraient être vérifiés avant toute intervention chirurgicale. Cette liste
a pour but de diminuer le nombre de complications après une intervention chirurgicale.
L'intervention et le site à opérer sont confirmés dans l'idéal par le patient. L'installation du patient et le
matériel nécessaires pour l'intervention sont aussi vérifiés, ainsi que l'existence de risques allergiques.
CCLIN Sud-Est – [email protected]
17 / 23
NosoVeille – Bulletin de veille
août 2009
Une vérification de tous ces points avant l'acte chirurgical est faite au sein de l'équipe. Concrètement, un
des membres de l'équipe chirurgicale renseigne la check list et annonce à voix haute les points à vérifier.
Cette check-list sera utilisée dans tous les blocs opératoires dès le 1er janvier 2010.
NosoBase n° 25085
Stérilisation, désinfection et nettoyage au bloc opératoire : faut-il étendre la classification
"Spaulding"
Lewis T; Patel V; Ismail A; Fraise A. Sterilisation, disinfection and cleaning of theatre equipment: do we
need to extend the spaulding classification ? The Journal of hospital infection 2009/08; 72 (4): 361-363.
Mots-clés : STERILISATION; DESINFECTION; BLOC OPERATOIRE; NETTOYAGE; ACINETOBACTER;
SURFACE
NosoBase n° 25079
Incidence et facteurs de risque d'infection du site opératoire après transplantation simultanée
pancréas-rein
Perdiz LB; Furtado G; Linhares MM; Gonzalez AM; Pestana J; Medeiros E. Incidence and risk factors for
surgical site infection after simultaneous pancreas - kidney transplantation. The Journal of hospital infection
2009/08; 72(4): 326-331.
Mots-clés : TRANSPLANTATION; SITE OPERATOIRE; INCIDENCE; FACTEUR DE RISQUE;
TRANSPLANTATION RENALE; TRANSPLANTATION PANCREATIQUE; MORTALITE
A simultaneous pancreas-kidney transplantation (SPKT) is the best treatment option for type I diabetic
patients with advanced chronic renal failure. Infectious complications affect 7-50% of the patients receiving
this procedure. We conducted a nested case-control study to assess the risk factors for surgical site
infection (SSI) in patients receiving SPKT at our centre between 2000 and 2006. Of the 119 evaluated
transplant recipients, 55 (46.2%) developed SSIs and the 30 day mortality was 11.8%. Gram-negative
organisms were the predominant organisms isolated from SSIs. After multivariate logistic regression, the
variables independently associated with SSI were: acute tubular necrosis, post-transplant fistula and graft
rejection. This study demonstrated a high incidence of SSI in this patient cohort and variables related to the
surgical procedure were closely associated with the development of SSI.
NosoBase n° 25139
Choix du moment de l'antibioprophylaxie et risque d'infection du site opératoire. Résultats d'un
essai pour réduire les erreurs d'antibioprophylaxie
Steinberg JP; Braun BI; Hellinger WC; Kusek L; Bozikis MR; Bush AJ; et al. Timing of antimicrobial
prophylaxis and the risk of surgical site infections. Results from the trial to reduce antimicrobial prophylaxis
errors. Annals of surgery 2009/07; 250(1): 10-16.
Mots-clés : ANTIBIOPROPHYLAXIE; SITE OPERATOIRE; RISQUE
Objective: The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis
(AMP).
Summary background data: National AMP guidelines should be supported by evidence from large
contemporary data sets.
Methods: Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected
cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained
through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The
association between the prophylaxis timing and the occurrence of SSI was assessed using conditional
logistic regression (conditioning on hospital).
Results: One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the
interval of time between antibiotic infusion and the incision increased (overall association between timing
and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and
fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes
prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60
CCLIN Sud-Est – [email protected]
18 / 23
NosoVeille – Bulletin de veille
août 2009
minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the
time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after
incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in
operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but
only when the preoperative dose was given correctly.
Conclusions: These data from a large multicenter collaborative study confirm and extend previous
observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward
lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were
given within 30 minutes prior to incision.
NosoBase n° 24758
La chirurgie laparoscopique diminue significativement les infections du site opératoire comparée à
la chirurgie ouverte
Varela JE; Wilson SE; Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections
compared with open surgery Surgical endoscopy. 2009 in press :7 pages
Mots-clés : CHIRURGIE; SITE OPERATOIRE; INCIDENCE; COUT; DUREE DE SEJOUR; MORBIDITE;
LAPAROSCOPIE
Background: Surgical-site infections (SSIs) are nosocomial infectious complications causing significant
morbidity, mortality, and hospital costs. Recently, the US Department of Human Health Services and the
Centers for Medicare and Medicare Services outlined measures intended to decrease and prevent hospitalacquired infections such as SSI. This study aimed to compare the incidence of SSI after laparoscopic and
open surgery.
Methods: A retrospective analysis of a large administrative, clinical, and financial database (University
Health System Consortium) of US Academic Medical Centers and affiliated community hospitals was
conducted. Patients who underwent laparoscopic (n = 94,665) or open (n = 36,965) appendectomy,
cholecystectomy, antireflux surgery, or gastric bypass between 2004 and 2008 were included in the
analysis. The main outcome measure was inpatient diagnosis of SSI after laparoscopic and open surgery.
Results: During the 45-month study period, a total of 131,630 patients underwent one of four selected
procedures. Overall, the incidence of SSI was significantly lower in laparoscopic (483 of 94,665, 0.5%) than
in open (669 of 36,965, 1.8%) surgery (p<0.01). Largely, laparoscopic techniques offered a protective effect
against SSI (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.25-0.31). Patients treated with
laparoscopy were 72% less likely to experience an SSI. This protective effect was shown to be sustained
after stratification by severity of illness (minor: OR, 0.19; 95% CI, 0.14-0.26; moderate: OR, 0.30; 95% CI,
0.25-0.35; major/extreme: OR, 0.65; 95% CI, 0.54-0.79), admission status (elective: OR, 0.25; 95% CI, 0.200.31; urgent: OR, 0.38; 95% CI, 0.28-0.53; emergent: OR,0.29; 95% CI, 0.25-0.34), and wound classification
(dirty wounds: OR, 0.45; 95% CI, 0.37-0.54).
Conclusions : In US academic medical centers, laparoscopy
significantly reduces SSI. Patients treated with laparoscopic procedures are less likely to experience SSI.
After stratification by severity of illness, admission status, and wound classification, laparoscopic techniques
showed a protective effect against SSI.
Staphylococcus aureus
NosoBase n° 24631
Bactériémies pédiatriques et néonatales à Staphylococcus aureus : épidémiologie, facteurs de
risque et issue
Burke RE; Halpern MS; Baron EJ; Gutierrez K. Pediatric and neonatal Staphylococcus aureus bacteremia:
epidemiology, risk factors, and outcome. Infection control and hospital epidemiology 2009/07; 30(7): 636644.
Mots-clés :
PEDIATRIE;
NEONATALOGIE;
PREVALENCE;
ETUDE
RETROSPECTIVE;
STAPHYLOCOCCUS AUREUS; BACTERIEMIE; EPIDEMIOLOGIE; FACTEUR DE RISQUE
Objective: To evaluate the impact of methicillin-resistant Staphylococcus aureus on the prevalence of S.
aureus bloodstream infection among children.
CCLIN Sud-Est – [email protected]
19 / 23
NosoVeille – Bulletin de veille
août 2009
Methods: Retrospective analysis of demographic data, risk factors for infection, and clinical outcomes for
children (age, less than 18 years) with S. aureus bacteremia hospitalized at a children's hospital during
2001-2006.
Results: We identified 164 episodes of S. aureus bacteremia among 151 children. The prevalence of
bacteremia due to methicillin-susceptible S. aureus during 2001-2003 was approximately the same as that
during 2004-2006 (29 and 30 cases, respectively, per 10,000 hospitalized children [hereafter, "per 10,000
hospitalizations"]), but the prevalence of bacteremia due to methicillin-resistant S. aureus increased from 4
to 11 cases, respectively, per 10,000 hospitalizations (P=.015). A total of 48% of infections involved children
who had S. aureus-positive blood cultures less than 3 days after hospital admission. Seventy-four percent of
these children had a preexisting comorbidity. When the prevalence of S. aureus bacteremia was stratified by
race, sex, or age, neonates hospitalized at birth and Hispanic children had significantly reduced risks of
infection. Children younger than 1 year of age (excluding neonates hospitalized at birth) had an increased
prevalence of hospital-onset S. aureus bacteremia. There was a disproportionate increase in the risk of S.
aureus bacteremia for each additional week of hospitalization among children with hospital-onset S. aureus
bacteremia. Children with methicillin-resistant S. aureus bacteremia had a longer hospital stay, were
transferred to another facility at a greater rate than they were discharged home, and had a greater mortality
rate, compared with children with methicillin-susceptible S. aureus bacteremia.
Conclusion: This study documents the prevalence of S. aureus bacteremia among children with a high risk
for acquiring this infection, and it describes populations of children who are at higher risk for bacteremia due
to either methicillin-susceptible or methicillin-resistant S. aureus. Methods to improve prevention of S.
aureus bacteremia are needed for children with healthcare-associated risk factors for S. aureus bacteremia.
NosoBase n° 25078
Evaluation de l'efficacité bactéricide de trois solutions hydroalcooliques contre 57 isolats cliniques
de S. aureus
Cheeseman KE; Denyer SP; Hosein IK; Williams GJ; Maillard JY. Evaluation of the bactericidal efficacy of
three different alcohol hand rubs against 57 clinical isolates of S. aureus. The Journal of hospital infection
2009/08; 72(4): 319-325.
Mots-clés : STAPHYLOCOCCUS AUREUS; SOLUTION HYDRO-ALCOOLIQUE; BACTERICIDIE;
OBSERVANCE
We tested the efficacy of three alcohol hand rubs (AHRs) used in two local Welsh intensive therapy units
(ITUs) against Staphylococcus aureus. The test protocol was based on a carrier test and parameters
(concentration, contact time) were chosen following observation of hand-sanitising practices in the ITUs.
Following AHR exposure, surviving bacteria were enumerated using a standard plate count method plus a
Bioscreen C Microbial Growth Analyser. The AHRs demonstrated variable efficacy against the clinical
isolates: the mean log(10) reduction after 10 s exposure to Soft Care Med H5, Cutan and Guest Medical
AHRs was 2.67, 0.696 and 1.96, respectively, and after 30 s exposure was 4.58, 1.74 and 3.60,
respectively. Since the average time taken by healthcare workers (HCWs) to rub AHR onto their hands was
11 s and 15 s at the two hospitals, the efficacy of these AHRs may be significantly limited against the S.
aureus isolates under the conditions observed in practice. In addition, differences observed in log(10)
reduction in bacterial number post-exposure using the Bioscreen compared to the plate count method
provided evidence that S. aureus may be able to recover following Guest Medical AHR treatment within 2
min exposure, whereas after 5 min exposure bacterial damage caused by the AHR was irreversible.
Although the introduction of AHRs improved hand hygiene compliance among HCWs, our observations
highlighted that contact time is an important factor to ensure the efficacy of these products
NosoBase n° 25037
Staphylococcus aureus sensible et résistant à la méticilline : prévention des infections du site
opératoire après chirurgie plastique
Elward AM; Mcandrews JM; Leroy Young V. Methicillin-sensitive and methicillin-resistant Staphylococcus
aureus: preventing surgical site infections following plastic surgery. Aesthetic surgery journal 2009/06; 29(3):
232-244.
Mots-clés : STAPHYLOCOCCUS AUREUS; PREVENTION; METICILLINO-RESISTANCE; ESTHETIQUE;
SITE OPERATOIRE; ANTIBIOTIQUE; EPIDEMIOLOGIE; FACTEUR DE RISQUE; DIAGNOSTIC; COUT;
PREVENTION; TRAITEMENT; BIBLIOGRAPHIE; INCIDENCE; ANTISEPTIQUE; TABAC
CCLIN Sud-Est – [email protected]
20 / 23
NosoVeille – Bulletin de veille
août 2009
Learning objectives : The reader is presumed to have a broad understanding of aesthetic surgical
procedures. After studying this article, the participant should be able to: 1. Explain the microbiology of
Staphylococcus species and discuss antibiotic resistance development in Staphylococcus species and
assess how clinical outcomes are affected. 2. Identify the epidemiology of Staphylococcus carriers and the
impact on the clinical practice and regulation. Practice effective measures that prevent surgical site
infections. 3. Practice screening for and decolonizing of patients with methicillin-resistant Staphylococcus
aureus (MRSA). Physicians may earn 2.5 AMA PRA Category 1 Credit by successfully completing the
examination based on material covered in this article. The examination begins on page 245. As a measure
of the success of the education we hope you will receive from this article, we encourage you to log on to the
Aesthetic Society website and take the preexamination before reading this article. Once you have completed
the article, you may then take the examination again for CME credit. The Aesthetic Society will be able to
compare your answers and use this data for future reference as we attempt to continually improve the CME
articles we offer. ASAPS members can complete this CME examination online by logging on to the ASAPS
Members-Only Website (http://www.surgery.org/members) and clicking on "Clinical Education" in the menu
bar. Staphylococcus aureus is the most common cause of surgical site infections (SSI), with both methicillinsensitive and methicillin-resistant strains causing these infections. The incidence of methicillin-resistant S
aureus (MRSA) has increased in the US over the past decade, largely due to the emergence of communityacquired MRSA (CA-MRSA). This article reviews the microbiology and epidemiology of methicillin-sensitive
S aureus (MSSA) and MRSA, risk factors for surgical site infections among plastic surgery patients, the
evidence supporting preoperative screening and decolonization measures to prevent surgical site infections
caused by MRSA, recommendations for anti-microbial prophylaxis, and treatment recommendations for
surgical site infections. Other proven methods of reducing SSI, including maintenance of normothermia
during surgery, glucose control, cessation of nicotine use, and not shaving the surgical site preoperatively
are discussed.
NosoBase n° 25064
Les sièges des toilettes sont-ils un vecteur de transmission de Staphylococcus aureus méticillinorésistant ?
Giannini MA; Nance D; Mccullers JA. Are toilet seats a vector for transmission of methicillin-resistant
Staphylococcus aureus? American journal of infection control 2009/08; 37(6): 505-506.
Mots-clés : TRANSMISSION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PEDIATRIE;
WC
We studied the bacterial burden on toilet seats in a children's cancer hospital to validate a policy requesting
that immunocompromised children use alcohol wipes on the seats prior to use of the toilets. Methicillinresistant Staphylococcus aureus (MRSA) was recovered from 3.3% of hospital toilets when wipes were not
in use. Use of wipes resulted in a 50-fold reduction in mean daily bacterial counts and eliminated MRSA.
NosoBase n° 24838
Mesures de prévention et de contrôle des infections à Staphylococcus aureus résistant à la
méthicilline (SARM) dans les milieux de réadaptation
Institut national de santé publique Québec. 2009/06: 1-81.
Mots-clés : RECOMMANDATION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
PREVENTION;
CONTROLE;
REEDUCATION;
TRANSPORT;
PRELEVEMENT;
DEPISTAGE;
INFORMATION
L’objectif poursuivi par les présentes recommandations est de réduire au minimum le risque de transmission
du SARM (Staphylococcus aureus résistant à la méthicilline) dans les MR (Milieux de réadaptation). Cet
objectif se distingue de celui poursuivi dans les CHSLD (Centres Hospitaliers de Soins de Longue Durée),
notamment parce que les risques de transmission et d’infections qui caractérisent les clientèles de chacun
de ces milieux et l’intensité des traitements qui y sont offerts sont différents. Les présentes
recommandations se fondent sur les recommandations et données disponibles dans la littérature ainsi que
sur l’avis d’experts, dont des intervenants en MR. Elles tiennent également compte des aspects éthiques
liés aux besoins spécifiques des porteurs comme des non porteurs. Elles sont abordées dans l’optique d’un
continuum de soins puisque la majeure partie de la clientèle qui requiert des traitements en MR y est
CCLIN Sud-Est – [email protected]
21 / 23
NosoVeille – Bulletin de veille
août 2009
admise suite à un séjour dans un autre milieu de soins. Ces recommandations s’adressent principalement
aux milieux qui offrent des services de réadaptation aux clientèles présentant des déficiences physiques
motrices, accompagnées ou non d’autres déficits (ex. : sensoriel, cognitif), c’est-à-dire les milieux suivants :
- Centres de réadaptation pour personnes ayant des déficiences physiques - motrices (CRDPM);
- Tout autre milieu qui offre des services de réadaptation à l’intérieur des programmes de déficience
physique ou de perte d’autonomie, ce qui inclut les unités de réadaptation fonctionnelle intensive (URFI) et
la réadaptation gériatrique (CHSGS, CHSLD).
NosoBase n° 24629
Traitement local des colonisations à Staphylococcus aureus : impact sur le risque infectieux
Robiczek A; Beaumont JL; Thomson RB; Govindarajan G; Peterson LR. Topical therapy for methicillinresistant Staphylococcus aureus colonization: impact on infection risk. Infection control and hospital
epidemiology 2009/07; 30(7): 623-632.
Mots-clés
:
METICILLINO-RESISTANCE;
STAPHYLOCOCCUS
AUREUS;
COLONISATION;
TRAITEMENT; EVALUATION; ETUDE RETROSPECTIVE; CENTRE HOSPITALIER UNIVERSITAIRE;
MUPIROCINE; CHLORHEXIDINE; INFECTION; RISQUE
Objective: We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillinresistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.
Design: Retrospective cohort study.
Setting and Intervention: Three hospitals with universal surveillance for MRSA; at their physician's
discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice
daily, plus chlorhexidine gluconate 4% every second day.
Patients and Methods: MRSA carriers were later retested for colonization (407 subjects; study 1) or followed
up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to
determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA
infection (in study 2).
Results: Independent risk factors for sustained colonization included residence in a long-term care facility
(odds ratio [OR], 1.8 [95% confidence interval [CI], 1.1-3.2]) and a pressure ulcer (OR, 2.3 [95% CI, 1.24.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy;
mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6-10.7]). Over a median follow-up duration of
269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of
stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0-1.4]), chronic lung disease (HR, 1.7 [95% CI,
1.0-2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1-3.1]). Receipt
of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among
patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P=.06).
Conclusions: Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization
but did not decrease the risk of subsequent infection.
NosoBase n° 24731
Effet antibactérien contre Staphylococcus aureus méticillino-résistant d'huiles essentielles
provenant de deux plantes médicinales
Tohidpour A; Sattari M; Omidbaigi R; Yadegar A; Nazemi J. Antibacterial effect of essential oils from two
medicinal plants against methicillin-resistant Staphylococcus aureus (MRSA). Phytomedicine 2009; in press:
4 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PCR; HUILE ESSENTIELLE
Antimicrobial properties of plants essential oils (EOs) have been investigated through several observations
and clinical studies which purpose them as potential tools to overcome the microbial drug resistance
problem. The aim of this research is to study the antibacterial effect of two traditional plants essential oils,
Thymus vulgaris and Eucalyptus globulus against clinical isolates of Methicillin resistant Staphylococcus
aureus (MRSA) and other standard bacterial strains through disk diffusion and agar dilution methods. Gas
Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) analysis examined the
chemical composition of the oils. Results revealed both of oils to possess degrees of antibacterial activity
against Gram (+) and Gram (-) bacteria. T. vulgaris EO showed better inhibitory effects than E. globulus
essential oil. GC analysis of T. vulgaris resulted in thymol as the oil major compound whereas GC/MS assay
CCLIN Sud-Est – [email protected]
22 / 23
NosoVeille – Bulletin de veille
août 2009
exhibited eucalyptol as the most abundant constitute of E. globulus EO. These results support previous
studies on these oils and suggest an additional option to treat MRSA infections. Clinical and further
analytical trials of these data are necessary to confirm the obtained outcomes.
Usager
NosoBase n° 25103
L'instruction des plaintes ou réclamations en établissement de santé et la commission des relations
avec les usagers et de la qualité de la prise en charge (CRU)
Ministère de la santé et des sports 2009/07 :1-4
Mots-clés : INFORMATION; USAGER; CRU
Toutes les plaintes ou réclamations sont prises en compte par l’établissement. Ce document a pour objet de
préciser aux usagers les différentes étapes de l’examen des plaintes ou réclamations, ainsi que l’importance
qu’elles présentent pour permettre à la CRU (Commission des relations avec les usagers) de remplir ses
missions.
NosoBase n° 25104
Les règles d'accessibilité aux informations de santé à caractère personnel
Ministère de la santé et des sports 2009/07: 1-6.
Mots-clés : INFORMATION; USAGER; DOSSIER MEDICAL
Ce document à l'intention des usagers précise les règles d'accessibilité aux informations de santé à
caractère personnel. Il indique les formalités à remplir pour accéder à son dossier médical, les délais de
conservation des dossiers, les recours en cas de refus de communication du dossier.
CCLIN Sud-Est – [email protected]
23 / 23