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  • 1. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 « NosoVeille n°5 Mai 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 Alimentation Antibiotiques Bactériémies Chirurgie Clostridum Désinfection Epidémie Environnement Grippe Hygiène des mains Indicateurs Personnel Prévention Staphylococcus aureus Surveillance Usager Vaccination Alimentation sommaire NosoBase n°23940 CCLIN Sud-Est – cclinse@chu-lyon.fr 1 / 24
  • 2. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Recommandations pour la pratique de l'alimentation entérale Bankhead R; Boullata J; Brantley S; Corkins M; Guenter P; Krenitsky J; et al. Enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutrition 2009/04; 33(2): 122-167. Mots-clés: RECOMMANDATION; ALIMENTATION ENTERALE; EAU; SURVEILLANCE; PEDIATRIE These American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Enteral Nutrition Practice Recommendations are based upon general conclusions of health professionals who, in developing such recommendations, have balanced potential benefits to be derived from a particular mode of providing enteral nutrition with known associated risks of this therapy. The underlying judgment regarding the propriety of any specific practice recommendation or procedure shall be made by the attending health professional in light of all the circumstances presented by the individual patient and the needs and resources particular to the locality. These recommendations are not a substitute for the exercise of such judgment by the health professional, but rather are a tool to be used by the health professional in the exercise of such judgment. Use of this document is voluntary and should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed toward obtaining the same result. NosoBase n° 24246 Modalités de préparation de l'alimentation du patient greffé de moelle osseuse Gardes E; Verdeil X; Marty N. Hygiènes 2009/03; XVII (1): 53-58. Mots-clés: GREFFE MEDULLAIRE; ALIMENTATION; ENQUETE; CUISINE; IMMUNODEPRIME; RECOMMANDATION; CONTAMINATION; QUESTIONNAIRE Le but de ce travail était de faire le bilan des modalités de préparation de l’alimentation des patients greffés de moelle (APGM) dans les centres de greffe français (CGF), en l’absence de consensus à ce propos. Méthode : Une enquête par questionnaire a été effectuée auprès des responsables des cuisines et du service d’hématologie de 16 CGF en août 2006. Résultats : Au total, sur les CGF sollicités, douze ont répondu. L’APGM était essentiellement de préparation hospitalière pour sept cas, faisait appel en supplément à des plats industriels achetés sous forme de conserves ou barquettes filmées pour cinq cas, et deux CGF utilisaient exclusivement l’alimentation parentérale pour les allogreffés. Les modalités de traitement de l’APGM étaient variées : stérilisation au four pour quatre établissements sur douze, stérilisation en autoclave dans trois, « pasteurisation » pour trois et aucun traitement particulier par rapport aux autres patients dans deux. Pour composer le plateau de service, l’alimentation était répartie soit sur le lieu de production (c’est-à-dire cuisine centrale ou cuisine diététique) dans quatre établissements, soit dans un office dédié dans le service, disposant d’un four et/ou d’une hotte à flux laminaire suivant le niveau de traitement des aliments et du contenant. Les prélèvements à visée d’analyses microbiologiques au moment du service au patient n’étaient réalisés que dans un établissement. Conclusion : Cette étude a fait apparaître une grande diversité dans les modalités de préparation de l’APGM. Le risque infectieux lié à l’alimentation chez ce type de patients mérite d’être pris en compte. Une réflexion nationale serait donc utile pour valider une stratégie consensuelle. Antibiotique/Antibiorésistance sommaire NosoBase n°23994 Evolution des micro-organismes résistant aux antibiotiques chez des patients sous ventilation mécanique prolongée Chien JY; Hsueh PR; YU CJ; Yang PC. The evolution of drug-resistant microorganisms in patients with prolonged mechanical ventilation. American journal of infection control 2009/04; 37(3): 231-236. Mots-clés: VENTILATION; ANTIBIORESISTANCE; INFECTION RESPIRATOIRE BASSE;ANTIBIOTIQUE; PSEUDOMONAS; KLEBSIELLA; STAPHYLOCOCCUS AUREUS; ACINETOBACTER; MORTALITE Background: Patients requiring prolonged mechanical ventilation (PMV) tend to become reservoirs of antimicrobial resistance. We assessed antimicrobial-resistant microorganisms in the respiratory tracts of patients receiving PMV. Methods: Over a 6-month period, the microorganisms from tracheal aspirates of PMV patients with lower airway infection were analyzed. CCLIN Sud-Est – cclinse@chu-lyon.fr 2 / 24
  • 3. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Results: Antimicrobial use was greatest during the acute critical stage of respiratory failure. Antimicrobial resistance in Pseudomonas aeruginosa and Klebsiella pneumoniae peaked during the fourth to 15th weeks of PMV. Methicillin-resistant Staphylococcus aureus (MRSA) developed rapidly during the first 3 weeks of PMV. The acquisition of multidrug-resistant P aeruginosa and MRSA were significantly correlated with previous exposure to ceftazidime (odds ratio [OR] = 121.3 and 72.5; P = .01 and .01, respectively). The rise of multidrug-resistant Acinetobacter baumannii was significantly correlated with previous exposure to piperacillin/tazobactam (OR = 26.81; P = .02) and imipenem (OR = 16.91; P = .03). Using univariate and multivariate logistic regression models, the lower respiratory tract infections with multidrug-resistant microorganisms were independently associated with increased 6-month mortality (OR = 3.41; P < .01). Conclusion: In patients receiving PMV, lower respiratory tract infection with multidrug-resistant microorganisms is common and is associated with higher mortality NosoBase n° 24064 Bactéries tolérantes au triclosan : changements dans la sensibilité aux antibiotiques Cottell A; Denyer S; Hanlon G; Ochs D; Maillard J. Triclosan-tolerant bacteria: changes in susceptibility to antibiotics. The Journal of hospital infection 2009/05; 72 (1): 71-76. Mots-clés: ANTIBIOTIQUE; ANTIBIORESISTANCE; ACINETOBACTER; ACINETOBACTER JOHNSONII; STAPHYLOCOCCUS AUREUS; ESCHERICHIA COLI; TRICLOSAN; BIOCIDE There is no clear consensus regarding the effect of biocide tolerance on antibiotic susceptibility. In this work, triclosan-tolerant strains of Escherichia coli, Staphylococcus aureus and Acinetobacter johnsonii were compared with sensitive strains in order to ascertain their susceptibility to a range of antibiotics. The minimum inhibitory concentrations of triclosan were measured using broth- and agar-dilution techniques. Antibiotic susceptibilities were determined using the British Society for Antimicrobial Chemotherapy guidelines. No triclosan-tolerant strains were resistant to antibiotics, and there was no overall tendency for triclosan-tolerant strains to have significantly smaller zones of inhibition compared with counterpart strains. Triclosan-tolerant strains of E. coli were significantly more susceptible to aminoglycoside antibiotics. The mechanism by which E. coli develops tolerance to triclosan appears to be linked to aminoglycoside susceptibility. It is proposed that changes in outer membrane, or the loss of plasmids, may be responsible for this relationship. NosoBase n°23674 Deux analyses chronologiques de l’impact de la consommation d’antibiotiques et de la désinfection des mains par friction hydro-alcoolique sur l’incidence des infections à Staphylococcus aureus résistant à la méticilline et à Clostridium difficile Kaier K; Hagist C; Frank U; Conrad A; Meyer E. Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection. Infection control and hospital epidemiology 2009/04; 30(4): 346-353. Mots-clés: ANTIBIOTIQUE; DESINFECTION; INCIDENCE; STAPHYLOCOCCUS AUREUS; METICILLINO- RESISTANCE; CLOSTRIDIUM; HYGIENE DES MAINS Objective: To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI). Methods: Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month. Results: The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P< .001). The multivariate analysis (R2=0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= CCLIN Sud-Est – cclinse@chu-lyon.fr 3 / 24
  • 4. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 .01), and lincosamides (P= .05). The multivariate analysis (R2=0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected. Conclusion: In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI. NosoBase n° 24136 Gestion des antibiotiques en réanimation. Avancées et obstacles Lawrence KlL Kollef MH. Antimicrobial stewardship in the intensive care unit. Advances and obstacles. American journal of respiratory and critical care medicine 2009/03; 179(6): 434-438. Mots-clés: ANTIBIOTIQUE; SOIN INTENSIF; ANTIBIORESISTANCE; PREVENTION; COUT Antimicrobial stewardship involves a multifaceted approach that strives to combat the emergence of resistance, improve clinical outcomes, and control costs by improving antimicrobial use. Therefore, stewardship is of great importance and relevance in the intensive care unit. Clinical decision support systems, biomarker-derived treatment algorithms, and improved knowledge regarding the different components of antimicrobial therapy represent some of the advances that have been made in stewardship. Yet, significant obstacles have prevented the full achievement of stewardship's goals, and approaches to confronting these obstacles should be appreciated. Clinicians should realize that antimicrobials are important therapeutic agents and strive to use them wisely. NosoBase n° 24100 Antibiotiques par aérosols pour le traitement des pneumonies acquises sous ventilation Luyt C; Combes A; Nieszkowska A; Trouillet J; Chastre J. Aerosolized antibiotics to treat ventilator- associated pneumonia. Current opinion in infectious diseases 2009/04; 22 (2): 154-158. Mots-clés: ANTIBIOTIQUE; PNEUMONIE; AEROSOL; VENTILATION ASSISTEE; MULTIRESISTANCE; TRAITEMENT This review summarizes the recent data on antibiotic aerosolization to treat ventilator-associated pneumonia. Recent findings : Most studies on antibiotic aerosolization have been case reports or descriptive studies. The result of a recent randomized, placebo-controlled trial indicated that adjunctive use of nebulized antibiotic with intravenous antibiotics to treat purulent tracheobronchitis was associated with a better outcome than placebo aerosolization. A randomized study, so far published only as an abstract, showed that amikacin aerosolized with a vibrating-mesh nebulizer - a new- generation device - was well distributed in the lung parenchyma and might lead to less intravenous antibiotic use. Several thorough review on nebulization devices, techniques and drawbacks have been published recently. Despite recent promising findings, the widespread use o aerosolized antibiotics to treat ventilator-associated pneumonia cannot be recommended. It should be restricted to the treatment of multidrug-resistant Gram- negative ventilator-associated pneumonia. NosoBase n°23990 Impact de la limitation de la durée du traitement antibiotique sur l'antibiorésistance dans une unité de soins intensifs Marra AR; De Almeida SM; Correa L; Silva M; Dalla M; Martino V; et al. The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting. American journal of infection control 2009/04; 37(3): 204-209. Mots-clés: ANTIBIORESISTANCE; TRAITEMENT; SOIN Background: Using antimicrobial agents for prolonged periods of time and/or in heavy densities is known to contribute to antimicrobial resistance. Methods: A quasiexperimental, before and after study to limit the duration of antimicrobial therapy to 14 days was conducted in a medical-surgical intensive care unit (ICU). An intervention to optimize antimicrobial CCLIN Sud-Est – cclinse@chu-lyon.fr 4 / 24
  • 5. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 therapy was performed when antimicrobial agents had been prescribed for more than 14 days. We then compared antimicrobial utilization using the defined daily dose (DDD) per 1000 patient-days, as well as resistance rates in selected organisms in the intervention phase to the previous 10-month period. Results: In the intervention phase, doctors approved to discontinue the antimicrobial therapy before 14 days in 89.8% (415/462) of the prescribed antibiotics in the ICU. Comparing the 2 time periods, we found a reduction in carbapenems (24.5% decrease), vancomycin (14.3% decrease), and cephalosporins (12.2% decrease) in the intervention phase. Imipenem resistance decreased in Acinetobacter baumannii from 88.5% to 20.0% (P # .001) and in Klebsiella pneumoniae from 54.5% to 10.7% (P 5 .01). Conclusion: These results suggest that an intervention to reduce the duration of antimicrobial therapy contributed to more rational use of antimicrobial agents and to the reduction of bacterial resistance in the critical care setting. NosoBase n° 24105 Recommandations relatives à l'utilisation des antibiotiques chez le brûlé à la phase aiguë - texte long Societe Francaise d'Etude et de Traitement des Brulures. Annales françaises d'anesthésie et de réanimation 2009: 10 pages. Mots-clés: ANTIBIOTIQUE; RECOMMANDATION; BRULE; BACTERICIDIE; ANTIBIOPROPHYLAXIE; CHIRURGIE; BACTERIE; BACTERIEMIE; INFECTION URINAIRE; CATHETER VEINEUX CENTRAL; BETALACTAMINE; FLUOROQUINOLONE; ANTIBIORESISTANCE Ces recommandations ont été établies par un groupe d'experts de la Société française d'étude et de traitement des brûlures (SFETB) à l'issue d'une table ronde intitulée "infection chez le brûlé", présentée lors du 17ème congrès de la SFETB en juin 2007. Bactériémie sommaire NosoBase n° 24123 La magnitude de la bactériémie est un facteur prédictif de mortalité au cours d'un suivi d'un an Gradel Ko; Sogaard M; Dethlefsen C; Nielsen H; Schonheyder HC. Magnitude of bacteraemia is a predictor of mortality during 1 year of follow-up. Epidemiology and infection 2009; 137 (1): 94-101. Mots-clés: BACTERIEMIE; MORTALITE; ANALYSE; RISQUE; COHORTE We evaluated magnitude of bacteraemia as a predictor of mortality, comprising all adult patients with a first- time mono-microbial bacteraemia. The number of positive bottles [1 (reference), 2, or 3] in the first positive blood culture (BC) was an index of magnitude of bacteraemia. We used Cox's regression analysis to determine age and comorbidity adjusted risk of mortality at days 0-7, 8-30, and 31-365. Of 6406 patients, 31.1% had BC index 1 (BCI 1), 18.3% BCI 2, and 50.6% BCI 3. BCI 3 patients had increased risk of mortality for days 0-7 (1.30, 95% CI 1.10-1.55) and days 8-30 (1.37, 95% CI 1.12-1.68), but not thereafter. However, in surgical patients mortality increased only beyond day 7 (8-30 days: 2.04, 95% CI 1.25-3.33; 31-365 days: 1.27, 95% CI 0.98-1.65). Thus, high magnitude of bacteraemia predicted mortality during the first month with a shift towards long-term mortality in surgical patients. Nosobase N° 24102 Définition d'un cas pour la surveillance nationale et internationale des bactériémies néonatales Modi N; Dore Cj; Saraswatula A; Richards M; Bamford KB; et al. A case definition for national and international neonatal bloodstream infection surveillance. Archives of disease in childhood. Fetal and neonatal edition 2009; 94 (1): F8-F12. Mots-clés: BACTERIEMIE; NEONATALOGIE; PREVALENCE; STATISTIQUE; SURVEILLANCE; ETUDE MULTICENTRIQUE Objective: Neonatal bloodstream infection (BSI) is a major contributor to mortality, health service costs, and the population burden of lifelong neurodisability. BSI surveillance, an essential component of infection control, requires an unambiguous standardised case definition as variability would invalidate any CCLIN Sud-Est – cclinse@chu-lyon.fr 5 / 24
  • 6. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 comparative analyses. In neonates a high proportion of blood cultures yield a mixed growth or skin commensals, principally coagulasenegative staphylococci (CoNS). As this might represent either genuine BSI or contamination, clinical correlates are necessary, but this adds to the difficulty of agreeing an objective, standardised case definition. Design : Utilising data from 26 UK neonatal units, the population prevalence of 12 predefined clinical signs of infection captured daily for 28 days was evaluated. The sensitivity, specificity, odds ratio and positive predictive value of each sign and sequential numbers of grouped signs were determined to develop a predictive model for a positive blood culture. Sandwich estimates of the standard errors of the logistic regression coefficients were used to take account of the correlations between these repeated measures. The model was tested in an independent data set. Results : >or= 3 clinical signs had the best predictive accuracy for a positive blood culture (76.2% specificity; 61.5%, 46.9% and 78.2% sensitivity for all positive cultures, cultures yielding CoNS, or a recognised pathogen, respectively). Conclusion: This study suggests that a simple case definition for national and international neonatal BSI surveillance is provided by a blood culture yielding a recognised pathogen in pure culture, or a mixed growth or skin commensal plus >or= 3 predefined clinical signs. NosoBase n°23671 Importante augmentation de bactéries à gram-négatif résistantes aux antibiotiques recensée à l’hôpital et rôle des patients âgés présentant une bactériémie détectée lors de leur admission. Pop-Vicas A; Tacconelli E; Lu B; D'agata E. Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection. Infection control and hospital epidemiology 2009/04; 30(4): 325-331. Mots-clés: BACTERIE; MULTIRESISTANCE; BACILLE GRAM NEGATIF; GERIATRIE; BACTERIEMIE; EPIDEMIOLOGIE; CAS TEMOIN; MAISON DE RETRAITE Background: Multidrug-resistant (MDR) gram-negative bacteria are reported increasingly frequently among isolates recovered from elderly patients. The clinical epidemiology of bloodstream infection (BSI) due to MDR gram-negative bacteria among elderly patients is unknown. Objective: To characterize the clinical epidemiology of BSI due to MDR gram-negative bacteria among elderly patients at hospital admission in an effort to provide a greater understanding of these serious infections and ultimately to improve patient outcomes. Design: Case-control study. Setting: Tertiary care hospital in Boston, Massachusetts. Patients: Patients 65 years of age and older. Methods: From 1999 to 2007, computerized medical records were reviewed for BSI due to MDR gram- negative bacteria within 48 hours of hospital admission. Risk factors for BSI due to these bacteria were identified. Results: MDR gram-negative bacteria were recovered from 61 (8%) of 724 elderly patients with BSI caused by gram-negative bacteria. Over the 8 1/2-year study period, the percentage of MDR gram-negative bacteria among bloodstream isolates increased from 2 (1%) of 199 to 34 (16%) of 216. Empiric therapy was ineffective for 38 (63%) of 60 patients with BSI caused by MDR gram-negative bacteria. The variables independently associated with BSI due to these bacteria were as follows: residency in a long-term care facility (odds ratio [OR], 4.9 [95% confidence interval {CI} 1.6-14.9]; P= .006), presence of an invasive device (OR, 6.0 [95% CI, 1.5-23.5]; P= .01), severe sepsis (OR, 7.9 [95% CI, 1.7-37.1]; P= .009), and delayed initiation of effective therapy (OR, 12.8 [95% CI, 3.9-41.1]; P= .001). Conclusion: The 16-fold increase in BSI due to MDR gram-negative bacteria at hospital admission among elderly patients, especially among those who resided in long-term care facilities prior to admission, contributes further to the expanding body of evidence that these patients are the main reservoirs of MDR gram-negative bacteria. Given their contribution to the influx of antimicrobial-resistant bacteria in the hospital setting, infection control interventions that target this high-risk group need to be considered. Chirurgie sommaire NosoBase n°23992 Application d'une analyse coût-bénéfice pour le choix des casaques chirurgicales et du drapage opératoire : étude de cas CCLIN Sud-Est – cclinse@chu-lyon.fr 6 / 24
  • 7. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Baykasoglu A; Dereli T; Yilankirkan N. Application of cost/benefit analysis for surgical gown and drape selection: a case study. American journal of infection control 2009/04; 37(3): 215-226. Mots-clés: COUT-BENEFICE; CHIRURGIE; TENUE VESTIMENTAIRE; CENTRE HOSPITALIER UNIVERSITAIRE; BLOUSE; CHAMP OPERATOIRE; REUTILISABLE; USAGE UNIQUE Background: The selection of medical textiles is an important subject for the health care sector in terms of benefits and costs. The basic cost calculation does not always yield to proper results in product selection; it would even mislead. It is usually a complicated task to give a decision whether to use reusable or single-use products, especially when the patient and surgeons lives are in consideration. The objective of the present paper is to carry out a cost/benefit study to help hospital managers and surgical team in comparing reusable and single-use surgical gowns and drapes. Methods: A detailed case study was carried out to determine the net benefits and costs associated with reusable and single-use surgical gown and drape use in the University of Gaziantep Hospital. The Analytic hierarchy process (AHP) is used to evaluate qualitative benefit data. The relevant data were determined through the literature research and interviews with the doctors, administrators, and personnel of related departments (such as infection control, cleaning, and others) in the hospital. The benefit/cost ratios of the alternatives have been examined, and a sensitivity analysis has been carried out to measure the impact of changes in costs and benefits. Conclusion: After the study, it is concluded that, even though cost is relatively higher, single-use gown and drape sets provide the highest benefit rates. Reduction of prices of single-use sets will make them more competitive and attractive in the health care sector. NosoBase n° 24177 Quelles zones de la casaque chirurgicale devraient être considérées comme plus stériles ? Bible JE; Biswas D; Whang PG; Simpson AK; Grauer JN. Which regions of the operating gown should be considered most sterile? Clinical orthopaedics and related research 2009/03; 467(3): 825-830. Mots-clés: TENUE VESTIMENTAIRE; BLOUSE; BLOC OPERATOIRE; TAUX; CONTAMINATION; USAGE UNIQUE; PRELEVEMENT Various guidelines have been proposed regarding which portions of a surgical gown may be considered sterile. Unfortunately, the validity of these recommendations has not been definitively established. We therefore evaluated gown sterility after major spinal surgery to assess the legitimacy of these guidelines. We used sterile culture swabs to obtain samples of gown fronts at 6- inch increments and at the elbow creases of 50 gowns at the end of 29 spinal operations. Another 50 gowns were swabbed immediately after they were applied to serve as negative controls. Bacterial growth was assessed using semiquantitative plating techniques on a nonselective, broad-spectrum media. Contamination was observed at all locations of the gown with rates ranging from 6% to 48%. Compared with the negative controls, the contamination rates were greater at levels 24 inches or less and 48 inches or more relative to the ground and at the elbow creases. The section between the chest and operative field had the lowest contamination rates. Based on these results, we consider the region between the chest and operative field to be the most sterile and any contact with the gown outside this area, including the elbow creases, should be avoided to reduce the risk of infection. NosoBase n° 24166 Endophtalmie à Stenotrophomonas maltophilia après chirurgie de la cataracte : enquête sur une épidémie et évolution clinique de 26 patients Horster S; Bader L; Seybold U; Eschler I; Riedel K; Bogner J. Stenotrophomonas maltophilia induced post- cataract-surgery endophthalmitis: outbreak investigation and clinical courses of 26 patients. Infection 2009/04; 37 (2): 117-122. Mots-clés: ENDOPHTALMIE; CHIRURGIE OPHTALMOLOGIQUE; EPIDEMIE; BACILLE GRAM NEGATIF; XANTHOMONAS; ENQUETE; CONTAMINATION; ANTIBIOTIQUE; STENOTROPHOMONAS MALTOPHILIA Background: Stenotrophomonas maltophilia, a microorganism which colonizes plastic material, is a rare causative agent of iatrogenic endophthalmitis. CCLIN Sud-Est – cclinse@chu-lyon.fr 7 / 24
  • 8. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Patients and methods: A cluster of 26 cases of acute post-cataract-surgery endophthalmitis (PE) was identified. An outbreak investigation was performed. Information was abstracted from patients' charts and questionnaires sent to patients and their general practitioners. Vision was examined before, during, as well as one and six months after acute PE. Bacterial isolates were subjected to molecular typing. Results: All patients initially received empiric systemic antibiotic treatment. The source of the infections was identified to be the rinsing solution used during cataract surgery, which was contaminated with two strains of S. maltophilia. Antibiotic therapy was subsequently changed to trimethoprim/sulfamethoxazol and ciprofloxacin for 30 days, complemented with iv fluocortolone and topical treatment with prednisolone, ciprofloxacin, and chloramphenicol. Twenty-one patients (81%) received pars plana vitrectomy and were additionally treated with intravitreal injections of vancomycin, amikacin and dexamethasone, or imipenem and dexamethasone, respectively. In addition, oxacillin, mezlocillin, and prednisolone were applied subconjunctivally after vitrectomy. Six months after acute infection, a final visual acuity of >/= 0.2 was achieved by 21/26 patients (80%), a visual acuity of >/= 0.5 by 14/26 patients (54%). Twenty of 26 patients (77%, 17 of whom had undergone vitrectomy) achieved a higher visual acuity than before surgery. Patients from the vitrectomy group had a median final visual acuity of 0.5 compared to 0.4 in the 5 patients without vitrectomy. There was 1 retinal ablation, 2 intra-retinal bleedings, and relapse of infection in 2/26 patients (8%), with isolation of S. maltophilia in one of the relapsing infection cases. Conclusions: Empiric antibiotic treatment of PE may not adequately treat rare pathogens such as S. maltophilia. Administration of an effective systemic or intravitreal antibiotic treatment after identification of S. maltophilia may have contributed to the favorable clinical course and relatively low relapse frequency in our patients. Despite the known problem of persistence of S. maltophilia, visual acuity outcome after treatment is comparable to PE induced by other Gram-positive or Gram-negative bacteria. NosoBase n° 24244 Evaluation des pratiques de préparation cutanée de l'opéré dans un centre hospitalier universitaire Raymond F; Dubre N; Joly-Guillou Ml; Eveillard M. Hygiènes 2009/03; XVII (1): 45-50. Mots-clés : EVALUATION; CENTRE HOSPITALIER UNIVERSITAIRE; SOIN PRE-OPERATOIRE; AUDIT; BLOC OPERATOIRE; DEPILATION Au centre hospitalier universitaire d’Angers le protocole de préparation cutanée de l’opéré (PCO), validé en 2004, présentait certaines différences par rapport aux recommandations de la conférence de consensus de 2004 sur ce sujet. Il a donc semblé intéressant d’évaluer les pratiques de PCO avant de réviser le protocole et l’établissement a choisi de participer à l’audit national POP en 2007. Méthode : L’étude a été réalisée dans l’ensemble des blocs opératoire (BO) et des services de chirurgie (SC), à l’exception de la chirurgie pédiatrique. L’audit était basé sur l’observation directe des pratiques au BO et sur l’interview du patient opéré le jour de son intervention. Le recueil des données a été réalisé sur deux semaines par le personnel des BO et des SC. Résultats : Au total, 349 fiches ont été exploitables. L’information au patient sur la toilette préopératoire a été transmise dans 88,9% des cas. Cette toilette a été réalisée dans 73,3% des cas. En excluant les spécialités pour lesquelles une dépilation est sans objet, 71,8% des patients ont été dépilés. Parmi eux, 59,7% ont été rasés. La proportion de PCO comprenant une détersion correcte était de 39,6%. Au total, une désinfection a été réalisée pour 92% des patients. La traçabilité des actions réalisées en préopératoire était totalement conforme pour 36,7% des interventions. Conclusion : Grâce à cet audit, de nombreuses non-conformités ont été identifiées dans la réalisation de la PCO. En complément de la révision du protocole, parmi les actions visant à l’amélioration des pratiques, ont été prévus notamment une information du personnel des services s’appuyant sur les résultats de l’étude, la mise à disposition de savon antiseptique à base de chlorhexidine, l’achat de tondeuse et de consommables à usage unique ainsi que des rappels relatifs aux obligations de traçabilité. NosoBase n° 24139 Interventions concernant le tabagisme et la consommation d'alcool avant chirurgie : preuves de bonnes pratiques Tonnesen H; Nielsen Pr; Lauritzen Jb; Moller AM. Smoking and alcohol intervention before surgery: evidence for best practice. British journal of anaesthesia 2009; 102 (3): 297-306. Mots-clés : CHIRURGIE; FACTEUR DE RISQUE; TABAGISME; ALCOOL; INCIDENCE; COMPLICATION; PRE-OPERATOIRE; POST-OPERATOIRE; QUALITE CCLIN Sud-Est – cclinse@chu-lyon.fr 8 / 24
  • 9. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Smoking and hazardous drinking are common and important risk factors for an increased rate of complications after surgery. The underlying pathophysiological mechanisms include organic dysfunctions that can recover with abstinence. Abstinence starting 3-8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections. However, this intervention must be intensive to obtain sufficient effect on surgical complications. All patients presenting for surgery should be questioned regarding smoking and hazardous drinking, and interventions appropriate for the surgical setting applied. Clostridium sommaire NosoBase n° 24065 Perception de Clostridium difficile par des patients Collins J; Roberts D; Evans C; De'ath H; Galland RB. Public perception of Clostridium difficile. The Journal of hospital infection 2009/05; 72 (1): :80-81. Mots-clés: CLOSTRIDIUM; INFORMATION; CLOSTRIDIUM DIFFICILE; USAGER; CONNAISSANCE NosoBase n°21580 Epidémie nosocomiale d'infection à Norovirus masquée sous des infections à Clostridium difficile Koo Hl; Ajami NJ; Jiang ZD; Dupont Hl; Atmar RL; Lewis D; et al. A Nosocomial Outbreak of Norovirus Infection Masquerading as Clostridium difficile Infection. Clinical infectious diseases 2009/04/01; 48(7): e75- e77. Mots-clés: EPIDEMIE; VIRUS; CLOSTRIDIUM; PSYCHIATRIE; INVESTIGATION; PERSONNEL ; NOROVIRUS; CLOSTRIDIUM DIFFICILE Noroviruses (NoVs) are increasingly being recognized as important enteric pathogens. At a university based hospital, we investigated a nosocomial outbreak of NoV infection that was originally attributed to Clostridium difficile. We describe here the unique challenges of the identification of NoVs as the true etiologic pathogen in an outbreak occurring in a health care setting, where C. difficile infection is endemic, as well as the important lessons learned. NosoBase n° 24066 Etude des connaissances du personnel concernant les diarrhées à Clostridium difficile Tsagkaraki A; Sampaziotis F; Cooke F; Gkrania-Klotsas E. Assessing staff knowledge about Clostridium difficile diarrhoea. The Journal of hospital infection 2009/05; 72 (1): :81-83. Mots-clés: PERSONNEL; CLOSTRIDIUM; DIARRHEE; DIAGNOSTIC; TRAITEMENT; CONTROLE; PROTOCOLE; QUESTIONNAIRE; CLOSTRIDIUM DIFFICILE; CONNAISSANCE Désinfection sommaire NosoBase n°23996 Produits à base d'éthanol versus d'alcool isopropylique pour décontaminer les stéthoscopes Lecat P; Cropp E; Mccord G; Awad Haller N. Ethanol-based cleanser versus isopropyl alcohol to decontaminate stethoscopes. American journal of infection control 2009/04; 37(3): 241-243. Mots-clés: DECONTAMINATION; ALCOOL; STETHOSCOPE; EFFICACITE Approximately 1 in 20 hospital admissions is complicated by a health care-associated infection. Stethoscopes may play a role in spreading nosocomial infections. The objective of this study was to determine the effectiveness of an ethanol-based cleanser (EBC) compared with isopropyl alcohol pads in reducing bacterial contamination of stethoscope diaphragms. Stethoscopes were cultured from medical professionals on 4 medical floors before and after cleaning with either EBC or isopropyl alcohol pads. The numbers of colony-forming units (cfu) grown were compared between the 2 cleaners and to baseline values. A total of 99 stethoscopes were cultured (49 EBC; 50 isopropyl alcohol), and all were positive for growth. CCLIN Sud-Est – cclinse@chu-lyon.fr 9 / 24
  • 10. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 After cleaning, 28.28% of the stethoscopes were growth-free (12 EBC; 16 isopropyl alcohol). Cleaning with EBC and isopropyl alcohol pads significantly reduced the cfu counts (by 92.8% and 92.5%, respectively), but neither was found to be statistically superior (F = 1.22; P = .2721). Cleaning a stethoscope diaphragm using either EBC or isopropyl alcohol led to a significant reduction in bacterial growth in culture. As an extension of the hand, a stethoscope should be cleaned with the same frequency as the hands. The simultaneous cleaning of hands and stethoscope may further increase compliance with current standards. Epidémie sommaire NosoBase n°23675 Epidémie de gale dans un service de soins intensifs avec exposition de 1659 personnes – facteurs clés pour contrôler l’épidémie. Buehlmann M; Beltraminelli H; Strub C; Bircher A; Jordan X; Battegay M; et al. Scabies outbreak in an intensive care unit with 1,659 exposed individuals - key factors for controlling the outbreak. Infection control and hospital epidemiology 2009/04; 30(4): 354-360. Mots-clés: SOIN INTENSIF; GALE; EPIDEMIE; INVESTIGATION; CENTRE HOSPITALIER UNIVERSITAIRE; TRAITEMENT; PERSONNEL Objective: To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. Design: Outbreak investigation. Setting: The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center. Methods: All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals. Interventions: All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination. Results: Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families. Conclusions: Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak. NosoBase n° 24056 Epidémie d'infections à Serratia marcescens dans une unité de réanimation néonatale : savon doux liquide contaminé et facteurs de risque Buffet-Bataillon S; Rabier V; Betremieux P; Beuchee A; Bauer M; Pladys P; et al. Outbreak of Serratia marcescens in a neonatal intensive care unit: contaminated unmedicated liquid soap and risk factors. The Journal of hospital infection 2009/05; 72 (1): 17-22. Mots-clés: ENTEROBACTERIE; NEONATALOGIE; SOIN INTENSIF; SAVON; FACTEUR DE RISQUE; EPIDEMIE; ENQUETE; CONTROLE; PEDIATRIE; CAS TEMOIN; ELECTROPHORESE EN CHAMP PULSE; COLONISATION; ENVIRONNEMENT; TRANSMISSION MANUPORTEE; PERSONNEL; SERRATIA MARCESCENS; DISTRIBUTEUR This study describes an outbreak of Serratia marcescens and its investigation and control in a neonatal intensive care unit (NICU). During a three-month period, five infants were colonised or infected by a single strain of S. marcescens. A caseecontrol study, culture surveys and pulse-field gel electrophoresis analysis implicated a bottle soap dispenser as a reservoir of S. marcescens (P = 0.032). Infants with S. marcescens CCLIN Sud-Est – cclinse@chu-lyon.fr 10 / 24
  • 11. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 colonisation or infection were also more likely to have been exposed to a central or percutaneous venous catheter (P = 0.05) and had longer exposure to endotracheal intubation (P = 0.05). Soap dispensers are used in many hospitals and may be an unrecognised source of nosocomial infections. This potential source of infection could be reduced by using airless dispensers which have no air intake for the distribution of soap. Prompt intervention and strict adherence to alcoholic hand disinfection were the key factors that led to the successful control of this outbreak. NosoBase n° 24199 Epidémie d’infections sous-cutanées à Mycobactéries atypiques liées à des infections multiples en mésothérapie Carbonne A; Brossier F; Arnaud I; Bougmiza I; Caumes E; Meningaud JP; et al. Outbreak on nontuberculous Mycobacteria subcutaneous infections related to multiple mesotherapy injections. Journal of clinical microbiology 2009; 13 pages. Mots-clés: MYCOBACTERIE; MESOTHERAPIE; PEAU; EAU;MATERIEL MEDICO-CHIRURGICAL; INJECTION; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE; ENVIRONNEMENT; ENQUETE; ETUDE RETROSPECTIVE; COHORTE; FACTEUR DE RISQUE; TRANSMISSION We describe an outbreak of severe subcutaneous infections due to nontuberculous mycobacteria (NTM) following mesotherapy. Epidemiological study and molecular comparison of Mycobacterium chelonae strains between patients and environment suggested that contamination could be associated with inappropriate cleaning of the multiple injection device using tap water. NosoBase n°23673 Eruption soudaine de cas de colonisation à Entérococcus résistant à la vancomycine chez des patients d'oncologie pédiatrique. Nolan S; Gerber J; Zaoutis T; Prasad P; Rettig S; Gross K et al. Outbreak of vancomycin-resistant Enterococcus colonization among pediatric oncology patients. Infection control and hospital epidemiology 2009/04; 30(4): 338-345. Mots-clés : VANCOMYCINE; COLONISATION; PEDIATRIE; CANCEROLOGIE; ENTEROCOCCUS; EPIDEMIE; FACTEUR DE RISQUE; PREVALENCE; ETUDE RETROSPECTIVE Objective: To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition. Design: Retrospective case-control study. Setting: The Children's Hospital of Philadelphia. Patients: Pediatric oncology patients hospitalized from June 2006 through December 2007. Methods: Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition. Results: The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49-198.21]; P= .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04-15.56]; P= .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270. Conclusions: Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms. CCLIN Sud-Est – cclinse@chu-lyon.fr 11 / 24
  • 12. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 NosoBase n° 24180 Epidémie d’infections à Pseudomonas aeruginosa après des interventions de chirurgie thoracique survenant via la contamination de bronchoscopes et d’un lave-endoscope automatique Shimono N; Takuma T; Tsuchimochi N; Shiose A; Murata M; Kanamoto Y et al. An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor. Journal of infection and chemotherapy 2009/03; 18(6): 786-790. Mots-clés: EPIDEMIE; PPSEUDOMONAS AERUGINOSA; CHIRURGIE THORACIQUE; CONTAMINATION; ENDOSCOPIE BRONCHIQUE;DESINFECTION; LAVE-ENDOSCOPE; INTUBATION An outbreak of Pseudomonas aeruginosa infections occurred after thoracic surgeries performed between May and June 2003. Clinical data of seven patients were reviewed and the fact was revealed that bronchoscopes were used during endotracheal intubation for one-lung ventilation in most patients. P. aeruginosa was recovered from the sputum of these patients at a very early stage postoperation. Environmental samples from bronchoscopes and an automated endoscope reprocessor (AER) were cultured and P. aeruginosa strains were recovered from all of them. All of these strains were confi rmed to be identical by pulsedfi eld gel electrophoresis (PFGE). Inspection of the sterilization cycles of bronchoscopes revealed inappropriate management of bronchoscopes and a fl aw in the AER; once its detergent tank was contaminated, it was not possible to disinfect it. After all the bronchoscopes had been disinfected, and the washing machine had been remodeled, with the washing process confi rmed to be appropriate, the outbreak fi nally ended. This outbreak had two causes, a fl aw in the AER and inappropriate disinfection procedures. Outbreaks associated with bronchoscopic examinations have been reported elsewhere. Bronchoscopes are widely Environnement sommaire NosoBase n° 24071 Bactéries pathogènes sur les sacs à main personnels du personnel de santé Dotan I; Somin M; Basevitz A; Beilinson N; Bardenstein R; Zimhony O; et al. Pathogenic bacteria on personal handbags of hospital staff. The Journal of hospital infection 2009/05; 72(1): 90-92. Mots-clés : PERSONNEL; SURFACE; PRELEVEMENT; SAC A MAIN NosoBase n° 24072 Les ordinateurs de l'hôpital peuvent-ils être désinfectés à l'aide d'une source de rayonnement ultra- violet tenue à la main ? Sweeney C; Dancer S. Can hospital computers be disinfected using a hand-held UV light source? The Journal of hospital infection 2009/05; 72 (1): 2-94. Mots-clés: DESINFECTION; ORDINATEUR; ULTRA-VIOLET; ENVIRONNEMENT; SURFACE; PROTOCOLE NosoBase n°23986 Impact des visites aux patients sur le climat intérieur d'une unité de réanimation médicale. Un an d'étude longitudinale Tang CS; Chung FF; Lin MC; Wan GH. Impact of patient visiting activities on indoor climate in a medical intensive care unit: a 1-year longitudinal study. American journal of infection control 2009/04; 37(3): 183-188. Mots-clés: SOIN INTENSIF;AIR;MEDECINE;QUALITE;AEROSOL;ENVIRONNEMENT Background: Bioaerosols from numerous sources have been implicated in respiratory diseases. This study evaluated the characteristics and weekly variations in indoor air in a medical intensive care unit (ICU) in northern Taiwan for 1 year. It also investigated the impact of patient visiting activities on the indoor climate in the medical ICU. CCLIN Sud-Est – cclinse@chu-lyon.fr 12 / 24
  • 13. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Methods: A 4-bed room with patients in the medical ICU was selected for long-term air monitoring. Air temperature, relative humidity, CO(2), particulate matter, bacteria, and fungi were measured. Results: Approximately 90% of the CO(2) samples exceeded 1000 ppm, and 20% of the fine particle samples exceeded 35 microg/m(3). The levels of bacteria and fungi varied during the survey period. The measured values for all indoor air characteristics except bacterial concentrations were higher after patient visitation than before patient visitation. A significant association was found between the coarse particle concentration and the number of patient visitors. Conclusion: Patient visiting activity impacts the indoor air quality of the ICU environment, especially in terms of coarse particle concentrations. Periodic monitoring of ventilation system efficiency is needed to ensure optimal indoor air quality NosoBase n° 24046 Sommes-nous informés des taux de contamination de nos téléphones mobiles par des pathogènes nosocomiaux ? Ulger F; Esen S; Dilek A; Yanik K; Gunaydin M; Leblebicioglu H. Are we aware how contaminated our mobile phones with nosocomial pathogens? Annals of clinical microbiology and antimicrobials 2009/03/06; 8 (1):4 pages. Mots-clés: CONTAMINATION; TAUX; PERSONNEL; MAIN; BLOC OPERATOIRE; SOIN INTENSIF; SURFACE; PRELEVEMENT; EQUIPEMENT; TELEPHONE MOBILE Background: The objective of this study was to determine the contamination rate of the healthcare workers' (HCWs') mobile phones and hands in operating room and ICU. Microorganisms from HCWs' hands could be transferred to the surfaces of the mobile phones during their use. Methods: 200 HCWs were screened; samples from the hands of 200 participants and 200 mobile phones were cultured. Results: In total, 94.5% of phones demonstrated evidence of bacterial contamination with different types of bacteria. The gram negative strains were isolated from mobile phones of 31.3% and the ceftazidime resistant strains from the hands were 39.5%. S. aureus strains isolated from mobile phones of 52% and those strains isolated from hands of 37.7% were methicillin resistant. Distributions of the isolated microorganisms from mobile phones were similar to hands isolates. Some mobile phones were contaminated with nosocomial important pathogens. Conclusion: These results showed that HCWs' hands and their mobile phones were contaminated with various types of microorganisms. Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals. Grippe sommaire NosoBase n° 24173 Infections par un virus A (H1N1) de la grippe résistant à l'oseltamivir aux Etats-Unis Dharan NJ; Gubareva LV; Meyer JJ; Okomo-Adhiambo M; Mcclinton RC; Marshall SA; et al. Infections with oseltamivir-resistant influenza A (H1N1) virus in the United States. JAMA 2009/03/11; 301 (10): 1034-1041. Mots-clés: GRIPPE; VIRUS; RESISTANCE; SURVEILLANCE; PREVALENCE; EPIDEMIOLOGIE; GRIPPE A; H1N1; OSELTAMIVIR Context: During the 2007-2008 influenza season, oseltamivir resistance among influenza A(H1N1) viruses increased significantly for the first time worldwide. Early surveillance data suggest that the prevalence of oseltamivir resistance among A(H1N1) viruses will most likely be higher during the 2008-2009 season. Objectives: To describe patients infected with oseltamivir-resistant influenza A(H1N1) virus and to determine whether there were any differences between these patients and patients infected with oseltamivir- susceptible A(H1N1) virus in demographic or epidemiological characteristics, clinical symptoms, severity of illness, or clinical outcomes. Design, Setting, And Patients: Influenza A(H1N1) viruses that were identified and submitted to the Centers for Disease Control and Prevention by US public health laboratories between September 30, 2007, and May 17, 2008, and between September 28, 2008, and February 19, 2009, were tested as part of ongoing surveillance. Oseltamivir resistance was determined by neuraminidase inhibition assay and pyrosequencing analysis. Information was collected using a standardized case form from patients with oseltamivir-resistant CCLIN Sud-Est – cclinse@chu-lyon.fr 13 / 24
  • 14. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 A(H1N1) infections and a comparison group of patients with oseltamivir-susceptible A(H1N1) infections during 2007-2008. Main Outcome Measures: Demographic and epidemiological information as well as clinical information, including symptoms, severity of illness, and clinical outcomes. Results: During the 2007-2008 season, influenza A(H1N1) accounted for an estimated 19% of circulating influenza viruses in the United States. Among 1155 influenza A(H1N1) viruses tested from 45 states, 142 (12.3%) from 24 states were resistant to oseltamivir. Data were available for 99 oseltamivir-resistant cases and 182 oseltamivir-susceptible cases from this period. Among resistant cases, median age was 19 years (range, 1 month to 62 years), 5 patients (5%) were hospitalized, and 4 patients (4%) died. None reported oseltamivir exposure before influenza diagnostic sample collection. No significant differences were found between cases of oseltamivir-resistant and oseltamivir-susceptible influenza in demographic characteristics, underlying medical illness, or clinical symptoms. Preliminary data from the 2008-2009 influenza season identified resistance to oseltamivir among 264 of 268 influenza A(H1N1) viruses (98.5%) tested. Conclusions: Oseltamivir-resistant A(H1N1) viruses circulated widely in the United States during the 2007-2008 influenza season, appeared to be unrelated to oseltamivir use, and appeared to cause illness similar to oseltamivir-susceptible A(H1N1) viruses. Circulation of oseltamivir-resistant A(H1N1) viruses will continue, with a higher prevalence of resistance, during the 2008-2009 season. NosoBase n° 24220 La grippe porcine A (H1N1) présente un potentiel de catastrophe mondiale Galwankar S; Clem A. Swine influenza A (H1N1) strikes a potential for global disaster. Journal of emergencies, trauma and shock 2009/04; 2 (2): 99-105. Mots-clés : GRIPPE; ANIMAL; EPIDEMIE; EPIDEMIOLOGIE; TRANSMISSION; DIAGNOSTIC; PREVENTION; RECOMMANDATION; MASQUE; SURVEILLANCE; VACCIN; TRAITEMENT; CHIMIOPROPHYLAXIE Candidats mots clés: H1N1; Pandémie NosoBase n° 24174 Morbidité et mortalité associées à la transmission nosocomiale du virus A (H1N1) de la grippe résistant à l'oseltamivir Gooskens J; Jonges M; Claas EC; Meijer A; Van Den Broek PJ; Kroes A. Morbidity and mortality associated with nosocomial transmission of oseltamivir-resistant influenza A (H1N1) virus. JAMA 2009/03/11; 301 (10): 1042-1046. Mots-clés : MORTALITE; MORBIDITE; GRIPPE; RESISTANCE; VIRUS; TRANSMISSION; EPIDEMIE; ENQUETE; PCR; DIAGNOSTIC; DEFICIT IMMUNITAIRE; PERSONNEL; PERSONNE AGEE; MOELLE OSSEUSE; OSELTAMIVIR; GRIPPE A; H1N1 Context: The sudden emergence and rapid spread of oseltamivir-resistant influenza A(H1N1) viruses with neuraminidase (NA) gene H274Y amino acid substitution is the hallmark of global seasonal influenza since January 2008. Viruses carrying this mutation are widely presumed to exhibit attenuated pathogenicity, compromised transmission, and reduced lethality. Objective: To investigate nosocomial viral transmission in a cluster of patients with influenza A(H1N1) virus infection. Design, Setting, And Patients: Descriptive outbreak investigation of 2 hematopoietic stem cell transplant recipients and an elderly patient who developed hospital-acquired influenza A virus infection following exposure to an index patient with community-acquired H274Y-mutated influenza A(H1N1) virus infection in a medical ward at a Dutch university hospital in February 2008. The investigation included a review of the medical records, influenza virus polymerase chain reaction and culture, phenotypic oseltamivir and zanamivir susceptibility determination, and hemagglutinin chain 1 (HA(1)) gene and NA gene sequence analysis. Main outcome measure: Phylogenetic relationship of patient cluster influenza A(H1N1) viruses and other 2007-2008 seasonal influenza A(H1N1) viruses. Results: Viral HA(1) and NA gene sequence analysis from the 4 patients revealed indistinguishable nucleotide sequences and phylogenetic clustering of H274Y-mutated, oseltamivir-resistant influenza A(H1N1) virus, confirming nosocomial transmission. Influenza virus pneumonia (3 patients) and attributable mortality (2 patients) during active infection was observed in patients with lymphocytopenia at onset. CCLIN Sud-Est – cclinse@chu-lyon.fr 14 / 24
  • 15. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Conclusion: Seasonal oseltamivir-resistant influenza A(H1N1) viruses with NA gene H274Y mutation are transmitted and retain significant pathogenicity and lethality in high-risk patients. NosoBase n° 24277 Préparation et réponses à une pandémie grippale Pandemic influenza preparedness and response. A who guidance document. 2009/04: 1-71. Mots-clés : VIRUS; GRIPPE; EPIDEMIE; RECOMMANDATION; PREVENTION; INFORMATION; H1N1; H2N2; H3N2; H5N1 Ce document actualise celui publié par l'OMS en mars 2005 sur le plan global de préparation à la grippe. Il porte sur le développement des virus de la grippe, des rôles et des responsabilités dans la préparation à une pandémie grippale du secteur de la santé, des communautés, des familles, de l'OMS. Il présente les phases de pandémie de l'OMS et les actions recommandées avant, pendant, et après une pandémie dans les phases 1-3, phase 4 ; phases 5-6. Ce document rappelle les caractéristiques des trois pandémies du 20ème siècle (H1N1, H2N2, H3N2). NosoBase n° 24114 Les Français à l'épreuve du risque pandémique : une enquête exploratoire Raude J; Deguen S; Setbon M. Bulletin épidémiologique hebdomadaire 2009/04/14; 15: 141-144. Mots-clés: ENQUETE; GRIPPE; SANTE PUBLIQUE; RISQUE; RISQUE SANITAIRE; GRIPPE AVIAIRE Au cours des trois dernières années, la multiplication des alertes liées à l’influenza aviaire a fait prendre conscience à la population de la menace d’une pandémie grippale comparable à celle de 1918-1919. Toutefois, on sait encore peu de chose sur la manière dont les Français se représentent le risque pandémique et ses modes de prévention. Les données historiques montrent pourtant que les comportements individuels et collectifs ont un impact considérable sur l’ampleur des conséquences des maladies infectieuses - en termes de morbidité et de mortalité. Dans la perspective d’une gestion de crise, il apparaît donc essentiel de déterminer 1) comment ; 2) quand et 3) pourquoi nos concitoyens envisagent de se protéger contre le risque en cas de menace pandémique. Les données de cette enquête ont été collectées par téléphone en juin 2008 auprès d’un échantillon national représentatif de la population adulte. Les résultats montrent que les Français reconnaissent généralement l’efficacité des mesures de prévention recommandées par les pouvoirs publics. Une majorité d’entre eux envisagent par ailleurs d’adopter des comportements de prévention précoces en cas d’alerte pandémique. Paradoxalement, les enquêtés les plus méfiants à l’égard du pouvoir politique, des sciences et des technologies apparaissent comme les plus sensibles au risque infectieux. NosoBase n° 24175 Evolution de la résistance de la grippe et son traitement Weinstock DM; Zuccotti G. The evolution of influenza resistance and treatment. JAMA 2009/03/11; 301 (10): 1066-1069. Mots-clés: RESISTANCE; RESISTANCE; TRAITEMENT; VIRUS; EPIDEMIOLOGIE Hygiène des mains sommaire NosoBase n° 24242 Hygiène des mains : audit des pratiques et évaluation de la perception des auditeurs au CHU de Poitiers Albouy-Llaty M; Ayraud-Thevenot S; Bousseau A; Petonnet C; Latus J; Laland C et al. Hygiènes 2009/03; XVII(1): 25-34. Mots-clés: LAVAGE DES MAINS; AUDIT; EVALUATION; OBSERVANCE; SOLUTION HYDRO- ALCOOLIQUE; PERSONNEL; ETUDIANT CCLIN Sud-Est – cclinse@chu-lyon.fr 15 / 24
  • 16. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Un audit sur l’observance et la qualité de l’hygiène des mains (DM) a été réalisée au centre hospitalier universitaire (CHU) de Poitiers, puis complété d’une étude sur la perception des étudiants infirmiers (EI) ayant joué le rôle d’auditeurs vis-à-vis de l’audit. Méthode : l’audit a été réalisé un jour donné en 2006, par 83 EI de deuxième année spécifiquement formés pour ce projet, dans 78 services du CHU (blocs opératoires et consultations exclus). 22 situations de soins (SS) prédéfinies pour lesquelles une DM était recommandée ont été étudiées. Résultats : 1150 observations ont été réalisées avant l’une des SS prédéfinies et 1120 après, soit en moyenne 15 observations par EI. Les professionnels les plus fréquemment observés étaient les infirmières/ puéricultrices (42% des observations), les aides-soignants (34%), les médecins (10%). Les SS le plus souvent observées étaient le nettoyage de la chambre et du mobilier (11% des SS observées), la manutention et le brancardage (10%), l’examen clinique (9%), les soins d’hygiène corporelle (9%). Avant SS, le taux d’observance de la DM était globalement de 52% et allait de 8 à 76% en fonction des SS, les taux les plus faibles correspondant aux injections, prélèvements et autres gestes invasifs. Après SS, le taux d’observance global de la DM était de 72% et allait de 41 à 86% en fonction des SS. L’objectivité de l’audit a été considérée moyenne par les EI et leur position d’auditeurs plutôt difficile. Conclusion : Suite à ce travail, les efforts ont été axés sur la formation du personnel à la DM et sur l’implantation des solutions hydro-alcooliques (SHA) au sein du CHU. En 2009, un autre audit d’observance évaluera l’utilisation des SHA. NosoBase n° 24239 Utilisation des produits hydro-alcooliques dans les établissements de santé et risque incendie Hajjar J. Hygiènes 2009/03; XVII(1): :6-7. Mots-clés: SOLUTION HYDRO-ALCOOLIQUE; ARCHITECTURE; DISTRIBUTION Le Dr Hajjar, au titre de la SFHH, a adressé ce courrier argumenté à Madame la Ministre de la santé, attirant son attention sur les difficultés rencontrées au quotidien par les professionnels de santé et les hygiénistes pour généraliser l’installation des distributeurs de produits hydro-alcooliques dans les services de soins, du fait du risque incendie. NosoBase n°24277 Recommandations de l’OMS pour l’hygiène des mains dans les soins en santé. Premier défi global pour la sécurité des patients. Un soin propre est un soin plus sûr. OMS. WHO guidelines on hand hygiene in health care. First global patient safety challenge clean care is safer care. 2009/04: 1-262. Mots-clés : HYGIENE DES MAINS; TRANSMISSION MANUPORTEE; SAVON; SOLUTION HYDRO- ALCOOLIQUE; EAU; CHLORHEXIDINE; ANTISEPTIQUE; TOLERANCE; PERSONNEL; OBSERVANCE; FORMATION; INFORMATION; GANT; BIJOU; RECOMMANDATION; INDICATEUR; QUALITE; COUT; COUT-EFFICACITE Ce document présente une synthèse des données scientifiques liées à l'hygiène des mains : poids des infections associées aux soins, flore bactérienne normale, transmission manuportée, produits utilisés pour l'hygiène des mains, désinfection chirurgicale des mains, réactions cutanées liées à l'hygiène des mains, pratiques du personnel participant aux soins et observance des recommandations, aspects religieux et culturels liés à l'hygiène des mains, comportement, formation et stratégies destinées à la promotion de l'hygiène des mains, stratégies de l'OMS pour l'amélioration de l'hygiène des mains, barrières potentielles à des pratiques optimales telles que les gants, les bijoux, les ongles et faux-ongles. Ce document présente des recommandations pour l'hygiène des mains et le port de gants, présente l'hygiène des mains comme un indicateur de performance, un indicateur de qualité pour la sécurité des patients et étudie son impact économique. Ce document traite des campagnes nationales et de l'implication des patients dans la promotion de l'hygiène des mains. NosoBase n° 24059 Pouvoir de l'expérience vécue dans l'observance de l'hygiène des mains CCLIN Sud-Est – cclinse@chu-lyon.fr 16 / 24
  • 17. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Nicol Pw; Watkins Re; Donovan Rj; Wynaden D; Cadwallader H. The power of vivid experience in hand hygiene compliance. The Journal of hospital infection 2009/05; 72 (1): 36-42. Mots-clés: LAVAGE DES MAINS; OBSERVANCE; PREVENTION; PERSONNEL; FORMATION; SOLUTION HYDRO-ALCOOLIQUE; GANT; HYGIENE DES MAINS; ETUDE MULTICENTRIQUE; AUSTRALIE;CROYANCE In recent years, explicit behavioural theories have been used in some research into hand hygiene behaviour. One of the most prominent of these has been the theory of planned behaviour (TPB). In this qualitative study aimed at increasing understanding of infection prevention practice in the acute care setting, TPB was identified as a suitable framework for the emergence of new insights that have the potential to improve the power of existing education and training. The theory emerging from the research was based on a finding that individual experience is of greater import than formal education in explaining hand hygiene behaviour. This indicated that exposure to vivid vicarious experience is a potential means to improving the power of existing training methods and increasing the propensity for instilling sustainable adequate hand hygiene habits. Indicateurs sommaire NosoBase n° 24151 Indicateurs en santé. Numéro thématique Fabry J; Lombrail P; Michel P; Dumay Mf. Risques et qualité en milieu de soins 2009/03; VI (1): 5-64. Mots-clés: INDICATEUR; QUALITE; SOIN; ARH; INFORMATIQUE; INTERNET; STRUCTURE DE SOINS; CHIRURGIE; MEDECINE; OBSTETRIQUE; COURTSEJOUR; SOIN INTENSIF; MORTALITE; MCO; SSR Extrait de sommaire : - Tricaud-Vialles S, Mihcel P. Restitution comparative de résultats d'indicateurs de qualité des soins : utilisation pertinente des représentations graphiques (Référence NosoBase n° 24153). - Lambert-Evans S, Loirat P, Filet B, et al. COMPAQH. Mesure de la sécurité des patients dans les établissements de santé : Etat des lieux et perspectives dans le contexte français (Référence NosoBase n° 24155). - Gardel C, Goubet S, Toupin MH, et al. Les indicateurs HAS : sélection, gestion et utilisation (Référence NosoBase n° 24156). - Morel L, Bourcy V, Tricuad-Vialles, et al. Le projet européen PATH (Performance Assessment Tool for quality improvement in hospitals) (Référence NosoBase n° 24157). - Misset B, Chouaid C, Hejblum G, et al. Indicateurs de qualité en réanimation (Référence Nosobase n° 24158). - Rambaud C. Indicateurs et usagers du système de santé : le point de vue du patient (Référence NosoBase n° 24159). Personnel sommaire NosoBase n°24015 Horaires de travail, stress au travail et collaboration parmi le personnel du service en relation avec des infections nosocomiales parmi les patients Virtanen M; Kurvinen T; Terho K; Oksanen T; Peltonen R; Vahtera J; et al. Work hours, work stress, and collaboration among ward staff in relation to risk of hospital-associated infection among patients. Medical care 2009/03; 47(3): 310-318. Mots-clés: PERSONNEL; RISQUE; SURVEILLANCE; PREVALENCE; ANALYSE; QUALITE; ETUDE MULTRICENTRIQUE; CHARGE DE TRAVAIL Objectives: To examine the association between work hours, work stress, and collaboration among the ward personnel, and the risk of hospital-associated infection among patients. Design: Cross-sectional data on hospital infections were collected between March and June 2004. These data were linked with ward-level responses to a personnel survey collected during the same time period. Setting: Medical records of patients in 60 non-psychiatric bed wards in 6 Finnish hospitals. Participants: One thousand ninety-two patients and 1159 staff survey responses. CCLIN Sud-Est – cclinse@chu-lyon.fr 17 / 24
  • 18. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Measurements: Prevalence surveillance was performed by 4 infection control nurses, using standard criteria. Data on several potential risk factors for infection were collected: sex, age, patient type (surgical vs. other), hospital type (university vs. regional hospital), unit type, number of patients in the ward, exposure to invasive devices, International Classification of Diseases version 10 diagnosis, chemotherapy, radiotherapy, and use of corticosteroids. Staff working conditions were measured by survey scales. Results: Ninety-nine cases (9.1%) of hospital-associated infection were found. Multilevel logistic regression analyses, adjusted for hospital factors and patient-related risk factors, showed that long work hours among staff were associated with increased risk of infection [odds ratio (OR) 2.74, 95% confidence interval (CI): 1.07-7.04]. Other staff-related correlates of infection were high work stress, as indicated by high imbalance between efforts and rewards (OR: 2.47; 95% CI: 1.38-4.42), low trust between work unit members (OR: 2.37; 95% CI: 1.27-4.43), injustice in the distribution of work (OR: 1.81; 95% CI: 1.04-3.16), and poor collaboration between ward supervisors (OR: 2.46; 95% CI: 1.38-4.38). Conclusions: Long work hours, high work stress, and poor collaboration among the ward staff are associated with hospital-associated infection among patients Prévention sommaire NosoBase n° 24103 Règles d'hygiène de la consultation gynécologique Blanchere JP. Journal de gynécologie obstétrique et biologie de la reproduction 2009/03; In press: 6 pages. Mots-clés: GYNECOLOGIE; CONSULTATION; PROFESSION LIBERALE; OBSTETRIQUE; RESPONSABILITE; MULTIRESISTANCE; EXPOSITION AU SANG; AGENT TRANSMISSIBLE NON CONVENTIONNEL; LAVAGE DES MAINS; GANT; TENUE VESTIMENTAIRE; USAGE UNIQUE; ANTISEPTIQUE; PEAU; SONDE; NETTOYAGE; RECOMMANDATION Les infections liées aux soins intéressent les praticiens exerçant en cabinet comme les hospitaliers. Les risques infectieux sont représentés par les bactéries multirésistantes, les agents transmissibles non conventionnels, ou prions, et les accidents d’exposition au sang. Des moyens simples d’hygiène, en particulier, le lavage des mains, la désinfection des dispositifs médicaux ou l’utilisation du matériel à usage unique, représentent les meilleures solutions pour y remédier. Nosocomial infections occur not only to hospitalized patients but also to outpatients treated in private practice. Infections are secondary to methicillin resistant staphylococcus aureus (MRSA). NosoBase n° 24045 Lampes à rayonnement ultra-violet montées près du plafond et ionisation négative de l'air pour la prévention de la transmission de la tuberculose Escombe A; Moore D; Gilman R; Navincopa M; Ticona E; Mitchell B et al. Upper-room ultraviolet light and negative air ionization to prevent tuberuclosis transmission. PLoS medicine 2009/03/17; 6 (3): :1-11. Mots-clés: PREVENTION; TUBERCULOSE; TRANSMISSION; AIR; ULTRA-VIOLET; ANTIBIORESISTANCE Institutional tuberculosis (TB) transmission is an important public health problem highlighted by the HIV/AIDS pandemic and the emergence of multidrug- and extensively drug-resistant TB. Effective TB infection control measures are urgently needed. We evaluated the efficacy of upperroom ultraviolet (UV) lights and negative air ionization for preventing airborne TB transmission using a guinea pig air-sampling model to measure the TB infectiousness of ward air. Methods and Findings : For 535 consecutive days, exhaust air from an HIV-TB ward in Lima, Peru. , was passed through three guinea pig air-sampling enclosures each housing approximately 150 guinea pigs, using a 2-d cycle. On UV-off days, ward air passed in parallel through a control animal enclosure and a similar enclosure containing negative ionizers. On UV- on days, UV lights and mixing fans were turned on in the ward, and a third animal enclosure alone received ward air. TB infection in guinea pigs was defined by monthly tuberculin skin tests. All guinea pigs underwent autopsy to test for TB disease, defined by characteristic autopsy changes or by the culture of Mycobacterium tuberculosis from organs. 35% (106/304) of guinea pigs in the control group developed TB infection, and this was reduced to 14% (43/303) by ionizers, and to 9.5% (29/307) by UV lights (both p < 0.0001 compared with the control group). TB disease was confirmed in 8.6% (26/304) of control group animals, and this was reduced to 4.3% (13/303) by ionizers, and to 3.6% (11/307) by UV lights (both p < CCLIN Sud-Est – cclinse@chu-lyon.fr 18 / 24
  • 19. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 0.03 compared with the control group). Time-to-event analysis demonstrated that TB infection was prevented by ionizers (log-rank 27; p < 0.0001) and by UV lights (log-rank 46; p < 0.0001). Time-to-event analysis also demonstrated that TB disease was prevented by ionizers (log-rank 3.7; p = 0.055) and by UV lights (log-rank 5.4; p = 0.02). An alternative analysis using an airborne infection model demonstrated that ionizers prevented 60% of TB infection and 51% of TB disease, and that UV lights prevented 70% of TB infection and 54% of TB disease. In all analysis strategies, UV lights tended to be more protective than ionizers. Conclusions : Upper-room UV lights and negative air ionization each prevented most airborne TB transmission detectable by guinea pig air sampling. Provided there is adequate mixing of room air, upper- room UV light is an effective, low-cost intervention for use in TB infection control in high-risk clinical settings. NosoBase n° 24104 Echographie en anesthésie et mesures de prévention du risque infectieux Hajjar J; Mounier M. Ultrasound equipment in anaesthesia and infection control measures. Annales françaises d'anesthésie et de réanimation 2009/04; 28 (4): :397-398. Mots-clés: ECHOGRAPHIE; ANESTHESIE; PREVENTION; RISQUE; SONDE; DESINFECTION Dans un article de 2008, Bloc et al soulignent l'absence de recommandations spécifiques pour la sonde d'échographie utilisée en Anesthésie locorégionale (ALR) périphérique. En s'appuyant sur la comparaison de deux techniques, ils proposent entre deux patients un essuyage successif de la sonde avec deux chiffons secs et propres sous réserve que la sonde ait été protégée par une gaine de protection, changée avant chaque échographie et dont l'intégrité aura été vérifiée au moment de son retrait. Ces propositions semblent discutables par les auteurs de cette lettre pour au moins quatre raisons : - la première raison tient à la méthodologie même de l'étude ; - la deuxième raison est liée à l'appréciation du risque infectieux potentiel d'un dispositif médical ; - la troisième est la prise en compte incomplète des différents éléments de classification de Spaulding qui préside à la détermination du niveau de traitement d'un dispositif médical ; - et, la dernière raison concerne le protocole proposé par les auteurs et inspiré du rapport du Haut Conseil de la Santé Publique (HCSP). NosoBase n° 24048 Stratégies de lutte contre le risque infectieux à l'hôpital pour Enterococcus résistant à la vancomyicne, Staphylococcus aureus résistant à la méticilline et Clostridium difficile Johnston BL; Bryce E. Hospital infection control strategies for vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus and Clostridium difficile. Canadian Medical Association journal 2009/03/17; 180 (6): :627-631. Mots-clés: ENTEROCOCCUS; VANCOMYCINE; ANTIBIORESISTANCE; CLOSTRIDIUM; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; PREVENTION; BIBLIOGRAPHIE; DEPISTAGE; OBSERVANCE; FACTEUR DE RISQUE; GANT; MASQUE; CLOSTRIDIUM DIFFICILE; HYGIENE DES MAINS; PRECAUTION COMPLEMENTAIRE NosoBase n° 24106 Guide pour une prophylaxie de masse des employés des hôpitaux dans le cadre de la préparation à une attaque de bioterrorisme Lee J; Johnson Sj; Sohmer MJ. Guide for mass prophylaxis of hospital employees in preparation for a bioterrorist attack. American journal of health-system pharmacy 2009/03/15; 66:570-575. Mots-clés: PREVENTION; PERSONNEL; PHARMACIE; ANTIBIOTIQUE; PROTOCOLE; ANTIBIOPROPHYLAXIE; FORMATION Purpose: The key elements required for the health-system pharmacist to prepare and implement a hospital- based mass prophylaxis distribution effort for hospital employees are described. Summary: A bioterrorist attack may involve multiple jurisdictions which would necessitate a regional response. Pharmacists should collaborate not only with colleagues in their immediate areas, but also with pharmacists and emergency-management planners in neighboring counties and jurisdictions. Pharmacists must also develop antibiotic drug selection protocols and define the quantity needed to maintain hospital operations after a bioterrorist attack. Once the desired antibiotics have been selected and the number of CCLIN Sud-Est – cclinse@chu-lyon.fr 19 / 24
  • 20. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 employees has been determined, along with the length of prophylaxis therapy, it should be determined how much money will be needed to purchase and store enough medications to meet the need. Next, provisions must be made to acquire and store the antibiotic cache, with attention paid to cache rotation and packaging and repackaging recommendations. A detailed procedure for the deployment of an antibiotic cache must be developed. This procedure should include job descriptions and job action sheets for deployment team members and plans for receiving and dispensing antibiotics from the Strategic National Stockpile. Once the employee prophylaxis procedure is developed, staff must be educated about it, and exercises should be conducted to identify possible weaknesses in the procedure. Conclusion: Health-system pharmacists should play an active role in designing and implementing an antibiotic prophylaxis plan for employees for a potential bioterrorist attack. Understanding and following procedures provided in the tool kit are critical to their successful readiness. Staphylococcus aureus sommaire NosoBase n°21578 Eradication du portage de Staphylococcus aureus résistant à la méticilline : revue systématique Ammerlaan H; Kluytmans J; Wertheim H; Nouwen J; Bonten M. Eradication of Methicillin Resistant Staphylococcus aureus Carriage: A Systematic Review. Clinical infectious diseases 2009/04/01; 48(7):922-930. Mots-clés: STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; COLONISATION; COLONISATION; BIBLIOGRAPHIE A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07.0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and 60% after a longer follow-up period. NosoBase n° 24243 Contamination des tenues professionnelles par Staphylococcus aureus résistant à la méticilline dans des services de soins de longue durée Gaspard P; Eschbach E; Gunther D; Roth C; Hamouda L; Kasser A; et al. Hygiènes 2009/03; XVII (1): : 37-44. Mots-clés: CONTAMINATION; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; TENUE VESTIMENTAIRE; EVALUATION; PERSONNEL; LONG SEJOUR; GERIATRIE; TRANSMISSION Une évaluation de la contamination des tenues professionnelles (TP) des soignants par Staphylococcus aureus résistant à la méticilline (SARM) a été réalisée dans trois services de soins de longue durée. Méthode : Les indications des tabliers plastiques à usage unique (TUU) et le contenu autorisé des poches ont été définis. Au cours de la période étudiée, les activités des infirmières (IDE) et aides-soignants (AS), les modalités d’utilisation des TUU et des poches ont été décrites. Des prélèvements microbiologiques ont été ensuite réalisés en fin de service au niveau des poches (zone P) et de la face ventrale des TP (zone T). Résultats : 512 prélèvements ont été réalisés. En l’absence de TUU, la fréquence de contamination de la zone T par le SARM était comprise entre 27,3 et 80,0 %. Le port d’un TUU pour les toilettes et les changes (AS), ou pour les pansements (IDE) n’était pas suffisant pour réduire significativement cette fréquence. En revanche, celle-ci était significativement plus faible lorsque les AS portaient également les TUU pour les aides aux repas (8,7 vs 34,9 et 31,2%, p=0,001). Pour les IDE, le port du TUU pour les pansements et pour les prélèvements biologiques a conduit à une faible fréquence de contamination, mais sans différence CCLIN Sud-Est – cclinse@chu-lyon.fr 20 / 24
  • 21. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 significative (10,0 versus 31 ,8 et 43,7%, p=0,07). Les fréquences de contamination de la zone P par SARM étaient comprises entre 18,1 et 60,0% en l’absence des mesures de maîtrise recommandées. Dans le service ayant demandé la suppression totale du contenu des poches, la fréquence de la contamination était de 3,6 %. Conclusion : Les modalités de bon usage de la TP doivent être parfaitement définies dans les services de soins, notamment concernant l’utilisation du TUU et des poches, pour limiter les risques de transmission croisée, en lien avec une hygiène des mains rigoureuse. NosoBase n° 24051 Staphylococcus aureus résistant à la méticilline chez des patients adultes présentant une muvoviscidose Giron RM; Buendia B; Pinedo C; Casanova A; Hoyos N; Ancochea J. Staphylococcus aureus resistente a meticilina en pacientes adultos con fibrosis quistica. Enfermedades infecciosas y microbiologia clinica 2009/03; 27 (2): :85-88. Mots-clés: STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; MUCOVISCIDOSE; PREVALENCE; COLONISATION; ANTIBIORESISTANCE; PRELEVEMENT Objective : To determine the prevalence of chronic colonization with methicillin- resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients. clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). Patients andmethods : Patients withchronic S. aureus colonization were selected from a total of 50 patients with cysticfibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8) : sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. Results : The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, andlinezolid. Patients with MRSA were older and had a larger number o frespiratory exacerbations than patients with MSSA. Conclusions : There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored. NosoBase n°23988 Eradication de Staphylococcus aureus résistant à la méticilline dans une unité de réanimation néonatale : quelles mesures pour quel succès ? Lepelletier D, Corvec S, CAILLON J, Reynaud A, Roze JC, Gras-Leguen C. Eradication of methicillin- resistant Staphylococcus aureus in a neonatal intensive care unit: which measures for which success? American journal of infection control 2009/04; 37(3): 195-200. Mots-clés: ERADICATION;STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SOIN INTENSIF; NEONATALOGIE; CENTRE HOSPITALIER UNIVERSITAIRE; ISOLEMENT; MUPIROCINE; AUDIT; FORMATION; PERSONNEL; COHORTE; EPIDEMIE; SURVEILLANCE; DEPISTAGE; HYGIENE DES MAINS Background: Various strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal intensive care units (NICUs) have been tried, with varying levels of success. We report a MRSA outbreak occurring between April 2004 and August 2007 in a 24-bed NICU in a large university hospital. We describe the difficulties involved in implementing measures to control the MRSA outbreak and the possible contribution of each measure. Methods: Cases were defined as neonates with MRSA obtained from either clinical cultures or surveillance cultures (from the anterior nares). Systematic screening of neonates for colonization was performed only between February and December 2005. Successive control strategies included barrier precaution and isolation in individual rooms, mupirocine ointment for neonates and health care workers, cohort isolation, hand hygiene observation, and staff training. CCLIN Sud-Est – cclinse@chu-lyon.fr 21 / 24
  • 22. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Results: During the routine surveillance culture period (February to December 2005; 48 weeks), 46 neonates were found to be positive for MRSA and were treated with mupirocin. After December 2005, the outbreak was controlled, but the ongoing spread was not eradicated; 9 sporadic MRSA cases were detected by clinical culture up to August 2007. Conclusion: The widespread use of mupirocine in staff and patients did not control the outbreak and is not recommended. The later control appeared to coincide with increased hand hygiene audits and training for staff, along with appropriate cohort isolation of neonates and cohort nursing NosoBase n°21577 Durée de colonisation à Staphylococcus aureus résistant à la méticilline Robicsek A; Beaumont JL Peterson LR. Duration of Colonization with Methicillin Resistant Staphylococcus aureus. Clinical infectious diseases 2009/04/01; 48(7): 910-913 Mots-clés: STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; COLONISATION The duration of colonization with methicillin-resistant Staphylococcus aureus is not well defined. During 1564 admissions after a clinical culture or surveillance test positive for methicillin-resistant Staphylococcus aureus, we retested patients for methicillin-resistant Staphylococcus aureus colonization. During the first year after the positive culture result was obtained, 48.8% of the patients (95% confidence interval, 45.8%.51.7%) remained colonized; at 4 years, 21.2% of the patients (95% confidence interval, 13.1%.31.4%) remained colonized. NosoBase n° 24144 Colonisation des patients et contamination de l'environnement du patient par SARM dans des conditions d'isolement en chambre seule Rohr U; Kaminski A; Wilhelm M; Jurzik L; Gatermann S; Muhr G. Colonization of patients and contamination of the patients' environment by MRSA under conditions of single-room isolation. International journal of hygiene and environmental health 2009/03; 212(2): 209-215. Mots-clés: COLONISATION; CONTAMINATION; ENVIRONNEMENT; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ISOLEMENT; SURFACE; PRELEVEMENT; ANALYSE; DEPISTAGE; ELECTROPHORESE EN CHAMP PULSE; SARM Meticillin-resistant Staphylococcus aureus (MRSA) are endemic in hospitals worldwide and present a major concern in hospital hygiene. The aim of the present study was to investigate the relationship between patients' MRSA colonization of the body and the frequency of environmental contamination. Twenty-five MRSA-positive hospitalized surgical patients and their environment in isolation rooms were screened on four occasions over a 14-day period. Out of 1099 samples from patients, 330 (30.0%) were MRSA-positive. The median number of MRSA-positive body sites per screening decreased significantly from the 1st (3, range 1-9) to the 14th (2, range 0-9, p=0.011) day of isolation. Contamination was found in 45% of the 100 environmental sampling dates and MRSA was detected in a low proportion of the 1000 environmental surface samples: 105/1000 (10.5%). The number of positive results for each sampling date decreased from the 1st (median 1, range 0-8) to the 14th (median 0, range 0-3, p=0.21) day of isolation. The results show a very strong correlation between the number of MRSA-positive body sites of individual patients and the MRSA contamination of the patient's hospital room (r=0.700, p<0.001). Pulsed-field gel electrophoresis (PFGE) analysis demonstrated a 98% agreement between patient and environmental samples. MRSA colonization of the groin area correlates most strongly with colonization of the body and environment. Seventy-five of 240 (31%) samples taken in rooms of patients with colonization of the groin were MRSA- positive, whereas only 27 of 760 (3.6%) samples taken in rooms of patients without colonization of the groin produced positive results (odds ratio 12.3; 95% confidence interval, 7.7-20). It is concluded that MRSA patients without colonization of the groin have a relatively low risk of environmental spread of MRSA and thus a reduced risk of transmission. Surveillance sommaire NosoBase n°23989 Surveillance des infections nosocomiales dans une unité de réanimation néonatale CCLIN Sud-Est – cclinse@chu-lyon.fr 22 / 24
  • 23. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 Battista G; D'ettorre G; Panero A; Chiarini F; Vullo V; Venditti M. Hospital-acquired infection surveillance in a neonatal intensive care unit. American journal of infection control 2009/04; 37(3): 201-203. Mots-clés: SOIN INTENSIF; SURVEILLANCE; NEONATALOGIE; BACTERIEMIE; PNEUMONIE; INFECTION URINAIRE; CONJONCTIVE; KLEBSIELLA; STAPHYLOCOCCUS; CANDIDA; MORTALITE; CENTRE HOSPITALIER UNIVERSITAIRE Background: Hospital-acquired infections (HAIs) represent an important cause of morbidity and mortality in neonatal intensive care units (NICUs). Methods: All neonates admitted for > 48 hours between January 2003 and December 2006 in the NICU of the teaching hospital Umberto I of Rome, Italy were considered. Results: Of the 575 neonates evaluated, 76 (13.2%) developed a total of 100 HAIs, including 36 bloodstream infections (BSIs), 33 pneumonias, 19 urinary tract infections, 8 conjunctivitis, and 4 onphalitis. There were 7.8 HAIs/1000 patient-days and 12.5 BSIs/1000 days of umbilical catheterization. Logistic analysis identified an association with mechanical ventilation (odds ratio [OR] = 3.05; 95% confidence interval [CI] = 1.75 to 5.31; P < .01) and birth weight <or= 1500 g (OR = 2.34; 95% CI = 1.36 to 4.03; P < . 01). Thirty-five neonates (6.1%) died. Klebsiella pneumoniae (37.7%) and coagulase-negative staphylococci (28.6%) were the most frequently isolated microorganisms. Only 3 Candida spp determined BSIs (8.3%). BSI mortality was higher in infections with gram-negative pathogens (36.4%) than in infections with gram- positive pathogens (4.5%). Conclusions: Although we found a low infection and mortality rate, attention should be directed toward antibiotic-resistant gram-negative pathogens. NosoBase n° 24107 Apport du système d'information médicalisé dans la surveillance en hygiène hospitalière Cclin Sud-Ouest; Bricout H; Coureau G; Gregoire F; Perret F; Picat Q; et al. 2009/04: 1-69 Mots-clés: SURVEILLANCE; SERVICE D'HYGIENE HOSPITALIERE; INDICATEUR; INFORMATION; INCIDENCE; MATERNITE; SITE OPERATOIRE; REANIMATION; ANTIBIORESISTANCE; PREVALENCE; EXPOSITION AU SANG; PMSI L’objectif principal de ce document est de faire le lien entre les données utiles dans le cadre des enquêtes en hygiène hospitalière et celles disponibles dans le système d’information des établissements de santé. L’objectif secondaire est d’émettre des recommandations concernant : - la standardisation des définitions des variables dans ces enquêtes, - le codage de l’information médicale dans le PMSI et plus largement dans le système d’information. Les surveillances initiées par les établissements en dehors du cadre officiel des réseaux RAISIN / CCLIN ne sont pas abordées dans ce document. Ce travail est composé de quatre parties : - les enquêtes et indicateurs en hygiène hospitalière, - le programme de médicalisation des systèmes d’information, - l’apport du PMSI dans le recueil des variables en hygiène hospitalière, - des perspectives et recommandations. NosoBase n° 24061 Surveillance et contrôle des infections nosocomiales. Situation actuelle dans les centres hospitaliers espagnols Sanchez-Paya J; Bischofberger C; Lizan M; Lozano J; Munoz Platon E; Navarro J; et al. Nosocomial infection surveillance and control: current situation in spanish hospitals. The Journal of hospital infection 2009/05; 72 (1): 50-56. Mots-clés: SURVEILLANCE; CONTROLE; PREVALENCE; INCIDENCE; PREVENTION; ETUDE TRANSVERSALE; PROTOCOLE; RESEAU; ETUDE NATIONALE We studied healthcare-associated infection (HCAI) surveillance and control programmes in Spanish hospitals in 2006 and the human resources and materials used. A questionnaire on the structure, organisation and resources for HCAI surveillance and control was sent to all hospitals registered in the 2005 National Catalogue of Hospitals. A total of 237 hospitals (29.8%) responded, representing 55.9% of the beds included in the catalogue. Some 92% of hospitals had a surveillance and control programme, although 29.9% had had it for less than five years. Only 17.4% of hospitals had one infection control nurse per 250 CCLIN Sud-Est – cclinse@chu-lyon.fr 23 / 24
  • 24. NosoVeille – Bulletin de veille du CCLIN SE mai 2009 beds, and only 36.2% had one infection control doctor per 500 beds. Surveillance is the main activity of those responsible for surveillance and control, and the most widely used systems are reviews of microbiology laboratory test results and studies of outbreaks, prevalence surveys, the incidence of certain procedures and of infection in critical care areas. Collaboration in multicentre studies is variable. EPINE, the prevalence survey of nosocomial infections in Spain, is performed annually in 80.5% of centres; ENVIN-UCI, a study of the incidence of infection in critically ill patients, is carried out in 24.8%, and the European study of the incidence of surgical infection, HELICS, in 22.7%. Priority should be given to improving specialised human resources and establishing common surveillance and control systems. Usager sommaire NosoBase n° 24054 Patients et grand public : connaissances, sources d'information et perception concernant les infections associées aux soins Gould D; Drey N; Millar M; Wilks M; Chamney M. Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection. The Journal of hospital infection 2009/05; 72 (1): 1-8. Mots-clés: INFORMATION; RISQUE; USAGER; CONNAISSANCE; PERCEPTION Statutory bodies provide information about healthcare-associated infection (HCAI) in the UK. Information is also available on National Health Service trust websites. Opinion polls demonstrate that fear of developing HCAI, especially meticillin-resistant Staphylococcus aureus, is the single greatest concern of people contemplating healthcare. We undertook a literature review to determine lay knowledge of HCAI, sources of information and perceptions of the risks. Twenty-two studies met the inclusion criteria. Of these, nine explored knowledge and perceptions as the primary research aim. The remainder consisted of a heterogeneous assortment of works comparing the knowledge and perceptions of different groups, their experiences of being infected or colonised and/or isolated. In all accounts, lay people expressed anxiety about the risks and consequences of HCAI. The most frequently reported source was the media, which has been blamed for sensationalist and inaccurate accounts. Lay people do not appear to access credible sources of information, or, if they do access them, are unable to understand their messages. Organisations that provide patient-focused information about HCAI are generic in scope, so that obtaining specific information may take time and effort to locate. Research is necessary to explore the acceptability, comprehensibility and accessibility of lay sources of information about HCAI and to find ways of readjusting risk perceptions to realistic levels in order to provide sensible levels of reassurance to those about to undergo healthcare. Vaccination sommaire NosoBase n° 24113 Calendrier des vaccinations et recommandations vaccinales 2009 selon l'avis du Haut conseil de la santé publique INVS. Bulletin épidémiologique hebdomadaire 2009/04/20; 16-17: 145-176. Mots-clés: VACCIN; RECOMMANDATION;GRIPPE;PERSONNEL;ANTIVIRAL;HEPATITE B;HEPATITE A Calendrier vaccinal suivi des recommandations vaccinales "particulières" propres à des conditions spéciales ou à des expositions professionnelles. CCLIN Sud-Est – cclinse@chu-lyon.fr 24 / 24