NosoVeille – Bulletin de veille Octobre 2017

NosoVeille n°10

Octobre 2017

Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques enregistrées au cours du mois écoulé.

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Sommaire de ce numéro :

Antibiotique / AntibiorésistanceArchitectureBactériémieCandidaChirurgieClostridium difficileDésinfection / StérilisationEndoscopieEpidémieHémodialyseHygiène des mainsInfection urinaireNéonatologiePédiatriePersonnelPneumonieSoin intensifSurveillanceTransportVaccination

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Antibiotique /Antibiorésistance

Recommandations de l'UE pour l'utilisation prudente des antibiotiques dans la santé humaine

European Centre for Disease Prevention and Control (ECDC), European Commission. EU Guidelines for the prudent use of antimicrobials in human health. ECDC 2017/06: 1-21.

Mots-clés : ANTIBIOTIQUE, PRESCRIPTION, CONSOMMATION, POLITIQUE DE SANTE, RECOMMANDATIONS DE BONNE PRATIQUE, SANTE PUBLIQUE, RECHERCHE MEDICALE, PREVENTION, ANTIBIORESISTANCE

Cette publication présente les recommandations pour le bon usage des antibiotiques dans la santé humaine, basées sur le rapport technique de l'ECDC en février 2017 avec la contribution des pays membres de l'Union Européenne. Ces recommandations sont formulées pour le gouvernement local, régional et national ; pour les différents établissements de santé et pour les professionnels et les usagers de la santé.https://ec.europa.eu/health/amr/sites/amr/files/amr_guidelines_prudent_use_en.pdf

Effet de l'intégration d'une application de santé sur téléphone portable à un programme multimodal pour le bon usage des antibiotiques dans trois centres hospitaliers universitaires : étude de séries temporelles interrompues

Charani E, Gharbi M, Moore LS, Castro-Sanchéz E, Lawson W, Gilchrist M, et al. Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study. Journal of antimicrobial chemotherapy 2017/06; 72(6): 1825-1831.

Mots-clés : AIDE A LA DECISION, TELEPHONE, PRESCRIPTION, ANTIBIOTIQUE, LOGICIEL, OBSERVANCE, RECOMMANDATIONS DE BONNE PRATIQUE, TELEPHONE PORTABLE

Objectives: To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods: In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators, using data (2008-14) from a biannual point prevalence survey of medical and surgical wards. There were six data points pre-implementation and six data points post-implementation. Results: There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in the two specialties of medicine (6.48%, 95% CI=-1.25 to 14.20) and surgery (6.63%, 95% CI=0.15-13.10) in the implementation period, with a significant sudden change in level in surgery (P<0.05). There was an increase, though not significant, in medicine (15.20%, 95% CI = -17.81 to 48.22) and surgery (35.97%, 95% CI=-3.72 to 75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (-16.25%, 95% CI=-42.52 to 10.01) and surgery (-14.62%, 95% CI=-42.88 to 13.63). Conclusions: Introducing the app into an existing ASP had a significant impact on the compliance with policy in surgery, and a positive, but not significant, effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may reflect a high level of compliance pre-intervention, due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform, e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions.http://dx.doi.org/10.1093/jac/dkx040

Contributions et limites des spécimens cliniques pour le dépistage des bactéries intestinales multi-résistantes en vue de l'automatisation de laboratoire

Geraud de Galassus A, Cizeau F, Agathine A, Domrane C, Ducellier D, Fihman V, et al. Contribution and limits of clinical specimens for the screening of intestinal multi-drug-resistant bacteria in view of laboratory automation. Journal of hospital infection 2017/09; 97(1): 59-63.

Mots-clés : LABORATOIRE, DEPISTAGE, MULTIRESISTANCE, BETA-LACTAMASE A SPECTRE ELARGI, CARBAPENEME, ENTEROBACTERIE, ENTEROCOCCUS RESISTANT A LA VANCOMYCINE, URINE

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The detection of multi-drug-resistant bacteria carriers constitutes a race against time for infection preventionists. Alongside standard analysis for diagnostic purposes and a rectal screening strategy, the authors tested a heavy-loaded selective method against 562 clinical specimens from 439 patients to detect extended-spectrum beta-lactamase-producing (ESBL) or carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant enterococci (VRE). The approach identified five more specimens positive for ESBL-producing Enterobacteriaceae than standard analysis, and six out of nine known VRE/CPE carriers (three new CPE/VRE strains were also identified in this cohort). In view of the ongoing automation of laboratories, this approach focusing on urine and stool specimens may be an alternative or complementary approach to dedicated rectal screening.http://dx.doi.org/10.1016/j.jhin.2017.06.001

Comparaison d'activités in vitro de tédizolide avec d'autres antibiotiques contre les isolats cliniques de Staphylococcus aureus recueillis dans 12 pays de 2014 à 2016

Karlowsky JA, Hackel MA, Bouchillon SK, Alder J, Sahma DF. In Vitro activities of Tedizolid and comparator antimicrobial agents against clinical isolates of Staphylococcus aureus collected in 12 countries from 2014 to 2016. Diagnostic microbiology and infectious diseases. 2017; 89: 151-157.

Mots-clés : STAPHYLOCOCCUS AUREUS, TEST, BACTERICIDIE, ANTIBIOTIQUE, CMI, LINEZOLIDE, OXAZOLIDINONE, METICILLINO-RESISTANCE, TEDIZOLIDE

Clinical isolates of Staphylococcus aureus (n=3929) collected by 54 medical center laboratories in 12 countries in 2014-2016 were tested for in vitro susceptibility to tedizolid, linezolid, and 11 comparators using Clinical and Laboratory Standards Institute (CLSI) broth microdilution methodology with minimum inhibitory concentrations (MICs) interpreted by CLSI M100-S26 (2016) criteria. All isolates of S. aureus tested were susceptible to both tedizolid (MIC, ≤0.5 μg/mL) and linezolid (MIC, ≤4 μg/mL). The concentration of tedizolid that inhibited 90% of isolates (MIC90) was 0.5 μg/mL, 4-fold lower than linezolid (MIC90, 2μg/mL). Tedizolid MIC frequency distributions were equivalent for methicillin-susceptible (MSSA; n=2090; MIC90, 0.25 μg/mL) and methicillin-resistant (MRSA; n=1839; MIC90, 0.25 μg/mL) S. aureus. We conclude that tedizolid possesses more potent in vitro activity than linezolid against recently collected isolates of S. aureus, including isolates of MRSA, and that resistance to currently marketed oxazolidinones (tedizolid and linezolid) remains very uncommon;http://dx.doi.org/10.1016/j.diagmicrobio.2017.07.001

Programme de gestion pour le bon usage des antibiotiques conduit par des pharmaciens dans des unités de soins intensifs en Chine orientale : étude de cohorte prospective multicentrique

Li Z, Cheng B, Zhang K, Xie G, Wang Y, Hou J, et al. Pharmacist-driven antimicrobial stewardship in intensive care units in East China: A multicenter prospective cohort study. American journal of infection control 2017/09; 45(9): 983-989.

Mots-clés : SOIN INTENSIF, ANTIBIORESISTANCE, PHARMACIEN, MORTALITE, PREVENTION, CONSOMMATION, PRESCRIPTION, ANTIBIOTIQUE

Background: Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. Method: We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality. Results: The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P=.007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P=.017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P=.037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P=.002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P=.030)Conclusions: Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use.

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http://dx.doi.org/10.1016/j.ajic.2017.02.021

Effets dramatiques d'un nouveau programme pour le bon usage des antibiotiques dans un hôpital communautaire rural

Libertin CR, Watson SH, Tillett WL, Peterson JH. Dramatic effects of a new antimicrobial stewardship program in a rural community hospital. American journal of infection control 2017/09; 45(9): 979-982.

Mots-clés : ANTIBIOTIQUE, PRESCRIPTION, CONSOMMATION, COUT-BENEFICE, PREVENTION, ANTIBIORESISTANCE, CLOSTRIDIUM DIFFICILE, INFECTIOLOGIE, HOPITAL LOCAL

Background: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. Methods: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015). Results: The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only. Conclusions: Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials.http://dx.doi.org/10.1016/j.ajic.2017.03.024

Effet de la consommation des antibiotiques sur la prévalence des entérocoques nosocomiaux résistant à la vancomycine - une étude écologique

Remschmidt C, Behnke M, Kola A, Peña Diaz LA, Rohde AM, Gastmeier P, et al. The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci- an ecologic study. Antimicrobial resistance and infection control 2017/09/13; 6: 1-8.

Mots-clés : ANTIBIOTIQUE, CONSOMMATION, ENTEROCOCCUS RESISTANT A LA VANCOMYCINE, DDJ, CARBAPENEME, GLYCOPEPTIDE, FACTEUR DE RISQUE, INFECTION NOSOCOMIALE

Background: Vancomycin-resistant enterococci (VRE) are among the most common antimicrobial-resistant pathogens causing nosocomial infections. Although antibiotic use has been identified as a risk factor for VRE, it remains unclear which antimicrobial agents particularly facilitate VRE selection. Here, we assessed whether use of specific antimicrobial agents is independently associated with healthcare-associated (HA) VRE rates in a university hospital setting in Berlin, Germany. Methods: We conducted the study between January 2014 and December 2015 at the Charité-university hospital of Berlin, Germany. From the hospital pharmacy, we extracted data for all antibacterials for systemic use (anatomical therapeutic chemical (ATC)-classification J01) and calculated ward specific antibiotic consumption in defined daily doses (DDDs) per 100 patient-days (PD). We used the microbiology laboratory database to identify all patients with isolation of invasive or non-invasive VRE and calculated HA-VRE incidence as nosocomial VRE-cases per 100 patients and HA-VRE incidence density as nosocomial VRE-cases per 1000 PD. We defined VRE isolates as hospital-acquired if they were identified three days or later after hospital admission and otherwise as community-acquired (CA-VRE). We performed univariable and multivariable regression analyses to estimate the association of the frequency of HA-VRE per month with antibiotic use and other parameters such as length of stay, type of ward or presence of at least one CA-VRE on ward. In a second analysis, we considered only patients with VRE infections. Results: We included data from 204,054 patients with 948,380 PD from 61 wards. Overall, 1430 VRE-cases were identified of which 409 (28.6%) were considered hospital-acquired (HA). We found that carbapenem use

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in the current month and prior-month use of glycopeptides increased the risk for HA-VRE by 1% per 1 DDD/100 PD and 3% per 1 DDD/100 PD, respectively. However, when only VRE from clinical samples were considered, only glycopeptide use showed a statistically significant association. In both models, detection of at least one patient with CA-VRE on a ward in the current month significantly increased the risk of HA-VRE, thereby indicating nosocomial spread of VRE. Conclusions: Our findings suggest that the risk of HA-VRE is associated with specific antimicrobial agents. Prudent use of these antimicrobial agents might reduce nosocomial VRE rates. That appearance of at least one CA-VRE case on the ward increased the risk of HA-VRE detection highlights the importance of strict hand hygiene practices to interrupt person-to-person transmission of VRE.http://dx.doi.org/10.1186/s13756-017-0253-5

Bon usage des antibiotiques : pourquoi nous devons, comment nous pouvons

Srinivasan A. Antibiotic stewardship: Why we must, how we can. Cleveland Clinic journal of medicine 2017/09; 84(9): 673-679.

Mots-clés : ANTIBIOTIQUE, CONSOMMATION, PRESCRIPTION, TRAITEMENT, EFFET INDESIRABLE, CLOSTRIDIUM DIFFICILE, POLITIQUE DE SANTE, QUALITE

Improving our antibiotic use is critical to the safety of our patients and the future of medicine. This can improve patient outcomes, save money, reduce resistance, and help prevent negative consequences such as Clostridium difficile infection. The US Centers for Disease Control and Prevention (CDC) is undertaking a nationwide effort to appropriately improve antibiotic use in inpatient and outpatient settings.http://dx.doi.org/10.3949/ccjm.84gr.17003

Epidémiologie des infections et bon usage des antibiotiques chez des patients hémodialysés australiens en ambulatoire : résultats du réseau de surveillance victorien 2008-2015

Worth LJ, Spelman T, Holt SG, Brett JA, Bull AL, Richards MJ. Epidemiology of infections and antimicrobial use in Australian haemodialysis outpatients: findings from a Victorian surveillance network, 2008-2015. Journal of hospital infection 2017/09; 97(1): 93-98.

Mots-clés : EPIDEMIOLOGIE, HEMODIALYSE, SURVEILLANCE, ANTIBIOTIQUE, BACTERIEMIE, INFECTION NOSOCOMIALE, STAPHYLOCOCCUS AUREUS, METICILLINO-RESISTANCE, CATHETER VEINEUX CENTRAL

Background: Patients with chronic renal failure who require haemodialysis are at high risk for infections. Aim: To determine the burden of bloodstream and local access-related infections and the prescribing patterns for intravenous antibiotics in Australian haemodialysis outpatients. Methods: A surveillance network was established following stakeholder consultation, with voluntary participation by haemodialysis centres and data collation by the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre. Definitions for infection and intravenous antimicrobial starts were based upon methods employed by the Centers for Disease Control and Prevention. Longitudinal mixed-effects Poisson regression was used to model time-trends for the period 2008-2015. Findings: Forty-eight of 78 Victorian dialysis centres participated in the network, with 3449 events reported over 78,826 patient-months. Rates of bloodstream infection, local infection and intravenous antimicrobial starts were much higher for patients with tunnelled central lines (2.60, 1.41, and 3.37 per 100 patient-months, respectively), compared to those with arteriovenous fistulae (0.27, 0.23, and 0.73 per 100 patient-months, respectively) and arteriovenous grafts (0.76, 1.08, 1.50 per 100 patient-months, respectively). Staphylococcus aureus was the most frequent pathogen, with meticillin-resistant isolates (MRSA) responsible for 14.0%. Access-related infections diminished significantly across all vascular-access modalities over time. Vancomycin contributed nearly half of all antimicrobial starts consistently throughout the study period.Conclusion: Risk for bloodstream and local access-related infections is highest in Australian haemodialysis patients with tunnelled central lines. S. aureus is the most frequent cause of infection, with a low incidence of MRSA. Future programmes should evaluate infection prevention practices and appropriateness of antibiotic prescribing in this population.http://dx.doi.org/10.1016/j.jhin.2017.05.018

Architecture

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Diminution de la colonisation à entérocoques résistants à la vancomycine après d’importants travaux de rénovation dans un service dédié aux hémopathies malignes et aux transplantations de cellules souches hématopoïétiques

Ford CD, Gazdik Stofer MA, Coombs J, Lopansri BK, Webb BJ, Motyckova G, et al. Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation. Infection control and hospital epidemiology 2017/09; 38(9): 1055-1061.

Mots-clés : ENTEROCOCCUS RESISTANT A LA VANCOMYCINE, INFECTION NOSOCOMIALE, COLONISATION, TRAVAUX HOSPITALIERS, ENVIRONNEMENT, SURFACE, HEMATOLOGIE, TRANSPLANTATION, MOELLE OSSEUSE, LEUCEMIE

Objective: While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence. Design: Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures.Setting: A regional referral center for acute leukemia and hematopoietic stem-cell transplantation. Patients: Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed. Intervention: During 2009-2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation. Results: We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18–0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation. Conclusions: Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE.http://dx.doi.org/10.1017/ice.2017.138

Bactériémie

Prévalence et facteurs de risque de bactériémies présentes à l'admission dans des centres hospitaliers

Aliyu S, Cohen B, Liu J, Larson EL. Prevalence and risk factors for bloodstream infection present on hospital admission. Journal of infection prevention 2017/07/28; in press: 1-6.

Mots-clés : PREVALENCE, FACTEUR DE RISQUE, BACTERIEMIE, ADMISSION, INFECTION COMMUNAUTAIRE, COHORTE, ANTIBIORESISTANCE

Background: Bloodstream infection present on hospital admission (BSI-POA) is a major cause of morbidity and mortality. The purpose of this study was to measure prevalence and describe the risk factors of patients with BSI-POA and to determine the prevalence of resistance in isolates by admission source. Methods: We conducted a retrospective cohort study of patients discharged from three hospitals in New York City between 2006 and 2014. BSI-POA was defined as BSI diagnosed within 48 h of hospitalisation. Results: The prevalence for BSI-POA was 5307/315,010 discharges (1.7%). The odds of being admitted with BSI-POA were greatest among patients admitted with renal failure, chronic dermatitis, malignancies and prior hospitalisation. Odds ratios and 95% confidence intervals (CI) were 2.72 (95% CI=2.56-2.88), 2.15 (95% CI=1.97-2.34), 1.76 (95% CI=1.64-1.88) and 1.59 (95% CI=1.50-1.69), respectively. The largest proportion of BSI-POA presented with Staphylococcus aureus (48.4%), followed by Enterococcus faecalis/faecium (20.3%), Klebsiella pneumoniae (16.2%), Streptococcus pneumoniae (8.7%), Pseudomonas aeruginosa (4.2%) and Acinetobacter baumannii (2.2%). Overall, 44% of those admitted from nursing homes presented with antibiotic resistant strains versus 34% from other hospitals and 31% from private homes (P=0.002).

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Conclusion: Understanding the risk factors of patients who present to the hospital with BSI could enable timely interventions and better patient outcomes. http://dx.doi.org/10.1177/1757177417720998

Facteurs prédictifs cliniques et évolutions cliniques de bactériémies à Klebsiella pneumoniae dans un hôpital régional de Hong Kong

An MY, Shum HP, Chan YH, Yan WW, Lee RA, Lau SK. Clinical predictors and outcomes of Klebsiella pneumoniae bacteraemia in a regional hospital in Hong Kong. Journal of hospital infection 2017/09; 97(1): 35-41.

Mots-clés : KLEBSIELLA PNEUMONIAE, BACTERIEMIE, EPIDEMIE, BETA-LACTAMASE A SPECTRE ELARGI, FACTEUR DE RISQUE, MORTALITE, SOIN INTENSIF

Background: Klebsiella pneumoniae (KP) infection is associated with high morbidity and mortality. Multidrug resistance, especially extended-spectrum β-lactamase (ESBL) production, in KP is endemic worldwide. Aim: To evaluate the clinical characteristics and outcomes of patients with KP bacteraemia in critical care and general ward settings. Methods: Adult patients admitted to a regional hospital in Hong Kong from January 1st, 2009 to June 30th, 2016 (7.5 years) with KP bacteraemia were included. Demographics, clinical features, microbiological characteristics, and outcomes were analysed. Findings: Among 853 patients, 178 (20.9%) required critical care and 176 (20.6%) died within 30 days of hospital admission. Thirty-day survivors were younger (P<0.001), had milder disease (defined by Sequential Organ Failure Assessment score) (P<0.001), presented with hepatobiliary sepsis (P<0.001) or urosepsis (P<0.001), less septic shock (P=0.013), fewer invasive organ supports (P<0.001), and had appropriate empirical antibiotics (P<0.001). Cox regression analysis showed that respiratory tract infection (hazard ratio: 2.99; 95% confidence interval: 2.061-4.337; P≤0.001), gastrointestinal tract infection (excluding hepatobiliary system) (2.763; 1.761-4.337; P≤0.001), mechanical ventilation (2.202; 1.506-3.221; P≤0.001), medical case (1.830; 1.253-2.672; P=0.002), inappropriate empirical antibiotics (1.716; 1.267-2.324; P≤0.001), female (1.699; 1.251-2.307; P<0.001), age >65 years (1.692; 1.160-2.467; P=0.006), and presence of solid tumour (1.457; 1.056-2.009; P=0.022) were independent risk factors for 30-day mortality. Unexpectedly, diabetes mellitus was associated with better 30-day survival (P=0.002). A total of 102 patients (12.0%) had infections with ESBL-producing strains, which were not associated with higher 30-day mortality. Conclusion: KP bacteraemia is associated with high 30-day mortality. Site of infection, patients' comorbidities and appropriate use of empirical antibiotic are important predictors of patients' outcomes.http://dx.doi.org/10.1016/j.jhin.2017.06.007

Impact de l’ajout de comorbidités sur la méthodologie d’ajustement du risque actuellement recommandée par le CDC pour comparer les taux de bactériémie sur voie centrale

Jackson SS, Leekha S, Magder LS, Pineles L, Anderson DJ, Trick TE, et al. The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line-Associated Bloodstream Infection Risk-Adjustment Methodology. Infection control and hospital epidemiology 2017/09; 38(9): 1019-1024.

Mots-clés : BACTERIEMIE, INFECTION NOSOCOMIALE, CATHETER VEINEUX CENTRAL, MORBIDITE

Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by

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adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.http://dx.doi.org/10.1017/ice.2017.129

Evaluation prospective des complications du cathéter central à insertion périphérique dans les milieux hospitalier et en soins ambulatoires

Liscynesky C, Johnston J, Haydocy KE, Stevenson KB. Prospective evaluation of peripherally inserted central catheter complications in both inpatient and outpatient settings. American journal of infection control 2017/09; 45(9): 1046-1049.

Mots-clés : CATHETER VEINEUX CENTRAL, BACTERIEMIE, COMPLICATION, PHLEBITE, EVENEMENT INDESIRABLE, ETUDE PROSPECTIVE, COHORTE, FACTEUR DE RISQUE, ALIMENTATION PARENTERALE, PICC

We describe a prospective observational cohort (N=187) to evaluate peripherally inserted central catheter line complications concurrently from the time of placement until removal. A significantly higher percentage of patients who experienced intraluminal thrombosis were receiving total parenteral nutrition (P≤.001) and had a dual lumen catheter (P=.01). Among patients with a confirmed or suspected infection, a significantly higher proportion received total parenteral nutrition (P=.01), had dual-lumen catheters (P=.04), and were neutropenic (P=.04).http://dx.doi.org/10.1016/j.ajic.2017.02.006

Introduction par étapes du bundle de prévention des bactériémies associées aux voies centrales "Toujours le meilleur soin" dans un réseau d'hôpitaux sud-africains

Richard GA, Brink AJ, Messina AP, Feldman C, Swart K, van den Bergh D. Stepwise introduction of the 'Best Care Always' central-line-associated bloodstream infection prevention bundle in a network of South African hospitals. Journal of hospital infection 2017/09; 97(1): 86-92.

Mots-clés : PREVENTION, BACTERIEMIE, CATHETER VEINEUX CENTRAL, INFECTION NOSOCOMIALE, VOIE VEINEUSE CENTRALE

Background: Healthcare-associated infection (HCAI) remains a major international problem. Aim: The 'Best Care Always!' (BCA) campaign was launched in South Africa to reduce preventable HCAI, including central-line-associated bloodstream infection (CLABSI). Methods: The intervention took place in 43 Netcare Private Hospitals, increasing later to 49 with 958 intensive care units (ICUs) and 439 high-care (HC) beds and 1207 ICUs and 493 HC beds, respectively. Phase 1, April 2010 to March 2011, ICU infection prevention and control (IPC) nurse-driven change: commitment from management and doctors and training of IPC nurses. Bundle compliance and infections per 1000 central-line-days were incorporated as standard IPC measures and captured monthly. Phase 2, April 2011 to March 2012, breakthrough collaborative method: multiple regional learning sessions for nursing leaders, IPC nurses and unit managers. Phase 3, April 2012 to May 2016: sustained goal-setting, benchmarks, ongoing audits. Findings: A total of 1,119,558 central-line-days were recorded. Bundle compliance improved significantly from a mean of 73.1% [standard deviation (SD): 11.2; range: 40.6-81.7%] in Phase 1 to a mean of 90.5% (SD: 4.7; range: 76.5-97.2%) in Phase 3 (P=0.0004). The CLABSI rate declined significantly from a mean of 3.55 (SD: 0.82; range: 2.54-5.78) per 1000 central-line-days in Phase 1 to a mean of 0.13 (SD: 0.09; range: 0-0.33) (P<0.0001). Conclusion: This intervention, the first of its kind in South Africa, through considerable motivation and education, and through competition between hospitals resulted in significant decreases in CLABSI.http://dx.doi.org/10.1016/j.jhin.2017.05.013

Bactériémies à Serratia marcescens : cas groupés nosocomiaux suite à un détournement de narcotiques

Schuppener LM, Pop-Vicas AE, Brooks EG, Duster MN, Crnich CJ, Sterkel AK, et al. Serratia marcescens Bacteremia: Nosocomial Cluster Following Narcotic Diversion. Infection control and hospital epidemiology 2017/09; 38(9): 1027-1031.

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Mots-clés : BACTERIEMIE, INFECTION NOSOCOMIALE, SERRATIA MARCESCENS

To describe the investigation and control of a cluster of Serratia marcescens bacteremia in a 505-bed tertiary-care center. Cluster cases were defined as all patients with S. marcescens bacteremia between March 2 and April 7, 2014, who were found to have identical or related blood isolates determined by molecular typing with pulsed-field gel electrophoresis. Cases were compared using bivariate analysis with controls admitted at the same time and to the same service as the cases, in a 4:1 ratio. In total, 6 patients developed S. marcescens bacteremia within 48 hours after admission within the above period. Of these, 5 patients had identical Serratia isolates determined by molecular typing, and were included in a case-control study. Exposure to the post-anesthesia care unit was a risk factor identified in bivariate analysis. Evidence of tampered opioid-containing syringes on several hospital units was discovered soon after the initial cluster case presented, and a full narcotic diversion investigation was conducted. A nurse working in the post-anesthesia care unit was identified as the employee responsible for the drug diversion and was epidemiologically linked to all 5 patients in the cluster. No further cases were identified once the implicated employee’s job was terminated. Illicit drug use by healthcare workers remains an important mechanism for the development of bloodstream infections in hospitalized patients. Active mechanisms and systems should remain in place to prevent, detect, and control narcotic drug diversions and associated patient harm in the healthcare setting.http://dx.doi.org/10.1017/ice.2017.137

Epidémie de bactériémies nosocomiales à Burkholderia cenocepacia attribuée au gel stérile contaminé utilisé pendant l'échographie pour l'insertion du cathéter veineux central et aux autres procédures

Shaban RZ, Maloney S, Gerrard J, Collignon P, MacBeth D, Cruickshank M, et al. Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures. American journal of infection control 2017/09; 45(9): 954-958.

Mots-clés : BACTERIEMIE, CONTAMINATION, EPIDEMIE, INFECTION NOSOCOMIALE, BURKHOLDERIA CEPACIA, CATHETERISME, EPIDEMIOLOGIE, BURKHOLDERIA CENOCEPACIA

Background: We report an outbreak of Burkholderia cenocepacia bacteremia and infection in 11 patients predominately in intensive care units caused by contaminated ultrasound gel used in central line insertion and sterile procedures within 4 hospitals across Australia. Methods: Burkholderia cenocepacia was first identified in the blood culture of a patient from the intensive care unit at the Gold Coast University Hospital on March 26, 2017, with 3 subsequent cases identified by April 7, 2017. The outbreak response team commenced investigative measures. Results: The outbreak investigation identified the point source as contaminated gel packaged in sachets for use within the sterile ultrasound probe cover. In total, 11 patient isolates of B cenocepacia with the same multilocus sequence type were identified within 4 hospitals across Australia. This typing was the same as identified in the contaminated gel isolate with single nucleotide polymorphism-based typing, demonstrating that all linked isolates clustered together. Conclusion: Arresting the national point-source outbreak within multiple jurisdictions was critically reliant on a rapid, integrated, and coordinated response and the use of informal professional networks to first identify it. All institutions where the product is used should look back at Burkholderia sp blood culture isolates for speciation to ensure this outbreak is no larger than currently recognized given likely global distribution.http://dx.doi.org/10.1016/j.ajic.2017.06.025

Enquête d'assurance qualité des événements de bactériémies associées aux voies centrales : Y a-t-il des exceptions à "jamais" ?

Strickler S, Gupta RR, Doucette JT, Kohli-Seth R. A quality assurance investigation of CLABSI events: are there exceptions to never? Journal of infection prevention 2017/07/28; in press: 1-7.

Mots-clés : FACTEUR DE RISQUE, CATHETERISME, ALIMENTATION PARENTERALE, INCIDENCE, INFECTION NOSOCOMIALE, CATHETER VEINEUX CENTRAL, BACTERIEMIE, QUALITE

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Background: In the USA, central line associated blood stream infections (CLABSIs) have been designated as ‘never events’, prompting initiatives towards a ‘zero CLABSIs’ standard. We propose that there are cascading risk factors predisposing certain patient cohorts to higher CLABSIs rates. Methods: A retrospective review of all CLABSI infections over a 12-month period was undertaken. Risk factors examined included catheter type, insertion site and parenteral nutrition (PN) status. Additional factors analysed included acute kidney injury (AKI), chronic kidney disease (CKD) and hospital-acquired infections (HAIs). Results: Thirty-four CLABSIs were identified in 33 adult patients (median age = 57 years). Temporary central venous catheters accounted for 12 (35%), peripherally inserted central catheters for five (14.7%), and permanent catheters for 17 CLABSIs (50%); the median duration from insertion was 15 days (interquartile range = 9–26). Among patient factors, immunosuppression and hyperglycaemia were the most common (n=19, 55%), followed by PN and CKD (n=17, 50.0%), AKI (n=16, 47.1%) and HAIs (n=13, 38.2%). A majority of patients with CLABSIs (n=20 58.8%) had at least three risk factors. Discussion: These findings reflect the complexity of CLABSIs with multiple patient and hospital factors influencing incidence. It suggests the need for further studies to re-calibrate the zero CLABSI model towards one with greater relevance.http://dx.doi.org/10.1177/1757177417720997

Candida

Les surfaces de l’environnement des établissements de santé sont une source potentielle de transmission de Candida auris et autres Candida sp.

Piedrahita CT, Cadnum JL, Jencson AL, Shaikh AA, Ghannoum MA, Donskey CJ. Environmental Surfaces in Healthcare Facilities are a Potential Source for Transmission of Candida auris and Other Candida Species. Infection control and hospital epidemiology 2017/09; 38(9): 1107-1109.

Mots-clés : SURFACE, CONTAMINATION, CANDIDA, CANDIDA AURIS, MULTIRESISTANCE, ENVIRONNEMENT, INFECTION NOSOCOMIALE

Contaminated surfaces have been implicated as a potential route for dissemination of the emerging multidrug-resistant fungal pathogen Candida auris. In laboratory testing, C. auris and other Candida species persisted for 7 days on moist or dry surfaces. Candida species were recovered frequently from the hospital environment, particularly from moist surfaceshttp://dx.doi.org/10.1017/ice.2017.127

Candida auris : un agent pathogène émergent multirésistant

Sears D, Schwartz BS. Candida auris: An emerging multidrug-resistant pathogen. International journal of infectious diseases 2017/09/06; 63: 95-98.

Mots-clés : CANDIDA AURIS, MULTIRESISTANCE, INFECTION NOSOCOMIALE, EPIDEMIE, PREVENTION, TRAITEMENT, ECHINOCANDINE

Candida aurisis an emerging multidrug-resistant pathogen that can be difficult to identify using traditional biochemical methods. C. auris is capable of causing invasive fungal infections, particularly among hospitalized patients with significant medical comorbidities. Echinocandins are the empiric drugs of choice for C. auris, although not all isolates are susceptible and resistance may develop on therapy. Nosocomial C. auris outbreaks have been reported in a number of countries and aggressive infection control measures are paramount to stopping transmission.http://dx.doi.org/10.1016/j.ijid.2017.08.017

Chirurgie

Intégrer la désinfection chirurgicale des mains comme indicateur de qualité dans un bloc opératoire d’urologie

François M. Intégrer la désinfection chirurgicale des mains comme indicateur de qualité dans un bloc opératoire d’urologie. Progrès en Urologie 2017; in press: 1-5.

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Mots-clés : INFECTION NOSOCOMIALE, DESINFECTION CHIRURGICALE DES MAINS PAR FRICTION, BLOC OPERATOIRE, UROLOGIE, QUALITE DES SOINS, AUDIT INTERNE, INSTRUMENTISTE, SITE OPERATOIRE

But : La désinfection chirurgicale des mains par friction (DCF) contribue à réduire le risque d’infections du site opératoire. Dans ce but et afin de favoriser une bonne observance des soins de qualité, le service d’urologie du Groupement hospitalier Sud (GH Sud) des hospices civils de Lyon (CHLS) a réalisé un audit interne continu visant à améliorer la qualité de la DCF. Méthodes : Un audit interne réalisé par les externes du service d’urologie a été instauré en 2013. La population étudiée était l’ensemble des opérateurs, instrumentistes et aides opératoires du bloc d’urologie du CHLS. Chaque externe réalisait 5 à 10 observations au hasard, incluant tous les types de professionnels. Les critères mesurés par l’audit étaient des critères concernant la friction. Résultats : L’évolution des indicateurs a été positive. L’augmentation de la durée des première et deuxième frictions était particulièrement statistiquement significative au cours du suivi (p = 0,001). La durée totale de friction montre une tendance comparable pour toutes les professions. Conclusion : La désinfection chirurgicale des mains par friction au bloc d’urologie du Centre Hospitalier Lyon Sud s’est progressivement améliorée au cours des audits itératifs.http://dx.doi.org/10.1016/j.purol.2017.08.009

Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes) 2017

Société Française d’Anesthésie et de Réanimation (SFAR). Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes) 2017. SFAR 2017: 37 pages.

Mots-clés : RECOMMANDATIONS DE BONNE PRATIQUE, ANTIBIOTIQUE, CHIRURGIE, ANTIBIOPROPHYLAXIE, CHIRURGIE OPHTALMOLOGIQUE, CHIRURGIE CARDIO-VASCULAIRE, CHIRURGIE ORL, CHIRURGIE GYNECOLOGIQUE, CHIRURGIE ORTHOPEDIQUE, CHIRURGIE DIGESTIVE, NEUROCHIRURGIE, RADIOLOGIE

L’infection est un risque pour toute intervention et, par exemple, en chirurgie l’on retrouve des bactéries pathogènes dans plus de 90 % des plaies opératoires, lors de la fermeture. Ceci existe quelle que soit la technique chirurgicale et quel que soit l’environnement (le flux laminaire ne supprime pas complètement ce risque). Ces bactéries sont peu nombreuses mais peuvent proliférer. Elles trouvent dans la plaie opératoire un milieu favorable (hématome, ischémie, modification du potentiel d’oxydoréduction...) et l’intervention induit des anomalies des défenses immunitaires. En cas d’implantation de matériel étranger le risque est majoré.L’objectif de l’antibioprophylaxie (ABP) est de s’opposer à la prolifération bactérienne afin de diminuer le risque d’infection du site de l’intervention. La consultation préopératoire représente un moment privilégié pour décider de la prescription d’une ABP. Il est possible d’y définir le type d’intervention prévu, le risque infectieux qui s’y rapporte (et donc la nécessité ou non d’une ABP), le moment de la prescription avant l’intervention et d’éventuels antécédents allergiques pouvant modifier le choix de la molécule antibiotique sélectionnée.http://sfar.org/antibioprophylaxie-en-chirurgie-et-medecine-interventionnelle-patients-adultes-2017/

La douche préopératoire ou la toilette à la chlorhexidine devrait-elle faire partie de bundle des mesures en chirurgie pour prévenir l'infection du site opératoire ?

Edmiston CE, Leaper D. Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection? Journal of infection prevention 2017/07/26; in press: 1-4.

Mots-clés : CHLORHEXIDINE, PREVENTION, DOUCHE, TOILETTE DU PATIENT, INFECTION NOSOCOMIALE, SITE OPERATOIRE, REVUE DE LA LITTERATURE, RECOMMANDATIONS DE BONNE PRATIQUE

Showering preoperatively with chlorhexidine gluconate is an issue that continues to promote debate; however, many studies demonstrate evidence of surgical site infection risk reduction. Methodological issues have been present in many of the studies used to compile guidelines and there has been a lack of standardisation of processes for application of the active agents in papers pre-2009. This review and commentary paper highlights the potential for enhancing compliance with this low-risk and low-cost

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intervention and provides some guidance for enhancing implementation of preoperative showering with both chlorhexidine in solution and impregnated wipes.http://dx.doi.org/10.1177/1757177417714873

Infections du site opératoire après transplantation hépatique : surveillance prospective et évaluation chez 250 greffés au Canada

Natori Y, Kassar R, Iaboni A, Hosseini-Moghaddam SM, Vu J, Husain S, et al. Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada. Infection control and hospital epidemiology 2017/09; 38(9): 1084-1090.

Mots-clés : SITE OPERATOIRE, TRANSPLANTATION HEPATIQUE, INFECTION NOSOCOMIALE, INCIDENCE, FACTEUR DE RISQUE

Objective: To evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections. Design: Prospective observational cohort study. Setting: Single transplant center in Canada. Patients: Patients who underwent liver transplantation between February 2011 and August 2014. Methods: Multivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients. Results: We enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) weremale.Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85-8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02-12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin. Conclusions: Organ-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.http://dx.doi.org/10.1017/ice.2017.131

Evaluation d'un dispositif de rayonnement ultraviolet-C pour la désinfection des postes de travail d'anesthésie au bloc opératoire

Nottingham M, Peterson G, Doern CD, Doll M, Masroor N, Sanogo K, et al. Ultraviolet-C light as a means of disinfecting anesthesia workstations. American journal of infection control 2017/09; 45(9): 1011-1013.

Mots-clés : DESINFECTION, ULTRA-VIOLET, EFFICACITE, ENVIRONNEMENT, SURFACE, STAPHYLOCOCCUS AUREUS, ENTEROCOCCUS FAECALIS, ACINETOBACTER, BLOC OPERATOIRE

Background: Anesthesia workstations (AWs) are a reservoir for pathogenic organisms potentially associated with surgical site infections. This study examined the effectiveness of the Tru-D SmartUVC device (Tru-D LLC, Nashville, TN) on bioburden reduction (BR) on AWs. Methods: Strips of tissue inoculated with a known concentration of either Staphylococcus aureus, Enterococcus faecalis, or Acinetobacter sp were placed on 22 high-touch surfaces of an AW. Half of the AW surfaces received direct ultraviolet (UV) light exposure and half received indirect exposure. Two inoculated strips, in sterile tubes outside of the room, represented the control. Trials were conducted on AWs in an operating room and a small room. Strips were placed in a saline solution, vortexed, and plated on blood agar to assess BR by the number of colony forming units. Results: All experimental trials, compared with controls, exhibited a BR >99%. There was a significantly greater reduction of E faecalis colony forming units in the operating room AW under direct exposure (P = .019) compared with indirect exposure. There was no significant difference in reduction when comparing AWs between rooms. Conclusion: Regardless of room size and exposure type, automated UV-C treatment greatly influences BR on AW high-touch surfaces. Hospitals instituting an automated UV-C system as an infection prevention adjunct

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should consider utilizing it in operating rooms for BR as part of a horizontal infection prevention surgical site infection-reduction strategy.http://dx.doi.org/10.1016/j.ajic.2017.02.016

Prévenir les infections du site opératoire à l'aide de sutures imprégnées d'un antibactérien naturel et biodégradable

Reinbold J, Uhde AK, Müller I, Weindl T, Geis-Gerstorfer J, Schlensak C, et al. Preventing Surgical Site Infections Using a Natural, Biodegradable, Antibacterial Coating on Surgical Sutures. Molecules 2017/09/19; 22(9): 1-15.

Mots-clés : PREVENTION, INFECTION NOSOCOMIALE, SITE OPERATOIRE, SUTURE, ANTIBIOTIQUE, BIOMATERIAU, STAPHYLOCOCCUS AUREUS

Surgical site infections (SSIs) are one of the most common nosocomial infections, which can result in serious complications after surgical interventions. Foreign materials such as implants or surgical sutures are optimal surfaces for the adherence of bacteria and subsequent colonization and biofilm formation. Due to a significant increase in antibiotic-resistant bacterial strains, naturally occurring agents exhibiting antibacterial properties have great potential in prophylactic therapies. The aim of this study was to develop a coating for surgical sutures consisting of the antibacterial substance totarol, a naturally occurring diterpenoid isolated from Podocarpustotara in combination with poly(lactide-co-glycolide acid) (PLGA) as a biodegradable drug delivery system. Hence, non-absorbable monofilament and multifilament sutures were coated with solutions containing different amounts and ratios of totarol and PLGA, resulting in a smooth, crystalline coating. Using an agar diffusion test (ADT), it became evident that the PLGA/totarol-coated sutures inhibited the growth of Staphylococcus aureus over a period of 15 days. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay showed that the coated sutures were not cytotoxic to murine fibroblasts. Overall, the data indicates that our innovative, biodegradable suture coating has the potential to reduce the risk of SSIs and postoperative biofilm-formation on suture material without adverse effects on tissue.http://dx.doi.org/10.3390/molecules22091570

Vol de mouches : validation et essai d'un nouvel outil épidémiologique pour guider la gestion des infections dues à une infestation de mouches Sarcophagidae dans un bloc opératoire d'un centre hospitalier

Schouest JM, Heinrich L, Nicholas B, Drach F. Fly rounds: Validation and pilot of a novel epidemiologic tool to guide infection control response to an infestation of Sarcophagidae flies in a community hospital's perioperative department. American journal of infection control 2017/029; 45(9): e91-e93.

Mots-clés : EPIDEMIOLOGIE, METHODOLOGIE, PREVALENCE, SURVEILLANCE, BLOC OPERATOIRE, INSECTE, EPIDEMIE, SARCOPHAGIDAE

During an outbreak of Sarcophagidae, or flesh flies, in a community hospital's perioperative department, the infection prevention and control (IPC) department developed, validated, and piloted a novel epidemiologic tool to track hourly fly prevalence by room. Interrater reliability of the tool was measured as 0.88 and hourly point prevalence counts were superimposed on floor plans to create heat maps. Such surveillance tools allowed more timely decision making in conjunction with the operations of the hospital incident command system.http://dx.doi.org/10.1016/j.ajic.2017.02.037

Clostridium difficile

Tendances de l'utilisation des tests de laboratoire pour le diagnostic de l'infection à Clostridium difficile et association avec les taux d'incidence au Québec, au Canada, de 2010 à 2014

Bogaty C, Lévesque S, Garenc C, Frenette C, Bolduc D, Galarneau LA, et al. Trends in the use of laboratory tests for the diagnosis of Clostridium difficile infection and association with incidence rates in Quebec, Canada, 2010-2014. American journal of infection control 2017/09; 45(9): 964-968.

Mots-clés : CLOSTRIDIUM DIFFICILE, DIAGNOSTIC BIOLOGIQUE, SURVEILLANCE, TEMPS, INCIDENCE, BIOLOGIE MOLECULAIRE, LABORATOIRE, TECHNIQUE DE DIAGNOSTIC

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Background: Several Clostridium difficile infection (CDI) surveillance programs do not specify laboratory strategies to use. We investigated the evolution in testing strategies used across Quebec, Canada, and its association with incidence rates. Methods: Cross-sectional study of 95 hospitals by surveys conducted in 2010 and in 2013-2014. The association between testing strategies and institutional CDI incidence rates was analyzed via multivariate Poisson regressions. Results: The most common assays in 2014 were toxin A/B enzyme immunoassays (EIAs) (61 institutions, 64%), glutamate dehydrogenase (GDH) EIAs (51 institutions, 53.7%), and nucleic acid amplification tests (NAATs) (34 institutions, 35.8%). The most frequent algorithm was a single-step NAAT (20 institutions, 21%). Between 2010 and 2014, 35 institutions (37%) modified their algorithm. Institutions detecting toxigenic C difficile instead of C difficile toxin increased from 14 to 37 (P<.001). Institutions detecting toxigenic C difficile had higher CDI rates (7.9 vs 6.6 per 10,000 patient days; P=.01). Institutions using single-step NAATs, GDH plus toxigenic cultures, and GDH plus cytotoxicity assays had higher CDI rates than those using an EIA-based algorithm (P<.05). Conclusions: Laboratory detection of CDI has changed since 2010. There is an association between diagnostic algorithms and CDI incidence. Mitigation strategies are warranted.http://dx.doi.org/10.1016/j.ajic.2017.04.002

Désinfection / Stérilisation

Essai croisé contrôlé par grappes en prospectif pour comparer l'impact d'un désinfectant amélioré à base de peroxyde d'hydrogène et d'un désinfectant à base d'ammonium quaternaire sur la contamination des surfaces et sur les évolutions cliniques

Boyce JM, Guercia KA, Sullivan L, Havill NL, Fekieta R, Kozakiewicz J, et al. Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes. American journal of infection control 2017/09; 45(9): 1006-1010.

Mots-clés : DESINFECTANT, PEROXYDE D'HYDROGENE, AMMONIUM QUATERNAIRE, NETTOYAGE, BIONETTOYAGE, DESINFECTION, SURFACE, HYGIENE HOSPITALIERE, ENVIRONNEMENT, HYGIENE DES MAINS, ANTIBIOTIQUE, INFECTION NOSOCOMIALE, INCIDENCE

Background: Quaternary ammonium-based (Quat) disinfectants are widely used, but they have disadvantages. Methods: This was a 12-month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5-8 high-touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods. Results: Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P=.003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P<.0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P=.068; 95% confidence interval, 0.579-1.029). Conclusions: Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.http://dx.doi.org/10.1016/j.ajic.2017.03.010

Endoscopie

Surveillance des endoscopes : comparaison de différentes techniques de prélèvement

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Cattoir L, Vanzieleghem T, Florin L, Helleputte T, De Vos M, Verhasselt B, et al. Surveillance of Endoscopes: Comparison of Different Sampling Techniques. Infection control and hospital epidemiology 2017/09; 38(9): 1062-1069.

Mots-clés : ENDOSCOPIE, DESINFECTION, PRATIQUE, PRELEVEMENT

Objective: To compare different techniques of endoscope sampling to assess residual bacterial contamination. Design: Diagnostic study. Setting: The endoscopy unit of an 1,100-bed university hospital performing ~13,000 endoscopic procedures annually. Methods: In total, 4 sampling techniques, combining flushing fluid with or without a commercial endoscope brush, were compared in an endoscope model. Based on these results, sterile physiological saline flushing with or without PULL THRU brush was selected for evaluation on 40 flexible endoscopes by adenosine triphosphate (ATP) measurement and bacterial culture. Acceptance criteria from the French National guideline (<25 colony-forming units [CFU] per endoscope and absence of indicator microorganisms) were used as part of the evaluation. Results: On biofilm-coated PTFE tubes, physiological saline in combination with a PULL THRU brush generated higher mean ATP values (2,579 relative light units [RLU]) compared with saline alone (1,436 RLU; P=.047). In the endoscope samples, culture yield using saline plus the PULL THRU (mean, 43 CFU; range, 1-400 CFU) was significantly higher than that of saline alone (mean, 17 CFU; range, 0–500 CFU; P<.001). In samples obtained using the saline + PULL THRU brush method, ATP values of samples classified as unacceptable were significantly higher than those of samples classified as acceptable (P=.001). Conclusion: Physiological saline flushing combined with PULL THRU brush to sample endoscopes generated higher ATP values and increased the yield of microbial surveillance culture. Consequently, the acceptance rate of endoscopes based on a defined CFU limit was significantly lower when the saline + PULL THRU method was used instead of saline alone.http://dx.doi.org/10.1017/ice.2017.115

Epidémie

Epidémie de coqueluche chez les professionnels de santé dans une maternité à l'hôpital

Petridou C, Gray H, Heard M, Sugden L, Davis-Blues K, Cortes N, et al. Outbreak of pertussis among healthcare workers in a hospital maternity unit. Journal of infection prevention 2017/09; 18(5): 253-255.

Mots-clés : MATERNITE, BORDETELLA PERTUSSIS, PERSONNEL, EPIDEMIE, PREVALENCE, EPIDEMIOLOGIE, FEMME ENCEINTE, VACCIN, VACCINATION, ANTIBIORESISTANCE, COQUELUCHE

In December 2015, an outbreak of pertussis was detected among staff working in the Maternity Unit of a district general hospital in Hampshire. This occurred in the background of increased pertussis activity in the community. The outbreak occurred over the Christmas holiday period causing staff shortages at a time when the departments were already overstretched. The high prevalence of upper respiratory tract infections at the time were difficult to distinguish from pertussis. This paper describes the outbreak, infection control measures implemented and the learning points.http://dx.doi.org/10.1177/1757177417693678

Impact, durée et coûts des fermetures de lits d'hôpital dues aux gastroentérites aigües en Angleterre par hiver, 2010/11 - 2015/16

Sandmann FG, Jit M, Robotham JV, Deeny SR. Burden, duration and costs of hospital bed closures due to acute gastroenteritis in England per winter, 2010/11-2015/16. Journal of hospital infection 2017/09; 97(1): 79-85.

Mots-clés : GASTRO-ENTERITE, DUREE DE SEJOUR, COUT, EPIDEMIE, NOROVIRUS

Background: Bed closures due to acute gastroenteritis put hospitals under pressure each winter. In England, the National Health Service (NHS) has monitored the winter situation for all acute trusts since 2010/11. Aim: To estimate the burden, duration and costs of hospital bed closures due to acute gastroenteritis in winter.

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Methods: A retrospective analysis of routinely collected time-series data of bed closures due to diarrhoea and vomiting was conducted for the winters 2010/11 to 2015/16. Two key issues were addressed by imputing non-randomly missing values at provider level, and filtering observations to a range of dates recorded in all six winters. The lowest and highest values imputed were taken to represent the best- and worst-case scenarios. Bed-days were costed using NHS reference costs, and potential staff absence costs were based on previous studies. Findings: In the best-to-worst case, a median of 88,000-113,000 beds were closed due to gastroenteritis each winter. Of these, 19.6-20.4% were unoccupied. On average, 80% of providers were affected, and had closed beds for a median of 15-21 days each winter. Hospital costs of closed beds were £5.7-£7.5 million, which increased to £6.9-£10.0 million when including staff absence costs due to illness.Conclusions: The median number of hospital beds closed due to acute gastroenteritis per winter was equivalent to all general and acute hospital beds in England being unavailable for a median of 0.88-1.12 days. Costs for hospitals are high but vary with closures each winter.http://dx.doi.org/10.1016/j.jhin.2017.05.015

Une épidémie de longue durée due à Klebsiella pneumoniae ST336 productrice de CTX-M-15 dans un service de rééducation : rapport et revue de la littérature

Valsdottir F, Elfarsdottir JA, Gudlaugsson O, Hilmarsdottir I. Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review. Journal of hospital infection 2017/09; 97(1): 42-51.

Mots-clés : KLEBSIELLA PNEUMONIAE, EPIDEMIE, REEDUCATION, REVUE DE LA LITTERATURE, MULTIRESISTANCE, CONTROLE, TYPAGE, BETA-LACTAMASE A SPECTRE ELARGI

Background: Whereas Klebsiella species are the most frequently occurring agents in nosocomial outbreaks due to multidrug-resistant Gram-negative organisms, very few outbreaks have been reported from rehabilitation wards. Aim: To describe a long-lasting outbreak due to extended-spectrum β-lactamase-producing (ESBL) Klebsiella pneumoniae in a rehabilitation ward. Methods: ESBL K. pneumoniae from all in- and outpatients whose specimens were tested at a tertiary care university hospital between 2007 and 2012 were typed by pulsed-field gel electrophoresis and selected isolates were submitted to multi-locus sequence typing and ESBL genotyping. Outbreak characteristics and infection control interventions were summarized. The literature was searched for K. pneumoniae-related outbreaks in rehabilitation wards. Findings: ESBL K. pneumoniae was detected in 69 out of 2478 K. pneumoniae-positive patients (2.8%) during the study period. Eight related outbreak clones from 35 patients, 25 of whom were in the rehabilitation ward, produced CTX-M-15 and belonged to ST336. The outbreak lasted for more than three years and was controlled by sequentially increasing measures culminating in review of all patient-related care, compulsory educational meetings for personnel, profession-specific guidelines and educational flyers for patients. Conclusion: Half of ESBL K. pneumoniae-positive patients identified over six years at a tertiary care university hospital harboured related clones, and more than a third were hospitalized in a rehabilitation ward. Rehabilitation wards pose particular challenges for infection control because of patient dependency and an environment that encourages socializing. They are, however, rarely involved in K. pneumoniae-related outbreaks.http://dx.doi.org/10.1016/j.jhin.2017.04.002

Hémodialyse

Infections sur catheters d’hémodialyse : variations du risque en fonction de la durée de cathétérisme

Izoard S. Infections sur catheters d’hémodialyse : variations du risque en fonction de la durée de cathétérisme. Néphrologie & Thérapeutique 2017; in press: 1-7.

Mots-clés : CATHETER, HEMODIALYSE, INFECTION NOSOCOMIALE, RISQUE

Contexte : Les recommandations internationales déconseillent l’utilisation prolongée des cathéters d’hémodialyse qui, par rapport aux fistules natives ou prothétiques, présentent un risque d’infections et de thromboses plus important. Cependant, pour les patients ayant des comorbidités contre-indiquant la mise en place de fistules, les cathéters doivent être utilisés au long cours. La variation du risque de complications

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infectieuses en fonction de la durée d’utilisation des cathéters est encore peu étudiée dans la littérature et les équipes l’ayant analysée rapportent des résultats contradictoires. Méthode : Nous avons réalisé une étude multicentrique prospective incluant 1053 cathéters tunnélisés incidents. Une régression logistique multivariée a été utilisée afin d’identifier les facteurs de risque d’infection significatifs. Dans un deuxième temps, une analyse de survie sans infection a été effectuée afin d’estimer les variations du risque infectieux instantané en fonction de la durée de cathétérisme. Résultats : Les principaux facteurs de risque d’infection sur cathéters tunnélisés étaient un antécédent d’infection à Staphylococcus aureus (aOR = 1,95 [1,16-3,27] ; p = 0,012), le diabète (aOR = 1,67 [1,16-2,41] ; p = 0,006) et une durée de cathétérisme prolongée (0-3 mois vs ≥ 24 mois : aOR = 2,42 [1,34-4,36] ; p = 0,003). L’analyse de survie a montré que le risque d’infection était maximal lors des mois suivant immédiatement la pose du cathéter et qu’il diminue par la suite. Conclusions : Notre étude a permis de mettre en évidence un profil de variations du risque infectieux qui incite à mettre en place des mesures de prévention particulièrement strictes lors des premiers mois d’utilisation du cathéter.http://dx.doi.org/10.1016/j.nephro.2017.01.021

Hygiène des mains

Etudier l'utilisation inappropriée de gant chez les aides-soignants dans les soins de longue durée

Burdsall DP, Gardner SE, Cox T, Schweizer M, Culp KR, Steelman VM, et al. Exploring inappropriate certified nursing assistant glove use in long-term care. American journal of infection control 2017/09; 45(9): 940-945.

Mots-clés : GANT, QUALITE, PRATIQUE, AIDE-SOIGNANT, PRECAUTION STANDARD, OBSERVATION, CONTAMINATION, PREVENTION, LONG SEJOUR

Background: Certified Nursing Assistants (CNAs) frequently wear gloves when they care for patients in standard precautions. If CNAs use gloves inappropriately, they may spread pathogens to patients and the environment, potentially leading to health care–associated infections (HAIs). Methods: Using a descriptive structured observational design, we examined the degree of inappropriate health care personnel glove use in a random sample of 74 CNAs performing toileting and perineal care at 1 long-term care facility. Results: During the 74 patient care events, CNAs wore gloves for 80.2% (1,774/2,213) of the touch points, failing to change gloves at 66.4% (225/339) of glove change points. CNAs changed gloves a median of 2.0 times per patient care event. A median of 1.0 change occurred at a change point. CNAs failed to change their gloves at a glove change point a median of 2.5 times per patient care event. Most (61/74; 82.4%) patient care events had >1 contaminated touch point. Over 44% (782/1,774) of the gloved touch points were defined as contaminated for a median of 8.0 contaminated glove touch points per patient care event. All contaminated touches were with gloved hands (P<.001). Conclusions: Inappropriate glove use was frequently observed in this study. Contaminated gloves may be a significant cause of cross-contamination of pathogens in health care environments. Future research studies should evaluate strategies to improve glove use to reduce HAIs.http://dx.doi.org/10.1016/j.ajic.2017.02.017

Interventions pour améliorer l'observance de l'hygiène des mains dans les soins aux patients (Revue)

Gould D, Moralejo D, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care (Review). Cochrane database of systematic reviews 2017/09; 9: 1-93.

Mots-clés : HYGIENE DES MAINS, OBSERVANCE, QUALITE, TAUX, INFECTION NOSOCOMIALE, RECOMMANDATIONS DE BONNE PRATIQUE, PRODUIT DE FRICTION POUR LES MAINS, REVUE DE LA LITTERATURE

Background: Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. Objectives: To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. Search methods: We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016.

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Selection criteria: We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. Data collection and analysis: Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. Main results: This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention. Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes. Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low. Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence. Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence. Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence. Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. Authors' conclusions: With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.http://dx.doi.org/10.1002/14651858.CD005186.pub4

La chlorhexidine n'est pas un élément essentiel dans les produits à base d'alcool pour la désinfection chirurgicale des mains : une étude comparative de deux produits de friction pour les mains basée sur un protocole de test modifié EN 12791

Hennig TJ, Werner S, Naujox K, Arndt A. Chlorhexidine is not an essential component in alcohol-based surgical hand preparation: a comparative study of two handrubs based on a modified EN 12791 test protocol. Antimicrobial resistance and infection control 2017/09/13; 6: 1-6.

Mots-clés : HLORHEXIDINE, TEST, PRODUIT DE FRICTION POUR LES MAINS, HYGIENE DES MAINS, ALCOOL, NORME CEN

Background: Surgical hand preparation is an essential part of modern surgery. Both alcohol-based and antiseptic detergent-based hand preparation are recommended practices, with a trend towards use of alcohol based handrubs. However, discussion has arisen whether chlorhexidine is a required ingredient in highly efficacious alcohol-based formulations, in view of providing sustained antimicrobial efficacy. Methods: One alcohol-only formulation (product A), containing ethanol and n-propanol, and one formulation containing a chlorhexidine-ethanol combination (product B) were directly compared with each other using a modified test protocol based on European standard EN 12791 (2016) with 25 volunteers. The alcohol-only formulation (product A) was applied for only 90 s, the chlorhexidine-alcohol formulation (product B) for 180 s. Microbial log reduction factors were determined and statistically compared immediately after application and at 6 h under surgical gloves.

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Results: The alcohol-only formulation (product A) achieved mean log reduction factors of 1.96±1.06 immediately after application and 1.67±0.71 after 6 h. The chlorhexidine-alcohol combination (product B) achieved mean log reduction factors of 1.42±0.79 and 1.24±0.90 immediately and after 6 h, respectively. The values for product A were significantly greater than those for product B at both measured time points (p≤0.025 immediately after application and p≤0.01 after 6 h). Conclusions: An optimized alcohol-only formulation tested according to a modified EN 12791 protocol in 25 healthy volunteers outperformed a chlorhexidine-alcohol formulation both immediately after application and at 6 h under surgical gloves, despite a much shorter application time. Thus, optimized alcohol-only formulations do not require chlorhexidine to achieve potent immediate and sustained efficacy. In conclusion, chlorhexidine is not an essential component for alcohol-based surgical hand preparation.http://dx.doi.org/10.1186/s13756-017-0258-0

Attitudes et pratiques des médecins hospitaliers irlandais lors de la friction hydroalcoolique pour l'hygiène des mains : une comparaison entre 2007 et 2015

Kingston LM, Slevin BL, O'Connell NH, Dunne CP. Attitudes and practices of Irish hospital-based physicians towards hand hygiene and hand rubbing using alcohol-based hand rub: a comparison between 2007 and 2015. Journal of hospital infection 2017/09; 97(1): 17-25.

Mots-clés : HYGIENE DES MAINS, MEDECIN, TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION, ATTITUDE, PRATIQUE, PREVENTION

Background: Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance. Aim: To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. Methods: In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey. Findings: Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they 'almost always' used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products. Conclusion: Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009.http://dx.doi.org/10.1016/j.jhin.2017.05.010

Vers une évaluation objective de la technique d'hygiène des mains : validation de la procédure d'évaluation de la qualité des frictions à base de colorant ultraviolet

Lehotsky A, Szilágyi L, Bansághi S, Szerémy P, Wéber G, Haidegger T. Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure. Journal of hospital infection 2017/09; 97(1): 26-29.

Mots-clés : HYGIENE DES MAINS, EVALUATION, ULTRA-VIOLET, TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION, PREVENTION, CONTROLE

Ultraviolet spectrum markers are widely used for hand hygiene quality assessment, although their microbiological validation has not been established. A microbiology-based assessment of the procedure was conducted. Twenty-five artificial hand models underwent initial full contamination, then disinfection with UV-dyed hand-rub solution, digital imaging under UV-light, microbiological sampling and cultivation, and digital imaging of the cultivated flora were performed. Paired images of each hand model were registered by a software tool, then the UV-marked regions were compared with the pathogen-free sites pixel by pixel. Statistical evaluation revealed that the method indicates correctly disinfected areas with 95.05% sensitivity and 98.01% specificity.

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http://dx.doi.org/10.1016/j.jhin.2017.05.022

La colonisation des mains des patients par des micro-organismes multirésistants est liée à la contamination de l’environnement dans les établissements de soins de suite

Patel Payal K, Mantey J, Mody L. Patient Hand Colonization With MDROs Is Associated with Environmental Contamination in Post-Acute Care. Infection control and hospital epidemiology 2017/09; 38(9): 1110-1113.

Mots-clés : MULTIRESISTANCE, COLONISATION, MAIN, ENVIRONNEMENT, CONTAMINATION, FACTEUR DE RISQUE, SONDAGE URINAIRE, ANTIBIOTIQUE, DUREE DE SEJOUR

We assessed multidrug-resistant organism (MDRO) patient hand colonization in relation to the environment in post-acute care to determine risk factors for MDRO hand colonization. Patient hand colonization was significantly associated with environmental contamination. Risk factors for hand colonization included disability, urinary catheter, recent antibiotic use, and prolonged hospital stay.http://dx.doi.org/10.1017/ice.2017.133

L'amélioration de l'hygiène des mains chez le patient peut-elle influer sur les événements d'infection à Clostridium difficile dans un centre hospitalier universitaire ?

Pokrywka M, Buraczewski M, Frank D, Dixon H, Ferrelli J, Shutt K, et al. Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? American journal of infection control 2017/09; 45(9): 959-963.

Mots-clés : CLOSTRIDIUM DIFFICILE, HYGIENE DES MAINS, USAGER DE LA SANTE, FORMATION, ENQUETE, QUALITE, OBSERVANCE

Background: Hand hygiene plays an important role in the prevention of Clostridium difficile (CD) infection (CDI). Patient hand hygiene (PHH) may be a potentially underused preventative measure for CDI. Patient mobility and acuity along with a lack of education present obstacles to PHH for the hospitalized patient. Surveys of patients at our institution showed a need for increased PHH opportunities. The objective of this study was to increase PHH and to examine if PHH affected CDI at our hospital. Methods: A biphasic, quasi-experimental study was performed to increase PHH through education for staff and to provide education, assistance, and opportunities to the patient for hand cleaning. PHH practice was assessed by patient surveys and analyzed by χ2 test. PHH effect on CDI was determined by following health care facility-onset CD laboratory-identified events data analyzed by National Healthcare Safety Network standardized infection ratios (SIRs). Results: PHH opportunities improved significantly (P<.0001) after staff and patient education. CD SIRs deceased significantly for 6 months (P≤.05) after the PHH intervention. Conclusions: PHH opportunities can be increased by providing education and opportunities for patients to clean their hands. PHH should be considered a relevant preventative measure for CDI in hospitalized patients.http://dx.doi.org/10.1016/j.ajic.2017.06.019

Comparaison des produits de friction pour les mains à l'éthanol entre un sachet à usage unique et des lingettes en paquet pour l'hygiène des mains du patient

Rai H, Knighton S, Zabarsky TF, Donskey CJ. Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene. American journal of infection control 2017/09; 45(9): 1033-1034.

Mots-clés : HYGIENE DES MAINS, USAGER DE LA SANTE, PRODUIT DE FRICTION POUR LES MAINS, QUALITE, REPAS, TEMPS, LINGETTE

To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 patients, a single-use ethanol hand sanitizer packet took less time to access than a single-use moist towelette packet (3 vs 23 seconds) and was preferred by 74% of patients for mealtime hand hygiene. Performance of patient hand hygiene increased when a reminder was provided at the time of meal tray deliveryhttp://dx.doi.org/10.1016/j.ajic.2017.03.018

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La charge de travail affecte même l'hygiène des mains dans un service hautement qualifié et bien doté : une étude d'observation prospective 365/7/24

Scheithauer S, Batzer B, Dangel M, Passweg J, Widmer A. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. Journal of hospital infection 2017/09; 97(1): 11-16.

Mots-clés : HYGIENE DES MAINS, CHARGE DE TRAVAIL, OBSERVANCE, INFIRMIER, SURVEILLANCE, TRAITEMENT HYGIENIQUE DES MAINS PAR FRICTION

Introduction: Compliance with hand hygiene (HH) has often not proved satisfactory; high workload is a commonly self-reported reason. Previous studies comparing workload and compliance have not measured workload precisely and have focused on certain times of day. This study aimed to investigate the association between HH compliance and workload, both electronically defined 365/7/24 (primary endpoint). In addition, the quality of commonly used compliance defining methods (hand disinfectant usage, direct observation) was investigated (secondary endpoint). Materials and methods: Correlation of electronically measured HH compliance (hand-rub activities (HRA)/HH opportunities) with electronically determined workload (nursing time output/nursing time input) was undertaken over one year at a stem cell transplant unit at University Hospital Basel, Switzerland. HRA and procedures requiring HRA according to the five World Health Organization indications were recorded continuously (365/7/24) using electronic dispensers and electronic documentation, and compliance was calculated accordingly. Hand disinfectant usage was calculated using spending records for one year; direct observation was performed for approximately 1800 HH opportunities. Results: During the investigation, 208,184 HRA, translating into 57 [standard deviation (SD) 10] HRA/patient-day (PD), were performed. Electronically determined compliance ranged from 24% to 66% [mean 42.39% (SD 8%)]. The higher the workload, the lower the compliance (R=-0.411; P<0.001). HRA/PD (r=-0.037), hand disinfectant usage (mean 160mL/PD) and observed compliance (95%; 1734 HRA/1813 HH opportunities) were not found to be associated with workload. Conclusion: Calculated compliance was inversely associated with nurses' workload. HRA/PD, observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.http://dx.doi.org/10.1016/j.jhin.2017.02.013

Utilisation de l'ingénierie environnementale pour améliorer l'observance de l'hygiène des mains : protocole d'une étude croisée

Schmidtke KA, Aujla N, Marshall T, Hussain A, Hodgkinson GP, Arheart K, et al. Using environmental engineering to increase hand hygiene compliance: a cross-over study protocol. BMJ Open 2017/09/11; 7(9): 1-10.

Mots-clés : HYGIENE DES MAINS, PROTOCOLE, OBSERVANCE, PREVENTION, ENVIRONNEMENT, PSYCHOLOGIE, INGENIERIE, COMPORTEMENT

Introduction: Compliance with hand hygiene recommendations in hospital is typically less than 50%. Such low compliance inevitably contributes to hospital-acquired infections that negatively affect patients' well-being and hospitals' finances. The design of the present study is predicated on the assumption that most people who fail to clean their hands are not doing so intentionally, they just forget. The present study will test whether psychological priming can be used to increase the number of people who clean their hands on entering a ward. Here, we present the protocol for this study. Methods and analysis: The study will use a randomised cross-over design. During the study, each of four wards will be observed during four conditions: olfactory prime, visual prime, both primes and neither prime. Each condition will be experienced for 42 days followed by a 7-day washout period (total duration of trial=189 days). We will record the number of people who enter each ward and whether they clean their hands during observation sessions, the amount of cleaning material used from the dispensers each week and the number of hospital-acquired infections that occur in each period. The outcomes will be compared using a regression analysis. Following the initial trail, the most effective priming condition will be rolled out for 3 months in all the wards. Ethics and dissemination: Research ethics approval was obtained from the South Central-Oxford C Research Ethics Committee (16/SC/0554), the Health Regulatory Authority and the sponsor.http://dx.doi.org/10.1136/bmjopen-2017-017108

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Infection urinaire

Un modèle de sondage urinaire in-vitro qui se rapproche des conditions cliniques pour l'évaluation des innovations afin de prévenir les infections urinaires sur sondes

Chua RY, Lim K, Leong SS, Tambyah PA, Ho B. An in-vitro urinary catheterization model that approximates clinical conditions for evaluation of innovations to prevent catheter-associated urinary tract infections. Journal of hospital infection 2017/09; 97(1): 66-73.

Mots-clés : PREVENTION, INFECTION URINAIRE, SONDAGE URINAIRE, BIOFILM, ESCHERICHIA COLI, INFECTION NOSOCOMIALE, BACTERIURIE, STERILISATION

Background: Catheter-associated urinary tract infections (CAUTI) account for approximately 25% of nosocomial infections globally, and often result in increased morbidity and healthcare costs. An additional concern is the presence of microbial biofilms which are major reservoirs of bacteria, especially antibiotic-resistant bacteria, in catheters. Since introduction of the use of closed drainage systems, innovations to combat CAUTI have not led to significant improvements in clinical outcomes. The lack of a robust laboratory platform to test new CAUTI preventive strategies may impede development of novel technologies. Aim: To establish an in-vitro catheterization model (IVCM) for testing of technological innovations to prevent CAUTI.Methods: The IVCM consists of a continuous supply of urine medium flowing into a receptacle (bladder) where the urine is drained through a urinary catheter connected to an effluent collection vessel (drainage bag). Test organism(s) can be introduced conveniently into the bladder via a rubber septa port. Development of bacteriuria and microbial biofilm on the catheter can be determined subsequently. Findings: With an initial inoculum of Escherichia coli [∼5×105 colony-forming units (cfu)/mL] into the bladder, a 100% silicone catheter and a commercially available silver-hydrogel catheter showed heavy biofilm colonization (∼108 cfu/cm and ∼107 cfu/cm, respectively) with similar bacterial populations in the urine (bacteriuria) (∼108) cfu/mL and ∼107 cfu/mL, respectively) within three days. Interestingly, an antimicrobial peptide (CP11-6A)-coated catheter showed negligible biofilm colonization and no detectable bacteriuria. Conlusion: The IVCM is a useful preclinical approach to evaluate new strategies for the prevention of CAUTI.http://dx.doi.org/10.1016/j.jhin.2017.05.006

Facteurs de risque d'infections urinaires dans les hôpitaux gériatriques

Girard R, Gaujard S, Pergay V, Pornon P, Martin-Gaujard G, Bourguignon L. Risk factors for urinary tract infections in geriatric hospitals. Journal of hospital infection 2017/09; 97(1): 74-78.

Mots-clés : FACTEUR DE RISQUE, INFECTION URINAIRE, GERIATRIE, EPIDEMIOLOGIE, INFECTION NOSOCOMIALE, PREVENTION, DUREE DE SEJOUR, SONDAGE URINAIRE

Background: Urinary tract infection (UTI) is the most frequent nosocomial infection in geriatric units. An understanding of risk factors for infection may help to identify prevention strategies. Aim: Identification of the risk factors for UTI in elderly patients. Methods: Retrospective analysis of three prospective cohorts. All hospitalized patients present in, or admitted to, a geriatric unit from June 1st to June 28th, for the years 2009, 2012, and 2015 were included and followed until discharge or until June 30th of the year concerned. For each patient, type and dates of stay, type and dates of catheter, risk factors, and nosocomial UTI (NUTI) data were collected. Univariate and multivariate (Cox model) analyses were made using SPSS software. Findings: A total of 4669 patients were included and were followed for a total of 83,068 days. There were 189 NUTIs (4.0% patients). NUTIs were significantly more frequent among female patients, in rehabilitation units, in immunosuppressed patients, among those with acute retention, post-void residual, history of urinary tract infection in the previous six months, and in case of dependency. NUTIs were significantly more frequent among those who had a catheter (Z-test, P<0.001). NUTIs were more frequent among patients with intermittent, indwelling, or suprapubic catheters. They were also more frequent in acute/subacute care or rehabilitation units, in women, in immunosuppressed patients, and in those with a history of previous UTI; they were less frequent in dementia patients. Conclusion: The occurrence of NUTI is an important issue in both catheterized and non-catheterized patients; prevention programmes should be widened to include non-catheterized patients.http://dx.doi.org/10.1016/j.jhin.2017.05.007

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Néonatologie

Dépistage de l'infection invasive à Streptococcus groupe B chez les nouveau-nés dans un hôpital irlandais (2001-2014) : un audit rétrospectif

Nielsen M. Screening for early-onset invasive group B Streptococcal disease in neonates in an Irish hospital (2001-2014): a retrospective audit. Infectious diseases 2017/06; 49(6): 454-460.

Mots-clés : NEONATOLOGIE, AUDIT, DEPISTAGE, STREPTOCOCCUS GROUPE B, NOUVEAU-NE, ETUDE RETROSPECTIVE, SEPTICEMIE, BACTERIEMIE, MENINGITE

Group B Streptococcus (GBS) is the most common cause of early-onset neonatal sepsis and meningitis. In babies with no clinical suspicion of infection, who are at risk of early-onset invasive disease based on maternal risk factors, blood cultures are taken to detect bacteraemia. In our institution, lumbar punctures are performed in infants with clinical signs of sepsis but not in infants who are well at the time of screening. Between 2001 and 2014, there were 112,361 live births weighing >500 g, of whom 13,959 (12.4%) infants had a blood culture taken on the first or second day of life, and 1971 (14.1%) of these infants had lumbar punctures on these first two days of life. Fifty-three cases of early-onset GBS disease were identified. Only three patients with invasive GBS disease had no clinical suspicion for sepsis at the time of testing. Thus, the number of blood cultures taken to detect one case of GBS bacteraemia in an infant who is well at the time of testing was 3996.http://dx.doi.org/10.1080/23744235.2017.1285045

Facteurs de risque et évolutions cliniques des septicémies tardives à bactéries Gram négatif résistantes aux carbapénèmes

Nour I, Eldegla HE, Nasef N, Shouman B, Abdel-Hady H, Shabaan AE. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. Journal of hospital infection 2017/09; 97(1): 52-58.

Mots-clés : FACTEUR DE RISQUE, NEONATOLOGIE, CARBAPENEME, SEPTICEMIE, BACTERIE A GRAM NEGATIF, ALIMENTATION PARENTERALE, KLEBSIELLA PNEUMONIAE, ANTIBIORESISTANCE, ANALYSE MULTIVARIEE, ETUDE PROSPECTIVE, PREVALENCE

Background: Carbapenem-resistant (CR), Gram-negative (GN), late-onset sepsis (LOS) is a serious threat in the neonatal intensive care unit (NICU). AIM: To assess the prevalence of CR-GN-LOS in NICU patients and to identify the risk factors and outcomes associated with its acquisition. Methods: Neonates with carbapenem-susceptible (CS)-GN-LOS were compared with those with CR-GN-LOS in a two-year observational study. Findings: A total of 158 patients had GN-LOS; 100 infants had CS-GN-LOS and 58 infants had CR-GN-LOS. The incidence rate of CR-GN-LOS was 6.5 cases per 1000 patient-days. The most frequent bacterial strain in both groups was Klebsiella pneumoniae. The duration of total parenteral nutrition (TPN) (P=0.006) and prior carbapenem use (P=0.01) were independent risk factors for CR-GN-LOS acquisition. CR-GN-LOS was associated with higher mortality than CS-GN-LOS (P=0.04). Birth weight, small for gestational age, time to start enteral feeding, exclusive formula feeding, previous surgery, previous antifungal use, central venous device before onset, duration of central venous device, and infectious complications were identified as dependent risk factors for overall mortality. However, only male gender (P=0.04) and infectious complications (P<0.001) were independent risk factors associated with mortality. Infectious complication rates, duration of mechanical ventilation, and length of hospital stay were significantly higher in infants with CR compared to CS-GN-LOS. Conclusion: The duration of TPN and carbapenem use were the independent predictors for CR-GN-LOS acquisition. CR-GN-LOS is associated with higher mortality, infectious complication rates, longer mechanical ventilation, and longer hospital stay. Male gender and infectious complications were the independent risk factors for mortality in neonates with GN-LOS.http://dx.doi.org/10.1016/j.jhin.2017.05.025

Pédiatrie

Epidémie à Fusarium oxysporum chez les enfants atteints de cancer : une expérience avec 7 épisodes de fungémie liée au cathéter

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Carlesse F, Amaral AP, Gonçalves SS, Xafranski H, Lee ML, Zecchin V, et al. Outbreak of Fusarium oxysporum infections in children with cancer: an experience with 7 episodes of catheter-related fungemia. Antimicrobial resistance and infection control 2017/09/07; 6: 1-7.

Mots-clés : FUSARIUM, ENFANT, CANCER, EPIDEMIE, PEDIATRIE, FONGEMIE, CATHETER VEINEUX CENTRAL, TYPAGE, EPIDEMIOLOGIE, TRAITEMENT

Background: Fusarium species are widely spread in nature as plant pathogens but are also able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstream infections in a single pediatric cancer center. Methods: All clinical and epidemiological data related to an outbreak involving seven cases of fungemia by Fusarium oxysporum during October 2013 and February 2014 were analysed. All cultured isolates (n=14) were identified to species level by sequencing of the TEF1 and RPB2 genes. Genotyping of the outbreak isolates was performed by amplified fragment length polymorphism fingerprinting. Results: In a 5-month period 7 febrile pediatric cancer patients were diagnosed with catheter-related Fusarium oxysporum bloodstream infections. In a time span of 11 years, only 6 other infections due to Fusarium were documented and all were caused by a different species, Fusarium solani. None of the pediatric cancer patients had neutropenia at the time of diagnosis and all became febrile within two days after catheter manipulation in a specially designed room. Extensive environmental sampling in this room and the hospital did not gave a clue to the source. The outbreak was terminated after implementation of a multidisciplinary central line insertion care bundle. All Fusarium strains from blood and catheter tips were genetically related by amplified fragment length polymorphism fingerprinting. All patients survived the infection after prompt catheter removal and antifungal therapy. Conclusion: A cluster with, genotypical identical, Fusarium oxysporum strains infecting 7 children with cancer, was most probably catheter-related. The environmental source was not discovered but strict infection control measures and catheter care terminated the outbreakhttp://dx.doi.org/10.1186/s13756-017-0247-3

Réduction de l'incidence de la pneumonie d'origine communautaire et de la mortalité hospitalière liée chez les enfants en Espagne (2001-2014)

Jimenez-Trujillo I, López de Andres A, Hernandez-Barrera V, Martinez-Huedo MA, Miguel-Diez J, Jiménez-García R. Decrease in the incidence and in hospital mortality of community-acquired pneumonia among children in Spain (2001-2014). Vaccine 2017/06/27; 35(30): 3733-3740.

Mots-clés : INCIDENCE, MORTALITE, PNEUMONIE, ENFANT, INFECTION COMMUNAUTAIRE, VACCINATION, VACCIN, STREPTOCOCCUS PNEUMONIAE, EFFICACITE

Objectives: To describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among Spanish children from 2001 to 2014 and to assess the effect of the pneumococcal vaccination (PCV) coverage in this period. Methods: This study was conducted using the Spanish National Hospital Database from 2001 to 2014 including subjects <18 years. We selected discharges with a primary diagnosis of CAP. Study variable included age, sex, comorbid conditions, procedures, isolated pathogens and hospital outcome variables. In order to estimate the effect of coverage of pneumococcal vaccination in hospitalizations for CAP, we used the number of commercialized doses of PCV (PCV7 PCV10, and PCV13) for each year. Incidence rates of admissions for CAP were calculated by dividing the number of admissions per year, sex, and age group by the corresponding number of people in that population group according to the census data. Results: We identified 194,419 admissions for CAP. Incidence rate was highest among children younger than 2 years and decreased significantly by 3.67% per year over the study period in this age group. Among children aged 2-4 years incidence of CAP seem to decrease after year 2009. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In children aged < 2years and 2-4 years increase in PVC was associated to a decrease in the incidence of CAP hospitalizations. Overall crude in hospital mortality following CAP fell significantly from 4.1‰ in 2001-2003 to 2.8‰ in 2012-2014. Conclusions: CAP incidence rates decreased significantly among children <2years of age from 2001 to 2014. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In hospital mortality paralleling CAP fell significantly in children and adolescents from 2001 to 2014. Improvement in vaccination coverage seems to have a mitigating effect on hospitalizations and outcomes for CAP in children.http://dx.doi.org/10.1016/j.vaccine.2017.05.055

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Personnel

Déclarer un évènement indésirable associé aux soins, une responsabilité professionnelle du soignant tiraillée entre éthique, morale et juridique

Guyonnet JP. Déclarer un évènement indésirable associé aux soins, une responsabilité professionnelle du soignant tiraillée entre éthique, morale et juridique. Ethique et santé 2017/09; 14(3): 164-173.

Mots-clés : RESPONSABILITE, DECLARATION, PERSONNEL, SOIN, ETHIQUE, DEONTOLOGIE, EVENEMENT INDESIRABLE, LEGISLATION, SIGNALEMENT, EVENEMENT INDESIRABLE ASSOCIE AUX SOINS, EIAS

Tous les jours, des évènements indésirables associés aux soins (EIAS) surviennent dans les établissements de santé. Cet article étudie les problématiques juridiques et éthiques soulevées par la déclaration d’un EIAS. La déclaration qui constitue une obligation réglementaire a pour but d’éviter, par la mise en place de mesures correctrices et préventives, la répétition de l’accident médical qui vient de se produire. Ce faisant, le soignant qui déclare l’évènement s’expose à la révélation d’une erreur ou d’une faute professionnelle susceptible de sanctions. Dès lors, la crainte de la sanction, disciplinaire, ordinale ou judiciaire fait courir le risque d’une non-déclaration évinçant à la fois le devoir éthique d’améliorer la qualité et la sécurité des soins mais aussi la morale. Une approche de la responsabilité professionnelle comme intégrant les deux facettes, d’une part, de la fierté de déployer ses compétences propres et, d’autre part, de l’obligation de faire face à ses erreurs, tente de répondre au dilemme posé. http://dx.doi.org/10.1016/j.etiqe.2017.07.013

Une approche systématique de gestion du changement pour améliorer la sécurité et prévenir les blessures par piqûre d'aiguille

Aziz AM. A change management approach to improving safety and preventing needle stick injuries. Journal of infection prevention 2017/09; 18(5): 257-262.

Mots-clés : PREVENTION, ACCIDENT D'EXPOSITION AU SANG, SECURITE SANITAIRE, GESTION DES RISQUES, MODELISATION

Key drivers for preventing healthcare-associated infection (HCAI) include evidence-based practices and procedures that prevent infection. Among the current guidance for preventing HCAIs is evidence and mandatory requirements for reducing needle stick injuries (NSIs). This article highlights how John Kotter’s model for change could help healthcare workers plan for successful and sustained deployment of needle safety devices (NSDs) and ultimately reduce the risk of a NSI.http://dx.doi.org/10.1177/1757177416687829

Taux de séroconversion chez les professionnels de santé après accidents d'exposition aux fluides corporels contaminés par le virus de l'hépatite C : expérience de 13 ans de l'Université de Pittsburgh

Egro FM, Nwaiwu CA, Smith S, Harper JD, Spiess AM. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: The University of Pittsburgh 13-year experience. American journal of infection control 2017/09; 45(9): 1001-1005.

Mots-clés : HEPATITE C, VIRUS, SEROCONVERSION, PERSONNEL, ACCIDENT D'EXPOSITION AU SANG, RISQUE PROFESSIONNEL, INCIDENCE, GESTION DES RISQUES

Background: Hepatitis C virus (HCV) transmission to health care personnel (HCP) after exposure to a HCV-positive source has been reported to occur at an average rate of 1.8% (range, 0%-10%). We aimed to determine the seroconversion rate after exposure to HCV-contaminated body fluid in a major U.S. academic medical center. Methods: A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Data collected include type of injury and fluid, injured body part, contamination of sharps, resident physicians' involvement, and patients' hepatitis B virus (HBV), HCV, and HIV status. Results: A total of 1,361 cases were included in the study. Most exposures were caused by percutaneous injuries (65.0%), followed by mucocutaneous injuries (33.7%). Most (63.3%) were injuries to the hand,

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followed by the face and neck (27.6%). Blood exposure accounted for 72.7%, and blood-containing saliva accounted for 3.4%. A total of 6.9% and 3.7% of source patients were coinfected with HIV and HBV, respectively. The HCV seroconversion rate was 0.1% (n=2) because of blood exposure secondary to percutaneous injuries. Conclusions: This study provides the largest and most recent cohort from a major U.S. academic medical center. The seroconversion rates among HCP exposed to HCV-contaminated body fluids was found to be lower than most of the data found in the literature.http://dx.doi.org/10.1016/j.ajic.2017.03.011

Une aiguille, une seringue, usage unique ? Enquête sur les connaissances, les attitudes et les pratiques des médecins et des infirmières en matière de sécurité des injections

Kossover-Smith RA, Coutts K, Hatfield KM, Cochran R, Akselrod H, Akselrod MK, et al. One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety. American journal of infection control 2017/09; 45(9): 1018-1023.

Mots-clés : ENQUETE, PERSONNEL, MEDECIN, INFIRMIER, SECURITE SANITAIRE, INJECTION, CONNAISSANCE, ATTITUDE, PRATIQUE, QUALITE

Background: To inform development, targeting, and penetration of materials from a national injection safety campaign, an evaluation was conducted to assess provider knowledge, attitudes, and practices related to unsafe injection practices. Methods: A panel of physicians (n=370) and nurses (n=320) were recruited from 8 states to complete an online survey. Questions, using 5-point Likert and Spector scales, addressed acceptability and frequency of unsafe practices (eg, reuse of a syringe on >1 patient). Results were stratified to identify differences among physician specialties and nurse practice locations. Results: Unsafe injection practices were reported by both physicians and nurses across all surveyed physician specialties and nurse practice locations. Twelve percent (12.4%) of physicians and 3% of nurses indicated reuse of syringes for >1 patient occurs in their workplace; nearly 5% of physicians indicated this practice usually or always occurs. A higher proportion of oncologists reported unsafe practices occurring in their workplace. Conclusions: There is a dangerous minority of providers violating basic standards of care; practice patterns may vary by provider group and specialty. More research is needed to understand how best to identify providers placing patients at risk of infection and modify their behaviors.http://dx.doi.org/10.1016/j.ajic.2017.04.292

Evaluation des écarts par rapport au protocole et de l’auto-contamination du personnel soignant pendant le port et le retrait d’un équipement de protection individuelle (EPI)

Kwon JH, Burnham CA, Reske KA, Liang SY, Hink T, Wallace MA, et al. Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing. Infection control and hospital epidemiology 2017/09; 38(9): 1077-1083.

Mots-clés : TENUE VESTIMENTAIRE, CONTAMINATION, EQUIPEMENT DE PROTECTION INDIVIDUEL

Objective: To evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage. Design: Prospective pilot study. Setting: Tertiary-care hospital. Participants: A total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE. Interventions: HCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped, and protocol deviations were recorded. Results: Overall, 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning, and 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (P=.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, versus 1 among CP PPE HCWs. Also, 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 EVD PPE HCWs (44%) and 5 CP PPE HCWs (28%), most commonly on hands. MS2 was recovered from 2 EVD PPE HCWs (11%) and 3 CP PPE HCWs (17%).

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Conclusions: Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and/or the trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study.http://dx.doi.org/10.1017/ice.2017.121

Quelle est la tendance en matière de maîtrise du risque infectieux ? Revues des publics ciblés et du vocabulaire utilisé

Mitchell BG, Petrie D, Morton L, Dancer SJ. What’s Trending in Infection Control? Scoping and Narrative Reviews. Infection control and hospital epidemiology 2017/09; 38(9): 1098-1102.

Mots-clés : HYGIENE HOSPITALIERE, INFIRMIER HYGIENISTE, MEDECIN HYGIENISTE, PERCEPTION, REVUE DE PRESSE, INTERNET

Objective: To explore the trends in infection control peer-reviewed journals, mainstream media, and blogs written by infection control professionals. Design: Narrative and scoping reviews. Methods: Narrative and scoping reviews were performed to identify trending infection prevention and control topics from international journals, national news websites, newspapers, and so-called grey literature throughout 2015. Data were analyzed using word frequencies, and results are displayed in word clouds.Results: For 2015, our search identified 6 news websites with a total of published 116 articles, 71 articles from selected newspapers, and 214 publications from infection control websites. In total, 1,059 journal articles were initially identified; 98 articles were anonymous and thus were excluded, leaving 961 articles in the reviews. The terms ‘superbug’ and ‘antibiotics’ were most commonly used in titles of news websites and newspapers, whereas the terms ‘infection’ and ‘prevention’ were most commonly used in infection control websites or blogs. The word frequency differences among the 4 selected journals reflected their respective specialties. Conclusion: In infection prevention and control, the integration of a range of mediums is necessary to best serve public interests. Whether the aim is advocacy, general health information dissemination, or warnings of imminent risk, health researchers have access to multiple forums with different strengths through which to influence public risk perceptions and responses.http://dx.doi.org/10.1017/ice.2017.130

Transmission de Staphylococcus aureus résistant à la méthicilline aux blouses et aux gants du personnel pendant les soins aux résidents des maisons de retraites pour les anciens combattants

Pineles L, Morgan DJ, Lydecker A, Johnson JK, Sorkin JD, Langenberg P, et al. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes. American journal of infection control 2017/09; 45(9): 947-953.

Mots-clés : GANT, STAPHYLOCOCCUS AUREUS, METICILLINO-RESISTANCE, TRANSMISSION, EHPAD, USAGER DE LA SANTE, PERSONNEL, TENUE VESTIMENTAIRE, BLOUSE, COLONISATION

Background: This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. Methods: Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. Results: There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P<.01). Transmission varied greatly by type of care from 0%-19% for gowns and 7%-37% for gloves. High-risk care activities (odds ratio [OR] > 1.0, P<.05) for gown contamination included changing dressings (eg, wound), dressing, providing hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR<1.0, P<.05 or no transmission) for gown contamination included glucose monitoring, giving medications, and feeding. Conclusions: MRSA transmission from colonized residents to gloves was higher than transmission to gowns. Transmission to gloves varies by type of care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types

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of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environmenthttp://dx.doi.org/10.1016/j.ajic.2017.03.004

Pneumonie

Pneumonies associées aux soins de réanimation

Leone M, Société Française d’Anesthésie et de Réanimation (SFAR), Société de Réanimation de Langue Française (SRLF). Pneumonies associées aux soins de réanimation. SFAR 2017: 1-32.

Mots-clés : PNEUMONIE, SOIN INTENSIF, DEFINITION, PREVENTION, MULTIRESISTANCE, PEIDATRIE, DIAGNOTIC CLINIQUE, PRELEVEMENT, TRAITEMENT, PSEUDOMONAS AERUGINOSA, STAPHYLOCOCCUS AUREUSLa pneumonie associée aux soins est l’infection la plus fréquente en réanimation. En réanimation, cette infection est associée à un taux de décès d’environ 20 %. Cependant, la mortalité attribuable à cette infection reste débattue, étant estimée entre 5 et 13 %. La Société Française d’Anesthésie et de Réanimation (SFAR) et la Société de Réanimation de Langue Française (SRLF) n’avaient jusqu’à ce jour jamais proposé de référentiel centré sur la pneumonie associée aux soins. Seize experts francophones sélectionnés par un comité d’organisation désigné par les comités en charge des référentiels sous l’approbation des conseils d’administration des deux sociétés ont eu pour mission de produire un référentiel couvrant trois champs spécifiques : prévention, diagnostic et traitement. Les spécificités de différentes populations pré-déterminées (BPCO, neutropénique, post-opératoire et pédiatrie) ont été analysées par des experts identifiés. Deux experts bibliographiques ont analysé la littérature des 10 dernières années sur le domaine en utilisant des mots-clés pré-définis.http://sfar.org/wp-content/uploads/2017/09/2-2_PNEUMONIES-ASSOCIEES-AUX-SOINS-DE-REANIMATION.pdf

La formation des infirmières aux recommandations pour la prévention des pneumonies sous ventilation améliore-t-elle l'observance de bonnes pratiques ?

Aloush SM. Does educating nurses with ventilator-associated pneumonia prevention guidelines improve their compliance? American journal of infection control 2017/09; 45(9): 969-973.

Mots-clés : PNEUMONIE, PREVENTION, EFFICACITE, FORMATION, ASSISTANCE RESPIRATOIRE, PERSONNEL, INFIRMIER, RECOMMANDATIONS DE BONNE PRATIQUE

Background: This study aimed to compare the compliance with ventilator-associated pneumonia (VAP)-prevention guidelines between nurses who underwent an intensive educational program and those who did not, and to investigate other factors that influence nurses' compliance. Method: A 2-group post-test design was used to examine the effect of the VAP-prevention guidelines education on nurses' compliance. Participants were randomly assigned to experimental and control groups.Results: The overall nurses' compliance scores were moderate. There was no statistically significant difference in compliance between the nurses who received VAP education and those who did not (t[100] =-1.43; P=.15). The number of beds in the unit and the nurse-patient ratio were found to influence nurses' compliance. Conclusion: Education in VAP-prevention guidelines will not improve nurses' compliance unless other confounding factors, such as their workload, are controlled. It is imperative to reduce nurses' workload to improve their compliance and enhance the effectiveness of education.http://dx.doi.org/10.1016/j.ajic.2017.04.009

Evaluation des critères de la Société américaine des maladies infectieuses et la Société américaine de chirurgie thoracique pour le risque de pathogènes multirésistants chez les patients atteints d'une pneumonie sous ventilation dans l'unité de soins intensifs

Ekren PK, Ranzani OT, Ceccato A, Li Bassi G, Muñoz Conejero E, Ferrer M, et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multi-drug Resistant Pathogens in Hospital-acquired and Ventilator-associated Pneumonia Patients in the Intensive Care Unit. American journal of respiratory and critical care medicine 2017/09/13; in press: 1-10.

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Mots-clés : SOIN INTENSIF, PNEUMONIE, ASSISTANCE RESPIRATOIRE, MULTIRESISTANCE, ANTIBIORESISTANCE, SENSIBILITE, SPECIFICITE, FACTEUR DE RISQUE, RECOMMANDATIONS DE BONNE PRATIQUE, EVALUATIONhttp://dx.doi.org/10.1164/rccm.201708-1717LE

Recommandations internationales des sociétés savantes ERS / ESICM / ESCMID / ALAT pour la prise en charge de la pneumonie nosocomiale et de la pneumonie sous ventilation : Recommandations pour la prise en charge de la pneumonie nosocomiale (HAP) et de la pneumonie sous ventilation (VAP) de la Société respiratoire européenne (ERS), Société européenne de réanimation (ESICM), Société européenne de microbiologie clinique et maladies infectieuses (ESCMID) et Association Latinoaméricaine du thorax (ALAT)

Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT). European respiratory journal 2017/09/10; 50(3): 1-26.

Mots-clés : PNEUMONIE, RECOMMANDATIONS DE BONNE PRATIQUE, PREVENTION, GESTION DES RISQUES, ASSISTANCE RESPIRATOIRE, INFECTION NOSOCOMIALE, SOIN INTENSIF, REVUE DE LA LITTERATURE

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.http://dx.doi.org/10.1183/13993003.00582-2017

Prévention

Mise en œuvre de la technique aseptique "sans contact" (ANTT®) dans le cadre des pratiques cliniques sur la technique aseptique : une évaluation pragmatique utilisant une approche mixte dans deux hôpitaux à Londres

Clare S, Rowley S. Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals. Journal of infection prevention 2017/08/04; in press: 1-10.

Mots-clés : PREVENTION, ASEPSIE, AUDIT, ENQUETE, ENTRETIEN, PERSONNEL, PRECAUTION STANDARD, HYGIENE DES MAINS, GANT, OBSERVANCE

Background: Aseptic technique is an important infection prevention competency for protecting patients from healthcare- associated infection (HAI). Healthcare providers using the Aseptic Non Touch Technique (ANTT®) aseptic technique have demonstrated reduced variability and improved compliance with aseptic technique. Objectives: The primary aim of this study is to determine whether standardizing aseptic technique for invasive IV procedures, using the ANTT® - Clinical Practice Framework (CPF), increases staff compliance with the infection prevention actions designed to achieve a safe and effective aseptic technique, and whether this is sustainable over time. Methods: A pragmatic evaluation using a mixed-methods approach consisting of an observational audit of practice, a self-report survey and structured interviews with key stakeholders.

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Compliance with aseptic technique before and after the implementation of ANTT® was measured by observation of 49 registered healthcare professionals. Results: Mean compliance with competencies was 94%; each component of practice was improved over baseline: hand hygiene = 63% (P≤0.001); glove use = 14% (P≤0.037); Key-Part protection = 54% (P≤0.001); a non-touch technique = 45% (P≤0.001); Key-Part cleaning = 82% (P≤0.001); and aseptic field management = 80% (P≤0.001). Conclusions: Results show implementation of ANTT® improved compliance with the prerequisite steps for safe and effective aseptic technique as defined by the ANTT®-CPF. Improvements in compliance were sustained over four years.http://dx.doi.org/10.1177/1757177417720996

Composite de nanoparticules d'argent et de silice : effets antibactériens prolongés et mécanismes d'interaction bactérienne pour les pansements

Mosselhy DA, Granbohm DA, Hynönen U, Ge YL, Palva A, Nordström K, et al. Nanosilver-Silica Composite: Prolonged Antibacterial Effects and Bacterial Interaction Mechanisms for Wound Dressings. Nanomaterials 2017/09/06; 7(9): 1-19.

Mots-clés : PANSEMENT, SOIN DE PLAIE CUTANEE, BIOMATERIAU, METAL, NANOTECHNOLOGIE, METHODOLOGIE

Infected superficial wounds were traditionally controlled by topical antibiotics until the emergence of antibiotic-resistant bacteria. Silver (Ag) is a kernel for alternative antibacterial agents to fight this resistance quandary. The present study demonstrates a method for immobilizing small-sized (~5 nm) silver nanoparticles on silica matrix to form a nanosilver-silica (Ag-SiO2) composite and shows the prolonged antibacterial effects of the composite in vitro. The composite exhibited a rapid initial Ag release after 24 h and a slower leaching after 48 and 72 h and was effective against both methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli). Ultraviolet (UV)-irradiation was superior to filter-sterilization in retaining the antibacterial effects of the composite, through the higher remaining Ag concentration. A gauze, impregnated with the Ag-SiO2

composite, showed higher antibacterial effects against MRSA and E. coli than a commercial Ag-containing dressing, indicating a potential for the management and infection control of superficial wounds. Transmission and scanning transmission electron microscope analyses of the composite-treated MRSA revealed an interaction of the released silver ions with the bacterial cytoplasmic constituents, causing ultimately the loss of bacterial membranes. The present results indicate that the Ag-SiO2 composite, with prolonged antibacterial effects, is a promising candidate for wound dressing applications.http://dx.doi.org/10.3390/nano7090261

Toilette du patient dépendant hospitalisé avec des lingettes jetables préemballées au lieu des cuvettes de bain pour la toilette traditionnelle : étude croisée

Martin ET, Haider S, Palleschi M, Eagle S, Crisostomo DV, Haddox P, et al. Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins: A case-crossover study. American journal of infection control 2017/09; 45(9): 990-994.

Mots-clés : TOILETTE DU PATIENT, EFFICACITE, SECURITE SANITAIRE, PREVENTION, INFECTION NOSOCOMIALE, INCIDENCE, MULTIRESISTANCE, PEAU, CONTAMINATION, LINGETTE, CUVETTE

Background: Basins used for patient bathing have been shown to be contaminated with multidrug-resistant organisms (MDROs) and have prompted the evaluation of alternatives to soap and water bathing methods.Methods: We conducted a prospective, randomized, open-label interventional crossover study to assess the impact of replacing traditional bath basins with prepackaged washcloths on the incidence of hospital-associated infections (HAIs), MDROs, and secondarily, rates of skin deterioration. Unit-wide use of disposable washcloths over an 8-month period was compared with an 8-month period of standard care using basins.Results: A total of 2,637 patients were included from 2 medical-surgical units at a single tertiary medical center, contributing 16,034 patient days. During the study period, there were a total of 33 unit-acquired infections, the rates of which were not statistically different between study phases (incidence rate ratio, 1.05; 95% confidence interval [CI], 0.50-2.23; P=.88). However, occurrence of skin integrity deterioration was significantly less in the intervention group (odds ratio, 0.44; 95% CI, 0.22-0.88; P=.02).

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Conclusions: Although we were unable to demonstrate a significant reduction in HAI or MDRO acquisition, we found a decrease in skin deterioration with the use of disposable washcloths and confirmed earlier findings of MDRO contamination of wash basins.http://dx.doi.org/10.1016/j.ajic.2017.03.023

Soin intensif

Mesurer et comptabiliser l'effet Hawthorne lors d'une étude d'observation directe des infirmières dans les unités de soins intensifs

Kurtz SL. Measuring and accounting for the Hawthorne effect during a direct overt observational study of intensive care unit nurses. American journal of infection control 2017/09; 45(9): 995-1000.

Mots-clés : SOIN INTENSIF, OBSERVATION, COMPORTEMENT, INFIRMIER, PERSONNEL, OBSERVANCE, HYGIENE DES MAINS

Background: Because suspecting nurses could alter hand hygiene (HH) behavior when observed, the goal of this article was to describe how the Hawthorne effect (HE) was measured and accounted for in a direct observational prospective study. Methods: Observations were made 8 h/d for 3-5 days in 5 intensive care units (ICUs) (4 hospitals) on a convenience sample of 64 ICU nurses in Texas. The HE was measured so if hand hygiene adherence rates of the first 2 hours were 20% higher than the last 6 hours, the first 2 hours would be dropped and an additional 2 hours would be added at the end of the observation period. Hourly rates were recorded during the observation period, using room entry and room exit. Results: The difference between aggregated rates of the first 2 hours and last 6 hours was 0.56% (range, 0.02%-15.74%) and not significant. On 12 observation days, higher rates were observed during the first 2 hours. On 6 days, higher rates were observed in the last 6 hours, with difference in rates of 1.43% (day 1), 2.97% (day 2), and 1.42% (day 3). Conclusions: The attempt at measuring and accounting for the HE showed little difference in HH rates throughout the observation period. Based on these results, necessity of the observer moving locations during HH surveillance after 10-20 minutes, because of a feared HE, might not be necessary.http://dx.doi.org/10.1016/j.ajic.2017.03.022

Mise en place de la toilette quotidienne à la chlorhexidine pour réduire la colonisation par des organismes multirésistants dans une unité de soins intensifs

Musuuza JS, Sethi AK, Roberts TJ, Safdar N. Implementation of daily chlorhexidine bathing to reduce colonization by multidrug-resistant organisms in a critical care unit. American journal of infection control 2017/09; 45(9): 1014-1017.

Mots-clés : COLONISATION, PEAU, MULTIRESISTANCE, SOIN INTENSIF, TOILETTE DU PATIENT, CHLORHEXIDINE, PREVENTION, INCIDENCE, PREVALENCE, DECOLONISATION

Background: Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU).Methods: From May 2010-January 2011, we screened patients admitted to a 24-bed ICU for and methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant gram-negative bacilli (FQRGNB). We calculated and plotted monthly incidence and prevalence of colonization of these MDROs. Results: Prevalence decreased in the immediate aftermath of daily CHG bathing implementation and generally remained at that level throughout the observation period. We observed low rates of incidence of MDRO colonization with VRE>FQRGNB>MRSA. Monthly prevalence of colonization and incidence for the composite of MRSA, VRE, and/or FQRGNB was 1.9%-27.9% and 0-1.1/100 patient-days, respectively. Conclusions: Following the implementation of daily CHG bathing, the incidence of MDROs remained low and constant over time, whereas the prevalence decreased immediately after the implementation.http://dx.doi.org/10.1016/j.ajic.2017.02.038

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Utilisation de recommandations fondées sur des preuves dans un bundle pour l'antibiothérapie à l'unité de soins intensifs

Mutters NT, De Angelis G, Restuccia G, Di Muzio F, Schouten J, Hulscher ME, et al. Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit. International journal of antimicrobial agents 2017/07/10; in press: 1-27.

Mots-clés : ANTIBIOTIQUE, SOIN INTENSIF, QUALITE, TRAITEMENT, RECOMMANDATIONS DE BONNE PRATIQUE, REVUE DE LA LITTERATURE

Purpose: To drive decisions on antibiotic therapy in the intensive care unit (ICU), we developed an antibiotic care bundle (ABC-Bundle) with evidence-based recommendations (EBRs) for antibiotic prescriptions. Methods: We conducted a 3-step prospective study. First, a systematic review of the literature reporting EBRs for antibiotic usage in the ICU was performed. Second, we developed an ABC-Bundle through a 2-round, RAND-modified Delphi method with an international expert panel, including the most relevant EBRs on a 9-point Likert scale. Those EBRs that were considered mandatory by >50% of the experts were included in the bundle. Third, we assessed the adherence to and applicability of the bundle in 2 mixed university ICUs.Results: Out of 1,190 potentially relevant articles, 14 (4 guidelines, 4 randomised controlled trials and 6 systematic reviews) fulfilled the eligibility criteria. Six EBRs were classified as relevant: 1. Provide rationale for antibiotic start; 2. Perform appropriate microbiological sampling; 3. Prescribe empirical antibiotic therapy according to guidelines (Day 1); 4. Review diagnosis; 5. Evaluate de-escalation based on microbiological results (Days 2-5); and 6. Consider discontinuation of treatment (Days 3-5). Daily adherence to the ABC-Bundle, prospectively assessed in 861 days of therapy in 142 ICU patients, ranged from 2% to 37%.Conclusions: The ABC-Bundle is a novel tool to improve delivery of appropriate antibiotic therapy to ICU patients. The low adherence in the prospective cohorts confirms the significant role that the ABC-Bundle could play in an antibiotic stewardship programme in the ICU setting.http://dx.doi.org/10.1016/j.ijantimicag.2017.06.020

Surveillance

Validation des critères d'assurance qualité pour les cultures de surveillance par écouvillonnage rectal

Amar M, Adler A. Validation of quality assurance criteria for rectal surveillance cultures. American journal of infection control 2017/09; 45(9): 1041-1042.

Mots-clés : SURVEILLANCE, PRELEVEMENT, RECTUM, BETA-LACTAMASE A SPECTRE ELARGI, QUALITE

We aimed to validate quality assurance (QA) criteria for rectal surveillance cultures (RSCs) for extended-spectrum β-lactamase-producing Enterobacteriaceae. QA for RSCs were tested by observing the presence or absence of fecal soiling and by examining the growth of Enterobacteriaceae on MacConkey agar. Extended-spectrum β-lactamase-producing Enterobacteriaceae were detected in 136 out of 434 soiled swabs (31.3%) and in 61 out of 257 nonsoiled swabs (23.7%) (P=.036). Observation of fecal soiling on RSCs can serve as a simple QA criterion and prevent the reporting of false-negative results.http://dx.doi.org/10.1016/j.ajic.2017.02.036

Transport

Transferts intra-hospitaliers et événements indésirables chez les patients : analyse des données administratives liées à la santé

Blay N, Roche MA, Duffield C, Xu X. Intra-hospital transfers and adverse patient outcomes: An analysis of administrative health data. Journal of clinical nursing 2017/07/26; in press: 18 pages.

Mots-clés : TRANSFERT DU MALADE, EVENEMENT INDESIRABLE, RISQUE, QUALITE, DONNEE STATISTIQUE, DONNEES DE SANTE

Aims and objectives: To determine whether there was an association between intra-hospital transfers and adverse outcomes.

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Background: Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored. Design: Retrospective cross sectional design using hospital administrative data. Method: Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n=14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes. Results: Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves.Conclusion: Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer.http://dx.doi.org/10.1111/jocn.13976

Caractérisation métagénomique des ambulances aux Etats-Unis

O'Hara NB, Reed HJ, Afshinnekoo E, Harvin D, Caplan N, Rosen G, et al. Metagenomic characterization of ambulances across the USA. Microbiome 2017/09/22; 5(1): 1-20.

Mots-clés : INFECTION NOSOCOMIALE, FACTEUR DE RISQUE, ANTIBIORESISTANCE, SURVEILLANCE, PRELEVEMENT, SURFACE, ENVIRONNEMENT, TRANSPORT SANITAIRE, GENOMIQUE, TYPAGE

Background: Microbial communities in our built environments have great influence on human health and disease. A variety of built environments have been characterized using a metagenomics-based approach, including some healthcare settings. However, there has been no study to date that has used this approach in pre-hospital settings, such as ambulances, an important first point-of-contact between patients and hospitals. Results: We sequenced 398 samples from 137 ambulances across the USA using shotgun sequencing. We analyzed these data to explore the microbial ecology of ambulances including characterizing microbial community composition, nosocomial pathogens, patterns of diversity, presence of functional pathways and antimicrobial resistance, and potential spatial and environmental factors that may contribute to community composition. We found that the top 10 most abundant species are either common built environment microbes, microbes associated with the human microbiome (e.g., skin), or are species associated with nosocomial infections. We also found widespread evidence of antimicrobial resistance markers (hits ~ 90% samples). We identified six factors that may influence the microbial ecology of ambulances including ambulance surfaces, geographical-related factors (including region, longitude, and latitude), and weather-related factors (including temperature and precipitation). Conclusions: While the vast majority of microbial species classified were beneficial, we also found widespread evidence of species associated with nosocomial infections and antimicrobial resistance markers. This study indicates that metagenomics may be useful to characterize the microbial ecology of pre-hospital ambulance settings and that more rigorous testing and cleaning of ambulances may be warranted.http://dx.doi.org/10.1186/s40168-017-0339-6

Vaccination

Efficacité de la vaccination contre la grippe saisonnière chez les patients atteints de diabète : protocole pour une étude de cas-témoins nichée

Casanova L, Cortaredona S, Gaudart J, Launay O, Vanhems P, Villani P et al. Effectiveness of seasonal influenza vaccination in patients with diabetes: protocol for a nested case-control study. BMJ Open 2017/08/18; 7(8): 1-9.

Mots-clés : EFFICACITE, VACCINATION, VACCIN, GRIPPE, DIABETE, CAS-TEMOIN, ADULTE, PROTOCOLE

Introduction: Seasonal influenza vaccination (SIV) is recommended for people with diabetes, but its effectiveness has not been demonstrated. All of the available studies are observational and marred with the

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healthy vaccine bias, that is, bias resulting from the generally better health behaviours practised by people who choose to be vaccinated against influenza, compared with those who do not. This protocol is intended to study the effectiveness of SIV in people with treated diabetes and simultaneously to control for bias.Methods and analyses: This case-control study is nested in a historical cohort and is designed to study vaccine effectiveness (VE) assessed by morbidity, mortality and anti-infective drug use. The cohort will comprise a representative sample of health insurance beneficiaries in France and will cover 10 consecutive epidemic seasons. It will include all patients reimbursed three separate times for drugs to treat diabetes. The first study of VE will use reasons for hospitalisation as the primary end point, and the second with the use of neuraminidase inhibitors and of antibiotics as the end points. A case will be defined as any person in the cohort reaching any end point at a given date. The case patient will be matched with the largest possible number of controls (individuals not reaching the end point by this date) according to the propensity score method with an optimal calliper width. A conditional logistic model will be used to estimate ORs to take into account both the matching and the repetition of measurements. The model will be applied separately during and outside of epidemic periods to estimate the residual confounding. Ethics and dissemination: The study has been approved by the French Commission on Individual Data Protection and Public Liberties (ref: AT/CPZ/SVT/JB/DP/CR05222O). The study's findings will be published in peer-reviewed journals and disseminated at international conferences and through social media.http://dx.doi.org/10.1136/bmjopen-2017-016023

Effets de la vaccination précédente contre le virus de la grippe sur la production d'anticorps maternels : implications pour la protection des nouveau-nés

Christian LM, Beverly C, Mitchell AM, Karlsson E, Porter K, Schultz-Cherry C, et al. Effects of prior influenza virus vaccination on maternal antibody responses: Implications for achieving protection in the newborns. Vaccine 2017/09/18; 35(39): 5283-5290.

Mots-clés : VACCINATION, GRIPPE, NOUVEAU-NE, VACCIN, FEMME ENCEINTE, ANTICORPS, SEROCONVERSION, IMMUNOGENICITE

Background: In the US, influenza vaccination is recommended annually to everyone ≥6months. Prior receipt of influenza vaccine can dampen antibody responses to subsequent vaccination. This may have implications for pregnant women and their newborns, groups at high risk for complications from influenza infection. Objective: This study examined effects of prior vaccination on maternal and cord blood antibody levels in a cohort of pregnant women in the US. Study design: Influenza antibody titers were measured in 141 pregnant women via the hemagglutination inhibition (HAI) assay prior to receipt of quadrivalent influenza vaccine, 30days post-vaccination, and at delivery (maternal and cord blood). Logistic regression analyses adjusting for age, BMI, parity, gestational age at vaccination, and year of vaccination compared HAI titers, seroprotection, and seroconversion in women with versus without vaccination in the prior year. Results: Compared to those without vaccination in the previous year (n=50), women with prior vaccination (n=91) exhibited higher baseline antibody titers and/or seroprotection rates against all four strains after controlling for covariates. Prior vaccination also predicted lower antibody responses and seroconversion rates at one month post-vaccination. However, at delivery, there were no significant differences in antibody titers or seroprotection rates in women or newborns, and no meaningful differences in the efficiency of antibody transfer, as indicated by the ratio of cord blood to maternal antibody titers at the time of delivery.Conclusion: In this cohort of pregnant women, receipt of influenza vaccine the previous year predicted higher baseline antibody titers and decreased antibody responses at one month post-vaccination against all influenza strains. However, prior maternal vaccination did not significantly affect either maternal antibody levels at delivery or antibody levels transferred to the neonate. This study is registered with the NIH as a clinical trial (NCT02148874). http://dx.doi.org/10.1016/j.vaccine.2017.05.050

Une proposition pro-active de vaccination pendant l'hospitalisation améliore la couverture vaccinale chez les patients après splénectomie : une expérience italienne

Gallone MS, Martino C, Tafuri S. Active offer of vaccinations during hospitalization improves coverage among splenectomized patients: An Italian experience. American journal of infection control 2017/08; 45(8): e87-e89.

Mots-clés : VACCINATION, TAUX, PREVENTION, RATE, CHIRURGIE, POLITIQUE DE SANTE

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In 2014, an Italian hospital implemented a protocol for pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines offer to splenectomized patients during their hospitalization. After 1 year, coverage for recommended vaccinations increased from 5.7%-66.7% and the average time between splenectomy and vaccines administration decreased from 84.7-7.5 days. http://dx.doi.org/10.1016/j.ajic.2017.02.039

Réponse de l'Italie à l'hésitation vaccinale : Un plan national d'immunisation innovant et coût-efficace basé sur des preuves scientifiques

Signorelli C, Guerra R, Siliquini R, Ricciardi W. Italy's response to vaccine hesitancy: An innovative and cost effective National Immunization Plan based on scientific evidence. Vaccine 2017/07/24; 35(33): 4057-4059.

Mots-clés : VACCIN, VACCINATION, POLITIQUE DE SANTE, SANTE PUBLIQUE, COUT-EFFICACITEhttp://dx.doi.org/10.1016/j.vaccine.2017.06.011

Efficacité des vaccins contre la grippe de 2013-14 à 2015-16, une étude négative au test chez les enfants

Valdin HL, Bégué RE. Influenza vaccines effectiveness 2013-14 through 2015-16, a test-negative study in children. Vaccine 2017/07/24; 35(33): 4088-4093.

Mots-clés : GRIPPE, VACCIN, VACCINATION, EFFICACITE, PREVENTION, PERSONNE AGEE, IMMUNOGENICITE

Background: Trivalent inactivated and live attenuated influenza vaccines (IIV3 and LAIV3) have been reformulated with an extra B strain (IIV4 and LAIV4). They were licensed based on immunogenicity and their effectiveness (VE) still must be empirically tested. Methods: Children 1-17years tested for influenza during 2013-16 were included and their immunization status verified. They were considered vaccinated if received ≥1 dose of an influenza vaccine ≥10days before evaluated for a respiratory episode. Age-groups were classified as 1-4years or 5-17years. VE was estimated by comparing vaccination status of influenza-positive versus influenza-negative cases. Results: 6779 children were enrolled in the three seasons. Overall, 27.2% received an influenza vaccine (87.1% IIV3 or IIV4 and 12.9% LAIV4), and 15.6% tested positive for influenza (77.9% A). IIV3 was predominantly used in 2013-14 and IIV4 in 2014-15 and 2015-16. IIV3 and IIV4 had comparable VE over the three seasons (60%, 57% and 53%) and performed similarly against influenza A and B and both age-groups. LAIV4 performed poorly for influenza A (15%, 37% and 48%) but better for influenza B (100%, 56% and 100%), especially among children 5-17years of age with VE=100% (95%CI: 55, 100). Conclusions: Influenza vaccination showed modest but consistent effectiveness over the years. The switch from IIV3 to IIV4 did not affect VE. LAIV4 did not perform as well as IIVs, yet it improved over the years and was particularly good protecting older children against influenza B. These results emphasize the regional nature of influenza and the need for local surveillance. http://dx.doi.org/10.1016/j.vaccine.2017.06.050

Responsables de la rubrique NosoVeille : N. Sanlaville, S. Yvars, K. Trouilloud (CPias Auvergne-Rhône-Alpes), I. Girot (CPias Bretagne), K. Lebascle (CPias Ile de France). Secrétaire : N. Vincent (CPias Auvergne-Rhône-Alpes)

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