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NosoVeille – Bulletin de veille Janvier 2017 NosoVeille n°1 Janvier 2017 Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au cours du mois écoulé. Il est disponible sur le site de NosoBase à l’adresse suivante : http://www.cclin-arlin.fr/nosobase Pour recevoir, tous les mois, NosoVeille dans votre messagerie : Abonnement / Désabonnement Sommaire de ce numéro : Alimentation Antibiotique Antiseptique Bactériémie Cathétérisme Clostridium difficile Désinfection Ebola EHPAD Endoscopie Environnement Epidémie Hygiène des mains Immunodépression Indicateur Infection ostéo-articulaire Infection urinaire Laboratoire Odontologie Pédiatrie Personnel Pharmacie Signalement 1 / 53

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NosoVeille – Bulletin de veille Janvier 2017

NosoVeille n°1

Janvier 2017

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

Il est disponible sur le site de NosoBase à l’adresse suivante :

http://www.cclin-arlin.fr/nosobase

Pour recevoir, tous les mois, NosoVeille dans votre messagerie :Abonnement / Désabonnement

Sommaire de ce numéro :

AlimentationAntibiotique AntiseptiqueBactériémieCathétérismeClostridium difficile DésinfectionEbolaEHPADEndoscopieEnvironnementEpidémieHygiène des mainsImmunodépressionIndicateurInfection ostéo-articulaireInfection urinaireLaboratoireOdontologiePédiatriePersonnelPharmacieSignalementStaphylococcus aureus SurveillanceUsagerVaccinationVille / Médecine de villeZika

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Alimentation

NosoBase ID notice : 422074Revue systématique et méta-analyse sur l’effet de l’émulsion lipidique sur la croissance microbienne en nutrition parentérale

Austin PD; Hand KS; Elia M. Systematic review and meta-analyses of the effect of lipid emulsion on microbial growth in parenteral nutrition. The journal of hospital infection 2016/12; 94(4): 307-319.

Mots-clés : META-ANALYSE; EMULSION LIPIDIQUE; ALIMENTATION PARENTERALE; CANDIDA ALBICANS; ESCHERICHIA COLI; STAPHYLOCOCCUS EPIDERMIDIS

Background: As lipid in parenteral nutrition (PN) purportedly enhances microbial growth, recommendations limit infusion of lipid PN (or lipid emulsion) from a single container to 24h (48h for lipid-free PN). However, the associated evidence base is ambiguous.Aim: To examine factors affecting microbial growth in PN.Methods: A systematic review with meta-analyses examined effects of nutrients on microbial growth in PN infusates over a 48-h period using the growth ratio {GR=log10[colony-forming units (cfu)/mL at 48h/cfu/mL at time zero]}.Findings: Factors influencing GR in PN included glucose, microbial species, temperature, osmolarity, presence of vitamins, trace elements and lipid, and amino acid profile. Using unmatched datasets (N=306), a general linear model found that lipid inclusion in PN represented 3.3% of the variability, which was less than that due to glucose concentration (5.8%), microbial species (35.3%) and microbe-infusate interaction (4.4%). Using matched datasets (N=38 pairs), lipid inclusion in PN represented 5.4% of the variability (P=0.076), which was less than that due to glucose concentration (8.5%; P=0.025), microbial species (75.5%; P<0.001) and microbe-infusate interaction (13.3%; P=0.382). Using meta-analyses of matched datasets, the presence of lipid in PN at fixed glucose concentrations did not significantly increase GR of Candida albicans, Escherichia coli or Staphylococcus epidermidis (P=0.352, P=0.025 and P=0.494, respectively; overall P=0.175).Conclusion: Lipid inclusion in PN is only one of several factors that may influence microbial growth in PN. Any recommendations about the duration of PN infusion from a single container should account for all these factors, and should be weighted according to microbial species likely to contaminate PN. DOI: https://dx.doi.org/10.1016/j.jhin.2016.08.026

NosoBase ID notice : 422279Infections liées aux cathéters veineux centraux chez des patients sous alimentation parentérale à domicile : résultats de Sustain, un registre national des données des patients en soins nutritionnels par ASPEN, la Société Américaine de Nutrition Parentérale et Entérale

Ross VM; Guenter P; Corrigan ML; Kovacevich D; Winkler MF; Resnick HE; et al. Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition’s National Patient Registry for Nutrition Care. American journal of infection control 2016/12; 44(12): 1462-1468.

Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; ALIMENTATION PARENTERALE; TAUX; SURVEILLANCE; FACTEURS DE RISQUE

Background: Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition’s National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. Objective: To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. Methods: Descriptive, χ(exp2), and t tests were used to analyze data from the Sustain registry. Results: Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly

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reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. Conclusions: Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI.DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.028

Antibiotique / Antibiorésistance

NosoBase ID notice : 423376Avis relatif au diagnostic microbiologique des entérobactéries productrices de carbapénémases ou résistantes à la colistine renfermant le gène mcr-1

Haut conseil de santé publique (HCSP). Avis relatif au diagnostic microbiologique des entérobactéries productrices de carbapénémases ou résistantes à la colistine renfermant le gène mcr-1. HCSP 2016/12/31: 1-6.

Mots-clés : ENTEROBACTERIE; DIAGNOSTIC BIOLOGIQUE; LABORATOIRE; ANTIBIORESISTANCE; ANTIBIOTIQUE; COLISTINE; IDENTIFICATION MOLECULAIRE

Le HCSP actualise, à la demande de la Direction générale de la santé, la définition des bactéries hautement résistantes émergentes (BHRe) ainsi que les modalités d’identification de la résistance de ces bactéries, tenant compte de l’évolution de l’épidémiologie. Le HCSP a diffusé le 27 septembre 2016 un premier avis relatif aux mesures à prendre par les établissements de santé, en lien avec l’émergence d’une résistance plasmidique à la colistine (mcr-1) chez les entérobactéries, en réponse à l’actualisation de la définition des BHRe. Le présent avis a pour objectif de répondre à la seconde question de la saisine concernant les modalités microbiologiques d’identification des souches d’entérobactéries résistantes à la colistine par présence du gène mcr-1. À l’occasion de la diffusion de cet avis, le HCSP actualise le chapitre « Dépistage et diagnostic microbiologique des entérobactéries productrices de carbapénémases » des recommandations pour la prévention de la transmission croisée des « Bactéries Hautement Résistantes émergentes (BHRe) » publié en 2013.

NosoBase ID notice : 422028Émergence de la résistance à la colistine chez les entérobactéries : une brèche dans le dernier rempart contre la pan-résistance !

Dortet L; Bonnin R; Jousset A; Gauthier L; Naas T. Émergence de la résistance à la colistine chez les entérobactéries : une brèche dans le dernier rempart contre la pan-résistance ! Journal des anti-infectieux 2016/12; 18(4): 139-159.

Mots-clés : COLISTINE; ANTIBIORESISTANCE; ENTEROBACTERIE; ANTIBIOTIQUE; POLYMYXINE; ANIMAL; REVUE DE LA LITTERATURE

La lutte contre les bactéries multi-résistantes aux antibiotiques (BMR) à Gram négatif représente un enjeu majeur de santé publique, particulièrement illustrée par la dissémination des entérobactéries productrices de carbapénèmases (EPC) ne restant sensibles le plus souvent uniquement à la colistine. Contrairement à la médecine vétérinaire, où la colistine est largement utilisée dans le traitement d’infections colibacillaires dans les filières animales de production, en médecine humaine, elle a longtemps été écartée des protocoles thérapeutiques en raison de sa toxicité, en particulier rénale. Elle est redevenue un antibiotique prescrit pour le traitement d’infections humaines sévères liées à des bactéries résistantes à toutes les autres options thérapeutiques avec l’émergence des EPC notamment. Dans les pays où la prévalence des EPC est importante, tels que la Grèce ou l’Italie, la résistance à la colistine est en constante augmentation. Cette résistance est pour l’essentiel liée à des mutations chromosomiques dans divers gènes conduisant à des modifications de charge du LPS, ce qui va empêcher la fixation de la colistine. Récemment, des gènes de résistance plasmidiques à la colistine, mcr-1 et mcr-2 ont été décrits chez de nombreuses espèces d’entérobactéries (Salmonella, Escherichia coli...) isolées en Asie du Sud-Est, en Amérique du Sud, en Afrique, au Danemark, au Royaume-Uni, au Portugal, mais aussi en France, surtout chez l’animal et dans une moindre mesure chez l’homme. L’émergence et la dissémination de la résistance plasmidique sont extrêmement inquiétantes, compromettant le dernier rempart sur la route vers la toto-résistance aux antibiotiques, ce d’autant que le pipeline et les perspectives de nouvelles molécules thérapeutiques dans le traitement des infections à EPC sont assez limités

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DOI: https://dx.doi.org/10.1016/j.antinf.2016.09.003NosoBase ID notice : 421587Bacilles à Gram négatif multirésistants : les implications pour le contrôle des infections

Adler A; Friedman ND; Marchaim D. Multidrug-Resistant Gram-Negative Bacilli. Infection Control Implications. Infectious disease clinics of North America 2016/12; 30(4): 967-997.

Mots-clés : BACILLE GRAM NEGATIF; MULTIRESISTANCE; ANTIBIORESISTANCE; INFECTION NOSOCOMIALE; ZOONOSE; TRANSMISSION; CONTAMINATION; COLONISATION; HYGIENE DES MAINS; PRECAUTION CONTACT; ISOLEMENT SEPTIQUE; ENVIRONNEMENT; ANTIBIOTIQUE; PRESCRIPTION; SURVEILLANCE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE

Antimicrobial resistance is a global iatrogenic complication of modern medical care. MDR-GNBs are becoming increasingly prevalent, and their containment and treatment pose an enormous challenge in most facilities. The authors’ suggestions are as follows.DOI: https://dx.doi.org/10.1016/j.idc.2016.08.001

NosoBase ID notice : 419477La prise en charge des Entérobactéries multi-résistantes

Bassetti M; Peghin M; Pecori D. The management of multidrug-resistant Enterobacteriaceae. Current opinion in infectious diseases 2016/12; 29(6): 583-594.

Mots-clés : ENTEROBACTERIE; MULTIRESISTANCE; ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE ELARGI; ANTIBIOTHERAPIE; PIPERACILLINE; TAZOBACTAM; CMI; COLISTINE; TIGECYCLINE; AMINOGLYCOSIDE; MEROPENEME; FOSFOMYCINE; REVUE DE LA LITTERATURE; CARBAPENEMASE; SUIVI THERAPEUTIQUE PHARMACOLOGIQUE

Purpose of review: Multidrug-resistant (MDR) Enterobacteriaceae are often related to the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases. ESBL and carbapenemase-producing Enterobacteriaceae (CRE), in particular, represent an increasing global threat. Recommendations for the therapeutic management of MDR-related infections, however, are mainly derived from retrospective and nonrandomized prospective studies. The aim of this review is to discuss the challenges in the treatment of patients with infections because of MDR Enterobacteriaceae and provide an expert opinion while awaiting for more definitive data.Recent findings: To avoid the selection of carbapenemase-producing Enterobacteriaceae, carbapenem-sparing strategies should be considered. β-lactams/β-lactamase inhibitors, mainly piperacillin-tazobactam, minimum inhibitory concentration (MIC) 16/4 μg/ml or less represents the best alternative to carbapenems for the treatment of ESBL-producing strains. Overall, combination therapy may be preferred over monotherapy for CRE. The combination of a carbapenem-containing regimen with colistin or high-dose tigecycline or aminoglycoside can be administered at high-dose prolonged infusion with therapeutic drug monitoring for the treatment of CRE with MIC for meropenem 8-16  mg/l or less. For MIC higher than 8-16  mg/l, the use of meropenem should be avoided and various combination therapies based on the in-vitro susceptibility of antimicrobials (e.g., colistin, high-dose tigecycline, fosfomycin, and aminoglycosides) should be selected.summary: Carbapenem-sparing strategies should be used, when feasible, for ESBL infections. The majority of available nonrandomized studies highlight that combination regimens involving carbapenems for CRE with MICs 8-16 mg/l or less for meropenem (in combination with colistin or high-dose tigecycline or aminoglycoside) seem to offer some therapeutic advantage over monotherapy. For CRE with meropenem MIC more than 8-16 mg/l, a combination of two or three antibiotics among colistin, high-dose tigecycline, aminoglycoside, and fosfomycin seems to decrease mortality. Strict infection control measures toward MDR Gram-negative pathogens remain necessary while awaiting for new treatment options.DOI: https://dx.doi.org/10.1097/QCO.0000000000000314

NosoBase ID notice : 422518Nouveau facteur de risque associé à la colonisation à entérobactéries productrices de carbapénémases : utilisation d’inhibiteurs de la pompe à protons en plus du traitement antibiotique

Cheng VCC; Chen JHK; So SYC; Wong SCY; Chau PH; Wong LMW; et al. A novel risk factor associated with colonization by carbapenemase-producing Enterobacteriaceae: use of proton pump inhibitors in addition to antimicrobial treatment. Infection control and hospital epidemiology 2016/12; 37(12): 1418-1425.

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Mots-clés : ENTEROBACTERIE; COLONISATION; ANTIBIORESISTANCE; CARBAPENEME; HEPATO-GASTRO-ENTEROLOGIE; TRAITEMENT; ANTIBIOTIQUE; TECHNIQUE DE DIAGNOSTIC; EPC

Objective: To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs). Methods: We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction. Results: Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15-3.18], P=.013), presence of wound or drain (3.12 [1.70-5.71], P<.001), and use of cephalosporins (3.06 [1.42-6.59], P=.004), carbapenems (2.21 [1.10-4.48], P=.027), and PPIs (2.84 [1.72-4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3-411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17-0.73], P=.005). Conclusions: Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE. DOI: https://dx.doi.org/10.1017/ice.2016.202

NosoBase ID notice : 422274Combattre l'antibiorésistance : le rôle du personnel infirmier pour le bon usage des antibiotiques

Manning ML; Pfeiffer J; Larson EL. Combating antibiotic resistance: The role of nursing in antibiotic stewardship. American journal of infection control 2016/12; 44(12): 1454-1457.

Mots-clés : ANTIBIORESISTANCE; PERSONNEL; INFIRMIER; ANTIBIOTIQUE; ANTIBIOTHERAPIE; PREVENTION; ROLE PROPRE

Antibiotic resistance is one of the top infectious disease threats facing the world today. The escalating resistance to antibiotics has been named by the Centers for Disease Control and Prevention as one of the top 5 threats to health in the United States and has led to the development of the National Action Plan for Combating Antibiotic-Resistant Bacteria. The plan, released by the White House in March 2015, calls for the establishment of antibiotic stewardship programs in all acute care hospitals by 2020. For antibiotic stewardship programs to achieve optimal success they must include nursing's perspectives and the active participation of nurses and the nursing profession. Although clearly any successful efforts to address this complex problem must be comprehensive, sustained, and involve all sectors of the health care community and public, the aim of this article is to convey the immediate need for nurses and the nursing profession to actively engage in initiatives, strategies, and solutions to combat antibiotic resistance, and to recommend what stakeholders within the nursing profession might contribute to antibiotic stewardship.DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.023

NosoBase ID notice : 419476Réduire l'impact des Entérobactéries résistantes aux carbapénèmes sur les groupes des patients vulnérables : qu'est-ce qui peut être fait ?

Metan G; Akova M. Reducing the impact of carbapenem-resistant Enterobacteriaceae on vulnerable patient groups: what can be done? Current opinion in infectious diseases 2016/12; 29(6): 555-560.

Mots-clés : CARBAPENEME; MULTIRESISTANCE; ANTIBIORESISTANCE; ENTEROBACTERIE; KLEBSIELLA PNEUMONIAE; COLISTINE; ANTIBIOTHERAPIE; EPIDEMIOLOGIE; BETA-LACTAMASE A SPECTRE ELARGI; REVUE DE LA LITTERATURE; CARBAPENEMASE

Purpose of review: Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide challenge and associated with a high mortality rate in critically ill patients. This review focused on rapid diagnosis, optimization of antimicrobial therapy, and implication of effective infection control precautions to reduce impact of CRE on vulnerable patients.

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Recent findings: Several new diagnostic assays have recently been described for the early diagnosis of CRE. Retrospective studies are supportive for colistin plus meropenem combination for the treatment of CRE infections; however, solid evidence is still lacking. Ceftazidime-avibactam may be an effective therapeutic agent for infections caused by carbapenem-hydrolyzing oxacillinase-48 and Klebsiella pneumoniae carbapenamase-producing Enterobacteriaceae, but not for New Delhi metallo-β-lactamase producers. Gastrointestinal screening may permit early identification of patients with CRE infections. There is not enough evidence to recommend selective digestive decontamination for CRE carriers.Summary: The information for rapid diagnosis of CRE is accumulating. There are new agents with high in-vitro activity against CRE, but clinical experience is limited to case reports. Active surveillance with a high rate of compliance to basic infection control precautions seems to be the best approach to reduce the impact of CRE on vulnerable patients.DOI: https://dx.doi.org/10.1097/QCO.0000000000000313

NosoBase ID notice : 422076Epidémies de différentes souches de Klebsiella pneumoniae productrices de carbapénémase type KPC résistantes à la colistine et sensibles à la colistine dans une unité de soins intensifs au Brésil

Rossi Gonçalves I; Ferreira ML; Araujo PA; Campos S; Royer DW; Batistão LP; et al. Outbreaks of colistin-resistant and colistin-susceptible KPC-producing Klebsiella pneumoniae in a Brazilian intensive care unit. The journal of hospital infection 2016/12; 94(4): 322-329.

Mots-clés : KLEBSIELLA PNEUMONIAE; SOIN INTENSIF; EPIDEMIE; COLISTINE; ANTIBIORESISTANCE; SENSIBILITE; CARBAPENEME; SURVEILLANCE; PFGE; INFECTION NOSOCOMIALE

Background: Carbapenem-resistant Enterobacteriaceae (CRE), especially those that produce Klebsiella pneumoniae carbapenemase (KPC) and are associated with colistin resistance, pose a severe health threat due to the limited treatment options.Aim: To describe two outbreaks of KPC-producing K. pneumoniae in an adult intensive care unit (AICU) in Brazil. In May 2015, 14 patients had colistin-susceptible KPC-producing strains (ColS-KPC), and in July 2015, nine patients had colistin-resistant KPC-producing strains (ColR-KPC).Methods: Between September 2014 and August 2015, we performed surveillance at a university hospital and all CRE were tested for blaKPC genes. Clonality was investigated by pulsed-field gel electrophoresis. Resistance to colistin was confirmed by broth microdilution method. Consumption of carbapenems and colistin was expressed as defined daily doses.Findings: In all, 111 patients with CRE were identified during the surveillance period; K. pneumoniae was the major isolate (77.13%). The two outbreaks were identified when infection rates (KPC per 1000 patient-days) exceeded the background level. Rates of carbapenem and colistin consumption were high. Control measures (bedside alcohol gel, contact precautions, regular rectal swabs) did not curtail the outbreaks. Mortality rates were 42.9% and 44.4% for ColS-KPC- and ColR-KPC-infected patients, respectively. After the death of four infected patients with ColR-KPC, the unit was closed to new admissions.Conclusion: Our experience demonstrates the serious risks presented by KPC, and especially ColR-KPC, in Brazilian AICUs. Selective pressure from excessive antibiotic use and transmission on healthcare workers' hands were likely the major factors in transmission.DOI: https://dx.doi.org/10.1016/j.jhin.2016.08.019

Antiseptique

NosoBase ID notice : 422302Chlorehexidine plus efficace que tricolosan pour éviter la recolonisation de la peau

Macias JH; Alvarez MF; Arreguín V; Munoz JM; Macías AE; Álvarez JA. Chlorhexidine avoids skin bacteria recolonization more than triclosan. American journal of infection control 2016/12; 44(12): 1530-1534.

Mots-clés : CHLORHEXIDINE; TRICLOSAN; ANTISEPTIQUE; BIGUANIDE; PEAU; COLONISATION CUTANEE; EFFICACITE

Background: We do not know whether differences exist between the residual effect of 2% chlorhexidine in 70% isopropyl alcohol when compared with 1% triclosan in 70% isopropyl alcohol.Methods: Using an analytic, longitudinal, controlled, and comparative experimental trial, with blinded measurements, we recruited healthy, adult volunteers from the University of Guanajuato who completed a

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stabilization phase of skin microbiota and had no history of skin allergies. Four 25-cm2 areas of the inner surface of the forearms were designated for study: unscrubbed control for establishing baseline bacterial counts, scrubbed control with tridistilled water, scrubbed with chlorhexidine, and scrubbed with triclosan. Quantitative cultures were taken of all the areas at 0, 3, and 24 hours, using agar plates with neutralizing agents.Results: A total of 135 healthy volunteers were tested. At 24 hours, the unscrubbed control counts were 288 CFU/cm2, whereas the scrubbed control counts were 96 CFU/cm2; 24 CFU/cm2 for chlorhexidine and 96 CFU/cm2) for triclosan (Kruskal-Wallis χ2)H=64.27; P<.001).Conclusions: Chlorhexidine is the best antiseptic option when a prolonged antiseptic effect is needed; for instance, when implanting medical devices or performing surgical procedures.DOI: https://dx.doi.org/10.1016/j.ajic.2016.04.235

NosoBase ID notice : 422618Qu'y-a-t-il de nouveau dans l'antisepsie cutanée pour les cathéters intravasculaires à court terme : de nouvelles données pour traiter des vieux problèmes ?

Mimoz O; Chopra V; Widmer A. What's new in skin antisepsis for short-term intravascular catheters: new data to address old problems? Intensive care medicine 2016/12; 42(12): 2043-2045.

Mots-clés : CATHETER; CATHETERISME; INFECTION NOSOCOMIALE; ANTISEPSIE; PEAU; ANTISEPTIQUE; CHLORHEXIDINE; ALCOOL; ISOPROPANOL; PRATIQUE; COUT-EFFICACITE; EFFET INDESIRABLEDOI: https://dx.doi.org/10.1007/s00134-016-4490-5

Bactériémie

NosoBase ID notice : 422891Mortalité attribuable aux bactériémies nosocomiales en soins intensifs : impact de la source, micro-organismes responsables, profil de résistance et antibiothérapie

Adrie C; Garrouste-Orgéas M; Ibn Essaied W; Schwebel C; Darmon M; Mourvillier B; et al. Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. Journal of infection 2016/11/09; in press: 1-11.

Mots-clés : MORTALITE; SOIN INTENSIF; INFECTION NOSOCOMIALE; BACTERIEMIE; REANIMATION; DEPISTAGE ; ANTIBIORESISTANCE; ANTIBIOTIQUE; ANTIBIOTHERAPIE; ETUDE PROSPECTIVE; COHORTE

Objectives: ICU-acquired bloodstream infection (ICUBSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging.Methods: We analyzed 571 ICU-BSI occurring amongst 10,734 patients who were prospectively included in the Outcomerea Database and who stayed at least 4 days in ICU. The hazard ratio of death associated with ICU-BSI was estimated using a multivariate Cox model adjusted on case mix, patient severity and daily SOFA.Results: ICU-BSI was associated with increased mortality (HR, 1.40; 95% CI, 1.16-1.69; p=0.0004). The relative increase in the risk of death was 130% (HR, 2.3; 95% CI, 1.8-3.0) when initial antimicrobial agents within a day of ICU-BSI onset were not adequate, versus only 20% (HR, 1.2; 95% CI, 0.9-1.5) when an adequate therapy was started within a day. The adjusted hazard ratio of death was significant overall, and even higher when the ICU-BSI source was pneumonia or unknown origin. When treated with appropriate antimicrobial agents, the death risk increase was similar for ICU-BSI due to multidrug resistant pathogens or susceptible ones. Interestingly, combination therapy with a fluoroquinolone was associated with more favorable outcome than monotherapy, whereas combination with aminoglycoside was associated with similar mortality than monotherapy.Conclusions: ICU-BSI was associated with a 40% increase in the risk of 30-day mortality, particularly if the early antimicrobial therapy was not adequate. Adequacy of antimicrobial therapy, but not pathogen resistance pattern, impacted attributable mortality.DOI: https://dx.doi.org/10.1016/j.jinf.2016.11.001

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NosoBase ID notice : 422531Facteurs de risque de bactériémies sur voie centrale réanimation en néonatale : potentiel de prévention : une étude PICNIC (Pediatric Investigators Collaborating Network on Infections in Canada)

Dahan M; O'Donnell S; Hebert J; Gonzalez M; Lee B; Chandran AU; et al. CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. Infection control and hospital epidemiology 2016/12; 37(12): 1446-1452.

Mots-clés : BACTERIEMIE; CATHETER VEINEUX CENTRAL; INFECTION NOSOCOMIALE; FACTEUR DE RISQUE; SURVEILLANCE; NEONATOLOGIE; SOIN INTENSIF; ABDOMEN; MORTALITE

Objective: Central-line-associated bloodstream infections (CLABSI) are an important cause of morbidity and mortality in neonates. We aimed to determine whether intra-abdominal pathologies are an independent risk factor for CLABSI. Methods: We performed a retrospective matched case-control study of infants admitted to the neonatal intensive care units (NICUs) of the Montreal Children's Hospital (Montreal) and the Royal Alexandra Hospital, Edmonton, Canada. CLABSI cases that occurred between April 2009 and March 2014 were identified through local infection control databases. For each case, up to 3 controls were matched (National Healthcare Safety Network [NHSN] birth weight category, chronological age, and central venous catheter (CVC) dwell time at the time of CLABSI onset). Data were analyzed using conditional logistic regression. Results: We identified 120 cases and 293 controls. According to a matched univariate analysis, the following variables were significant risk factors for CLABSI: active intra-abdominal pathology (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.8-6.4), abdominal surgery in the prior 7 days (OR, 3.5; 95% CI, 1.0-10.9); male sex (OR, 1.7; 95% CI, 1.1-2.6) and ≥3 heel punctures (OR, 4.0; 95% CI, 1.9-8.3). According to a multivariate matched analysis, intra-abdominal pathology (OR, 5.9; 95% CI, 2.5-14.1), and ≥3 heel punctures (OR, 5.4; 95% CI, 2.4-12.2) remained independent risk factors for CLABSI. Conclusion: The presence of an active intra-abdominal pathology increased the risk of CLABSI by almost 6-fold. Similar to CLABSI in oncology patients, a subgroup of CLABSI with mucosal barrier injury should be considered for infants in the NICU with active intra-abdominal pathology. DOI: https://dx.doi.org/10.1017/ice.2016.203

NosoBase ID notice : 422097Bactériémies à Gram-négatives associées aux soins : résistance antibiotique et facteurs prédictifs de mortalité

Ergönül O; Aydin M; Azap A; Başaran S; Tekin S; Kaya S; et al. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. The journal of hospital infection 2016/12; 94(4): 381-385.

Mots-clés : ANTIBIORESISTANCE; BACTERIEMIE; MORTALITE; PREVALENCE; KLEBSIELLA PNEUMONIAE; CARBAPENEME; BACTERIE A GRAM NEGATIF; ACINETOBACTER BAUMANNII

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.DOI: https://dx.doi.org/10.1016/j.jhin.2016.08.012

NosoBase ID notice : 422714Faible observance aux recommandations pour la prévention des bactériémies sur voie centrale : résultats d'une enquête mondiale

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Valencia C; Hammami N; Agodi A; Lepape A; Herrejon EP; Blot S; et al. Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey. Antimicrobial resistance and infection control 2016/11/22; 5(49): 1-8.

Mots-clés : PREVENTION; CATHETER VEINEUX CENTRAL; INFECTION NOSOCOMIALE; BACTERIEMIE; PREVENTION; ENQUETE; SOIN INTENSIF; SURVEILLANCE; ATTITUDE; PRATIQUE; OBSERVANCE; ETUDE MULTICENTRIQUE

Background: Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines.Methods: Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates.Results: Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE=1.5) and 81% (HIC, SE=1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE=1.7) and 62% (HIC,SE=1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE=2.0) and 73% (HIC,SE=1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available.Conclusions: This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries. DOI: https://dx.doi.org/10.1186/s13756-016-0139-y

Cathétérisme

NosoBase ID notice : 422359Chlorehexidine 2 % et choix de pansement transparent augmentent les réactions cutanées aux sites d'insertion des cathéters veineux centraux

Loewenthal M; Dobson P; Boyle M. Chlorhexidine 2% and choice of transparent dressing increase skin reactions at central venous catheter insertion sites. American journal of infection control 2016/12; 44(12): 1712-1714.

Mots-clés : CHLORHEXIDINE; CATHETER VEINEUX CENTRAL; PANSEMENT; PEAU; EFFET INDESIRABLE

Infection at central venous catheter (CVC) sites remains a common problem, particularly with long-term use. This report discusses the influence of choice of transparent dressing type and chlorhexidine concentration on skin reactions at CVC insertion sites. A concentration of 2% chlorhexidine is associated with a higher rate of skin reactions than either 0.5% or 1% chlorhexidine. Higher chlorhexidine concentrations may not decrease the number of central line-associated bloodstream infections.DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.020

NosoBase ID notice : 422842Efficacité de deux régimes d’antisepsie sur la colonisation cutanée des sites d’insertion pour deux types de cathéters différents : essai clinique randomisé

Lutz JT; Diener IV; Freiberg K; Zillmann R; Shah-Hosseini K; Seifert H; et al. Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial . Infection 2016/12; 44(6): 707-712.

Mots-clés : COLONISATION; ANTISEPSIE; PEAU; CATHETERISME; CATHETER VEINEUX CENTRAL; CATHETER EPIDURAL; DESINFECTION; ALCOOL; ANTISEPTIQUE; BENZALKONIUM CHLORURE; BACTERIEMIE; PREVENTION; RANDOMISATION; EFFICACITE; OCTÉNIDINE

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Purpose: Catheter-related bloodstream infections affect patients in surgical and intensive care settings worldwide, causing complications, aggravation of existing symptoms and increased length of stay. The trial aimed at comparing two registered skin antiseptics with respect to their residual and therefore infection-preventing effects.Methods: In a parallel, monocentric, prospective, triple-blind, randomized trial the difference in bacterial recolonization of catheter skin sites in central venous (CVC) and epidural catheters (EC) was investigated by comparing two alcoholic-based skin disinfectants. Patients receiving planned surgeries or intensive care were eligible for the trial. Those in the trial group received skin disinfection with the additive octenidine dihydrochloride (OCT) (n=51), those in the control group were treated with benzalkonium chloride as additive (BAC) (n=59) prior to catheter insertion. Randomization was carried out by assigning patients to groups week-wise. Endpoints of the investigation were skin colonization of the catheter site counted in colony forming units per swab at three time points: (1) prior to catheter insertion, on untreated skin; (2) directly after catheter insertion, prior to sterile coverage; (3) 48 h after catheter insertion. The hypothesis was tested by a Wilcoxon test with a two-sided alpha=5%.Results: From second to third swab, recolonization of the catheter-surrounding skin was significantly lower in the trial group for both sorts of catheters: delta 2-3 OCT group: 0.72 (95% CI: 0.42; 1.02); delta 2-3 BAC group: 1.97 (95% CI: 1.45; 2.50); p<0.001. None of the patients enrolled developed a catheter-related blood stream infection (CRBSI) during follow-up.Conclusions: Previous studies have shown that skin colonization is strongly associated with the occurrence of CRBSI. This randomized controlled trial supports the observations made in previous trials that octenidine dihydrochloride in disinfectants is more effective than agents containing other additives with regard to skin recolonization surrounding CVC and EC insertion sites. Therefore, it is likely to also reduce the risk of CRBSI in these patient groups. The trial was approved by the North Rhine Medical Association in July 2014 (application-no.: 2014222). DOI: https://dx.doi.org/10.1007/s15010-016-0899-6

NosoBase ID notice : 422616Qu'y a-t-il de nouveau dans la prévention des infections liées aux cathéters : préparation (détersion) cutanée et antisepsie cutanée

Mimoz O; Chopra V; Timsit JF. What's new in catheter-related infection: skin cleansing and skin antisepsis. Intensive care medicine 2016/11; 42(11): 1784-1786.

Mots-clés : CATHETER; PREVENTION ; INFECTION NOSOCOMIALE; PEAU; ANTISEPSIE; CHLORHEXIDINE; ISOPROPANOL; POLYVIDONE IODEE; ETHANOL; ANTISEPTIQUEDOI: https://dx.doi.org/10.1007/s00134-016-4244-4

NosoBase ID notice : 421580Prévention des infections associées aux cathéters vasculaires

Rupp ME; Majorant D. Prevention of Vascular Catheter-Related Bloodstream Infections. Infectious disease clinics of North America 2016/12; 30(4): 853-868.

Mots-clés : PREVENTION; CATHETER; BACTERIEMIE; CATHETER VEINEUX CENTRAL; INTERVENTION; FORMATION ; CATHETER IMPREGNE; PEAU; DESINFECTION; CHLORHEXIDINE; PANSEMENT; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE; BUNDLE; SOLUTION VERROU DU CATHETER

Catheter-related bloodstream infections (CRBSI) are responsible for significant morbidity, mortality, and excess health care costs. It is increasingly evident that many CRBSI can be prevented with current knowledge and techniques. Preventive measures can be broadly grouped into clinical practice-based interventions and technologic innovations. Clinical practice-based interventions require changes in human behavior and can be subdivided into interventions before and at the time of insertion and postinsertion. Despite recent successes with prevention of CRBSI, pertinent questions regarding pathogenesis and prevention remain unanswered and work on improved surveillance, devices less prone to infection, and more effective prevention techniques are needed.DOI: https://dx.doi.org/10.1016/j.idc.2016.07.001

Clostridium difficile

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NosoBase ID notice : 421588Prévention des infections à Clostridium difficile

Cooper CC; Jump RLP; Chopra T. Prevention of Infection Due to Clostridium difficile. Infectious disease clinics of North America 2016/12; 30(4): 999-1012.

Mots-clés : PREVENTION; CLOSTRIDIUM DIFFICILE; LAVAGE DES MAINS; HYGIENE DES MAINS; PRECAUTION CONTACT; DECONTAMINATION; ENVIRONNEMENT; CHLORE; ANTIBIOTIQUE; PRESCRIPTION; INHIBITEUR DE LA POMPE A PROTONS; PROBIOTIQUE; VACCIN; REVUE DE LA LITTERATURE

C difficile remains a significant problem in the health care setting. Successful prevention efforts typically require a multifaceted bundled approach. A combination of decreased antibiotic use, strict hand hygiene, isolation precautions, and effective environmental decontamination is required, and these can all result in considerable reductions in CDI rates. However, further research is required to develop long-term preventative interventions and efficiently implement current approaches to CDI prevention outside of the acute care setting.DOI: https://dx.doi.org/10.1016/j.idc.2016.07.005

NosoBase ID notice : 422514Tests de détection de Clostridium difficile inappropriés entraînant des sur-traitements et des publications de résultats inexacts

Kelly SG; Yarrington M; Zembower TR; Sutton SH; Silkaitis C; Postelnick M; et al. Inappropriate Clostridium difficile testing and consequent overtreatment and inaccurate publicly reported metrics. Infection control and hospital epidemiology 2016/12; 37(12): 1395-1400.

Mots-clés : CLOSTRIDIUM DIFFICILE; DIARRHEE; TECHNIQUE DE DIAGNOSTIC; SELLES; PCR; INFECTION NOSOCOMIALE; COLONISATION; SURVEILLANCE; ETUDE RETROSPECTIVE

Background: The nationally reported metric for Clostridium difficile infection (CDI) relies solely on laboratory testing, which can result in overreporting due to asymptomatic C. difficile colonization. Objective: To review the clinical scenarios of cases of healthcare facility-onset CDI (HO-CDI) and to determine the appropriateness of C. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement. Design: Retrospective cohort study. Setting: Northwestern Memorial Hospital, a large, tertiary academic hospital in Chicago, Illinois. Patients: The cohort included all patients with a positive C. difficile test result who were reported to the National Healthcare Safety Network as HO-CDI during a 1-year study period. Methods: We reviewed the clinical scenario of each HO-CDI case. On the basis of documentation and predefined criteria, appropriateness of C. difficile testing was determined; cases were deemed appropriate, inappropriate, or indeterminate. Statistical analysis was performed to compare demographic and clinical parameters among the categories of testing appropriateness. Results: Our facility reported 168 HO-CDI cases to NHSN during the study period. Of 168 cases, 33 (19.6%) were judged to be appropriate tests, 25 (14.8%) were considered inappropriate, and 110 (65.5%) were indeterminate. Elimination of inappropriate testing would have improved our facility's standardized infection ratio from 0.962 to 0.819. Conclusion: Approximately 15% of HO-CDI cases were judged to be tested inappropriately. Testing only patients with clinically significant diarrhea would more accurately estimate CDI incidence, reduce unnecessary antibiotic use, and improve facilities' performance of reportable CDI metrics. Improved documentation could facilitate targeted interventions. DOI: https://dx.doi.org/10.1017/ice.2016.210

NosoBase ID notice : 422515Évaluation de la nourriture comme source potentielle d’acquisition de Clostridium difficile chez des patients hospitalisés

Kwon JH; Lanzas C; Reske KA; Hink T; Seiler SM; Bommarito KM; et al. An evaluation of food as a potential source for Clostridium difficile acquisition in hospitalized patients. Infection control and hospital epidemiology 2016/12; 37(12): 1401-1407.

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Mots-clés : CLOSTRIDIUM DIFFICILE; ALIMENT; RESTAURATION HOSPITALIERE; CONTAMINATION; COLONISATION; PRELEVEMENT; ADMISSION; ETUDE PROSPECTIVE

Objective: To determine whether Clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with C. difficile in food. Methods: This was a prospective cohort study of inpatients at a university-affiliated tertiary care center, May 9, 2011-July 12, 2012. Enrolled patients submitted a portion of food from each meal. Patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at discharge, and were cultured for C. difficile. Clinical data were reviewed for evidence of infection due to C. difficile. A stochastic, discrete event model was developed to predict exposure to C. difficile from food, and the estimated number of new colonization events from food exposures per 1,000 admissions was determined. Results: A total of 149 patients were enrolled and 910 food specimens were obtained. Two food specimens from 2 patients were positive for C. difficile (0.2% of food samples; 1.3% of patients). Neither of the 2 patients was colonized at baseline with C. difficile. Discharge colonization status was available for 1 of the 2 patients and was negative. Neither was diagnosed with C. difficile infection while hospitalized or during the year before or after study enrollment. Stochastic modeling indicated contaminated hospital food would be responsible for less than 1 newly colonized patient per 1,000 hospital admissions. Conclusions: The recovery of C. difficile from the food of hospitalized patients was rare. Modeling suggests hospital food is unlikely to be a source of C. difficile acquisition.DOI: https://dx.doi.org/10.1017/ice.2016.218

Désinfection

NosoBase ID notice : 423387Arrêté du 13 décembre 2016 modifiant l’arrêté du 25 mars 1992 relatif aux conditions que doivent remplir les procédés et appareils destinés à la désinfection obligatoire

Ministère des affaires sociales et de la santé. Arrêté du 13 décembre 2016 modifiant l’arrêté du 25 mars 1992 relatif aux conditions que doivent remplir les procédés et appareils destinés à la désinfection obligatoire . Journal officiel de la République française Lois et décrets 2016/12/16: 2 pages.

Mots-clés : LEGISLATION; DESINFECTION PAR VOIE AERIENNE; DESINFECTION; SURFACE; NORME; BACTERICIDIE; FONGICIDIE; LEVURICIDIE; MYCOBACTERIE; SPORICIDIE; VIRUCIDIE; BACTERIOPHAGE

NosoBase ID notice : 422352Efficacité d'un dispositif à rayonnement ultra-violet C dans une salle de bain commune hospitalière

Coope J; Bryce E; Astrakianakis G; Stefanovic A; Bartlett K. Efficacy of an automated ultraviolet C device in a shared hospital bathroom. American journal of infection control 2016/12; 44(12): 1692-1694.

Mots-clés : SANITAIRE; WC; ULTRA-VIOLET; DESINFECTION; CHAMBRE DU MALADE; ENVIRONNEMENT; SURFACE; AEROSOL; AEROBIOCONTAMINATION; EFFICACITE

Toilet flushing can contribute to disease transmission by generating aerosolized bacteria and viruses that can land on nearby surfaces or follow air currents. Aerobic and anaerobic bacterial bioaerosol loads, and bacterial counts on 2 surfaces in a bathroom with a permanently installed, automated ultraviolet C (UVC) irradiation device, were significantly lower than in a comparable bathroom without the UVC device. Permanently installed UVC lights may be a useful supplementary decontamination tool in shared patient bathrooms.DOI: https://dx.doi.org/10.1016/j.ajic.2016.07.004

NosoBase ID notice : 422316Evaluation d'un dispositif de rayonnement ultra-violet C pour la désinfection des dispositifs électroniques portables

Li LM; Wong T; Rose E; Wickham G; Bryce E. Evaluation of an ultraviolet C light-emitting device for disinfection of electronic devices. American journal of infection control 2016/12; 44(12): 1554-1557.

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Mots-clés : DESINFECTION; ULTRA-VIOLET; ORDINATEUR; INFORMATION; SURFACE; TEST; STAPHYLOCOCCUS AUREUS ; METICILLINO-RESISTANCE; PSEUDOMONAS AERUGINOSA; ACINETOBACTER; EQUIPEMENT

Background: A tabletop-type ultraviolet C (UVC) light-emitting disinfecting device was evaluated for microbiologic effectiveness, safety, usability, and end-user satisfaction.Methods: Three different inoculums of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex strains suspended in both saline and trypticase soy broth were applied onto stainless steel carriers and electronic device surfaces in triplicate and cultured for growth after UVC disinfection. Assessments of functionality and usability were performed by biomedical and human factors engineers. End-user feedback was captured using a standardized in-use survey.Results: The 54 stainless steel carriers displayed growth at inoculums as low as 102 colony forming units (CFU) when a quartz dish supplied by the manufacturer was used during UVC exposure. Without the quartz dish, 54 electronic device surfaces displayed no growth for inoculums from 102-104 CFU for all organisms suspended in saline, but lower kill rates (95.7%-100%) for organisms in broth. Several minor safety and usability issues were identified prior to clinical evaluation. In-use evaluation revealed keen user endorsement; however, suboptimal sensitivity of the machine's input sensors during sequential object insertion precluded implementation.Conclusions: Optimization of some safety and functionality parameters would improve a conceptually popular and microbiologically effective tabletop UVC disinfecting device. DOI: https://dx.doi.org/10.1016/j.ajic.2016.07.028

Ebola

NosoBase ID notice : 422343Maladie à virus Ebola et les médias sociaux : une revue systématique

Fung ICH; Duke CH; Finch KC; Snook KR; Tseng PL; Hernandez AC; et al. Ebola virus disease and social media: A systematic review. American journal of infection control 2016/12; 44(12): 1660-1671.

Mots-clés : SANTE PUBLIQUE; FIEVRE HEMORRAGIQUE; ARBOVIRUS; VIRUS; INTERNET; RESEAU NUMERIQUE; SURVEILLANCE; COMMUNICATION; CIRCULATION DE L'INFORMATION; USAGER DE LA SANTE; REVUE DE LA LITTERATURE; EBOLA

Objectives: We systematically reviewed existing research pertinent to Ebola virus disease and social media, especially to identify the research questions and the methods used to collect and analyze social media.Methods: We searched 6 databases for research articles pertinent to Ebola virus disease and social media. We extracted the data using a standardized form. We evaluated the quality of the included articles.Results: Twelve articles were included in the main analysis: 7 from Twitter with 1 also including Weibo, 1 from Facebook, 3 from YouTube, and 1 from Instagram and Flickr. All the studies were cross-sectional. Eleven of the 12 articles studied ≥ 1of these 3 elements of social media and their relationships: themes or topics of social media contents, meta-data of social media posts (such as frequency of original posts and reposts, and impressions) and characteristics of the social media accounts that made these posts (such as whether they are individuals or institutions). One article studied how news videos influenced Twitter traffic. Twitter content analysis methods included text mining (n=3) and manual coding (n=1). Two studies involved mathematical modeling. All 3 YouTube studies and the Instagram/Flickr study used manual coding of videos and images, respectively.Conclusions: Published Ebola virus disease-related social media research focused on Twitter and YouTube. The utility of social media research to public health practitioners is warranted.DOI: https://dx.doi.org/10.1016/j.ajic.2016.05.011

NosoBase ID notice : 422903Emergence de la maladie à virus Ebola dans un établissement de soins aigus français : étude de simulation basée sur des contacts inter-individuels documentés

Vanhems P; Von Raesfeldt R; Ecochard R; Voirin N. Emergence of Ebola virus disease in a french acute care setting: a simulation study based on documented inter-individual contacts. Scientific reports 2016/11/09; 6: 1-7.

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Mots-clés : VIRUS; ARBOVIRUS; FIEVRE HEMORRAGIQUE; MODELISATION; GESTION DES RISQUES; RISQUE PROFESSIONNEL; PERSONNEL; TRANSMISSION; EPIDEMIOLOGIE; EBOLA

The potential spread of nosocomial Ebola virus disease (EVD) in non-outbreak areas is not known. The objective was to use detailed contact data on patients and healthcare workers (HCW) to estimate emergence probability and secondary incident cases (SIC) of EVD after hospitalization of an index case with undetected EVD. Contact data were collected through RFID devices used by patients and HCW during hospital care. A "susceptible-exposed-infected" model was used. Emergence probability, ranged from 7% to 84%. A plateau around 84% was observed. Emergence probability was proportional to time exposed to the dry phase of patients with nonspecific symptoms. Nurses were at higher risk of nosocomial EVD than physicians with around 60% emergence probability in this subgroup. The risk of nosocomial EVD in non-outbreak areas might be substantial if no preventive measures are implemented when asymptomatic patients or those with mild symptoms are hospitalized. DOI: https://dx.doi.org/10.1038/srep36301

EHPAD

NosoBase ID notice : 423379Entérobactéries productrices de carbapénémases et autres bacilles Gram négatif multirésistants : mesures intérimaires de prévention et de contrôle pour les milieux d’hébergement et de soins de longue durée

Institut national de santé publique Québec (INSPQ). Entérobactéries productrices de carbapénémases et autres bacilles Gram négatif multirésistants : mesures intérimaires de prévention et de contrôle pour les milieux d’hébergement et de soins de longue durée. INSPQ 2016/11: 1-11.

Mots-clés : ENTEROBACTERIE; ANTIBIORESISTANCE; MULTIRESISTANCE; CARBAPENEME; BACILLE GRAM NEGATIF; PREVENTION; SOIN DE LONGUE DUREE; EHPAD; EPIDEMIOLOGIE; PRECAUTION COMPLEMENTAIRE; DESINFECTION; DEPISTAGE

En 2010, le Comité sur les infections nosocomiales du Québec (CINQ) publiait des lignes directrices pour la prévention et le contrôle de la transmission des entérobactéries productrices de carbapénémases, puis plus récemment en 2015, les mesures pour la prévention et le contrôle de la transmission des bacilles Gram négatif multirésistants (BGNMR) en milieux de soins aigus.L’application de mesures de prévention et contrôle des infections (PCI) dans les milieux d’hébergement et de soins de longue durée (CHSLD) doit être adaptée aux caractéristiques propres à ces milieux, ainsi qu’à la clientèle qui y est hébergée. L’objectif de ce document est de présenter aux intervenants en PCI des centres d’hébergement et de soins de longue durée (CHSLD) et aux cliniciens qui y pratiquent, des informations actualisées et orientées pour ces milieux spécifiques.L’orientation principale retenue pour les mesures de PCI en CHSLD est de prévenir la transmission des cas d’entérobactéries productrices de carbapénémases (EPC) à l’intérieur de ces milieux afin d’éviter que ces centres ne deviennent un réservoir et augmentent ainsi le risque de transmission en soins de courte durée lors de transferts.

NosoBase ID notice : 422540Prévalence et facteurs de risque associés à la colonisation par des bactéries multirésistantes dans 3 maisons de retraite

McKinnell JA; Miller LG; Singh R; Kleinman K; Peterson EM; Evans KD; et al. Prevalence of and factors associated with multidrug resistant organism (MDRO) colonization in 3 nursing homes. Infection control and hospital epidemiology 2016/12; 37(12): 1485-1488.

Mots-clés : MULTIRESISTANCE; MAISON DE RETRAITE; GERIATRIE; COLONISATION; PREVALENCE; INFECTION NOSOCOMIALE; TRANSMISSION; SARM; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; ENTEROCOCCUS; ANTIBIORESISTANCE; VANCOMYCINE; CARBAPENEME; SOIN INFIRMIER; DISPOSITIF MEDICAL; FACTEUR DE RISQUE

Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase-producing

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Enterobacteriaceae (ESBL, 17%); vancomycin-resistant Enterococcus spp. (VRE, 16%); carbapenem-resistant Enterobacteriaceae (CRE, 1%). MDRO colonization was associated with history of MDRO, care needs, incontinence, and catheters.DOI: https://dx.doi.org/10.1017/ice.2016.215

Endoscopie

NosoBase ID notice : 422806Complications infectieuses en endoscopie digestive et comment les prévenir

Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Practice & Research Clinical Gastroenterology 2016/10; 30(5): 689-704.

Mots-clés : ENDOSCOPIE; ENDOSCOPIE DIGESTIVE; TRANSMISSION; INFECTION CROISEE; EPIDEMIE; DESINFECTION; STERILISATION; BIOFILM; ENTEROBACTERIE; PSEUDOMONAS AERUGINOSA; REVUE DE LA LITTERATURE; RECOMMANDATIONS DE BONNE PRATIQUE

Gastrointestinal endoscopes are medical devices that have been associated with outbreaks of health care-associated infections. Because of the severity and limited treatment options of infections caused by multidrug-resistant Enterobacteriaceae and Pseudomonas aeruginosa, considerable attention has been paid to detection and prevention of these post-endoscopic outbreaks. Endoscope reprocessing involves cleaning, high-level disinfection/sterilization followed by rinsing and drying before storage. Failure of the decontamination process implies the risk of settlement of biofilm producing species in endoscope channels. This review covers the infectious complications in gastrointestinal endoscopy and their prevention and highlights the problem of infection risk associated with different steps of endoscope reprocessing. DOI: https://dx.doi.org/10.1016/j.bpg.2016.09.008

Environnement

NosoBase ID notice : 423383Arrêté du 27 décembre 2016 portant agrément d’un éco-organisme de la filière des déchets d’activités de soins à risques infectieux (DASRI) perforants, produits par les patients en autotraitement ou par les utilisateurs des autotests de diagnostic en application des articles L. 4211-2-1 et R. 1335-8-7 à R. 1335-8-11 du code de la santé publique et de l’article L. 541-10 du code de l’environnement

Ministère de l'environnement, de l'énergie et de la mer, en charge des relations internationales sur le climat . Arrêté du 27 décembre 2016 portant agrément d’un éco-organisme de la filière des déchets d’activités de soins à risques infectieux (DASRI) perforants, produits par les patients en autotraitement ou par les utilisateurs des autotests de diagnostic en application des articles L. 4211-2-1 et R. 1335-8-7 à R. 1335-8-11 du code de la santé publique et de l’article L. 541-10 du code de l’environnement . Journal officiel de la République française Lois et décrets 2016/12/30: 2 pages.

Mots-clés : LEGISLATION; DECHET D'ACTIVITE DE SOINS A RISQUE INFECTIEUX; PIQUANT PERFORANT; GESTION DES DECHETS; CAHIER DES CHARGES

Selon le principe de la responsabilité élargie des producteurs (REP), la gestion des DASRI perforants, utilisés par les patients en autotraitement ou issus des autotests de diagnostic doit être assurée par les exploitants ou importateurs de médicaments, les fabricants ou leurs mandataires, distributeurs ou importateurs de dispositifs médicaux et de dispositifs médicaux de diagnostic in vitro. Pour remplir leurs obligations, ces derniers doivent mettre en place un système individuel approuvé ou adhérer à un éco-organisme titulaire d’un agrément. Ce dispositif a pour vocation d’optimiser la gestion de ces déchets, mais aussi de prévenir la production des déchets et, en amont de cette gestion, favoriser l’écoconception des produits mis à disposition des patients en autotraitement et des utilisateurs d’autotest de diagnostic.

NosoBase ID notice : 423020Limiter le risque infectieux associé aux claviers et ordinateurs en secteurs de soins

SF2H; Baron R; Chaize P; Girard R; Leroy MG; Meunier O; Simon L. Limiter le risque infectieux associé aux claviers et ordinateurs en secteurs de soins. Hygiènes 2016/12; 24(6): 301-307.

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Mots-clés : RECOMMANDATIONS DE BONNE PRATIQUE; ORDINATEUR; CONTAMINATION; BACTERIE; VIRUS; LEVURE; TRANSMISSION; DESINFECTION; NETTOYAGE; HYGIENE DES MAINS; CLAVIER

Les matériels informatiques et notamment les ordinateurs sont présents dans tous les services cliniques et les plateaux techniques des établissements de santé. Les équipes opérationnelles d’hygiène (EOH) sont interrogées sur les risques infectieux associés à ces ordinateurs et sur la nécessité de les désinfecter. La majorité de ces ordinateurs ne sont pas des dispositifs médicaux et n’ont pas été conçus pour être nettoyés ou désinfectés. Or, ces objets de la vie courante sont au contact des patients soit directement, soit par l’intermédiaire des mains des soignants. Les EOH doivent, le cas échéant, proposer des procédures de nettoyage et désinfection. Ces procédures doivent prendre en compte la fragilité des matériels, claviers, écrans, souris, etc., afin de minimiser les risques de détérioration. Après avoir réalisé la revue de la littérature, le groupe de travail fait des propositions pour diminuer la charge microbienne des claviers et des autres périphériques d’ordinateurs. Les utilisateurs et acheteurs des dispositifs médicaux intégrant des périphériques informatiques peuvent s’inspirer de ce document.

NosoBase ID notice : 422357Réduction de la contamination bactérienne des textiles hopitaliers par un nouveau traitement à la lessive à base d'argent

Openshaw JJ; Morris WM; Lowry GV; Nazmi A. Reduction in bacterial contamination of hospital textiles by a novel silver-based laundry treatment. American journal of infection control 2016/12; 44(12): 1705-1708.

Mots-clés : PREVENTION; LINGE; MATERIAU; TEST; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; BACTERICIDIE; HYGIENE HOSPITALIERE; ARGENT

Treating hospital patient textiles with ionic silver after each washing results in a significant decrease in microbial contamination. Although further study is needed to better understand the role textiles play in hospital-acquired infections and to quantify the influence of silver textile treatment on health care-associated infection risk and patient outcomes, ionic silver treatment of textiles may prove useful in hospital-acquired infection reduction strategies.DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.021

NosoBase ID notice : 422322Nettoyage des zones grises des hôpitaux : étude interventionnelle croisée en prospective

Semret M; Dyachenko A; Ramman-Haddad L; Belzile E; McCusker J. Cleaning the grey zones of hospitals: A prospective, crossover, interventional study. American journal of infection control 2016/12; 44(12): 1582-1588.

Mots-clés : NETTOYAGE; ENVIRONNEMENT; SURFACE; PREVENTION; TRANSMISSION; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; CLOSTRIDIUM DIFFICILE; EQUIPEMENT; HYGIENE HOSPITALIERE

Background: Environmental cleaning is a fundamental principle of infection prevention in hospitals, but its role in reducing transmission of health care-acquired pathogens has been difficult to prove experimentally. In this study we analyze the influence of cleaning previously uncleaned patient care items, grey zones (GZ), on health care-acquired transmission rates.Methods: The intervention consisted of specific GZ cleaning by an extra cleaner (in addition to routine cleaning) on 2 structurally different acute care medical wards for a period of 6 months each, in a crossover design. Data on health care-acquired transmissions of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus, and Clostridium difficile were collected during both periods. Adjusted incidence rate ratios (IRRs) using Poisson regression were calculated to compare transmission of pathogens between both periods on both wards.Results: During the intervention VRE transmission was significantly decreased (2-fold) on the ward where patients had fewer roommates; cleaning of GZ did not have any effect on the ward with multiple-occupancy rooms. There was no impact on methicillin-resistant S aureus transmission and only a nonsignificant decrease in transmission of C difficile.Conclusions: Our data provide evidence that targeted cleaning interventions can reduce VRE transmission when rooming conditions are optimized; such interventions can be cost-effective when the burden of VRE is

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significant. Enhanced cleaning interventions are less beneficial in the context of room sharing where many other factors contribute to transmission of pathogens.DOI: https://dx.doi.org/10.1016/j.ajic.2016.04.234

NosoBase ID notice : 422520Évaluation de la charge microbienne totale des micro-organismes multirésistants présents sur les surfaces de l’environnement en établissements de santé

Shams AM; Rose LJ; Edwards JR; Cali S; Harris AD; Jacob JT; et al. Assessment of the overall and multidrug-resistant organism bioburden on environmental surfaces in healthcare facilities. Infection control and hospital epidemiology 2016/12; 37(12): 1426-1432.

Mots-clés : MULTIRESISTANCE; MICROORGANISME; SURFACE; CHAMBRE DU MALADE; PRELEVEMENT; BIONETTOYAGE; DESINFECTION; ENVIRONNEMENT; INFECTION NOSOCOMIALE; ETUDE PROSPECTIVE

Objective: To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. Design: Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). Setting: MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. Participants: Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms).Methods: Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room. Composite 1 included the TV remote, telephone, call button, and bed rails. Composite 2 included the room door handle, IV pole, and overbed table. Composite 3 included toileting surfaces. Total bacteria and MDROs (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci [VRE], Acinetobacter baumannii, Klebsiella pneumoniae, and C. difficile) were quantified, confirmed, and tested for drug resistance. Results: The mean microbial bioburden and range from routine cleaned room composites were higher (2,700 colony-forming units [CFU]/100 cm2; ≤1-130,000 CFU/100 cm2) than from terminal cleaned room composites (353 CFU/100 cm2; ≤1-4,300 CFU/100 cm2). MDROs were recovered from 34% of routine cleaned room composites (range ≤1-13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (≤1-524 CFU/100 cm2). MDROs were recovered from 40% of rooms; VRE was the most common (19%). Conclusions: This multicenter bioburden summary provides a first step to determining microbial bioburden on healthcare surfaces, which may help provide a basis for developing standards to evaluate cleaning and disinfection as well as a framework for studies using an evidentiary hierarchy for environmental infection control. DOI: https://dx.doi.org/10.1017/ice.2016.198

NosoBase ID notice : 422318Réduction des infections nosocomiales dans un hôpital communautaire de soins aigus en utilisant une combinaison de linge et de surfaces composites auto-désinfectantes imprégnées de cuivre

Sifri CD; Burke GH; Enfield KB. Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. American journal of infection control 2016/12; 44(12): 1565-1571.

Mots-clés : DESINFECTION; MATERIAU; CUIVRE; ENVIRONNEMENT; SURFACE; LINGE; PREVENTION; INFECTION NOSOCOMIALE; CLOSTRIDIUM DIFFICILE; EFFICACITE; HYGIENE HOSPITALIERE

Background: The purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (HAIs).Methods: We performed a quasiexperimental study with a control group, assessing development of HAIs due to multidrug resistant organisms (MDROs) and Clostridium difficile in the acute care units of a community hospital following the replacement of a 1970s-era clinical wing with a new wing outfitted with copper-impregnated composite hard surfaces and linens.Results: The study was conducted over a 25.5-month time period that included a 3.5-month washout period. HAI rates obtained from the copper-containing new hospital wing (14,479 patient-days; 72 beds) and the unmodified hospital wing (19,177 patient-days) were compared with those from the baseline period (46,391

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patient-days). The new wing had 78% (P=.023) fewer HAIs due to MDROs or C difficile, 83% (P=.048) fewer cases of C difficile infection, and 68% (P=.252) fewer infections due to MDROs relative to the baseline period. No changes in rates of HAI were observed in the unmodified hospital wing.Conclusions: Copper-impregnated composite hard surfaces and linens may be useful technologies to prevent HAIs in acute care hospital settings. Additional studies are needed to determine whether reduced HAIs can be attributed to the use of copper-containing antimicrobial hard and soft surfaces. DOI: https://dx.doi.org/10.1016/j.ajic.2016.07.007

Epidémie

NosoBase ID notice : 422083Première épidémie nosocomiale d'Enterococcus raffinosus résistant à la vancomycine type vanA en France

Jolivet S; Fines-Guyon M; Nebbad B; Merle JC; Le Pluart D; Brun-Buisson C; et al. First nosocomial outbreak of vanA-type vancomycin-resistant Enterococcus raffinosus in France. The journal of hospital infection 2016/12; 94(4): 346-350.

Mots-clés : ENTEROCOCCUS; INFECTION NOSOCOMIALE; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE; SOIN INTENSIF; INVESTIGATION; EPIDEMIE; PCR; SURVEILLANCE; MICROBIOLOGIE; CONTROLE; ENTEROCOCCUS RAFFINOSUS

Background: Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks.Aim: To report the successful control of a nosocomial outbreak of vanA-type vancomycin-resistant E. raffinosus in a surgical intensive care unit.Methods: The investigation of the outbreak is reported with control measures taken. Molecular typing of vancomycin-resistant E. raffinosus isolates was performed by repetitive sequence-based polymerase chain reaction (PCR).Findings: Between September and October 2014, vancomycin-resistant E. raffinosus isolates were isolated from four patients. The index patient had been hospitalized previously in Portugal, and was not found to be colonized by vancomycin-resistant enterococci on screening cultures obtained at admission. However, vancomycin-resistant E. raffinosus was isolated from a bile sample 19 days after hospital admission. All four isolates were resistant to both vancomycin and teicoplanin due to the presence of the vanA gene, while remaining susceptible to daptomycin and linezolid. Repetitive sequence-based PCR confirmed the spread of a single vanA-positive E. raffinosus clone. Infection control measures including direct PCR screening on rectal specimens, contact precautions, and cohorting of patients and personnel led to successful control of the outbreak.Conclusion: This is the first reported outbreak of vanA-type vancomycin-resistant E. raffinosus in France in both clinical and screening specimens among hospitalized patients. The inability of routine selective screening media to detect the vancomycin-resistant E. raffinosus in the index case likely contributed to the outbreak.DOI: https://dx.doi.org/10.1016/j.jhin.2016.09.004

NosoBase ID notice : 422078Barrières à l'investigation et à la notification des épidémies nosocomiales aux autorités sanitaires de Sâo-Paulo, Brésil : une approche mixte

Maciel ALP; de Carvalho BA; Timmons S; Padoveze MC. Barriers to investigating and reporting nosocomial outbreaks to health authorities in São Paulo, Brazil: a mixed methods approach. The journal of hospital infection 2016/12; 94(4): 330-337.

Mots-clés : INVESTIGATION; INFECTION NOSOCOMIALE; EPIDEMIE; SURVEILLANCE; EOH; PERCEPTION

Background: Not all nosocomial outbreaks (NOs) are reported to health authorities (HAs).Aim: To identify barriers to investigating and reporting NOs to HAs.Methods: A mixed methods approach was performed with a convergent parallel design. The quantitative and qualitative branches of the study were a statewide (electronic) survey and focus groups (FGs), respectively. Infection control practitioners (ICPs) working in the State of São Paulo, Brazil were recruited.Findings: Eighty-five ICPs were enrolled in the survey and 22 ICPs were enrolled in the FGs. Barriers to investigating and reporting NOs included: (i) difficulty in translating outbreak investigation knowledge into

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practice; (ii) weak planning in outbreak investigation process; (iii) organizational culture and context; (iv) lack of awareness about reporting; and (v) lack of autonomy of ICPs to report outbreaks to HAs.Conclusion: HAs could overcome these barriers by revising their strategies to work with healthcare services, as well as delivering translational educational programmes to support improvement in knowledge and skills for NO investigation. DOI: https://dx.doi.org/10.1016/j.jhin.2016.06.022

NosoBase ID notice : 423444Investigation de cas groupés à Elizabethkingia anophelis - Illinois, 2014-2016

Navon L; Clegg WJ; Morgan J; Austin C; McQuiston JR; Blaney DD; et al. Investigation of Elizabethkingia anophelis Cluster - Illinois, 2014–2016. MMWR Morbidity and mortality weekly report 2016/12/09; 65(48): 1380-1381.

Mots-clés : BACILLE GRAM NEGATIF; INVESTIGATION; EPIDEMIE; INFECTION RESPIRATOIRE BASSE; BIOLOGIE MOLECULAIRE; FACTEUR DE RISQUEDOI: https://dx.doi.org/10.15585/mmwr.mm6548a6

NosoBase ID notice : 422087Une épidémie irlandaise d'Enterobactéries productrices de carbapénémase New Delhi métallo-bêta-lactamases (NDM)-1 : prévalence croissante mais non reconnue

O'Connor C; Cormican M; Boo TW; McGrath E; Slevin B; O'Gorman A; et al. An Irish outbreak of New Delhi metallo-β-lactamase (NDM)-1 carbapenemase-producing Enterobacteriaceae: increasing but unrecognized prevalence. The journal of hospital infection 2016/12; 94(4): 351-357.

Mots-clés : PREVALENCE; ENTEROBACTERIE; CARBAPENEME; EPIDEMIE; INFECTION NOSOCOMIALE; ETUDE RETROSPECTIVE; ANTIBIORESISTANCE; MICROBIOLOGIE; CONTROLE

Background: Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases.Aim: To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures.Methods: This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates.Findings: This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected.Conclusion: The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk.DOI: https://dx.doi.org/10.1016/j.jhin.2016.08.005

Hygiène des mains

NosoBase ID notice : 422283Utilité des dispositifs électroniques de comptage de l'hygiène des mains pour mesurer l'observance de l'hygiène des mains par les médecins en soins ambulatoires

Arai A; Tanabe M; Nakamura A; Yamasaki D; Muraki Y; Kaneko T; et al. Utility of electronic hand hygiene counting devices for measuring physicians' hand hygiene adherence applied to outpatient settings. American journal of infection control 2016/12; 44(12): 1481-1485.

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Mots-clés : HYGIENE DES MAINS; OBSERVANCE; SURVEILLANCE; PERSONNEL; MEDECIN; EQUIPEMENT; AUDIT

Background: Our objectives were to evaluate the utility of electronic hand hygiene counting devices in outpatient settings and the impact of results feedback on physicians' hand hygiene behaviors.Methods: We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians' hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories.Results: Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders.Conclusions: Physicians' adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians' hand hygiene compliance. DOI: https://dx.doi.org/10.1016/j.ajic.2016.08.002

NosoBase ID notice : 422873Campagnes sur l'hygiène des mains dans les unités de soins intensifs en Belgique, 2005-2015

Fonguh S; Uwineza A; Catry B; Simon A. Belgian hand hygiene campaigns in ICU, 2005-2015. Archives of public health 2016/11/07; 74(47): 1-5.

Mots-clés : HYGIENE DES MAINS; OBSERVANCE; SOIN INTENSIF; INTERVENTION; RETOUR EXPERIENCE; PERSONNEL; PREVENTION

Background: Healthcare-associated infections (HCAI) are still a major problem especially in most intensive care units (ICU). Incompliance by clinical staff with hand hygiene (HH) increases rates of preventable infections. We report the outcome of the Belgian national hand hygiene campaign from 2005 to 2015 with focus on intensive care units.Methods: Using the World Health organisation (WHO) standardised observation roster, trained infection control teams measured adherence to HH guidelines by direct observation. HH opportunities were counted and the actual episodes of HH were scored as no HH, HH with water and soap, or HH with alcohol-based hand rub. Measurements were repeatedly done before and after a one month awareness campaign every second year. Compliance was stratified by indication and by type of healthcare worker, and computed as a percentage of the number of HH episodes with water and soap or with alcohol-based hand rub, divided by the number of opportunities.Results: A total of 108,050 hand hygiene opportunities were observed in ICU during this period. HH compliance increased significantly from 49.6% before campaign in 2005 to 72.0 % before campaign in 2015. Over the same time frame, post campaign compliance increased from 67.0 to 80.2%. The number of opportunities observed substantially increased when automated feedback was installed.Conclusions: In Belgian intensive care units, hand hygiene compliance is getting improved overtime, though consecutive campaigns with immediate feedback are required to achieve and sustain a high compliance rate. DOI: https://dx.doi.org/10.1186/s13690-016-0159-3

NosoBase ID notice : 422338Influence des propriétés du matériau sur l'efficacité de la barrière bactérienne des gants en présence de microperforation

Hermann Bardorf M; Jäger B; Boeckmans E; Kramer A; Assadian O. Influence of material properties on gloves' bacterial barrier efficacy in the presence of microperforation. American journal of infection control 2016/12; 44(12): 1645-1649.

Mots-clés : GANT; MATERIAU; LATEX; CONTAMINATION; RISQUE; PERFORATION; TRANSMISSION; EFFICACITE; NITRILE; NEOPRENE

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Background: Medical examination gloves and surgical gloves protect the wearer directly and the patient indirectly from the risk of contamination. Because of concerns related to latex allergy, an increasing trend toward the use of synthetic gloves made of materials other than latex is observable. However, currently it is unknown if the physical properties of different materials may influence bacterial passage in case of a glove puncture.Methods: We examined 9 different medical examination gloves from various manufacturers made of nitrile (n=4), latex (n=3), or neoprene (n=2). Additionally, 1 latex surgical glove each with and without antibacterial chlorhexidine gluconate coating and 1 synthetic surgical glove made of thermoplastic elastomer were included in the experiments. The studied materials were perforated following a standardized procedure, and direct bacterial passage was measured under dynamic conditions. Glove elasticity at 1  cm up to 2.5 cm elongation was measured following EN 455-2.Results: Nitrile gloves demonstrated higher material stiffness compared with latex gloves. Medical examination gloves made of nitrile and neoprene showed a 10-fold higher bacterial passage through a standardized puncture compared with latex gloves. All surgical gloves showed a lower bacterial passage compared with the tested examination gloves.Conclusion: Bacterial passage through punctures is correlated with the stiffness or elasticity of the glove material. Therefore, gloves made of latex may have an increased protective effect in case of a glove breach. Whenever gloves are purchased and selected, a risk-benefit assessment should be conducted, balancing the risk of allergy against the degree of required protection in case of a glove puncture. DOI: https://dx.doi.org/10.1016/j.ajic.2016.03.070

NosoBase ID notice : 422282Audit automatisé de l'hygiène des mains avec et sans intervention

Kwok YL; Juergens CP; McLaws ML. Automated hand hygiene auditing with and without an intervention. American journal of infection control 2016/12; 44(12): 1475-1480.

Mots-clés : HYGIENE DES MAINS; AUDIT; OBSERVANCE; INTERVENTION; PRATIQUE; PERSONNEL; EQUIPEMENT; SURVEILLANCE; RETOUR EXPERIENCE

Background: Daily feedback from continuous automated auditing with a peer reminder intervention was used to improve compliance. Compliance rates from covert and overt automated auditing phases with and without intervention were compared with human mandatory audits.Methods: An automated system was installed to covertly detect hand hygiene events with each depression of the alcohol-based handrub dispenser for 5 months. The overt phase included key clinicians trained to share daily rates with clinicians, set compliance goals, and nudge each other to comply for 6 months. During a further 6 months, the intervention continued without being refreshed. Hand Hygiene Australia (HHA) human audits were performed quarterly during the intervention in accordance with the World Health Organization guidelines. Percentage point (PP) differences between compliance rates were used to determine change.Results: HHA rates for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 PPs and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs.Conclusions: Automation provided a unique opportunity to respond to daily rates, but compliance will return to preintervention levels once active intervention ceases or human auditors leave the ward, unless clinicians are committed to change.DOI: https://dx.doi.org/10.1016/j.ajic.2016.08.014

NosoBase ID notice : 422544Maintien d’un niveau élevé de l’observance des recommandations pour les pratiques d’hygiène des mains en utilisant l’approche du patient comme observateur dans un secteur ambulatoire

Lee RA; Cutter GR; Pate JL; Boohaker E; Camins BC. Sustained high level of healthcare worker adherence with hand hygiene practice recommendations using the patient-as-observer approach in the ambulatory setting. Infection control and hospital epidemiology 2016/12; 37(12): 1496-1498.

Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PERSONNEL; QUALITE; PRODUIT HYDROALCOOLIQUE; AUDIT; PATIENT; SOIN AMBULATOIRE

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We report on a quality improvement initiative for hand hygiene adherence using the patient-as-observer method in the ambulatory setting. There were 604,661 observations recorded with improvement of adherence from 88% to 95% or greater; alcohol-based hand sanitizer purchasing correlated with this increase. This sustainable method effectively ensures hand hygiene adherence. DOI: https://dx.doi.org/10.1017/ice.2016.211

Immunodépression

NosoBase ID notice : 422689Quelles mesures pour maîtriser le risque infectieux chez les patients immunodéprimés ? Recommandations formalisées d’experts

SF2H. Quelles mesures pour maîtriser le risque infectieux chez les patients immunodéprimés ? Recommandations formalisées d’experts. Hygiènes 2016/11; 24(5): 1-64.

Mots-clés : RECOMMANDATIONS DE BONNE PRATIQUE; DEFICIT IMMUNITAIRE; HEMATOLOGIE; MICROORGANISME; RISQUE; ASPERGILLUS; ENVIRONNEMENT; AIR; EAU; LEGIONELLA; EAU EMBOUTEILLEE; PRECAUTION COMPLEMENTAIRE; TENUE VESTIMENTAIRE; GANT; USAGE UNIQUE; CHAUSSURE; NETTOYAGE; DESINFECTION; LOCAL; DESINFECTION PAR VOIE AERIENNE; CHAMBRE DU MALADE; ALIMENTATION; LINGE; JOUET; LIVRE

L’objectif de ce document élaboré par la SF2H est d’aider les professionnels de santé à évaluer le risque infectieux chez les patients immunodéprimés et à mettre en œuvre les mesures de prévention adaptées.Ces recommandations visent à homogénéiser les pratiques quel que soit le lieu de prise en charge des patients (hématologie ou hors hématologie, MCO ou soins de suite) et à proposer aux soignants des mesures basées sur les données de la littérature et réalisables au quotidien.Dans ce travail, l’évaluation du risque est basée sur l’identification d’un triptyque incluant le type de réservoir (humain et environnemental) et son importance (ie, dose infectante), le mode de transmission et la durée d’exposition au risque, et enfin le profil du patient (type d’immunodépression).Il s’agit ensuite de proposer en regard du risque infectieux identifié des mesures spécifiques en fonction du ou des terrains concernés.

Indicateur

NosoBase ID notice : 422906Indicateurs de qualité et de sécurité des soins - Infections Associées aux Soins (ex-Tableau de Bord des Infections Nosocomiales) - Résultats nationaux de la campagne 2016 - Données 2015 [Rapport]

Haute Autorité de la Santé (HAS). Indicateurs de qualité et de sécurité des soins - Infections Associées aux Soins (ex-Tableau de Bord des Infections Nosocomiales) - Résultats nationaux de la campagne 2016 - Données 2015 [Rapport]. HAS 2016/12: 1-78.

Mots-clés : INDICATEUR; TABLEAU DE BORD; ICATB; ICSHA; ICA; ICA-BMR

Les données du Bilan annuel des activités de lutte contre les infections nosocomiales dans les établissements de santé (Bilan LIN) permettent le calcul des indicateurs de ce qui fut le Tableau de bord des infections nosocomiales (TBIN), devenu désormais le thème IAS. Les établissements de santé remplissent annuellement le Bilan LIN. Ce recueil est régi par l’arrêté du 7 avril 2011 modifié1 relatif au bilan annuel des activités de lutte contre les infections nosocomiales dans les établissements de santé, en application de l'article R. 6111-8 du Code de la santé publique. Les résultats des indicateurs IAS reflètent le niveau d'engagement des établissements dans la prévention des infections nosocomiales. L'évolution individuelle des résultats et le positionnement de l'établissement par rapport aux établissements de même catégorie contribuent à évaluer la qualité et la sécurité des soins dans le domaine de la prévention des infections associées aux soins. Un arrêté annuel du ministère chargé de la santé fixe la liste des indicateurs obligatoires pour l'amélioration de la qualité et de la sécurité des soins et les conditions de mise à disposition du public de certains résultats par l'établissement de santé. Cette diffusion de leur résultat par les établissements de santé est accompagnée d'une diffusion publique nationale sur le site Scope Santé (www.scopesante.fr).

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NosoBase ID notice : 422699Instruction DGOS/PF2/DGS/PP/DGCS n° 2016-372 du 2 décembre 2016 relative à un appel d'offre spécifique pour la réalisation d'une enquête nationale sur les événements indésirables graves associés aux soins

Ministère des affaires sociales et de la santé. Instruction DGOS/PF2/DGS/PP/DGCS n° 2016-372 du 2 décembre 2016 relative à un appel d'offre spécifique pour la réalisation d'une enquête nationale sur les événements indésirables graves associés aux soins. Non parue au Journal officiel: 8 pages.

Mots-clés : EVENEMENT INDESIRABLE GRAVE; ETABLISSEMENT PUBLIC DE SANTE; EHPAD; DECLARATION; LEGISLATION; ENQUETE; METHODOLOGIE; INDICATEUR QUALITE; INDICATEUR DE SANTE; EPIDEMIOLOGIE; PARCOURS DE SOINS; QUALITE DES SOINS; GESTION DES RISQUES; SECURITE SANITAIRE; EVENEMENT INDESIRABLE GRAVE ASSOCIE AUX SOINS; SECTEUR VILLE

La DGOS lance un appel d'offre pour la réalisation d’une enquête nationale sur les événements indésirables graves associés aux soins dans les trois secteurs (établissements de santé, médico-social [EHPAD] et ville). Le projet de recherche qui sera sélectionné via cet appel d'offre devra concevoir et mettre en oeuvre une méthode permettant la réalisation d’une enquête nationale prospective et une comparabilité avec les résultats des études ENEIS 1 et 2. La construction de l’échantillon statistique choisi garantira une représentativité propre à assurer une extrapolation dans un intervalle de confiance satisfaisant. Le candidat devra notamment assurer la faisabilité de la mise en œuvre, en identifiant, le cas échéant, un prestataire apte à administrer sur le terrain l’enquête nationale. L’étude se déroulera sur la période 2017-2019.Le dépôt du projet associera un porteur individuel d’une part, et un établissement de santé, d’autre part, sous réserve de l'engagement du responsable légal de cet établissement.

Infection ostéo-articulaire

NosoBase ID notice : 422704Instruction DGOS/PF2 n° 2016-355 du 29 novembre 2016 relative au renouvellement du dispositif des structures labellisées pour la prise en charge des infections ostéo-articulaires complexes

Ministère des affaires sociales et de la santé. Instruction DGOS/PF2 n° 2016-355 du 29 novembre 2016 relative au renouvellement du dispositif des structures labellisées pour la prise en charge des infections ostéo-articulaires complexes. Non parue au Journal officiel: 34 pages.

Mots-clés : INFECTION NOSOCOMIALE; PRISE EN CHARGE SANITAIRE ET SOCIALE; OS; EXPERTISE; ARTICULATION; CENTRE DE REFERENCE; APPAREIL OSTEO-ARTICULAIRE; LEGISLATION; SIGNALEMENT; SURVEILLANCE; MULTIRESISTANCE

La présente instruction a pour objet de préciser les conditions de renouvellement en 2017 du dispositif des structures labellisées pour la prise en charge des infections ostéo-articulaires complexes.

Infection urinaire

NosoBase ID notice : 421582Infections urinaires

Chenoweth CE; Saint S. Urinary Tract Infections. Infectious disease clinics of North America 2016/12; 30(4): 869-885.

Mots-clés : INFECTION URINAIRE; PREVENTION; CATHETER; SONDAGE URINAIRE; SONDE; FACTEUR DE RISQUE; COMPLICATION; INFECTION NOSOCOMIALE; ANTIBIORESISTANCE; INTERVENTION; SURVEILLANCE; CATHETER IMPREGNE; REVUE DE LA LITTERATURE; BUNDLE

CAUTIs are common, costly, and cause significant patient morbidity. Despite studies showing benefit of interventions for prevention of CAUTI, adoption of these practices has not occurred consistently in many health care facilities in the United States. Duration of urinary catheterization is the predominant risk for CAUTI; preventive measures directed at limiting placement and early removal of urinary catheters have a significant impact on decreasing CAUTI. Intervention bundles, collaboratives, and support from hospital leadership are powerful tools for implementing preventive measures for HAI, including CAUTI.

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DOI: https://dx.doi.org/10.1016/j.idc.2016.07.007

NosoBase ID notice : 422582Une revue systématique et une méta-analyse sur l’efficacité des antiseptiques pour le nettoyage du méat urinaire et la prévention des infections urinaires sur sonde

Fasugba O; Koerner J; Mitchell BG; Gardner A. A systematic review and meta-analysis of the effectiveness of antiseptics for meatal cleaning in the prevention of catheter associated urinary tract infections. The journal of hospital infection 2016/10/26; in press: 39 pages.

Mots-clés : INFECTION URINAIRE; MEAT URINAIRE; SONDAGE URINAIRE; ANTISEPTIQUE; META-ANALYSE; POLYVIDONE IODEE; CHLORHEXIDINE; ALCOOL; INFECTION NOSOCOMIALE

Background: Catheter associated urinary tract infections (CAUTI) are one of the most frequent healthcare associated infections. Antiseptic cleaning of the meatal area before and during catheter use may have the potential to reduce CAUTI risk. Aim: To systematically review the literature and meta-analyse studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTI. Methods: Electronic databases were searched to identify randomised controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated and compared across intervention and control groups using DerSimonian-Laird random effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic.Findings: We identified 2665 potential papers, of which 14 studies were eligible for inclusion. There was no difference in CAUTI incidence when comparing an antiseptic and non-antiseptic agent (pooled OR=0.90, 95% CI=0.73-1.10; P=0.31) and for different agents compared: povidone-iodine versus routine care; povidone-iodine versus soap and water; chlorhexidine versus water; povidone-iodine versus saline; povidone-iodine versus water; and green soap and water versus routine care (P>0.05 for all). Comparison of an antibacterial with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in CAUTI incidence regarding country, setting, risk of bias, sex and frequency of administration.Conclusions: There were no differences in CAUTI rates although methodological issues hamper generalisability of this finding. Antibacterials might be significant in a well conducted study. Results provide good evidence to inform infection control guidelines in catheter management.DOI: https://dx.doi.org/10.1016/j.jhin.2016.10.025

NosoBase ID notice : 422575Prévalence d'infections urinaires dues aux entérobactéries de bêta-lactamase à spectre élargi en pédiatrie : revue systématique et méta-analyse

Flokas ME; Detsis M; Alevizakos M; Mylonakis E. Prevalence of ESBL-producing Enterobacteriaceae in paediatric urinary tract infections: A systematic review and meta-analysis. Journal of infection 2016/12; 73(6): 547-557.

Mots-clés : PREVALENCE; PEDIATRIE; ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI; INFECTION URINAIRE; FACTEUR DE RISQUE; DUREE DE SEJOUR; REVUE DE LA LITTERATURE; META-ANALYSE

Objectives: We aimed to evaluate the prevalence of paediatric urinary tract infections (UTIs) caused by extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), identify predisposing factors and examine their effect on the length of hospital stay (LOS).Methods: For this systematic review and meta-analysis, we searched the PubMed and EMBASE databases for studies that provide data on the rate of ESBL-PE among paediatric UTIs.Results: Out of 1828 non-duplicate citations, 16 studies reporting a total of 7374 cases of UTI were included. The prevalence of ESBL-PE was 14% [(95%CI 8, 21)]. Vesicoureteral reflux (VUR) [OR=2.79, (95%CI 1.39, 5.58)], history of UTI [OR=2.89 (95%CI 1.78, 4.68)] and recent antibiotic use [OR=3.92, (95%CI 1.76, 8.7)] were identified as risk factors. The LOS was significantly longer among children infected with ESBL-PE, compared to those infected with other uropathogens. [SMD=0.88, (95%CI 0.40, 1.35)].Conclusions: In the paediatric population, 1 out of 7 UTIs are caused by ESBL-PE. Patients with VUR, previous UTI or recent antibiotic use constitute a high risk group and these pathogens are associated with increased LOS. The significant incidence of ESBL-PE in this population should be taken into consideration in

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the development of empiric treatment protocols and antibiotic stewardship programmes, especially in high-prevalence areas.DOI: https://dx.doi.org/10.1016/j.jinf.2016.07.014

Laboratoire

NosoBase ID notice : 423382Décret n° 2016-1989 du 30 décembre 2016 fixant les missions et les modalités de désignation des laboratoires de biologie médicale de référence

Ministère des affaires sociales et de la santé. Décret n° 2016-1989 du 30 décembre 2016 fixant les missions et les modalités de désignation des laboratoires de biologie médicale de référence. Journal officiel de la République française Lois et décrets 2016/12/31: 3 pages.

Mots-clés : LEGISLATION; LABORATOIRE; BIOLOGIE MEDICALE; SURVEILLANCE

Le décret définit les missions d’un LBMR. Pour qu’un laboratoire de biologie médicale (LBM) devienne un LBMR, celui-ci doit avoir une compétence de haut niveau déjà reconnue aujourd’hui, soit sur un type particulier d’examen de biologie médicale, soit sur une pathologie. Le LBMR doit répondre à un besoin de santé publique. Le décret définit la procédure de candidature pour qu’un LBM puisse devenir un LBMR. Enfin, il prévoit la procédure mettant fin aux fonctions de LBMR.

NosoBase ID notice : 423407Arrêté du 23 décembre 2016 fixant le cahier des charges pour la désignation des laboratoires de biologie médicale de référence

Ministère des affaires sociales et de la santé. Arrêté du 23 décembre 2016 fixant le cahier des charges pour la désignation des laboratoires de biologie médicale de référence. Journal officiel de la République française Lois et décrets 2016/12/29: 4 pages.

Mots-clés : LEGISLATION; CAHIER DES CHARGES; LABORATOIRE; BIOLOGIE MEDICALE; EVALUATION; ACCREDITATION

Odontologie

NosoBase ID notice : 422101Surveillance de la contamination bactérienne des réseaux d'eau des unités dentaires en utilisant la bioluminescence de l'adenosine triphosphate

Watanabe A; Tamaki N; Yokota K; Matsuyama M; Kokeguchi S. Monitoring of bacterial contamination of dental unit water lines using adenosine triphosphate bioluminescence. The journal of hospital infection 2016/12; 94(4): 393-396.

Mots-clés : CONTAMINATION; SURVEILLANCE; ODONTOLOGIE; INFECTION NOSOCOMIALE; ADENOSINE TRIPHOSPHATE; LUMINESCENCE; EAU

Bacterial contamination of dental unit waterlines (DUWLs) was evaluated using ATP bioluminescence analysis and a conventional culture method. Water samples (N=44) from DUWLs were investigated for heterotrophic bacteria by culture on R2A agar, which gave counts ranging from 1.4×103 to 2.7×105 cfu/mL. The ATP bioluminescence results for DUWL samples ranged from 6 to 1189 relative light units and could be obtained within 1min; these correlated well with the culture results (r=0.727-0.855). We conclude that the results of the ATP bioluminescence assay accurately reflect the results of conventional culture-based testing. This method is potentially useful for rapid and simple monitoring of DUWL bacterial contamination. DOI: https://dx.doi.org/10.1016/j.jhin.2016.08.001

Pédiatrie

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NosoBase ID notice : 423003Les premiers soins néonatals - recommandations interdisciplinaire

Girard T; Heim C; Hornung R; Hösli I; Krayer S; Panchard MA; et al. Les premiers soins néonatals - recommandations interdisciplinaire. Forum médical suisse 2016; 16(44): 938-942.

Mots-clés : NEONATOLOGIE; RECOMMANDATIONS DE BONNE PRATIQUE; OBSTETRIQUE; SOIN; ANESTHESIE; CESARIENNE; INSTRUMENT

Ces recommandations s’orientent vers des standards et des conseils internationaux. Elles définissent les exigences pour une prise en charge périnatale optimale, sûre et de grande qualité, aussi bien de la mère que de l’enfant. Ce document a été élaboré par les délégués des sociétés des disciplines concernées au cours de 11 séances de groupes de travail et 25 versions de texte. Tous les comités directeurs des sociétés des disciplines concernées ont approuvé ce document. Une mise à jour de ce document terminé en mars 2016 est prévue en janvier 2019. Responsables sont les sociétés des disciplines impliquées sous la direction de "gynécologie suisse".

NosoBase ID notice : 422281Etude d'observation sur l'observance du lavage des mains dans une crèche

Clark J; Henk JK; Crandall PG; Crandall MA; O'Bryan CA. An observational study of handwashing compliance in a childcare facility. American journal of infection control 2016/12; 44(12): 1469-1474.

Mots-clés : HYGIENE DES MAINS; LAVAGE DES MAINS; OBSERVANCE; PERSONNEL; ENFANT; CRECHE; OBSERVATION; SURVEILLANCE

Background: Handwashing (HW) compliance, although an effective means of limiting childhood illness, remains low among personnel in early childhood centers (ECCs). Our study determined HW compliance and efficacy of ECC personnel. Methods: Surveillance cameras were used to determine HW opportunities, compliance, occurrences, and effectiveness based on child-care oriented criteria. Results: We observed 349HW triggering events, with 14 events per hour; a median of 2 personnel (caregivers, paraprofessional aides, or parents) were present at any given time period. Compliance was 30% (caregivers), 11% (paraprofessional aides), and 4% (parents), with an overall compliance of 22%. Betweenroom and between-age groups of children being cared for and compliance of caregivers and paraprofessional aides were not found to be significantly different (P<.05). For all personnel between the 10 different rooms, the median compliance was 20.2% (95% confidence interval, 8%-35%). Only 7% of personnel taking care of 2- to 3-year-old children washed their hands, the lowest compliance per age group. Of all steps in HW, paper towel usage had the highest compliance, with a 97% adherence, whereas turning off the faucet with a paper towel was the lowest at 17%. Conclusions: Methods and strategies need to be developed to increase compliance. Current technology provides an effective means of gathering data for determining HW compliance in ECCs.DOI: https://dx.doi.org/10.1016/j.ajic.2016.08.006

NosoBase ID notice : 421583Evénements associés à la ventilation assistée et comment les prévenir

Cocoros NM; Klompas M. Ventilator-Associated Events and Their Prevention. Infectious disease clinics of North America 2016/12; 30(4): 887-908.

Mots-clés : PREVENTION; VENTILATION ASSISTEE; COMPLICATION; PNEUMONIE; EPIDEMIOLOGIE; FACTEUR DE RISQUE; PEDIATRIE; ENFANT; NEONATOLOGIE; NOUVEAU-NE; DEFINITION; REVUE DE LA LITTERATURE

The introduction of VAE definitions transformed national surveillance for complications in adults receiving mechanical ventilation. VAE definitions expand the purview of surveillance to include both infectious and noninfectious conditions and use objective data to measure events. In the short time since the initiation of VAE surveillance by NHSN, a comprehensive view of VAEs is beginning to emerge. The epidemiology of VAEs described in different studies has been generally consistent (see Table 1). Increased hospital mortality, prolonged mechanical ventilation, and longer lengths of stay have been reported by numerous groups in

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patients with VAEs compared with patients without VAEs. Excess fluid balance, deeper levels of sedation, prolonged sedation, and high tidal volumes are risk factors for VAEs. The most common and consistent complications that trigger VAE criteria are pneumonia, pulmonary edema, ARDS, and atelectasis. Interventional studies suggest that conservative fluid management and enhancing the performance of SATs and SBTs can prevent VAEs. A strategic framework for preventing VAEs is to bundle together interventions that minimize duration of mechanical ventilation and prevent 1 or more of the clinical conditions that most frequently trigger VAEs. Promising candidates for a VAE prevention bundle, therefore, include minimizing sedation, paired daily SATs and SBTs, early exercise and mobility, low tidal volume ventilation, conservative fluid management, and conservative blood transfusion thresholds. To date, no study has evaluated the potential impact of bundling all of all these interventions into a single comprehensive VAE prevention set. We therefore still do not have a clear sense of the preventable fraction of VAEs and to what extent a comprehensive VAE prevention program can improve global outcomes for ventilated patients. Further studies of VAE epidemiology, risk factors, and prevention are needed to solidify and extend our capacity to predict and prevent VAEs. DOI: https://dx.doi.org/10.1016/j.idc.2016.07.002

NosoBase ID notice : 422285La fréquence des actes d'hygiène des mains est-elle associée à la survenue d'épidémies dans les établissements de soins de longue durée en pédiatrie ?

Cohen B; Murray M; Jia H; Jackson O; Saiman L; Neu N; et al. Is hand hygiene frequency associated with the onset of outbreaks in pediatric long-term care? American journal of infection control 2016/12; 44(12): 1492-1494.

Mots-clés : HYGIENE DES MAINS; PEDIATRIE; EPIDEMIE; SOIN DE LONGUE DUREE; INFECTION NOSOCOMIALE; PRATIQUE; EPIDEMIOLOGIE

Background: Studies in adult long-term care facilities (LTCFs) have shown a correlation between hand hygiene (HH) and viral outbreak reduction, but no such studies have been conducted in pediatric LTCFs where the epidemiology of viral pathogens is different.Methods: We compared electronically monitored facility-wide HH frequency in the weeks immediately prior to outbreaks of acute respiratory or gastrointestinal infections versus control weeks in a 137-bed pediatric LTCF from October 2012-August 2015. Control weeks were the 8-14 day (control 1) and 15-21 day (control 2) periods prior to the onset of each outbreak.Results: There was no difference in HH frequency in the weeks leading up to the outbreaks versus control weeks (odds ratio [OR], 1.0; 95% confidence interval CI, 1.00-1.001 using control 1 and OR, 1.0; 95% CI, 1.00-1.001 using control 2).Conclusions: Our findings differed from those in adult LTFCs, possibly because of the greater contact between residents and staff in the pediatric setting, increased susceptibility to viral pathogens because of immunologic immaturity, or differences in the types of pathogens prevalent in each setting. Although HH may be important for limiting the number of residents infected during outbreaks, we found no association between HH frequency and subsequent outbreak onset.DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.022

NosoBase ID notice : 421900Epidémiologie et poids économique de la rougeole, des oreillons, de la coqueluche et de la varicelle en Allemagne : une revue systématique

Damm O; Witte J; Wetzka S; Prosser C; Braun S; Welte R; et al. Epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany: a systematic review. International Journal of Public Health 2016/09; 61(7): 847-860.

Mots-clés : EPIDEMIOLOGIE; VARICELLE; ROUGEOLE; OREILLONS; BORDETELLA PERTUSSIS; COUT; ENFANT; SURVEILLANCE; SIGNALEMENT; MORBIDITE; INCIDENCE; REVUE DE LA LITTERATURE

Objectives: Despite the availability of vaccines and the existence of public vaccination recommendations, outbreaks of vaccine-preventable childhood diseases still cause public health debate. The objective of this systematic review was to provide an overview of the current epidemiology and economic burden of measles, mumps, pertussis, and varicella in Germany.

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Methods: We systematically reviewed studies published since 2000. The literature search was conducted using PubMed and EMBASE. Also, we used German notification data to give an up-to-date overview of the epidemiology of the four diseases under consideration.Results: Thirty-six studies were included in our review. Results suggest that there is still considerable morbidity due to childhood diseases in Germany. Studies providing cost estimates are scarce. Comparative analyses of different data sources (notification data vs. claims data) revealed a potential underestimation of incidence estimates when using notification data. Furthermore, several studies showed regional differences in incidence of some of the diseases under consideration.Conclusions: Our findings underline the need for improved vaccination and communication strategies targeting all susceptible age and risk groups on a national and local level.DOI: https://dx.doi.org/10.1007/s00038-016-0842-8

NosoBase ID notice : 422163Pseudomonas aeruginosa résistant aux carbapénèmes et multirésistant chez les enfants aux Etats-Unis, 1999-2012

Logan LK; Gandra S; Mandal S; Klein EY; Levinson J; Weinstein RA; et al. Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012. Journal of the pediatric infectious diseases society 2016/11/16; in press: 1-8.

Mots-clés : PSEUDOMONAS AERUGINOSA; EPIDEMIOLOGIE; ENFANT; ANTIBIORESISTANCE; PEDIATRIE; CARBAPENEME; SURVEILLANCE; PREVALENCE; MULTIRESISTANCE

Background: Pseudomonas aeruginosa is a common cause of healthcare-associated infection. Multidrug-resistant (MDR) (>3 classes) and carbapenem-resistant (CR) P aeruginosa are significant threats globally. We used a large reference-laboratory database to study the epidemiology of P aeruginosa in children in the United States.Methods: Antimicrobial susceptibility data from the Surveillance Network were used to phenotypically identify MDR and CR P aeruginosa isolates in children aged 1 to 17 years between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of MDR and CR P aeruginosa. Isolates from infants (<1 year old) and patients with cystic fibrosis were excluded.Results: Among the isolates tested, the crude proportion of MDR P aeruginosa increased from 15.4% in 1999 to 26% in 2012, and the proportion of CR P aeruginosa increased from 9.4% in 1999 to 20% in 2012. The proportion of both MDR and CR P aeruginosa increased each year by 4% (odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03-1.04] and 1.04 [95% CI, 1.04-1.05], respectively). In multivariable analysis, both MDR and CR P aeruginosa were more common in the intensive care setting, among children aged 13 to 17 years, in respiratory specimens, and in the West North Central region. In addition, resistance to other antibiotic classes (aminoglycosides, fluoroquinolones, cephalosporins, and piperacillin-tazobactam) often used to treat P aeruginosa increased.Conclusions: Rates of MDR and CR P aeruginosa infection in children are rising nationally. Aggressive prevention strategies, including instituting antimicrobial stewardship programs in pediatric settings, are essential for combating antimicrobial resistance.DOI: https://dx.doi.org/10.1093/jpids/piw064

NosoBase ID notice : 418291Infections à Streptococcus groupe B chez des nouveau-nés admis dans une unité de soins intensifs de néonathologie (NICU) allemande : gros plan sur le dépistage et l'observance des recommandations pré-analytiques

Reinheimer C; Kempf VAJ; Wittekindt BE; Allendorf A; Wichelhaus TA; Hogardt M; et al. Group B streptococcus infections in neonates admitted to a German NICU: Emphasis on screening and adherence to pre-analytical recommendations. Early human development 2016/12; 103: 37-41.

Mots-clés : STREPTOCOCCUS GROUPE B; NOUVEAU-NE; ANTIBIOPROPHYLAXIE; ANTIBIOTIQUE; TRANSMISSION MATERNO-FOETALE; DEPISTAGE; PREVENTION

Background: Infections by group B streptococci (GBS), e.g. Streptococcus agalactiae, presenting as early-onset disease (EOD) or late-onset disease (LOD), are leading causes of severe infections in newborn and premature patients. Although screening and intra partum antibiotic prophylaxis are frequently performed, vertically transmitted GBS remain a challenge for pediatrics.

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Aims: In order to prevent or reduce potential life-threatening events, this study retrospectively investigated epidemiological, microbiological and clinical aspects of infants admitted to the Division of Neonatology at the Department of Pediatrics at the University Hospital Frankfurt, Germany (UHF).Study design and subjects: Between January 2010 and January 2016, perinatal GBS screening status, clinical presentation of EOD or LOD and therapeutic management of neonates admitted to UHF were retrospective analysed. Infants tested positive for GBS within their first three months of life were included; patient data were obtained from the chart report. Severity of neonatal disease was analysed by using the NEOMOD and CRIB score.Results: 108 GBS infected infants born to 105 mothers were observed. N=101 of them (93.5%) presented with EOD, whereof n=9 (10%) primarily presented with pneumonia or pneumothorax. In 82 (78%) mothers of infected infants GBS status was unknown prior to hospitalization of the neonate. 3/108 (2.8%) infants died from GBS septicemia.Conclusion: Avoidance of GBS transmission sub partu is the key issue in preventing neonatal GBS infection and should be the focus of preventive strategies. Our results highlight the impact of perinatal screening.DOI: https://dx.doi.org/10.1016/j.earlhumdev.2016.07.007.

Personnel

NosoBase ID notice : 422373Observance du suivi des personnels après les accidents d'exposition au sang : un bref rapport

Díaz JC; Johnson LA. Health care worker follow-up compliance after occupational bloodborne pathogens exposure: A brief report. American journal of infection control 2016/12; 44(12): 1738-1740.

Mots-clés : ACCIDENT D'EXPOSITION AU SANG; RISQUE PROFESSIONNEL; PERSONNEL; ETUDE RETROSPECTIVE; COHORTE; OBSERVANCE; SUIVI; VIRUS DE L'IMMUNODEFICIENCE HUMAINE; HEPATITE C

A retrospective cohort study was conducted examining health care worker (HCW) compliance with Centers for Disease Control and Prevention recommendations following occupational bloodborne pathogen (BBP) exposure. HCWs with a BBP exposure from a known HIV- or hepatitis C virus-seropositive individual were less likely to complete recommended follow-up compared with HCWs with seronegative source patient exposures (adjusted odds ratio, 0.02 and 0.09, respectively). Continued targeted education and extra vigilance in performing postexposure surveillance are warranted in this higher-risk population.DOI: https://dx.doi.org/10.1016/j.ajic.2016.04.243

NosoBase ID notice : 422093Promouvoir la prise en charge par le personnel de santé de la prévention et du contrôle des infections : utilisation de la théorie des processus de normalisation comme cadre interprétatif

Gould DJ; Hale R; Waters E; Allen D. Promoting health workers' ownership of infection prevention and control: using Normalization Process Theory as an interpretive framework. The journal of hospital infection 2016/12; 94(4): 373-380.

Mots-clés : INFECTION NOSOCOMIALE; PREVENTION; CONTROLE; ANTIBIORESISTANCE; EVALUATION; PERSONNEL; SOCIOLOGIE DU TRAVAIL; CLOSTRIDIUM DIFFICILE; PERCEPTION

Background: All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the UK is impressive, but the determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase.Methods: The authors undertook a retrospective, independent evaluation of an action plan to enhance IPC and 'ownership' (individual accountability) for IPC introduced throughout a healthcare organization. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalization Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating.Findings: Six themes emerged through inductive analysis. Theme 1: 'Ability to make sense of ownership' provided evidence of the first element of NPT (coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: 'Always being vigilant' (Theme 2), 'Importance of access to information' (Theme 3) and 'Being able to learn together in a no-blame culture' (Theme 4). Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation),

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undertaking the work necessary to achieve change (collective action), and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC).Conclusion: Eighteen months after implementing the action plan incorporating IPC ownership, there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation ('normalization') of IPC into everyday health care can help explain the success of IPC initiatives and inform implementation.DOI: https://dx.doi.org/10.1016/j.jhin.2016.09.015

NosoBase ID notice : 422610Cas groupés d'infections à Streptococcus groupe A dans un EHPAD. Le rôle potentiel du "Présentéisme" (présence au travail malgré la maladie) chez les professionnels de la santé

Kobayashi M; Lyman MM; Francois Watkins LK; Toews KA; Bullard L; Radcliffe RA; et al. A Cluster of Group A Streptococcal Infections in a Skilled Nursing Facility - the Potential Role of Healthcare Worker Presenteeism. Journal of the american geriatrics society 2016/12; 64(12): e279-e284.

Mots-clés : STREPTOCOCCUS GROUPE A; TRANSMISSION; TRANSMISSION SOIGNANT-SOIGNE; EPIDEMIE; EHPAD; PERSONNEL; GESTION DU PERSONNEL

Objectives: To determine the extent of a group A streptococcus (GAS) cluster (2 residents with invasive GAS (invasive case-patients), 2 carriers) caused by a single strain (T antigen type 2 and M protein gene subtype 2.0 (T2, emm 2.0)), evaluate factors contributing to transmission, and provide recommendations for disease control. Design: Cross-sectional analysis and retrospective review. Setting: Skilled nursing facility (SNF). Participants: SNF residents and staff. Measurements: The initial cluster was identified through laboratory notification and screening of SNF residents with wounds. Laboratory and SNF administrative records were subsequently reviewed to identify additional residents with GAS, oropharyngeal and wound (if present) swabs were collected from SNF staff and residents to examine GAS colonization, staff were surveyed to assess infection control practices and risk factors for GAS colonization, epidemiologic links between case-patients and persons colonized with GAS were determined, and facility infection control practices were assessed. Results: No additional invasive case-patients were identified. Oropharyngeal swabs obtained from all 167 SNF residents were negative; one wound swab grew GAS that was the same as the outbreak strain (T2, emm 2.0). The outbreak strain was not identified in any of the 162 staff members. One of six staff members diagnosed with GAS pharyngitis worked while ill and had direct contact with invasive case-patients within a few weeks before their onset of symptoms. Additional minor breaches in infection control were noted.Conclusion: Sick healthcare workers may have introduced GAS into the SNF, with propagation by infection control lapses. “Presenteeism,” or working while ill, may introduce and transmit GAS to vulnerable in SNF populations. Identification of an invasive GAS case-patient should trigger a prompt response by facilities to prevent further transmission and workplace culture, and policies should be in place to discourage presenteeism in healthcare settings.DOI: https://dx.doi.org/10.1111/jgs.14505

NosoBase ID notice : 422335Bactéries émises dans l'air ambiant pendant la bronchoscopie - un risque pour les professionnels de santé ?

Marchand G; Duchaine C; Lavoie J; Veillette M; Cloutier Y. Bacteria emitted in ambient air during bronchoscopy-a risk to health care workers? American journal of infection control 2016/12; 44(12): 1634-1638.

Mots-clés : RISQUE PROFESSIONNEL; AEROBIOCONTAMINATION; AIR; BRONCHOSCOPIE; PERSONNEL ; RISQUE

Background: Health care workers are at risk of occupational infections, and some procedures are known to increase this risk. The aim of this study was to qualify and quantify bioaerosol concentrations during bronchoscopy to estimate the occupational risk.

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Methods: Full-day sampling was conducted in 2 rooms while bronchoscopies were performed on patients. Two microbial air samplers were used, a wet wall cyclonic sampler and an impactor, on culture media. Identification of the culturable bacterial flora was performed with chromatographic analysis of cellular fatty acid of the isolated strain and additional biochemical tests if needed. Specific polymerase chain reaction analysis was completed on wet wall cyclonic samples for the detection of influenza A and B and Mycobacterium spp.Results: A wide variety of bacteria were collected from the ambient air. All samples yielded at least 1 Staphylococcus species. Although most of the culturable bacteria identified were normal nonpathogenic flora, such as Streptococcus spp, Neisseria spp, and Corynebacterium spp, some opportunistic pathogens, such as Streptococcus pneumoniae, were found. Neither Mycobacterium spp nor influenza virus was detected with the polymerase chain reaction method during this study.Conclusions: Culturable bacteria from oral, nasal, and pulmonary flora are aerosolized during bronchoscopy and could be inhaled by medical staff. The potential presence of pathogens in those aerosols could represent an occupational infection risk. DOI: https://dx.doi.org/10.1016/j.ajic.2016.04.241

NosoBase ID notice : 422162Epuisement (burnout) du personnel dans une unité de réanimation néonatale et son lien avec les infections associées aux soins

Tawfik DS; Sexton JB; Kan P; Sharek PJ; Nisbet CC; Rigdon J; et al. Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections. Journal of perinatology 2016/11/17; in press: 1-6.

Mots-clés : SOIN INTENSIF; INFECTION NOSOCOMIALE; REANIMATION; NEONATOLOGIE; NOUVEAU-NE; PERSONNEL; CHARGE DE TRAVAIL; PERCEPTION; PSYCHOLOGIE

Objective: To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates.Study design: Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects.Results: We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34).Conclusion: Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive. DOI: https://dx.doi.org/10.1038/jp.2016.211

Pharmacie

NosoBase ID notice : 423398Ordonnance n° 2016-1729 du 15 décembre 2016 relative aux pharmacies à usage intérieur

Ministère des affaires sociales et de la santé. Ordonnance n° 2016-1729 du 15 décembre 2016 relative aux pharmacies à usage intérieur. Journal officiel de la République française Lois et décrets 2016/12/16: 5 pages.

Mots-clés : LEGISLATION; PHARMACIE A USAGE INTERIEUR; MEDICAMENT; DISPOSITIF MEDICAL STERILE; PHARMACOVIGILANCE; MATERIOVIGILANCE; POLITIQUE DU MEDICAMENT

Signalement

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NosoBase ID notice : 423350Arrêté du 28 décembre 2016 relatif à l'obligation de signalement des structures sociales et médico-sociales

Ministère des affaires sociales et de la santé. Arrêté du 28 décembre 2016 relatif à l'obligation de signalement des structures sociales et médico-sociales. Journal officiel de la République française Lois et décrets 2016/12/31; 304: 5 pages.

Mots-clés : STRUCTURE SOCIALE; STRUCTURE MEDICO-SOCIALE; SIGNALEMENT; EVENEMENT INDESIRABLE; GESTION DES RISQUES; SECURITE SANITAIRE; LEGISLATION; LEGIONELLA; EPIDEMIE; MALADIE INFECTIEUSENosoBase ID notice : 423386Décret n° 2016-1813 du 21 décembre 2016 relatif à l’obligation de signalement des structures sociales et médico-sociales

Ministère des affaires sociales et de la santé. Décret n° 2016-1813 du 21 décembre 2016 relatif à l’obligation de signalement des structures sociales et médico-sociales. Journal officiel de la République française Lois et décrets 2016/12/23: 2 pages.

Mots-clés : LEGISLATION; SIGNALEMENT; STRUCTURE MEDICO-SOCIALE; STRUCTURE SOCIALE; USAGER DE LA SANTE; EVENEMENT INDESIRABLE GRAVE; EVENEMENT INDESIRABLE GRAVE ASSOCIEE AUX SOINS

Les structures sociales et médico-sociales et les lieux de vie et d’accueil soumis à autorisation ou à déclaration (mentionnés aux articles L. 312-1, L. 321-1 et L. 322-1 du code de l’action sociale et des familles) doivent déclarer aux autorités administratives compétentes (préfet de département, directeur général de l’agence régionale de santé, président du conseil départemental) tout dysfonctionnement grave dans leur gestion ou organisation susceptible d’affecter la prise en charge des usagers et tout événement ayant pour effet de menacer ou de compromettre la santé, la sécurité ou le bien-être des personnes prises en charge. Le présent décret a pour objet de préciser les modalités de ce signalement.

Staphylococcus aureus

NosoBase ID notice : 421326Initiative mondiale contre la pneumonie à Staphylococcus aureus résistant à la méticilline (GLIMP): étude internationale de cohorte observationnelle

Aliberti S; Reyes LF; Faverio P; Sotgiu G; Dore S. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet infectious diseases 2016/12; 16(12): 1364-1376.

Mots-clés : PNEUMONIE; STAPHYLOCOCCUS AUREUS; SARM; ANTIBIORESISTANCE; COHORTE; ETUDE MULTICENTRIQUE; PREVALENCE; FACTEUR DE RISQUE

Background : Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia.Methods : We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analysis.Findings : 3702 patients hospitalised with pneumonia were enrolled, with 3193 patients receiving microbiological tests within 24 h of admission, forming the patient population. 1173 (37%) had at least one pathogen isolated (culture-positive population). The overall prevalence of confirmed MRSA pneumonia was 3·0% (n=95), with differing prevalence between continents and countries. Three risk factors were independently associated with MRSA pneumonia: previous MRSA infection or colonisation (odds ratio 6·21, 95% CI 3·25-11·85), recurrent skin infections (2·87, 1·10-7·45), and severe pneumonia disease (2·39, 1·55-3·68).

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Interpretation : This multicountry study shows low prevalence of MRSA pneumonia and specific MRSA risk factors among community-dwelling patients hospitalised with pneumonia.DOI: https://dx.doi.org/10.1016/S1473-3099(16)30267-5

Surveillance

NosoBase ID notice : 422523Comparaison des recueils de données de surveillance des infections associées aux soins dans des maisons de retraite

Epstein L; Stone ND; LaPlace L; Harper J; Lynfield R; Warnke L; et al. Comparison of data collection for healthcare-associated infection surveillance in nursing homes. Infection control and hospital epidemiology 2016/12; 37(12): 1440-1445.

Mots-clés : INFECTION NOSOCOMIALE; EHPAD; MAISON DE RETRAITE; PREVALENCE; SURVEILLANCE; PERSONNEL; ANTIBIOTIQUE; FACTEUR DE RISQUE; DEFINITION

Objective: To facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff. Design: A 1-day point-prevalence survey Setting and participants: Overall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study. Methods: NH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed. Results: The overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents). Conclusion: We identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys.DOI: https://dx.doi.org/10.1017/ice.2016.200

NosoBase ID notice : 422287Rapport de l'INICC, résumé des résultats de 50 pays pour 2010-2015 : module associé aux dispositifs médicaux

Rosenthal VD; Al-Abdely HM; El-Kholy AA; AlKhawaja SA; Leblebicioglu H; Mehta Y; et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module. American journal of infection control 2016/12; 44(12): 1495-1504.

Mots-clés : SURVEILLANCE; INFECTION NOSOCOMIALE; SOIN INTENSIF; DISPOSITIF MEDICAL; PNEUMONIE; VENTILATION ASSISTEE; INFECTION URINAIRE; SONDAGE URINAIRE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; ANTIBIORESISTANCE; PAYS EN DEVELOPPEMENT; ETUDE MULTICENTRIQUE; ETUDE PROSPECTIVE

Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-

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associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically. DOI: https://dx.doi.org/10.1016/j.ajic.2016.08.007

NosoBase ID notice : 422293Caractéristiques des programmes de surveillance des infections associées aux soins aux niveaux régional et national : une étude qualitative

Russo PL; Havers SM; Cheng AC; Richards M; Graves N; Hall L. Characteristics of national and statewide health care-associated infection surveillance programs: A qualitative study. American journal of infection control 2016/12; 44(12): 1505-1510.

Mots-clés : SURVEILLANCE; INFECTION NOSOCOMIALE; POLITIQUE DE SANTE; ENTRETIEN; ORGANISATION; PREVENTION

Background: There are many well-established national health care-associated infection surveillance programs (HAISPs). Although validation studies have described data quality, there is little research describing important characteristics of large HAISPs. The aim of this study was to broaden our understanding and identify key characteristics of large HAISPs.Methods: Semi-structured interviews were conducted with purposively selected leaders from national and state-based HAISPs. Interview data were analyzed following an interpretive description process.Results: Seven semi-structured interviews were conducted over a 6-month period during 2014-2015. Analysis of the data generated 5 distinct characteristics of large HAISPs: (1) triggers: surveillance was initiated by government or a cooperative of like-minded people, (2) purpose: a clear purpose is needed and determines other surveillance mechanisms, (3) data measures: consistency is more important than accuracy, (4) processes: a balance exists between the volume of data collected and resources, and (5) implementation and maintenance: a central coordinating body is crucial for uniformity and support.Conclusions: National HAISPs are complex and affect a broad range of stakeholders. Although the overall goal of health care-associated infection surveillance is to reduce the incidence of health care-associated infection, there are many crucial factors to be considered in attaining this goal. The findings from this study will assist the development of new HAISPs and could be used as an adjunct to evaluate existing programs. DOI: https://dx.doi.org/10.1016/j.ajic.2016.06.034

Usager

NosoBase ID notice : 423400Arrêté du 19 décembre 2016 fixant le montant de l’indemnité de formation prévue au II de l’article L. 1114-1 du code de la santé publique

Ministère des affaires sociales et de la santé. Arrêté du 19 décembre 2016 fixant le montant de l’indemnité de formation prévue au II de l’article L. 1114-1 du code de la santé publique. Journal officiel de la République française Lois et décrets 2016/12/21. 5 pages.

Mots-clés : LEGISLATION; FORMATION; REFERENT; USAGER DE LA SANTE

NosoBase ID notice : 423390Décret n° 2016-1768 du 19 décembre 2016 relatif au financement de la formation de base des représentants des usagers du système de santé

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Ministère des affaires sociales et de la santé. Décret n° 2016-1768 du 19 décembre 2016 relatif au financement de la formation de base des représentants des usagers du système de santé. Journal officiel de la République française Lois et décrets 2016/12/20: 2 pages.

Mots-clés : LEGISLATION; USAGER DE LA SANTE; FORMATION; FINANCEMENT; REFERENT

Les représentants des usagers siégeant dans les instances hospitalières ou de santé publique sont tenus de suivre une formation de base délivrée par les associations de représentants d’usagers agréées. Lorsque les représentants des usagers participent à la session de formation de base, ils perçoivent une indemnité versée par l’association agréée délivrant cette formation. Le présent décret détermine les modalités d’allocation de la subvention publique attribuée aux associations assurant cette formation. La subvention a pour objet de financer l’indemnité versée par l’association aux représentants d’usagers bénéficiaires de la formation de base ainsi que les actions de formation de base délivrées par cette association.

NosoBase ID notice : 423389Arrêté du 9 décembre 2016 fixant la liste des associations habilitées à délivrer la formation de base des représentants d’usagers du système de santé

Ministère des affaires sociales et de la santé. Arrêté du 9 décembre 2016 fixant la liste des associations habilitées à délivrer la formation de base des représentants d’usagers du système de santé. Journal officiel de la République française Lois et décrets 2016/12/14: 1 page.

Mots-clés : LEGISLATION; USAGER DE LA SANTE; FORMATION; REFERENT; CISS; COLLECTIF INTERASSOCIATIF SUR LA SANTE

Vaccination

NosoBase ID notice : 423380Avis relatif au transfert du Comité technique des vaccinations à la Haute Autorité de santé : 18 novembre 2016

Haut conseil de la santé publique (HCSP). Avis relatif au transfert du Comité technique des vaccinations à la Haute Autorité de santé : 18 novembre 2016. HCSP 2016/12/22: 1-14.

Mots-clés : VACCINATION; ORGANISATION; HAUTE AUTORITE DE SANTE; COMITE TECHNIQUE DES VACCINATIONS

Le Comité technique des vaccinations (CTV) a pour missions principales l’élaboration de la stratégie vaccinale et des avis sur les nouveaux vaccins.La ministre des Affaires sociales et de la santé a décidé du transfert du CTV du Haut Conseil de santé publique à la Haute Autorité de santé (HAS) en janvier dernier.Dans cette perspective, et sur demande de la ministre, le HCSP a constitué un groupe de travail afin de faire des propositions sur l’évolution du CTV dans le cadre de la Haute Autorité de santé (HAS).Ce groupe a travaillé en lien avec les représentants de la HAS, de Santé Publique France et de l’Agence Nationale de sécurité du médicament et des produits de santé (ANSM).Les principales recommandations du groupe de travail s’appuient sur l’organisation qui existait au sein du HCSP :- le CTV reste une structure permanente et bien identifiée au sein de la HAS avec des missions spécifiques dans le prolongement de celles du CTV,- une composition pluridisciplinaire afin de prendre en compte l’ensemble des dimensions nécessaires et impliquant les autres institutions (HCSP, ANSM, Santé publique France),- une organisation permettant de répondre aux saisines en urgence,- une articulation avec les autres structures de la HAS concernées par l’évaluation des vaccins (CT, CEESP),- le maintien de la possibilité d’auto-saisine afin d’anticiper et de répondre aux questions de santé publique éventuelles,- l’amélioration de la qualité de l’expertise,- la transparence des travaux et des liens avec les firmes pharmaceutiques,- la structuration de procédures permettant la réalisation d’études médico-économiques.

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NosoVeille – Bulletin de veille Janvier 2017

NosoBase ID notice : 423392Décret n° 2016-1758 du 16 décembre 2016 relatif à la vaccination contre l’hépatite B des thanatopracteurs

Ministère des affaires sociales et de la santé. Décret n° 2016-1758 du 16 décembre 2016 relatif à la vaccination contre l’hépatite B des thanatopracteurs. Journal officiel de la République française Lois et décrets 2016/12/18: 2 pages.

Mots-clés : VACCINATION; HEPATITE B; LEGISLATION; THANATOPRAXIE; CERTIFICAT MEDICAL

Le décret précise les conditions de réalisation de l’obligation vaccinale contre l’hépatite B par les thanatopracteurs en formation ou en exercice, en l’absence d’infection par ce virus ou de contre-indication à cette vaccination. Il détermine les modalités selon lesquelles les informations concernant le respect des obligations légales de vaccination sont transmises aux organismes de formation ou au préfet, dans le respect du secret de toute autre information médicale confidentielle.

NosoBase ID notice : 422577Connaissances, attitudes et pratiques des étudiants australiens concernant la vaccination contre la grippe

Walker L; Knowledge, attitudes and practices of Australian medical students towards influenza vaccination. Vaccine 2016/12/07; 34(50): 6193-6199.

Mots-clés : VACCINATION; GRIPPE; CONNAISSANCE; ATTITUDE; PRATIQUE; ETUDIANT EN MEDECINE; ENQUETE

Background: Annual influenza vaccination is recommended but not compulsory for healthcare workers in Australia, including medical students. A quarter of healthcare workers are estimated to have an influenza infection in any given year, with a subsequent transmission risk to colleagues and patients. During clinical placements, medical students are also at risk of influenza. While compliance with other vaccination requirements are high, influenza vaccine uptake of healthcare workers and medical students remain low globally. We aimed to explore medical students' influenza vaccination rates, attitudes, knowledge and intended practices at a large Australian university.Method: A 35 item self-administered online survey was distributed to medical students enrolled at a large Australian university (UNSW Australia) in April/May 2014. The survey examined the knowledge, attitudes and practices of medical students towards influenza vaccination and identified factors associated with vaccine uptake.Results: Of the 606 students, 53.8% (95%CI 49.8-57.8%) receiving their most recent influenza vaccine in 2014. Self-protection was the most common motivator (83%) and inconvenience (64%) the most common barrier to vaccination, despite access to on campus clinics. Students generally held positive attitudes to the influenza vaccine and vaccination recommendations, though some misconceptions existed. The majority (61%) were in support of mandatory influenza vaccination policies for medical students. Significant predictors of influenza vaccination included living on campus, clinical experience, awareness of vaccination recommendations and agreeing that vaccination was important for medical students, while those with perceived time constraints were less likely to be vaccinated.Conclusion: Misconceptions and access to influenza vaccine were barriers to uptake of influenza vaccine by medical students. Medical programs need to emphasise the benefits of influenza vaccination in the protection of healthcare workers and patient safety across the medical education program. Our results suggesting majority support for mandatory influenza vaccination may represent a shifting perspective in the medical community. DOI: https://dx.doi.org/10.1016/j.vaccine.2016.10.074

Ville / Médecine de ville

NosoBase ID notice : 423251Instruction DGOS/R5 n° 2016-392 du 2 décembre 2016 relative aux équipes de soins primaires (ESP) et aux communautés professionnelles territoriales de santé (CPTS)

Ministère des affaires sociales et de la santé. Instruction DGOS/R5 n° 2016-392 du 2 décembre 2016 relative aux équipes de soins primaires (ESP) et aux communautés professionnelles territoriales de santé (CPTS). Non parue au Journal officiel: 12 pages.

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NosoVeille – Bulletin de veille Janvier 2017

Mots-clés : SOIN DE SANTE PRIMAIRE; PARCOURS DE SOINS; PROFESSION SANITAIRE; EQUIPE SOIGNANTE; DEMARCHE DE PROJET; PROGRAMME REGIONAL DE SANTE; OFFRE DE SOINS; MAISON DE SANTE; CENTRE DE SANTE; TERRITOIRE DE SANTE; ACTION DE SANTE PUBLIQUE; POLITIQUE DE SANTE; ASSURANCE MALADIE; LEGISLATION; EXERCICE LIBERAL; COMMUNAUTE PROFESSIONNELLE TERRITORIALE DE SANTE; CPTS; EQUIPE DE SOINS PRIMAIRES; ESP

La loi de modernisation de notre système de santé s’attache à répondre aux attentes exprimées par les professionnels de santé qui souhaitent promouvoir les soins primaires et l’amélioration de la structuration des parcours. Pour ce faire, elle a créé les Equipes de Soins Primaires (ESP) et les Communautés professionnelles territoriales de santé (CPTS). L’instruction détaille les modalités de mise en œuvre de ces différents dispositifs. Elle précise notamment le rôle des ARS dans cette démarche.

Zika

NosoBase ID notice : 422355Comment les gens réagissent-ils face aux épidémies à virus Zika sur Twitter ? Une analyse comparationnelle de contenu

Fu KW; Liang H; Saroha N; Tse ZT; Ip P; Fung IC. How people react to Zika virus outbreaks on Twitter? A computational content analysis. American journal of infection control 2016/12; 44(12): 1700-1702.

Mots-clés : VIRUS; ARBOVIRUS; EPIDEMIE; SANTE PUBLIQUE; INTERNET; RESEAU NUMERIQUE; COMMUNICATION; CIRCULATION DE L'INFORMATION; USAGER DE LA SANTE; ZIKA

Zika-related Twitter incidence peaked after the World Health Organization declared an emergency. Five themes were identified from Zika-related Twitter content: (1) societal impact of the outbreak; (2) government, public and private sector, and general public responses to the outbreak; (3) pregnancy and microcephaly: negative health consequences related to pregnant women and babies; (4) transmission routes; and (5) case reports. User-generated contents sites were preferred direct information channels rather than those of the government authorities.DOI: https://dx.doi.org/10.1016/j.ajic.2016.04.253

Responsables de la rubrique NosoVeille : N. Sanlaville, S. Yvars, A, K. Trouilloud (CClin Sud-Est), I. Girot (CClin Ouest), K. Lebascle (CClin Paris-Nord). Secrétaire : N. Vincent (CClin Sud-Est)

Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de votre inter-région :

CCLIN EstTél : 03.83.15.34.73 Fax : [email protected]

CCLIN OuestTél : 02.99.87.35.31Fax : [email protected]

CCLIN Paris-NordTél : 01.40.27.42.00 Fax : [email protected]

CCLIN Sud-EstTél : 04.78.86.49.50Fax : [email protected]

CCLIN Sud-OuestTél : 05.56.79.60.58Fax : [email protected]

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