NosoVeille Août 2011

NosoVeille – Bulletin de veille
Juillet 2016
NosoVeille n°7
Juillet 2016
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Kae Trouilloud
Secrétariat de rédaction : Nathalie Vincent
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
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Sommaire de ce numéro :
Acinetobacter baumannii
Antibiorésistance
Antibiotique
Antiseptique
Bactériémie
Cancérologie
Chirurgie
Clostridium difficile
Désinfection
Endoscopie
Environnement
Gestion des risques
Hygiène des mains
Infection urinaire
Matériel médico-chirurgical
Mycobactérie
Odontologie
Personnel
Personne âgée
Pneumonie
Précautions complémentaires
Prévention
Règlementation
Soin intensif
Staphylococcus aureus
Vaccination
Zika
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Juillet 2016
Acinetobacter baumannii
NosoBase ID notice : 414959
Epidémiologie moléculaire et impact clinique sur le complexe Acinetobacter calcoaceticus-baumannii
dans un centre belge pour brûlé
De Vos D; Pirnay JP; Bilocq F; Jennes S; Verbeken G; Rose T; et al. Molecular epidemiology and clinical
impact of Acinetobacter calcoaceticus-baumannii complex in a Belgian burn wound center. PLoS One
2016/05/25; 11(5): 1-26.
Mots-clés : EPIDEMIOLOGIE; ACINETOBACTER BAUMANNII; BRULE; EPIDEMIE; ANTIBIOTIQUE;
BIOLOGIE MOLECULAIRE; TYPAGE; ACINETOBACTER CALCOACETICUS|
Multidrug resistant Acinetobacter baumannii and its closely related species A. pittii and A. nosocomialis, all
members of the Acinetobacter calcoaceticus-baumannii (Acb) complex, are a major cause of hospital
acquired infection. In the burn wound center of the Queen Astrid military hospital in Brussels, 48 patients
were colonized or infected with Acb complex over a 52-month period. We report the molecular epidemiology
of these organisms, their clinical impact and infection control measures taken. A representative set of 157
Acb complex isolates was analyzed using repetitive sequence-based PCR (rep-PCR) (DiversiLab) and a
multiplex PCR targeting OXA-51-like and OXA-23-like genes. We identified 31 rep-PCR genotypes (strains).
Representatives of each rep-type were identified to species by rpoB sequence analysis: 13 types to A.
baumannii, 10 to A. pittii, and 3 to A. nosocomialis. It was assumed that isolates that belonged to the same
rep-type also belonged to the same species. Thus, 83.4% of all isolates were identified to A. baumannii, 9.6%
to A. pittii and 4.5% to A. nosocomialis. We observed 12 extensively drug resistant Acb strains (10 A.
baumannii and 2 A. nosocomialis), all carbapenem-non-susceptible/colistin-susceptible and imported into the
burn wound center through patients injured in North Africa. The two most prevalent rep-types 12 and 13
harbored an OXA-23-like gene. Multilocus sequence typing allocated them to clonal complex 1 corresponding
to EU (international) clone I. Both strains caused consecutive outbreaks, interspersed with periods of
apparent eradication. Patients infected with carbapenem resistant A. baumannii were successfully treated
with colistin/rifampicin. Extensive infection control measures were required to eradicate the organisms.
Acinetobacter infection and colonization was not associated with increased attributable mortality.
Antibiorésistance
NosoBase ID notice : 411415
Le succès croissant d’Acinetobacter baumannii résistant aux antibiotiques demeure un défi en tant
que pathogène nosocomial
Gonzalez-Villoria AM; Valverde-Garduno V. Antibiotic-resistant Acinetobacter baumannii increasing success
remains a challenge as a nosocomial pathogen. Journal of pathogens 2016; 2016: 1-10.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; MULTIRESISTANCE; REVUE DE LA
LITTERATURE; EPIDEMIOLOGIE; SURVEILLANCE; SIGNALEMENT
Antibiotic-resistant infectious bacteria currently imply a high risk and therefore constitute a strong challenge
when treating patients in hospital settings. Characterization of these species and of particular strains is a
priority for the establishment of diagnostic tests and preventive procedures. The relevance of Acinetobacter
baumannii as a problematic microorganism in inpatient facilities, particularly intensive care units, has
increased over time. This review aims to draw attention to (i) the historical emergence of carbapenemresistant Acinetobacter baumannii, (ii) the current status of surveillance needs in Latin America, and (iii)
recent data suggesting that A. baumannii continues to spread and evolve in hospital settings. First, we
present synopsis of the series of events leading to the discovery and precise identification of this
microorganism in hospital settings. Then key events in the acquisition of antibiotic-resistant genes by this
microorganism are summarized, highlighting the race between new antibiotic generation and emergence of A.
baumannii resistant strains. Here we review the historical development of this species as an infectious threat,
the current state of its distribution, and antibiotic resistance characteristics, and we discuss future prospects
for its control.
NosoBase ID notice : 414719
Attitudes et perceptions des personnels de santé dans le Nord-Est de l’Allemagne vis-à-vis des
organismes multirésistants
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Marschall P; Hübner NO; Maletzki S; Wilke F; Dittmann K; Kramer A. Attitudes and perceptions of health care
workers in Northeastern Germany about multidrug-resistant organisms. American journal of infection control
2016/06; 44(6): e91-e94.
Mots-clés : ATTITUDE; PERSONNEL; RESISTANCE; ANTIBIORESISTANCE
There were 256 health care workers in 39 facilities who were interviewed about their perceptions of the
quality of care of patients with and without multidrug-resistant organisms based on a standardized
questionnaire. There are remarkable differences in the responses between facility types (acute care hospitals,
long-term care hospitals, rehabilitation hospitals, and home care services). Hygiene management must be
specifically tailored to the requirements of each facility.
NosoBase ID notice : 415723
Modification et évaluation du test Carba NP en utilisant une bande de papier pour une détection
simple et rapide d’entérobactéries productrices de carbapénèmes
Srisrattakarn A; Lulitanond A; Wilailuckana C; Charoensri N; Wonglakorn L; Piyapatthanakul S; et al.
Modification and evaluation of the Carba NP test by use of paper strip for simple and rapid detection of
carbapenemase-producing Enterobacteriaceae. World journal of microbiology and biotechnology 2016/07;
32(7): 8 pages.
Mots-clés : ENTEROBACTERIE; ESCHERICHIA COLI; KLEBSIELLA PNEUMONIAE; PSEUDOMONAS
AERUGINOSA; TECHNIQUE DE DIAGNOSTIC; TEST; DEPISTAGE; BETA-LACTAMASE A SPECTRE
ELARGI; PCR; COUT-EFFICACITE; CARBAPENEME; IMIPENEME
Carbapenemase-producing Enterobacteriaceae (CPE) isolates have now emerged worldwide. We therefore
modified the phenotypic Carba NP test by use of a filter paper strip for easily and rapidly identifying CPE in
routine laboratory. A collection of 56 CPE and carbapenemase-producing Pseudomonas spp. isolates
(including 28 NDM-1, 11 IMP-14a, 1 IMP-1, 1 IMP-4, 1 IMP-9, 1 IMP-15, 4 VIM-2, 1 VIM-1, 1 IMP-14a with
VIM-2, 3 OXA-48, 3 OXA-181 and 1 KPC-2 producers) and 41 non-CPE isolates (including 19 ESBL, 7
pAmpC, 3 AmpC, 9 ESBL with pAmpC and 3 non-ESBL & non-AmpC producers) as confirmed by the PCR
methods were tested by the paper strip method using pharmaceutical imipenem/cilastatin as a substrate.
Bacterial colonies of each isolate were applied directly on filter paper strips dropped with either imipenemphenol red (test strip) or phenol red solution alone (control strip). The reaction was read within 5 min. This test
failed to detect 3 OXA-181, 2 OXA-48 and 3 IMP-14a producers (85.7% sensitivity), whereas no false
positives were seen (100% specificity). Further evaluation of the paper strip test in 267 CPE screeningpositive isolates from three hospitals by their medical technologists showed 92.0% sensitivity (100% for NDM
producers) and 100% specificity compared with the PCR methods. Because of its ease, rapidness and cost
effective, the paper strip test has a potential for routine CPE testing in low-resource laboratories particularly in
areas with high prevalence of NDM enzymes, leading to appropriate antimicrobial therapy and infection
control strategy.
Antibiotique
NosoBase ID notice : 415800
Préserver l’efficacité des antibiotiques, limiter l’émergence des bactéries multirésistantes
Fascia P; Cauterman M; Giard M; Dumartin C; Savey A; Gauzit R. Préserver l’efficacité des antibiotiques,
limiter l’émergence des bactéries multirésistantes. Bulletin CClin-Arlin 2016/06; 3: 1-3.
Mots-clés : ANTIBIOTIQUE; INFORMATION; MULTIRESISTANCE
Dans le cadre du Plan d’alerte sur les antibiotiques 2011-2016, un collectif regroupant une fédération
hospitalière (la Fédération Hospitalière de France), une société savante (la SPILF) et une association
d’usagers (Le Lien) a initié une campagne sur le juste usage des antibiotiques. Cette campagne s’intitule «les
antibios… juste ce qu’il faut» et elle s’inscrit dans un partenariat avec l’Alliance contre le développement des
bactéries multirésistantes (AC2BMR).
Cette campagne repose sur un engagement des établissements de santé et un engagement individuel
nominatif des prescripteurs. Ces engagements, rendus publics par affichage, ont pour objectif principal
d’améliorer l’usage des antibiotiques.
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NosoBase ID notice : 415816
Ressources humaines nécessaires aux équipes multidisciplinaires en antibiothérapie dans les
établissements de santé français
Le Coz P; Carlet J; Roblot F; Pulcini C. Human resources needed to perform antimicrobial stewardship
teams’ activities in French hospitals. Médecine et maladies infectieuses 2016/06; 46(4): 200-206.
Mots-clés : MULTIRESISTANCE; ANTIBIOTIQUE; PRESCRIPTION; RECOMMANDATIONS DE BONNE
PRATIQUE; ENQUETE; MEDECIN SPECIALISTE; CHARGE DE TRAVAIL; COUT
Objectif : En janvier 2015, la ministre de la santé française a constitué un groupe de travail sur
l’Antibiorésistance. Le groupe « Bon usage des antibiotiques » a mené une étude pour évaluer les
ressources humaines nécessaires afin d’assurer toutes les missions des équipes multidisciplinaires en
antibiothérapie (EMA, associant référents en antibiothérapie/infectiologie, microbiologistes et pharmaciens)
dans les établissements de santé (ES) français.
Méthodes : Nous avons mené une enquête nationale à l’aide d’un questionnaire disponible sur Internet,
conçu à partir de textes réglementaires et de consensus d’experts. L’enquête s’est déroulée de mars à mai
2015. Nous avons utilisé la liste de diffusion mail de la Société de pathologie infectieuse de langue française
(SPILF).
Résultats : Au total, 65 ES ont participé à l’étude. Les ressources humaines nécessaires pour mener à bien
toutes les missions des EMA ont été évaluées à 3,6 postes équivalents temps pleins (ETP) de référents en
antibiothérapie/infectiologie pour 1000 lits de médecine-chirurgie-obstétrique, 2,5 ETP pharmaciens/1000 lits
et 0,6 ETP microbiologistes/1000 lits. Ceci équivaut à près de 2000 postes ETP pour tous les ES français
(publics et privés), soit un coût annuel d’environ 200 millions d’euros.
Conclusion : Un financement dédié et pérenne des EMA est indispensable à court terme si nous souhaitons
mettre en place des programmes de bon usage des anti-infectieux complets et effectifs dans tous les ES.
NosoBase ID notice : 414197
Méthodes de recherche concernant l’épidémiologie en santé et la gestion des antibiotiques : essais
contrôlés randomisés
Anderson DJ; Juthani-Mehta M; Morgan DJ. Research methods in healthcare epidemiology and antimicrobial
stewardship: Randomized controlled trials. Infection control and hospital epidemiology 2016/06; 37(6): 629634.
Mots-clés : ANTIBIOTIQUE;
RECHERCHE MEDICALE
EPIDEMIOLOGIE;
RANDOMISATION;
ESSAI
THERAPEUTIQUE;
Randomized controlled trials (RCT) produce the strongest level of clinical evidence when comparing
interventions. RCTs are technically difficult, costly, and require specific considerations including the use of
patient- and cluster-level randomization and outcome selection. In this methods paper, we focus on key
considerations for RCT methods in healthcare epidemiology and antimicrobial stewardship (HE&AS)
research, including the need for cluster randomization, conduct at multiple sites, behavior modification
interventions, and difficulty with identifying appropriate outcomes. We review key RCTs in HE&AS with a
focus on advantages and disadvantages of methods used. A checklist is provided to aid in the development
of RCTs in HE&AS.
NosoBase ID notice : 414199
Caractéristiques des programmes de gestion des antibiotiques dans les «Veterans Affairs Hospital» :
résultats d’une enquête nationale
Chou AF; Graber CJ; Jones MM; Zhang Y; Goetz MB; Madaras-Kelly K; et al. Characteristics of antimicrobial
stewardship programs at veterans affairs hospitals: Results of a nationwide survey. Infection control and
hospital epidemiology 2016/06; 37(6): 647-654.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; ANTIBIOGRAMME; DDJ; CLOSTRIDIUM DIFFICILE;
INFECTION NOSOCOMIALE
Background: Antimicrobial stewardship programs (ASPs) are variably implemented.
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Objective: To characterize variations of antimicrobial stewardship structure and practices across all inpatient
Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage.
Design: A web-based survey regarding stewardship activities was administered to each facility's designated
contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012
were determined.
Setting: Total of 130 Veterans Affairs facilities with inpatient services.
Results: Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an
approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams
included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied
across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]),
stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96
[74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03),
an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as
frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address
antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration
were associated with increased use (P=.03).
Conclusions: ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID
presence and certain select practices. Further statistical assessments may help optimize antimicrobial
practices.
NosoBase ID notice : 414216
Des processus d’audit avec retour d’expérience inclus dans des programmes de gestion des
antibiotiques : une enquête de la Society for Healthcare Epidemiology of America Research Network
(SRN)
Livorsi DJ; Heintz B; Jacob JT; Krein SL; Morgan DJ; Perencevich EN. Audit and feedback processes among
antimicrobial stewardship programs: A survey of the society for healthcare epidemiology of america research
network. Infection control and hospital epidemiology 2016/06; 37(6): 704-706.
Mots-clés : ANTIBIOTIQUE; AUDIT; PRESCRIPTION; MEDECIN; PHARMACIEN; COMPORTEMENT;
RECOMMANDATIONS DE BONNE PRATIQUE; SHEA
Optimal implementation of audit-and-feedback is an important part of advancing antimicrobial stewardship
programs. Our survey demonstrated variability in how 61 programs approach audit-and-feedback. The
median (interquartile range) number of recommendations per week was 9 (5-19) per 100 hospital-beds. A
major perceived barrier to more comprehensive stewardship was lack of resources.
NosoBase ID notice : 414196
Méthodes de recherche concernant l’épidémiologie en santé et la gestion des antibiotiques
Morgan DJ; Safdar N; Milstone AM; Anderson DJ. Research methods in healthcare epidemiology and
antimicrobial stewardship. Infection control and hospital epidemiology 2006/06; 37(6): 627-628.
Mots-clés : EPIDEMIOLOGIE; ANTIBIOTIQUE; PRESCRIPTION; RECHERCHE MEDICALE; ESSAI
THERAPEUTIQUE
Research in Healthcare Epidemiology and Antimicrobial Stewardship (HE&AS) is rapidly expanding with the
involvement of researchers from varied countries and backgrounds. Researchers must use scientific methods
that will provide the strongest evidence to advance healthcare epidemiology, but there are limited resources
for information on specific aspects of HE&AS research or easy ways to access examples of studies using
specific methods with HE&AS. In response to this need, the SHEA Research Committee has developed a
series of white papers on research methods in HE&AS. The objective of this series is to promote rigorous
healthcare epidemiology research by summarizing critical components, practical considerations, and pitfalls
of commonly used research methods.
NosoBase ID notice : 415720
Investigation d’une épidémie méconnue à grande échelle de fongémie : Candida parapsilosis sensu
stricto dans un centre hospitalier universitaire en Chine
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Wang H; Zhang L; Kudinha T; Kong F; Ma XJ; Chu YZ; et al. Investigation of an unrecognized large-scale
outbreak of Candida parapsilosis sensu stricto fungaemia in a tertiary-care hospital in China. Scientific reports
2016/06/02; 6: 1-11.
Mots-clés : CANDIDA PARAPSILOSIS; CANDIDA NON ALBICANS; FONGEMIE; CANDIDEMIE;
EPIDEMIE;
INVESTIGATION;
ETUDE
RETROSPECTIVE;
TRANSMISSION;
IDENTIFICATION
MOLECULAIRE; GENOTYPE
A data analysis of yeast collections from the National China Hospital Invasive Fungal Surveillance Net (CHIFNET) programme in 2013 revealed a sudden increase in the proportion of Candida parapsilosis complex
isolates (n = 98) in one participating hospital (Hospital H). Out of 443 yeast isolates submitted to the CHIFNET reference laboratory by Hospital H (2010-2014), 212 (47.9%) were identified as C. parapsilosis sensu
stricto by sequencing analysis of the internal transcribed spacer region and D1/D2 domain of the 26S rRNA
gene. Among the 212 C. parapsilosis sensu stricto isolates, 176 (83.0%) bloodstream-based isolates and 25
isolates from tip cultures of various vascular catheters from 25 patients with candidaemia, were subjected to
microsatellite genotyping, and a phylogenetic relationship analysis was performed for 152 isolates. Among
the 152 isolates, 45 genotypes (T01 to T45) were identified, and two prevalent genotypes (63.8%) were
found: T15 (n=74, 48.7%) and T16 (n=23, 15.1%). These two main clones were confined mainly to three
different wards of the hospital, and they persisted for 16-25 months and 12-13 months, respectively. The lack
of proper coordination between the clinical microbiology laboratory and infection control staff as part of public
health control resulted in the failure to timely identify an outbreak, which led to the wide and long-term
dissemination of C. parapsilosis sensu stricto in Hospital H.
Antiseptique
NosoBase ID notice : 415435
Comment s’assurer de l’efficacité des antiseptiques ? Revue des indications et des modes
d’utilisation
Badrikian L; Aumeran C; Traoré O. Comment s’assurer de l’efficacité des antiseptiques ? Revue des
indications et des modes d’utilisation. Hygiènes 2016/06; 24(3): 111-114.
Mots-clés : ANTISEPTIQUE;
COLONISATION
EFFICACITE;
RESISTANCE;
PEAU;
TOILETTE
DU
PATIENT;
Les antiseptiques sont des substances largement utilisées dont l'efficacité a été prouvée dans la prévention
des infections liées aux soins invasifs. Les produits utilisés actuellement ont une activité essentiellement
testée in vitro et l'on peut se préoccuper d'une baisse d'activité in vivo ainsi que d'une expression de gènes
de résistance pouvant être favorisée par des pratiques existantes. L'analyse de la littérature permet de mieux
comprendre les limites de l'efficacité de l'antisepsie, les conditions favorisant l'apparition de résistances et
l'importance de respecter quelques règles simples de choix et d'utilisation optimale des produits.
Bactériémie
NosoBase ID notice : 415853
Evaluation de la prise en charge de 493 bactériémies dans 23 hôpitaux du nord de la France
Alfandari S; Cabaret P; Nguyen S; Descamps D; Vachée A; Cattoen C; et al. Evaluating the management of
493 patients presenting with bacteremia in 23 northern French hospitals. Médecine et maladies infectieuses
2016/06; 46(4): 194-199.
Mots-clés : BACTERIEMIE; INFECTION NOSOCOMIALE; ANTIBIOTIQUE; ETUDE PROSPECTIVE
Objectifs : Actualiser les connaissances épidémiologiques des bactériémies et évaluer la prise en charge et le
devenir des patients présentant des bactériémies.
Méthodes : Enquête multicentrique prospective d’octobre à novembre 2011 auprès de patients consécutifs
ayant une hémoculture positive.
Données évaluées : type et conformité des antibiothérapies probabilistes et documentées, délai avant
administration d’un antibiotique actif, adhésion au référentiel local et devenir à j10.
Résultats : Vingt-trois établissements publics et privés et 633 patients ont été inclus, dont 493 patients avec
un pathogène et 139 un contaminant. Les patients venaient des services de médecine (57 %), chirurgie (19
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%), réanimation (14 %), pédiatrie (3,4 %), onco-hématologie (3,7 %), infectiologie (1,8 %) et obstétrique (1,2
%). Principaux pathogènes : Escherichia coli (34 %), Staphylococcus aureus (16 %), staphylocoque à
coagulase négative et Klebsiella sp. (8 % chacun). Il y avait 43 (8,7 %) BMR, dont 26 BLSE et 15 SARM. Un
antibiotique actif a été observé dans 74 % des cas en probabiliste et 96 % en documenté. Le délai médian
entre hémoculture et 1er antibiotique actif était de 0,61 jours. L’antibiothérapie probabiliste était conforme au
référentiel local dans 77 % des cas. Seules 4 % des contaminations ont été traitées. La mortalité à j10 était
de 12,1 %, plus élevée en cas de sepsis grave ou de choc septique (22,5 %) que pour les bactériémies
simples (7,1 % ; p < 0,0001).
Conclusion : La prise en charge initiale des bactériémies dans ces établissements volontaires semble
correcte mais les bactériémies restent des infections sévères.
NosoBase ID notice : 416093
Détection rapide du gène blaOXA dans les bactériémies à Acinetobacter radioresistens sensibles au
carbapénème donnant lieu à l’administration injustifiée d’antibiotiques
Brady AC; Lewis JS; Pfeiffer CD. Rapid detection of blaOXA in carbapenem-susceptible Acinetobacter
radioresistens bacteremia leading to unnecessary antimicrobial administration. Diagnostic microbiology and
infectious disease 2016/05/05; in press: 1-2.
Mots-clés : ACINETOBACTER; TECHNIQUE DE DIAGNOSTIC; IDENTIFICATION MOLECULAIRE;
BIOLOGIE MOLECULAIRE; GENOTYPE; BIOTYPE; SENSIBILITE; CARBAPENEME; BACTERIEMIE;
ANTIBIOTIQUE; ACINETOBACTER RADIORESISTENS; CARBAPENEMASE
Rapid molecular techniques to identify resistant pathogens are revolutionizing antibiotic stewardship;
however, it is important to recognize the limitations of these techniques. Herein we describe two cases of
bacteremia that were both initially identified by genotypic testing as carbapenem-resistant Acinetobacter spp.
and subsequently identified phenotypically as carbapenem-susceptible A. radioresistens. The genotypic
results prompted unnecessary broad-spectrum antibiotic use and infection control concerns.
NosoBase ID notice : 414983
Guide ASPIC pour la prévention des bactériémies associées aux voies centrales
Ling ML; Apisarnthanarak A; Jaggi N; Harrington G; Morikane K; Thi Anh Thu L; et al. APSIC guide for
prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrobial resistance & infection
control 2016/05/04; 5(16): 1-9.
Mots-clés :
PREVENTION;
BACTERIEMIE;
CATHETER
VEINEUX
CENTRAL;
QUALITE;
CHLORHEXIDINE; HYGIENE DES MAINS; GANT; DESINFECTION; PANSEMENT; SURVEILLANCE;
RECOMMANDATIONS DE BONNE PRATIQUE; BUNDLE
This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated
Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line
Insertion and Maintenance Bundles and its implementation using the quality improvement methodology,
namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders.
Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the
success of implementing best practices. A surveillance program is recommended to monitor outcomes and
adherence to evidence-based central line insertion and maintenance practices (compliance rate) and identify
quality improvement opportunities and strategically targeting interventions for the reduction of CLABSI.
NosoBase ID notice : 414211
Bundle d’entretien des voies centrales pour la prévention des bactériémies sur voie centrale en
dehors des soins intensifs
O'Neil C; Ball K; Wood H; McMullen K; Kremer P; Jafarzadeh SR; et al. A central line care maintenance
bundle for the prevention of central line-associated bloodstream infection in non-intensive care unit settings.
Infection control and hospital epidemiology 2016/06; 37(6): 692-698.
Mots-clés : CATHETER VEINEUX CENTRAL; BACTERIEMIE; INFECTION NOSOCOMIALE; TAUX;
PANSEMENT; ENTRETIEN; PREVENTION; CENTRE HOSPITALIER UNIVERSITAIRE; SERVICE DE
SOINS
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Objective: To evaluate a central line care maintenance bundle to reduce central line-associated bloodstream
infection (CLABSI) in non-intensive care unit settings.
Design: Before-after trial with 12-month follow-up period.
Setting: A 1,250-bed teaching hospital.
Participants: Patients with central lines on 8 general medicine wards. Four wards received the intervention
and 4 served as controls.
Intervention: A multifaceted catheter care maintenance bundle consisting of educational programs for nurses,
update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress
reports, and consolidation of supplies necessary for catheter maintenance.
Results: Data were collected for 25,542 catheter-days including 43 CLABSI (rate, 1.68 per 1,000 catheterdays) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the
CLABSI incidence density was observed on intervention floors but this was not statistically significant (95%
CI, -5.3% to 0.4%). On control floors, there was a smaller but marginally significant decrease in CLABSI
incidence during the study (change in monthly rate, -1.1%; 95% CI, -2.1% to -0.1%). Implementation of the
bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8%
compliance before intervention vs 87.9% during intervention/follow-up; P<.001) but improvement was also
observed on control wards (84.9% compliance before intervention vs 90.9% during intervention/follow-up;
P=.001).
Conclusions: A multifaceted program to improve catheter care was associated with improvement in catheter
dressing care but no change in CLABSI rates. Additional study is needed to determine strategies to prevent
CLABSI in non-intensive care unit patients.
NosoBase ID notice : 414936
Prévention des bactériémies liées aux cathéters chez les patients hémodialysés : défis et stratégies
de gestion
Soi V; Moore CL; Kumbar L; Yee J. Prevention of catheter-related bloodstream infections in patients on
hemodialysis: challenges and management strategies. International journal of nephrology and renovascular
disease 2016/04/18; 9: 95-103.
Mots-clés : PREVENTION; CATHETERISME; BACTERIEMIE; HEMODIALYSE; EPIDEMIOLOGIE; COUT;
PERSONNE AGEE; CATHETER IMPREGNE; DESINFECTANT
Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage
renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many
patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in
arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production
of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter
maintenance, infection control measures, and early removal of devices as patients transition to other access.
Despite best efforts, when conservative measures fail to prevent infections in a high-risk population,
antimicrobial lock therapy should be considered as an option to combat catheter-related bloodstream
infections.
Cancérologie
NosoBase ID notice : 415427
Suivi de la qualité de l’air dans un centre de lutte contre le cancer : évaluation et caractérisation de
l’exposition aux contaminants fongiques (Biohospitalair)
Heutte N; André V; Bonhomme J; Dubos Arvis C; Kientz-Bouchart V; Lemarié F; et al. Suivi de la qualité de
l’air dans un centre de lutte contre le cancer : évaluation et caractérisation de l’exposition aux contaminants
fongiques (Biohospitalair). Hygiènes 2016/06; 24(3): 123-132.
Mots-clés : AIR; QUALITE; CONTAMINATION; MYCOLOGIE; ASPERGILLUS FUMIGATUS; AEROSOL
Contexte : La qualité de l'air dans un établissement de soins est une préoccupation importante en termes de
santé publique en particulier chez les patients immunodéprimés qui peuvent être exposés à des
contaminants d'origine microbiologique tels que les moisissures, les endotoxines, les (1,3)-β-D-glucanes et
les mycotoxines.
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Méthodes : Le projet Biohospitalair, soutenu par I'ADEME (Agence de l'environnement et de la maîtrise de
l'énergie), a consisté, durant deux ans, à prélever mensuellement et à caractériser des bio aérosols et des
isolats fongiques collectés dans un centre de lutte contre le cancer (centre F. Baclesse), dans des zones ne
possédant pas de traitement d'air spécifique.
Résultats : Parmi plus de cent espèces fongiques différentes identifiées, certaines peuvent être retenues en
raison de leur fréquence, de leur concentration et/ou de leur capacité à produire in vitro des mycotoxines:
Aspergillus fumigatus, Aspergillus melleus, Aspergillus niger, Aspergillus versicolor, Cladosporium herbarum,
Paecilomyces lilacinus, Penicillium brevicompactum. D'un point de vue quantitatif, les niveaux moyens en
particules fongiques viables restent inférieurs à 30 CFU/m 3 d'air et sont corrélés au nombre de particules
totales de 0,30 à 20 µm. Cette étude met également en évidence des variations saisonnières avec
l'apparition de pics de particules fongiques en été et en automne. De plus, l'analyse statistique révèle que
l'humidité relative est une variable explicative du nombre de CFU/m 3 d'air, ce qui pourrait faire de ce
paramètre un indicateur de contamination fongique pertinent.
Chirurgie
NosoBase ID notice : 415541
Note d'information DGOS/PF2 n° 2016-164 du 24 mai 2016 relative aux points critiques récurrents et à
la mise en œuvre, pour l'activité de chirurgie ambulatoire, de la politique d'amélioration continue de la
qualité et de la sécurité des soins et de gestion des risques en établissement de santé
Ministère des affaires sociales et de la santé. Note d'information DGOS/PF2 n° 2016-164 du 24 mai 2016
relative aux points critiques récurrents et à la mise en œuvre, pour l'activité de chirurgie ambulatoire, de la
politique d'amélioration continue de la qualité et de la sécurité des soins et de gestion des risques en
établissement de santé. Non parue au Journal officiel: 17 pages.
Mots-clés : CHIRURGIE AMBULATOIRE; QUALITE DES SOINS; DEMARCHE QUALITE; GESTION DES
RISQUES; SECURITE SANITAIRE; PREVENTION; EVENEMENT INDESIRABLE; LEGISLATION; USAGER
DE LA SANTE; MEDICAMENT; INDICATEUR; DROITS DU MALADE; SECURITE DES SOINS;
EVENEMENT INDESIRABLE ASSOCIE AUX SOINS
La présente note d’information propose aux établissements de santé des fiches relatives aux points critiques
récurrents et à la mise en œuvre, pour l’activité de chirurgie ambulatoire, de la politique d’amélioration
continue de la qualité et de la sécurité des soins et de gestion des risques en établissement de santé.
NosoBase ID notice : 415500
Les unités de chauffage-refroidissement : contamination des appareils cruciaux en chirurgie
cardiothoracique
Götting T; Klassen S; Jonas D; Benk C; Serr A; Wagner D; et al. Heater-cooler units: contamination of crucial
devices in cardiothoracic surgery. The journal of hospital infection 2016/07; 93(3): 223-228.
Mots-clés : CONTAMINATION; CHIRURGIE THORACIQUE; CIRCULATION EXTRA-CORPORELLE;
BIOFILM; MYCOBACTERIE; AIR; MYCOBACTERIUM CHIMAERA
Background: Several cases of Mycobacterium chimaera infection have recently been reported in
cardiosurgical patients. So-called heater-cooler units (HCUs) used in cardiosurgical procedures are
suspected to be the reservoir for pathogen growth and dissemination.
Aim: To assess the contamination status of HCUs at our facility.
Methods: Air sampling for mycobacteria was conducted at different distances from the machines and in the
area around the operating table. Air sampling was also conducted for non-fermenters as a surrogate
parameter for water-associated pathogens.
Findings: Mycobacterium chimaera was detected in the water tanks of the HCUs. When the devices were
operating, M. chimaera was also found in their exhaust air, as well as in the area around the operating table.
Non-fermenters were identified at different distances from the running HCU and the area around the
operating table. Cultures remained negative when the devices were switched off.
Conclusions: Exhaust air from HCUs may be a pathway of pathogen transmission to patients undergoing
open chest heart surgery. Although, for technical reasons, relocation of HCUs is difficult to achieve, only strict
separation of the HCU from the operating room appears to enhance patient safety. Using non-fermenters as a
surrogate parameter may be considered a viable option for a timely risk assessment. The design of HCUs
should be modified to keep susceptibility to contamination at a minimum.
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NosoBase ID notice : 414213
Améliorer la surveillance des infections du site opératoire après arthroplastie totale de la hanche ou
du genou par l’utilisation des diagnostics et des codes d’intervention dans un réseau de surveillance
en province
Rusk A; Bush K; Brandt M; Smith C; Howatt A; Chow B; et al. Improving surveillance for surgical site
infections following total hip and knee arthroplasty using diagnosis and procedure codes in a provincial
surveillance network. Infection control and hospital epidemiology 2016/06; 37(6): 699-703.
Mots-clés : PROTHESE TOTALE DE HANCHE; PROTHESE TOTALE DE GENOU; CHIRURGIE
ORTHOPEDIQUE; SURVEILLANCE; TAUX; DIAGNOSTIC; CODAGE DES ACTES PROFESSIONNELS;
INFECTION NOSOCOMIALE; ETUDE RETROSPECTIVE
Objective: To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following
primary elective total hip or knee arthroplasty.
Design: Retrospective cohort study.
Setting: All acute care facilities in Alberta, Canada.
Methods: Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to
identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection
control professional at the acute care facility where the patient was identified with a diagnosis or procedure
code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI
definition. The performance of traditional surveillance methods and administrative data-triggered medical
chart review was assessed.
Results: Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by
an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42%
vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their
procedure facility. Administrative data-triggered medical chart review with infection control professional
confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs
identified by administrative data resulted in sensitivity of 90% and specificity of 99%.
Conclusion: Medical chart review for cases identified through administrative data is an efficient supplemental
SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification
consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at
nonprocedure facilities.
NosoBase ID notice : 415780
Coût hospitalier marginal des ulcères de pression nosocomiaux dus à la chirurgie
Spector WD; Limcangco R; Owens PL; Steiner CA. Marginal hospital cost of surgery-related hospitalacquired pressure ulcers. Medical care 2016/05/23; in press: 1-7.
Mots-clés : COUT; CHIRURGIE; PEAU; PLAIE; ULCERE; FACTEUR DE RISQUE
Background: Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have
longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to
developing pressure ulcers (PUs).
Objective: To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for
major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics.
Research design and subjects: Data are from the Healthcare Cost and Utilization Project (HCUP) State
Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information
was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are
derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using
Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the
cost distribution using Simultaneous Quantile Regression.
Results: We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ~$8200
to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital
characteristics. This is an ~44% addition to the cost of a major surgical stay but less than half of the
unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added
~$12,100, whereas for low-cost stays (25th percentile) HAPUs added ~$3900.
Conclusions: This paper suggests that HAPUs add ~44% to the cost of major surgical hospital stays, but the
amount varies depending on the total cost of the visit.
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NosoBase ID notice : 416223
Incidence, causes et impact des infections nosocomiales après implantation d’une valve aortique
transcathéter
Tirado-Conte G; Freitas-Ferraz AB; Nombela-Franco L; Jimenez-Quevedo P; Biagioni C; Cuadrado A; et al.
Incidence, causes, and impact of in-hospital infections after transcatheter aortic valve implantation. The
american journal of cardiology 2016/05/14; in press: 1-7.
Mots-clés : INCIDENCE; FACTEUR DE RISQUE; CHIRURGIE; CHIRURGIE CARDIAQUE; VALVE
ARTIFICIELLE; SITE OPERATOIRE
In-hospital infections (IHI) are one of the most common and serious problems after invasive procedures.
Transcatheter aortic valve implantation (TAVI) is an increasingly used alternative to surgery in patients with
severe symptomatic aortic stenosis. The aim of this study was to determine the incidence, origin, risk factors,
and clinical outcomes of IHI after TAVI. A total of 303 consecutive patients with severe aortic stenosis who
underwent transfemoral TAVI were included and followed during a median time of 21 months. We examined
the occurrence, types, origin, and timing of infections during hospital stay as well as short- and long-term
clinical outcomes according to the occurrence of IHI. A total of 51 patients (17%; 62 infectious episodes)
experienced IHI after TAVI. Respiratory and urinary tract infections were the most frequent type of infections
(44% and 34%, respectively), followed by surgical site infection (8%) and bloodstream infection (5%). Positive
cultures were obtained in 74% of the samples, of which 65% were gram-negative bacilli. Modifiable factors
such as bleeding (p=0.005) and length of coronary care unit stay (p <0.001) were independently associated
with an increased infection risk. Patients with IHI had a longer hospital stay (14 vs 6 days, p<0.001), an
increased mortality (hazard ratio 2.48, 95% CI 1.45 to 4.23) and readmission rate (hazard ratio 2.0, 95% CI
1.27 to 3.14) during the follow-up. In conclusion, IHI is a frequent complication after TAVI with a significant
impact on short- and long-term clinical outcomes. The most important risk factors associated with the
development of this complication were modifiable periprocedural aspects. These results underline the
importance to implement specific preventive strategies to reduce in-hospital-acquired infections after TAVI.
Clostridium difficile
NosoBase ID notice : 415418
Evaluation in vitro de l’activité d’un détergent-désinfectant à base d’acide peracétique et de
l’hypochlorite de sodium vis-à-vis des spores de Clostridium difficile
Fouquet C; Suzon L; Eckert C; Barbut F. Evaluation in vitro de l’activité d’un détergent-désinfectant à base
d’acide peracétique et de l’hypochlorite de sodium vis-à-vis des spores de Clostridium difficile. Hygiènes
2016/06; 24(3): 103-110.
Mots-clés : DETERGENT; DESINFECTANT; CLOSTRIDIUM DIFFICILE;
DESINFECTION; SPORICIDIE; JAVEL; SURFACE; NORME; LINGETTE
ACIDE
PERACETIQUE;
L'objectif de cette étude était d'évaluer l'activité sporicide d'un détergent-désinfectant à base d'acide
peracétique (APA) (Oxy'Floor®, Anios) et de la comparer à celle de l'eau de javel (EDJ) selon un protocole en
trois étapes. Le protocole d'étude a mesuré : 1) la capacité d'une lingette imbibée de produit à éradiquer les
spores de Clostridium difficile (env.107 UFC/ml) d'une surface expérimentalement contaminée ; 2) la capacité
des lingettes précédentes à transférer des spores sur une surface propre ; 3) l'activité sporicide d'une lingette
imprégnée de désinfectant sur laquelle a été directement inoculée une suspension de spores. Trois souches
ont été utilisées (PCR ribotypes 027, 078 et 014) sur trois types de porte-germes (acier, laminé, PVC).Toutes
les manipulations ont été réalisées en triplicate à la fois avec et sans substances interférentes. L'activité
sporicide a été mesurée par la diminution (exprimée en log10 de la contamination initiale). En l'absence de
substances interférentes, la réduction de la contamination initiale obtenue avec les lingettes imprégnées
d'EDJ ou d'APA était respectivement de 4,46 ± 0,67 log10 et 4,90 ± 0,47 log10 (p = 0,002). Le nombre de
spores transférées par les lingettes était significativement plus élevé avec I'APA comparé à I'EDJ (p = 0,039).
L'activité sporicide mesurée par inoculation directe de spores sur les lingettes était de 4,40 ± 0,78 log 10 pour
l'EDJ et 4,70 ±0,67 log10 pour l'APA (p = 0,12). In vitro, l'activité sporicide de I'APA est comparable à celle de
I'EDJ et pourrait représenter une option plus simple pour la désinfection quotidienne environnementale des
chambres.
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NosoBase ID notice : 414206
Interaction possible entre transmissions nosocomiale et communautaire dans le cas d’un nouveau
Clostridium difficile séquence type 295 dépisté par une méthode de séquençage nouvelle génération
Moloney G; Mac Aogáin M; Kelleghan M; O'Connell B; Hurley C; Montague E; et al. Possible interplay
between hospital and community transmission of a novel Clostridium difficile sequence type 295 recognized
by next-generation sequencing. Infection control and hospital epidemiology 2016/06; 37(6): 680-684.
Mots-clés : CLOSTRIDIUM DIFFICILE; INFECTION NOSOCOMIALE; INFECTION COMMUNAUTAIRE;
SDF; BIOLOGIE MOLECULAIRE; RIBOTYPE; EPIDEMIE; TRANSMISSION; ETUDE PROSPECTIVE
Objective: To use next-generation sequencing (NGS) analysis to enhance epidemiological information to
identify and resolve a Clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of
current standard PCR ribotyping.
Methods: NGS analysis was performed as part of prospective surveillance of all detected C. difficile isolates
at a university hospital. An outbreak of a novel C. difficile sequence type (ST)-295 was identified in a hospital
and a community hostel for homeless adults. Phylogenetic analysis was performed of all ST-295 and closest
ST-2 isolates. Epidemiological details were obtained from hospital records and the public health review of the
community hostel.
Results: We identified 7 patients with C. difficile ST-295 infections between June 2013 and April 2015. Of
these patients, 3 had nosocomial exposure to this infection and 3 had possible hostel exposure. Current
Society for Healthcare Epidemiology of America (SHEA)- Infectious Diseases Society of America (IDSA)
surveillance definitions (2010) were considered in light of our NGS findings. The initial transmission was not
detectable using current criteria, because of 16 weeks between ST-295 exposure and symptoms. We
included 3 patients with hostel exposure who met surveillance criteria of hospital-acquired infection due to
their hospital admissions.
Conclusion: NGS analysis enhanced epidemiological information and helped identify and resolve an outbreak
beyond the capacity of standard PCR ribotyping. In this cluster of cases, NGS was used to identify a hostel as
the likely source of community-based C. difficile transmission.
NosoBase ID notice : 415781
Infection à Clostridium difficile : histoire, diagnostic et méthodes de typage moléculaire de la souche
Rodriguez C; Van Broeck J; Taminiau B; Delmée M; Daube G. Clostridium difficile infection: Early history,
diagnosis and molecular strain typing methods. Microbial pathogenesis 2016/05/26; 97: 59-78.
Mots-clés : CLOSTRIDIUM DIFFICILE; DIAGNOSTIC BIOLOGIQUE; HISTORIQUE; TYPAGE; PFGE;
REVUE DE LA LITTERATURE
Recognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium
difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the
bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and
rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies.
This review explores the history of C. difficile and the current scope of the infection. The variety of available
laboratory tests for CDI diagnosis and strain typing methods are also examined.
NosoBase ID notice : 415524
Poids économique de la première infection à Clostridium difficile comparée à une infection récurrente
chez des patients hospitalisés : une étude de cohorte prospective
Shah DN; Aitken SL; Barragan LF; Bozorgui S; Goddu S; Navarro ME; et al. Economic burden of primary
compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study. The
journal of hospital infection 2016/07; 93(3): 286-289.
Mots-clés : CLOSTRIDIUM DIFFICILE; COUT; ETUDE PROSPECTIVE; ETUDE DE COHORTE;
INFECTION RECURRENTE
Background: Few studies have investigated the additional healthcare costs of recurrent C. difficile infection
(CDI).
Aim: To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary
CDI only, compared with CDI patients who experienced recurrent CDI.
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Methods: This was a prospective, observational cohort study of hospitalized adult patients with primary CDI
followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of
stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least
one recurrent CDI episode.
Findings: In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of
whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile
range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with
primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI
(P<0.0001, each). Total hospital median LOS and costs increased from 11 (6-22) days and $20,693 (11,28741,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients
with recurrent CDI (P<0.0001, each). The median cost of pharmacological treatment while hospitalized was
$60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI
(P=0.0013).
Conclusion: This study demonstrated that patients with CDI experience a significant healthcare economic
burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with
recurrent CDI.
Désinfection
NosoBase ID notice : 415799
Antisepsie cutanée avant geste invasif : une révolution ?
Lucet JC. Antisepsie cutanée avant geste invasif : une révolution ? Bulletin CClin-Arlin 2016/06; 3: 1-7.
Mots-clés : ANTISEPSIE; RECOMMANDATIONS DE BONNE PRATIQUE;
CHIRURGIE; CHLORHEXIDINE; POLYVIDONE IODEE; ALCOOL; RESISTANCE
PEAU;
CATHETER;
Cet article reprend une présentation à la journée annuelle du CClin Sud-Est en mars 2016. Il n’est pas
l’expression du groupe de travail, et n’engage que son auteur. Les 14 recommandations sont présentées cicontre. L’auteur invite le lecteur à lire en détail les recommandations avec leurs commentaires, ainsi que les
argumentaires.
NosoBase ID notice : 415515
Impact des protocoles de test standard sur l’efficacité sporicide
Wesgate R; Rauwel G; Criquelion J; Maillard JY. Impact of standard test protocols on sporicidal efficacy. The
journal of hospital infection 2016/07; 93(3): 256-262.
Mots-clés : SPORICIDIE; CLOSTRIDIUM DIFFICILE; BACILLUS SUBTILIS; EFFICACITE; DESINFECTION;
BIOCIDE
Background: There has been an increase in the availability of commercial sporicidal formulations. Any
comparison of sporicidal data from the literature is hampered by the number of different standard tests
available and the use of diverse test conditions including bacterial strains and endospore preparation.
Aim: To evaluate the effect of sporicidal standard tests on the apparent activity of eight biocides against
Clostridium difficile and Bacillus subtilis.
Methods: The activity of eight biocidal formulations including two oxidizing agents, two aldehydes, three
didecyldimethylammonium chloride (DDAC) and amine formulations, and sodium hypochlorite were evaluated
using four standard sporicidal tests (BS EN 14347, BS EN13704, ASTM E2197-11, and AOAC MB-15-03)
against B. subtilis (ACTC 19659) and C. difficile (NCTC 11209) spores.
Findings: C. difficile spores were more susceptible to the sporicides than were B. subtilis spores, regardless
of the method used. There were differences in sporicidal activity between methods at 5 min but not at 60 min
exposure. DDAC and amine-based products were not sporicidal when neutralized appropriately.
Neutralization validation was confirmed for these biocides using the reporting format described in the BS EN
standard tests, although the raw data appear to indicate that neutralization failed.
Conclusion: The different methods, whether based on suspension or carrier tests, produced similar sporicidal
inactivation data. This study suggests that detailed neutralization validation data should be reported to ensure
that neutralization of active spores is effective. Failure to do so may lead to erroneous sporicidal claims.
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Endoscopie
NosoBase ID notice : 414227
Revue épidémiologique des infections à entérobactéries résistantes aux carbapénèmes en lien avec
les duodénoscopes et l’échographie endoscopique dans les établissements du "Department of
Veteran Affairs"
Ryono RA; Schirmer PL; Lucero-Obusan C; Oda G; Dominitz JA; Holodniy M. Epidemiologic review of
carbapenem-resistant Enterobacteriaceae, duodenoscopes, and endoscopic ultrasonography in the
department of Veterans affairs. Infection control and hospital epidemiology 2016/06; 37(6): 725-728.
Mots-clés : ENDOSCOPIE DIGESTIVE; ECHOGRAPHIE; ENTEROBACTERIE; ANTIBIORESISTANCE;
CARBAPENEME; EPIDEMIOLOGIE; EPC
Environnement
NosoBase ID notice : 415519
Les biofilms à Staphylococcus aureus sur des surfaces sèches ne sont pas tués par l’hypochlorite de
sodium : les implications pour la maîtrise des infections
Almatroudi A; Gosbell IB; Hu H; Jensen SO; Espedido BA; Tahir S; et al. Staphylococcus aureus dry-surface
biofilms are not killed by sodium hypochlorite: implications for infection control. The journal of hospital
infection 2016/07; 93(3): 263-270.
Mots-clés : STAPHYLOCOCCUS AUREUS; BIOFILM; SURFACE; DESINFECTANT;
CONTAMINATION; EFFICACITE; HYPOCHLORITE DE SODIUM; CHLORINE
CONTROLE;
Background: Dry hospital environments are contaminated with pathogenic bacteria in biofilms, which
suggests that current cleaning practices and disinfectants are failing.
Aim: To test the efficacy of sodium hypochlorite solution against Staphylococcus aureus dry-surface biofilms.
Methods: The Centers for Disease Control and Prevention Biofilm Reactor was adapted to create a drysurface biofilm, containing 1.36 × 107 S. aureus/coupon, by alternating cycles of growth and dehydration over
12 days. Biofilm was detected qualitatively using live/dead stain confocal laser scanning microscopy (CLSM),
and quantitatively with sonicated viable plate counts and crystal violet assay. Sodium hypochlorite (100020,000 parts per million) was applied to the dry-surface biofilm for 10min, coupons were rinsed three times,
and residual biofilm viability was determined by CLSM, plate counts and prolonged culture up to 16 days.
Isolates before and after exposure underwent minimum inhibitory concentration (MIC) and minimum
eradication concentration (MEC) testing, and one pair underwent whole-genome sequencing.
Findings: Hypochlorite exposure reduced plate counts by a factor of 7 log 10, and reduced biofilm biomass by a
factor of 100; however, staining of residual biofilm showed that live S. aureus cells remained. On prolonged
incubation, S. aureus regrew and formed biofilms. Post-exposure S. aureus isolates had MICs and MECs that
were not significantly different from the parent strains. Whole-genome sequencing of one pre- and postexposure pair found that they were virtually identical.
Conclusions: Hypochlorite exposure led to a 7-log kill but the organisms regrew. No resistance mutations
occurred, implying that hypochlorite resistance is an intrinsic property of S. aureus biofilms. The clinical
significance of this warrants further study.
NosoBase ID notice : 415511
Echantillonage de bioaérosols : mécanismes d’échantillonage, bioefficacité et champs d’étude
Haig CW; Mackay WG; Walker JT; Williams C. Bioaerosol sampling: sampling mechanisms, bioefficiency and
field studies. The journal of hospital infection 2016/07; 93(3): 242-255.
Mots-clés : AEROSOL; ECHANTILLON; ENVIRONNEMENT; AIR
Investigations into the suspected airborne transmission of pathogens in healthcare environments have posed
a challenge to researchers for more than a century. With each pathogen demonstrating a unique response to
environmental conditions and the mechanical stresses it experiences, the choice of sampling device is not
obvious. Our aim was to review bioaerosol sampling, sampling equipment, and methodology. A
comprehensive literature search was performed, using electronic databases to retrieve English language
papers on bioaerosol sampling. The review describes the mechanisms of popular bioaerosol sampling
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devices such as impingers, cyclones, impactors, and filters, explaining both their strengths and weaknesses,
and the consequences for microbial bioefficiency. Numerous successful studies are described that point to
best practice in bioaerosol sampling, from the use of small personal samplers to monitor workers' pathogen
exposure through to large static samplers collecting airborne microbes in various healthcare settings. Of
primary importance is the requirement that studies should commence by determining the bioefficiency of the
chosen sampler and the pathogen under investigation within laboratory conditions. From such foundations,
sampling for bioaerosol material in the complexity of the field holds greater certainty of successful capture of
low-concentration airborne pathogens. From the laboratory to use in the field, this review enables the
investigator to make informed decisions about the choice of bioaerosol sampler and its application.
NosoBase ID notice : 414685
Evaluation d’un dispositif de rayonnement d’ultaviolet-C de faible intensité pour la décontamination
des claviers d’ordinateur
Shaikh AA; Ely D; Cadnum JL; Koganti S; Alhmidi H; Sankar T; et al. Evaluation of a low-intensity ultravioletC radiation device for decontamination of computer keyboards. American journal of infection control 2016/06;
44(6): 705-707.
Mots-clés : ULTRA-VIOLET; ORDINATEUR; DECONTAMINATION; CLOSTRIDIUM DIFFICILE;
ESCHERICHIA COLI; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; CARBAPENEME
Computer keyboards are a potential source for dissemination of pathogenic microorganisms. We
demonstrated that a low-intensity ultraviolet-C (UV-C) radiation device was effective in reducing methicillinresistant Staphylococcus aureus, carbapenem-resistant Escherichia coli, and Clostridium difficile spores on
steel carriers and significantly reduced bacterial counts on in-use keyboards.
Gestion des risques
NosoBase ID notice : 416177
Bonnes pratiques de sécurité : comment améliorer leur mise en œuvre dans les établissements de
santé ?
Lindecker-Cournil V; Mounic V; May-Michelangeli L. Bonnes pratiques de sécurité : comment améliorer leur
mise en œuvre dans les établissements de santé ? Revue d’expériences françaises et internationales.
Risques & qualité en milieu de soins 2016/06; 13(2): 85-92.
Mots-clés : QUALITE DES SOINS; EVENEMENT INDESIRABLE; SECURITE DU PATIENT; EVENEMENT
INDESIRABLE ASSOCIE AUX SOINS; RETOUR D'EXPERIENCE
Dès 1999, le rapport « To err is human de l’Institute of Medicine », a interpellé les professionnels sur la
fréquence, la gravité et le caractère souvent évitable des événements indésirables associés aux soins
(EIAS). Cela les a conduits à rechercher des moyens et définir des « solutions pour la sécurité » pour
prévenir, dépister ou récupérer les EIAS. Ainsi, dans les années 2000, plusieurs équipes aux Etats-Unis
comme celle de l’Institute of Healthcare Improvement ou celle du Dr Peter Pronovost de l’université Johns
Hopkins ont élaboré des bundles ou des check-lists basés sur les données probantes pour réduire les
infections associées aux soins. L’Agency for Healthcare Research and Quality a défini dix « pratiques pour la
sécurité du patient » à mettre en œuvre prioritairement. Enfin, l’Organisation mondiale de la santé a publié en
2007 neuf « solutions pour la sécurité du patient ». Ce concept a été repris ultérieurement par la Haute
Autorité de la santé qui élabore des « solutions pour la sécurité » issues du retour d’expérience du dispositif
d’accréditation des médecins des spécialités à risque. Plusieurs expériences de mise en œuvre de «
solutions pour la sécurité » ont ainsi été menées avec succès au sein d’équipes avec une forte culture qualité
et sécurité. Néanmoins, leur mise à disposition dans les établissements de santé ne suffit pas à elle seule à
améliorer les soins. Le leadership apparaît déterminant pour conduire une véritable stratégie de mise en
œuvre incluant le développement d’une culture de sécurité dans les équipes.
NosoBase ID notice : 415421
Vers une approche transversale en qualité et sécurité des soins : expérience d’un programme-action
sur la gestion des risques appliquée à la prévention du risque infectieux
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Loonis C; de Salins V; Terrien N. Vers une approche transversale en qualité et sécurité des soins :
expérience d’un programme-action sur la gestion des risques appliquée à la prévention du risque infectieux.
Hygiènes 2016/06; 24(3): 115-121.
Mots-clés : GESTION DES RISQUES; QUALITE DES SOINS; PREVENTION; CONNAISSANCE; ANALYSE
DES CAUSES; RETOUR D'EXPERIENCE; REX
Face aux enjeux croissants de sécurité des soins, les hygiénistes et les gestionnaires de risques ont
développé des compétences complémentaires pour tendre vers une gestion des risques coordonnée au sein
des établissements. Dans ce cadre, l'antenne régionale de lutte contre les infections nosocomiales (ARLIN)
Pays de la Loire et le Réseau QualiSanté (structure d'appui à la qualité et la gestion des risques), ont
collaboré afin de proposer aux hygiénistes un programme-action intitulé Du concept à la pratique en hygiène:
méthodes et outils de la gestion des risques appliqués à l'hygiène. L'objectif de ce travail est de permettre
l'appropriation par les hygiénistes des méthodes et outils de gestion des risques associés aux soins et de
favoriser une collaboration intra-établissement entre hygiénistes et gestionnaires de risques. Organisé en six
temps, le programme allie évaluation des connaissances, apports théoriques, études de cas, mise en
pratique et retour d'expériences. Cette première édition a rencontré un franc succès tant dans le volet de la
collaboration inter structures d'appui que dans l'appropriation des méthodes et outils par les hygiénistes.
Cette action s'inscrit parfaitement dans le Programme national d'actions de prévention des infections
associées aux soins (PROPIAS) comme un des moyens pour développer une culture partagée de sécurité et
de prévention des infections associées aux soins.
Hygiène des mains
NosoBase ID notice : 413769
Micro-organismes multirésistants sur les mains des patients : une opportunité manquée
Cao J; Min L; Lansing B; Foxman B; Mody L. Multidrug-resistant organisms on patients' hands: A missed
opportunity. JAMA internal medicine 2016/05; 176(5): 705-706.
Mots-clés : MULTIRESISTANCE; INFECTION NOSOCOMIALE; MAIN; CONTAMINATION; HYGIENE DES
MAINS; COLONISATION; REEDUCATION; SARM; ENTEROCOCCUS RESISTANT A LA VANCOMYCINE;
BACILLE GRAM NEGATIF; ANTIBIORESISTANCE; ETUDE PROSPECTIVE; OBSERVATION; COHORTE;
LAVAGE DES MAINS
NosoBase ID notice : 414218
La consommation de solutions hydro-alcooliques est le reflet de l’observance de l’hygiène des mains
Haubitz S; Atkinson A; Kaspar T; Nydegger D; Eichenberger A; Sommerstein R; et al. Handrub consumption
mirrors hand hygiene compliance. Infection control and hospital epidemiology 2016/06; 37(6): 707-710.
Mots-clés : SOLUTION HYDROALCOOLIQUE; CONSOMMATION;
HYGIENE DES MAINS; INFECTION NOSOCOMIALE; STATISTIQUE
INDICATEUR;
OBSERVANCE;
We assessed handrub consumption as a surrogate marker for hand hygiene compliance from 2007 to 2014.
Handrub consumption varied substantially between departments but correlated in a mixed effects regression
model with the number of patient-days and the observed hand hygiene compliance. Handrub consumption
may supplement traditional hand hygiene observations.
NosoBase ID notice : 414656
La formation par simulation comme seule intervention n’améliore pas les pratiques de l’hygiène des
mains : une étude de suivi contrôlée randomisée
Jansson MM; Syrjälä HP; Ohtonen PP; Meriläinen MH; Kyngäs HA; Ala-Kokko TI. Simulation education as a
single intervention does not improve hand hygiene practices: A randomized controlled follow-up study.
American journal of infection control 2016/06; 44(6): 625-630.
Mots-clés : HYGIENE DES MAINS; FORMATION; COMPORTEMENT; PERSONNEL; INFIRMIER
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Background: To evaluate how critical nurses' knowledge of and adherence to current care hand hygiene (HH)
guidelines differ between randomly allocated intervention and control groups before and after simulation
education in both a simulation setting and clinical practice during a 2-year follow-up period. It was
hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase
compared with a control group after simulation education.
Methods: A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a
22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized
critical care nurses participated in the baseline measurements; of these, 17 completed all the study
procedures. Participants' HH adherence was observed only in high-risk contact situations prior to and
postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants' HH
knowledge was evaluated at the end of each observational session.
Results: The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final
postintervention measurement at 24 months (P=.002). However, the linear mixed model did not identify any
significant group (P=.77) or time-group interactions (P=.17) between the study groups after 2 years of
simulation education. In addition, simulation education had no impact on participants' HH knowledge.
Conclusions: After a single simulation education session, critical care nurses' knowledge of and adherence to
current HH guidelines remained below targeted behavior rates.
NosoBase ID notice : 414684
Pratiques fondées sur les preuves pour augmenter l’observance de l’hygiène des mains dans les
établissements de santé : une revue intégrée
Jeffrey JR; Sagha-Zadeh R; Vielemeyer O; Franklin E. Evidence-based practices to increase hand hygiene
compliance in health care facilities: An integrated review. American journal of infection control 2016/06; 44(6):
691-704.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; REVUE DE LA LITTERATURE; FORMATION
Background: Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission
and nosocomial infections. However, most HH interventions (HHI) have not been sustainable.
Aims: This review aims to provide a comprehensive summary of recently published evidence-based HHI
designed to improve HH compliance (HHC) that will enable health care providers to make informed choices
when allocating limited resources to improve HHC and patient safety.
Methods: The Medline electronic database (using PubMed) was used to identify relevant studies. English
language articles that included hand hygiene interventions and related terms combined with health care
environments or related terms were included.
Results: Seventy-three studies that met the inclusion criteria were summarized. Interventions were
categorized as improving awareness with education, facility design, and planning, unit-level protocols and
procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as
effective when applied to other health care environments. HH education should be interactive and engaging.
Electronic monitoring and reminders should be implemented in phases to ensure costeffectiveness. To create
hospital-wide programs that engage end users, policy makers should draw expertise from interdisciplinary
fields. Before implementing the various components of multimodal interventions, health care practitioners
should identify and examine HH difficulties unique to their organizations.
Conclusions: Future research should seek to achieve the following: replicate successful HHI in other health
care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions,
examine ways (eg, hospital leadership, financial support, and strategies from public health and infection
prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs.
NosoBase ID notice : 415008
La promotion d’un programme d’hygiène des mains en utilisant les médias sociaux : étude
observationnelle
Pan SC; Sheng WH; Tien KL; Chien KT; Chen YC; Chang SC. Promoting a hand hygiene program using
social media: An observational study. JMIR Public health and surveillance 2016/02/02; 2(1): 1-6.
Mots-clés : HYGIENE DES MAINS; PROMOTION DE LA SANTE; OBSERVANCE; COMMUNICATION;
MEDIAS SOCIAUX
Background: Hand hygiene is an important component in infection control to protect patient safety and reduce
health care-associated infection.
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Objective: Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene
(HH) program.
Methods: The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary
care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese
version was promoted through three platforms: the hospital website, the hospital group email, and the
Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH
compliance was measured in November 2013 and 2014.
Results: There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%).
The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was
151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91%
(91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2
venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014
(P=.13) among all HCWs.
Conclusions: Facebook had the highest connection rate in the HH video campaign. The use of novel social
media such as Facebook should be considered for future programs that promote hand hygiene and other
healthy behaviors.
NosoBase ID notice : 414657
Vers l’amélioration des 5 temps OMS de l’hygiène des mains pour la prévention de l’infection croisée
Price L; Roome K; Lisa R; Reilly J; McIntyre J; Godwin J; et al. Toward improving the World Health
Organization fifth moment for hand hygiene in the prevention of cross-infection. American journal of infection
control 2016/06; 44(6): 631-635.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; PERCEPTION; ENQUETE; PERSONNEL
Background: The World Health Organization describes that there are 5 moments during a health care
encounter when hand hygiene should be performed. This research explores a number of explanatory
hypotheses to inform future intervention development with regard to improving compliance with the fifth
moment.
Methods: A sequential, mixed-methods study was conducted using nonparticipant observation and a survey
with focus groups informing the development of the questionnaire. A total of 484 participants were observed
and 410 returned a postobservation questionnaire; a response rate of 85%. Analysis explored the role of
organizational culture, professional culture/practice, and individual-level variables in explaining compliance
with the fifth moment.
Results: Ninety-three percent of participants performed hand hygiene following the fifth moment. Compliance
varied between regions, but not by professional group. More than 65% indicated that the fifth moment was
clearly defined, achievable, valuable, encouraged, and widely known. However, 60% suggested that it was
repetitive. There was a positive relationship between the performance of hand hygiene following the fifth
moment and the perception that it was widely known.
Conclusions: Interventions to improve compliance with the fifth moment should focus on promoting
awareness of the fifth moment and how it should be implemented in practice. Mechanisms for raising
awareness should include education and role modeling.
NosoBase ID notice : 414201
Essai contrôlé randomisé avec une méthode pragmatique sur la technique d’hygiène des mains en 6
étapes (proposée par l’OMS) versus une technique en 3 étapes (CDC) dans un centre hospitalier au
Royaume-Uni
Reilly J; Price L; Lang S; Robertson C; Cheater F; Skinner K; et al. A pragmatic randomized controlled trial of
6-step vs 3-step hand hygiene technique in acute hospital care in the United Kingdom. Infection control and
hospital epidemiology 2016/06; 37(6): 661-666.
Mots-clés : HYGIENE DES MAINS; RANDOMISATION; TECHNIQUE; SOLUTION HYDROALCOOLIQUE;
PRATIQUE; MEDECIN; INFECTION NOSOCOMIALE; RECOMMANDATIONS DE BONNE PRATIQUE;
ORGANISATION MONDIALE DE LA SANTE; CENTRE HOSPITALIER UNIVERSITAIRE
Objective: To evaluate the microbiologic effectiveness of the World Health Organization's 6-step and the
Centers for Disease Control and Prevention's 3-step hand hygiene techniques using alcohol-based handrub.
Design: A parallel group randomized controlled trial.
Setting: An acute care inner-city teaching hospital (Glasgow).
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Participants: Doctors (n=42) and nurses (n=78) undertaking direct patient care.
Intervention: Random 1:1 allocation of the 6-step (n=60) or the 3-step (n=60) technique.
Results: The 6-step technique was microbiologically more effective at reducing the median log10 bacterial
count. The 6-step technique reduced the count from 3.28 CFU/mL (95% CI, 3.11-3.38 CFU/mL) to 2.58
CFU/mL (2.08-2.93 CFU/mL), whereas the 3-step reduced it from 3.08 CFU/mL (2.977-3.27 CFU/mL) to 2.88
CFU/mL (-2.58 to 3.15 CFU/mL) (P=.02). However, the 6-step technique did not increase the total hand
coverage area (98.8% vs 99.0%, P=.15) and required 15% (95% CI, 6%-24%) more time (42.50 seconds vs
35.0 seconds, P=.002). Total hand coverage was not related to the reduction in bacterial count.
Conclusions: Two techniques for hand hygiene using alcohol-based handrub are promoted in international
guidance, the 6-step by the World Health Organization and 3-step by the Centers for Disease Control and
Prevention. The study provides the first evidence in a randomized controlled trial that the 6-step technique is
superior, thus these international guidance documents should consider this evidence, as should healthcare
organizations using the 3-step technique in practice.
Infection urinaire
NosoBase ID notice : 415531
Système de surveillance automatisé des infections urinaires associées aux soins au Danemark
Condell O; Gubbels S; Nielsen J; Espenhain L; Frimodt-Møller N; Engberg J; et al. Automated surveillance
system for hospital-acquired urinary tract infections in Denmark. The journal of hospital infection 2016/07;
93(3): 290-296.
Mots-clés : SURVEILLANCE; INFECTION URINAIRE; INCIDENCE; PREVALENCE
Background: The Danish Hospital-Acquired Infections Database (HAIBA) is an automated surveillance
system using hospital administrative, microbiological, and antibiotic medication data.
Aim: To define and evaluate the case definition for hospital-acquired urinary tract infection (HA-UTI) and to
describe surveillance data from 2010 to 2014.
Methods: The HA-UTI algorithm defined a laboratory-diagnosed UTI as a urine culture positive for no more
than two micro-organisms with at least one at ≥104 cfu/mL, and a probable UTI as a negative urine culture
and a relevant diagnosis code or antibiotic treatment. UTI was considered hospital-acquired if a urine sample
was collected ≥48h after admission and <48h post discharge. Incidence of HA-UTI was calculated per 10,000
risk-days. For validation, prevalence was calculated for each day and compared to point prevalence survey
(PPS) data.
Findings: HAIBA detected a national incidence rate of 42.2 laboratory-diagnosed HA-UTI per 10,000 risk-days
with an increasing trend. Compared to PPS the laboratory-diagnosed HA-UTI algorithm had a sensitivity of
50.0% (26/52) and a specificity of 94.2% (1842/1955). There were several reasons for discrepancies between
HAIBA and PPS, including laboratory results being unavailable at the time of the survey, the results
considered clinically irrelevant by the surveyor due to an indwelling urinary catheter or lack of clinical signs of
infection, and UTIs being considered HA-UTI in PPS even though the first sample was taken within 48h of
admission.
Conclusion: The HAIBA algorithm was found to give valid and valuable information and has, among others,
the advantages of covering the whole population and allowing continuous standardized monitoring of HA-UTI.
NosoBase ID notice : 415535
Sur-traitement des bactériuries asymptomatiques : une étude qualitative
Eyer MM; Läng M; Aujesky D; Marschall J. Overtreatment of asymptomatic bacteriuria: a qualitative study.
The journal of hospital infection 2016/07; 93(3): 297-303.
Mots-clés : BACTERIURIE; INFECTION URINAIRE; ANTIBIOTIQUE; QUALITE DES SOINS;
RECOMMANDATIONS DE BONNE PRATIQUE; MESUSAGE; INTERVIEW; CHARGE DE TRAVAIL;
COMPORTEMENT
Background: Overtreatment of asymptomatic bacteriuria (ASB) is widespread and may result in antibiotic
side-effects, excess costs to the healthcare system, and may potentially trigger antimicrobial resistance.
According to international management guidelines, ASB is not an indication for antibiotic treatment (with few
exceptions).
Aim: To determine reasons for using antibiotics to treat ASB in the absence of a treatment indication.
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Methods: A qualitative study was conducted at a tertiary care hospital in Switzerland during 2011. We
interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a
semi-structured questionnaire. Responses were analysed in an inductive thematic content approach using
dedicated software (MAXQDA®).
Findings: In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were
reported (in order of reporting frequency): (i) treating laboratory findings without taking the clinical picture into
account (N=17); (ii) psychological factors such as anxiety, overcautiousness, or anticipated positive impact on
patient outcomes (N=13); (iii) external pressors such as institutional culture, peer pressure, patient
expectation, and excessive workload that interferes with proper decision-making (N=9); (iv) difficulty with
interpreting clinical signs and symptoms (N=8).
Conclusion: In this qualitative study we identified both physician-centred factors (e.g. overcautiousness) and
external pressors (e.g. excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we
interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone
as lack of awareness of evidence-based best practices.
Matériel médico-chirurgical
NosoBase ID notice : 414204
Facteurs prédictifs d’une contamination importante du stéthoscope après examen clinique
Tschopp C; Schneider A; Longtin Y; Renzi G; Schrenzel J; Pittet D. Predictors of heavy stethoscope
contamination following a physical examination. Infection control and hospital epidemiology 2016/06; 37(6):
673-679.
Mots-clés : STETHOSCOPE; CONTAMINATION; INFECTION NOSOCOMIALE; MEDECIN; MAIN; PEAU;
MICROORGANISME; ETUDE PROSPECTIVE
Background: The degree of bacterial contamination of stethoscopes can vary significantly following a physical
examination.
Objective: To conduct a prospective study to investigate the impact of various environmental and patient
characteristics on stethoscope contamination.
Methods: Following a standardized examination, the levels of bacterial contamination of 4 regions of the
physicians' hands and 2 sections of the stethoscopes, and the presence of different pathogenic bacteria,
were assessed. Predictors of heavy stethoscope contamination were identified through multivariate logistic
regression.
Results: In total, 392 surfaces were sampled following examination of 56 patients. The microorganisms most
frequently recovered from hands and stethoscopes were Enterococcus spp. (29% and 20%, respectively) and
Enterobacteriaceae (16% and 7%, respectively). Staphylococcus aureus (either methicillin susceptible or
resistant), extended-spectrum β-lactamase-producing Enterobacteriaceae, and Acinetobacter baumannii
were recovered from 4%-9% of the samples from either hands or stethoscopes. There was a correlation
between the likelihood of recovering these pathogens from the stethoscopes vs from the physicians' hands
(ρ=0.79; P=.04). The level of patient's skin contamination was an independent predictor of contamination of
the stethoscope diaphragm (adjusted odds ratio [aOR], 1.001; P=.007) and tube (aOR, 1.001; P=.003). Male
sex (aOR, 28.24; P=.01) and reception of a bed bath (aOR, 7.52; P=.048) were also independently
associated with heavy tube contamination.
Conclusions: Stethoscope contamination following a single physical examination is not negligible and is
associated with the level of contamination of the patient's skin. Prevention of pathogen dissemination is
needed.
Mycobactérie
NosoBase ID notice : 415503
La décontamination des unités de chauffage-refroidissement associée à une contamination par des
mycobactéries atypiques
Garvey MI; Ashford R; Bradley CW; Bradley CR; Martin TA; Walker J; et al. Decontamination of heater-cooler
units associated with contamination by atypical mycobacteria. The journal of hospital infection 2016/07; 93(3):
229-234.
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Mots-clés :
DECONTAMINATION;
MYCOBACTERIE
ATYPIQUE;
CONTAMINATION;
EAU;
MYCOBACTERIUM AVIUM; CIRCULATION EXTRA-CORPORELLE; CHIRURGIE CARDIAQUE; ACIDE
PERACETIQUE; MYCOBACTERIUM CHIMAERA
Background: Non-tuberculosis mycobacteria such as Mycobacterium chimaera are found widely in hospital
water systems. Invasive M. chimaera infections have recently been attributed to heater-cooler units (HCUs) of
cardiopulmonary bypass equipment.
Aim: To assess the extent of microbiological contamination within the HCUs and to inform decontamination
strategies for reducing the microbial load.
Methods: Water samples taken from HCUs used at University Hospitals Birmingham for cardiopulmonary
bypass surgery were sampled to determine the number of micro-organisms by membrane filtration. Various
decontamination processes were used throughout the study, all based on the manufacturer's guidance.
Findings: Total viable counts >300cfu per 100mL containing a wide variety of micro-organisms were obtained
from water inside the HCUs. Working with the manufacturers, we significantly reduced the microbial load of
the water within the HCUs by removing the internal tubing soiled with biofilm followed by a weekly
decontamination regimen with peracetic acid.
Conclusion: A decontamination cycle including an initial replacement of internal tubing with weekly
microbiological water samples is required to maintain the water quality within HCUs at an acceptable level.
Odontologie
NosoBase ID notice : 415053
L’effet de la digue dentaire en caoutchouc sur les aérosols atmosphériques bactériens pendant les
soins dentaires
Al-Amad SH; Awad MA; Edher FM; Shahramian K; Omran TA. The effect of rubber dam on atmospheric
bacterial aerosols during restorative dentistry. Journal of infection and public health 2016/05/24; in press : 16.
Mots-clés :
ODONTOLOGIE;
DISPOSITIF
MEDICAL;
EFFICACITE;
SURFACE;
AEROSOL;
CONTAMINATION; RISQUE PROFESSIONNEL; CHIRURGIEN DENTISTE; TENUE VESTIMENTAIRE;
ETUDIANT
Rotatory dental instruments generate atmospheric aerosols that settle on various surfaces, including the
dentist's head. The aim of this study was to quantitatively assess bacterial contamination of the dentist's head
and to evaluate whether it is affected by using a rubber dam. Senior dental students (n=52) were asked to
wear autoclaved headscarves as collection media while performing restorative dental treatment with and
without a rubber dam. Four points from each headscarf were swabbed for bacterial culture after 30min of
operative work. Bacterial contamination was quantified by counting the colony-forming units. Regardless of
the collection point, using a rubber dam was associated with more bacterial colony-forming units than not
using a rubber dam (P=0.009). Despite its clinical value, the rubber dam seems to result in significantly higher
aerosol levels on various areas of the dentist's head, requiring that dentists cover their heads with suitable
protective wear.
NosoBase ID notice : 415009
Transmission d’agents pathogènes à diffusion hématogène dans les établissements de soins
dentaires américains
Cleveland JL; Gray SK; Harte JA; Robison VA; Moorman AC; Gooch BF. Transmission of blood-borne
pathogens in US dental health care settings. Journal of the american dental association 2016/05/24; in press:
1-10.
Mots-clés : ODONTOLOGIE; TRANSMISSION; SANG; VACCINATION; HEPATITE B; HEPATITE C;
TUBERCULOSE; PREVENTION
Background: During the past decade, investigators have reported transmissions of blood-borne pathogens
(BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in
infection prevention on the basis of available information.
Methods: The authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of
BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of
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Juillet 2016
known or suspected health care-associated BBP infections submitted by state health departments to the
Centers for Disease Control and Prevention.
Results: The authors identified 3 published reports whose investigators described the transmission of
hepatitis B virus and hepatitis C virus. In 2 of these reports, the investigators described single-transmission
events (from 1 patient to another) in outpatient oral surgery practices. The authors of the third report
described the possible transmission of hepatitis B virus to 3 patients and 2 dental health care personnel in a
large temporary dental clinic. The authors identified lapses in infection prevention practices that occurred
during 2 of the investigations; however, the investigators were not always able to link a specific lapse to a
transmission event. Examples of lapses included the failure to heat-sterilize handpieces between patients, a
lack of training for volunteers on BBPs, and the use of a combination of unsafe injection practices.
Conclusions: The authors found that reports describing the transmission of BBPs in dental settings since
2003 were rare. Failure to adhere to Centers for Disease Control and Prevention recommendations for
infection control in dental settings likely led to disease transmission in these cases.
Practical implications: The existence of these reports emphasizes the need to improve dental health care
personnel's understanding of the basic principles and implementation of standard precautions through the
use of checklists, policies, and practices.
NosoBase ID notice : 414676
Evaluation d’une méthode éthique visant à améliorer l’observance des règles d’hygiène dans la
pratique dentaire
Offner D; Strub M; Rebert C; Musset AM. Evaluation of an ethical method aimed at improving hygiene rules
compliance in dental practice. American journal of infection control 2016/06; 44(6): 666-670.
Mots-clés : ODONTOLOGIE; OBSERVANCE; ENQUETE; COMPORTEMENT
Background: The objective of this study is to determine the efficiency of an ethical method, based on a
thought experiment in ethics, on hygiene rules compliance for dental health care team members.
Methods: This is a prospective study that assesses hygiene compliance in dental practice before and after a
thought experiment in ethics, using 2 questionnaires. Participants included 130 clinician students in dentistry
at Strasbourg University Hospital, France.
Results: The results emphasize a better implementation of hygiene rules after the thought experiment in
ethics, when comparing the relative frequencies of completed hygiene items. A Wilcoxon signed-rank test
shows significant differences between the first questionnaire and the second one after the thought experiment
in ethics (P<.001).
Conclusions: This ethical method provides efficiency on hygiene rules compliance, which makes it beneficial
to implement. However, far from being an absolute unit method, this thought experiment in ethics appears to
be an original, supplemental, and complementary method.
Personnel
NosoBase ID notice : 415132
Décret n° 2016-743 du 2 juin 2016 relatif aux compétences des sages-femmes en matière
d'interruption volontaire de grossesse par voie médicamenteuse et en matière de vaccination
Ministère des affaires sociales et de la santé. Décret n° 2016-743 du 2 juin 2016 relatif aux compétences des
sages-femmes en matière d'interruption volontaire de grossesse par voie médicamenteuse et en matière de
vaccination. Journal officiel de la République française Lois et décrets 2016/06/05; 130: 4 pages.
Mots-clés : SAGE-FEMME; COMPETENCE; INTERRUPTION
TRAITEMENT MEDICAMENTEUX; VACCINATION; LEGISLATION
VOLONTAIRE
DE
GROSSESSE;
L'article L. 4151-1 du code de la santé publique, dans sa rédaction issue de la loi n° 2016-41 du 26 janvier
2016 de modernisation de notre système de santé, prévoit que les sages-femmes peuvent pratiquer les
interruptions volontaires de grossesse par voie médicamenteuse.
Le présent décret a pour objet de préciser les conditions requises de ces sages-femmes. L'article L. 4151-2
de ce même code, dans sa rédaction issue de la loi susmentionnée, prévoit que les sages-femmes peuvent
prescrire et pratiquer les vaccinations de la femme et du nouveau-né et aussi celles des personnes vivant
dans leur entourage.
Le présent décret a également pour objet de préciser les conditions de prescription, de réalisation des
vaccinations et de transmission de l'information au médecin traitant.
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NosoBase ID notice : 416351
Décret n° 2016-839 du 24 juin 2016 relatif aux conditions et modalités d'exercice des biologistes
médicaux et portant création de la Commission nationale de biologie médicale
Ministère des affaires sociales et de la santé. Décret n° 2016-839 du 24 juin 2016 relatif aux conditions et
modalités d'exercice des biologistes médicaux et portant création de la Commission nationale de biologie
médicale. Journal officiel de la République française Lois et décrets 2016/06/26; 148: 6 pages.
Mots-clés : BIOLOGISTE; EXERCICE PROFESSIONNEL; COMPETENCE; ACTE MEDICAL;
PRELEVEMENT; INTERNE; EXERCICE INSTITUTIONNEL; LEGISLATION; BIOLOGIE MEDICALE
Le décret modifie les conditions d'habilitation des biologistes médicaux à effectuer certains actes de
prélèvement et modifie des modalités de remplacement temporaire de biologistes médicaux par des internes.
Il réduit par ailleurs le champ d'attribution de la Commission nationale de biologie médicale lorsqu'elle siège
en formation restreinte.
NosoBase ID notice : 415400
Impact de la mise en place d’un groupe de codéveloppement professionnel à destination des
correspondants en hygiène sur leurs aptitudes et compétences déclarées
Léger C; Bouvin F; Beneteau C; Chubilleau C; Venier AG. Impact de la mise en place d’un groupe de
codéveloppement professionnel à destination des correspondants en hygiène sur leurs aptitudes et
compétences déclarées. Hygiènes 2016/06; 24(3): 135-140.
Mots-clés : REFERENT; COMPETENCE;
DEVELOPPEMENT PROFESSIONNEL
EVALUATION;
REPRESENTATION;
QUESTIONNAIRE;
Le groupe de codéveloppement professionnel est une méthode qui utilise les interactions entre participants
pour améliorer les compétences du groupe.
Objectif : Identifier si le groupe de codéveloppement professionnel pouvait être un outil utilisable par les
équipes d'hygiène pour la coordination de leurs réseaux de correspondants.
Méthode : Nous avons mis en place une étude interventionnelle prospective exposé non exposé avec mesure
avant-après dans un centre hospitalier général en 2014 et 2015. Une comparaison de l'évolution des
connaissances, des capacités déclarées et de la reconnaissance des collègues a été réalisée entre les deux
populations.
Résultats : En complément de l'enseignement qu'il apporte aux participants, le groupe de codéveloppement a
contribué à l'identification du correspondant au sein de son service (64 à 81 % dans le groupe exposé vs 59 à
58 % dans le groupe témoin). Les participants classent la reconnaissance de la fonction en tête de l'ordre
des acquis en matière de score (4/5), elle est suivie par la facilité acquise pour communiquer avec les
collègues (4,2/5) et la capacité d'être devenu un levier dans le service (3,4/5). Les aptitudes des
correspondants n'ayant pas participé au groupe de codéveloppement professionnel n'ont pas ou faiblement
évolué entre le début/et la fin de l'étude.
Conclusion : Cette étude a montré que le groupe de codéveloppement professionnel présente un intérêt dans
la coordination, l'accompagnement et la formation des correspondants.
NosoBase ID notice : 416179
Une chambre des erreurs, méthode frontière de simulation
Péan S; Moll MC. Une chambre des erreurs, méthode frontière de simulation. Risques & qualité en milieu de
soins 2016/06; 13(2): 109-116.
Mots-clés : METHODE PEDAGOGIQUE; FORMATION; CONNAISSANCE; SIMULATION; CHAMBRE DES
ERREURS
Prévenir et traiter les événements indésirables graves (EIG) associés aux soins est une priorité de santé
publique. Leurs causes sont dans la majorité des cas multifactorielles. Il est indispensable de développer la
culture positive de l’erreur, la déclaration et l’analyse des causes profondes des EIG ainsi que le partage
d’expérience. Améliorer la qualité et la sécurité des prises en charge des patients est primordial. La
simulation a prouvé son efficacité sur la rétention des connaissances et l’impact sur les facteurs humains
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grâce aux mises en situation. La chambre des erreurs, méthode frontière en matière de simulation en santé,
permet de répondre aux objectifs précédemment évoqués. Il s’agit d’une reconstitution fictive d’une chambre
de patient, de résident, d’une salle de soins ou de tout autre milieu de soins, dans lesquels des erreurs ont
été volontairement introduites. Ces erreurs concernent une ou plusieurs thématiques, notamment le circuit
des produits de santé et l’hygiène. Après un briefing, les apprenants sont mis en situation dans la chambre.
Cette dernière fait ensuite l’objet d’un débriefing. Ce véritable projet comporte différentes étapes. Les
conseils de professionnel ayant organisé une ou des chambres des erreurs sont précieux. Cet article
présente également les principaux résultats d’une chambre des erreurs ainsi que des témoignages de
participants. Le réseau AQuaREL Santé, en partenariat avec le CHU d’Angers, a réalisé un kit permettant de
construire et mettre en œuvre sa chambre des erreurs, avec des outils clés en main. Cet outil ludique,
innovant, multiprofessionnel et multidisciplinaire est plébiscité par les professionnels.
NosoBase ID notice : 414198
Combien coûtent les accidents par piqure ? Revue systématique des évaluations économiques se
rapportant aux accidents d'exposition au sang par piqûre et coupure chez le personnel de soins
Mannocci A; De Carli G; Di Bari V; Saulle R; Unim B; Nicolotti N; et al. How much do needlestick injuries
cost? A systematic review of the economic evaluations of needlestick and sharps injuries among healthcare
personnel. Infection control and hospital epidemiology 2016/06; 37(6): 635-646.
Mots-clés : ACCIDENT D'EXPOSITION AU SANG; COUT; INFECTION NOSOCOMIALE; PERSONNEL;
PIQURE; REVUE DE LA LITTERATURE; INCIDENCE; HEPATITE
Objective: To provide an overview of the economic aspects of needlestick and sharps injury (NSI)
management among healthcare personnel (HCP) within a Health Technology Assessment project to evaluate
the impact of safety-engineered devices on health care
Methods: A systematic review of economic analyses related to NSIs was performed in accordance with the
PRISMA statement and by searching PubMed and Scopus databases (January 1997-February 2015). Mean
costs were stratified by study approach (modeling or data driven) and type of cost (direct or indirect). Costs
were evaluated using the CDC operative definition and converted to 2015 International US dollars (Int$).
Results: A total of 14 studies were retrieved: 8 data-driven studies and 6 modeling studies. Among them, 11
studies provided direct and indirect costs and 3 studies provided only direct costs. The median of the means
for aggregate (direct + indirect) costs was Int$747 (range, Int$199-Int$1,691). The medians of the means for
disaggregated costs were Int$425 (range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range,
Int$152-Int$413) for indirect costs (6 studies). When compared with data-driven studies, modeling studies had
higher disaggregated and aggregated costs, but data-driven studies showed greater variability. Indirect costs
were consistent between studies, mostly referring to lost productivity, while direct costs varied widely within
and between studies according to source infectivity, HCP susceptibility, and post-exposure diagnostic and
prophylactic protocols. Costs of treating infections were not included, and intangible costs could equal those
associated with NSI medical evaluations.
Conclusions: NSIs generate significant direct, indirect, potential, and intangible costs, possibly increasing
over time. Economic efforts directed at preventing occupational exposures and infections, including provision
of safety-engineered devices, may be offset by the savings from a lower incidence of NSIs.
NosoBase ID notice : 414200
Fluctuation de la virémie chez des professionnels de santé infectés par le virus de l’hépatite B qui
accomplissent des gestes à haut risque de transmission aux Pays Bas
Raven SF; de Heus B; Wong A; Zaaijer HL; van Steenbergen JE. Fluctuation of viremia in hepatitis B virusinfected healthcare workers performing exposure-prone procedures in the Netherlands. Infection control and
hospital epidemiology 2016/06; 37(6): 655-660.
Mots-clés : HEPATITE B; VIRUS; PERSONNEL; ETUDE RETROSPECTIVE
Objective: To determine the longitudinal changes in viral load of hepatitis B virus (HBV)-infected healthcare
workers (HCWs) and its consequences for exclusion of infected HCWs performing exposure-prone
procedures, various HBV DNA safety thresholds, and the frequency of monitoring.
Design: Retrospective cohort study June 1, 1996 - January 31, 2013. Participants In the Netherlands,
chronically HBV-infected HCWs performing exposure-prone procedures are notified to the Committee for
Prevention of Iatrogenic Hepatitis B. Of the 126 notified HCWs, 45 had 2 or more HBV DNA levels
determined without antiviral therapy.
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Methods: A time-to-event analysis for HBV-infected HCWs categorized in various viremia levels surpassing a
HBV DNA threshold level of 1×105 copies/mL, above which exposure-prone procedures are not allowed in the
Netherlands.
Results: Fluctuations of HBV DNA in follow-up samples ranged from -5.4 to +2.2 log10 copies/mL. A high
correlation was seen for each HBV DNA level with the 3 previous levels. In a time-to-event analysis, after 6
months 7.2%, 6.5%, and 14.3% of individuals had surpassed the threshold of 1×10 5 copies/mL for viral load
categories 4.8×103 to 1.5×104; 1.5×104 to 4.0×104; and 4.0×104 to 1.0×105, respectively.
Conclusions: We propose standard retesting every 6 months, with more frequent retesting just below the high
threshold value (1×105 copies/mL), and prolonging this standard interval to 1 year after 3 consecutive levels
below the threshold in policies with lower safety thresholds (1×10 3 or 1×104 copies/mL).
NosoBase ID notice : 414900
Acquisition de Staphylococcus aureus méticillino-résistant chez les personnels de santé atteints de
fibrose cystique : étude transversale rétrospective
Wood ME; Sherrard LJ; Ramsay KA; Yerkovich ST; Reid DW; Kidd TJ; et al. Methicillin-resistant
Staphylococcus aureus acquisition in healthcare workers with cystic fibrosis: a retrospective cross-sectional
study. BMC pulmonary medicine 2016/05/11; 16(78): 1-7.
Mots-clés :
STAPHYLOCOCCUS
MUCOVISCIDOSE; INCIDENCE
AUREUS;
METICILLINO-RESISTANCE;
PERSONNEL;
Background: People with cystic fibrosis (CF) may work in healthcare settings risking nosocomial pathogen
acquisition. The aim of this study was to determine the incidence of methicillin-resistant Staphylococcus
aureus (MRSA) infection in adult healthcare workers with CF (HCWcf).
Methods: Data was collected in this observational study on MRSA acquisition from 405 CF patients attending
an adult CF centre in Australia between 2001-2012. Demographic and clinical characteristics were compared
between HCWcf and non-HCWcf. A sub-analysis was subsequently performed to compare demographic and
clinical characteristics between those patients (HCWcf versus non-HCWcf) that acquired MRSA. We also
investigated rates of chronic MRSA infection and the outcome of eradication treatment in HCWcf.
Results: A higher proportion of HCWcf acquired MRSA [n=10/21] compared to non-HCWcf [n=40/255]
(P<0.001). The odds of MRSA acquisition were 8.4 (95% CI, 3.0-23.4) times greater in HCWcf than nonHCWcf. HCWcf with MRSA were older (P=0.02) and had better lung function (P= 0.009), yet hospitalisation
rates were similar compared to non-HCWcf with MRSA. Chronic MRSA infection developed in 36/50 CF
patients (HCWcf, n=6; non-HCWcf, n=30), with eradication therapy achieved in 5/6 (83%) HCWcf.
Conclusions: The rate of MRSA incidence was highest in HCWcf and the workplace is a possible source of
acquisition. Vocational guidance should include the potential for MRSA acquisition for CF patients considering
healthcare professions.
NosoBase ID notice : 412952
Protéger le personnel soignant de la transmission de maladies infectieuses : une exploration d’un
partenarait entre des partenariats sud-africains et canadiens
Yassi A; Zungu M; Spiegel JM; Kistnasamy D; Lockhart D; Jones LM; et al. Protecting health workers from
infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships.
Globalization and Health 2016/03/31; 12(10): 1-15.
Mots-clés : TRANSMISSION; PERSONNEL; PREVENTION; RISQUE PROFESSIONNEL; TUBERCULOSE;
VIRUS DE L'IMMUNODEFICIENCE HUMAINE; REVUE DE LA LITTERATURE; PARTENARIAT; PAYS EN
DEVELOPPEMENT; COOPERATION SANITAIRE INTERNATIONALE; SECURITE SANITAIRE;
FORMATION;
CONDITION
DE
TRAVAIL;
MEDECINE
DU
TRAVAIL;
COOPERATION
INTERETABLISSEMENTS; INFORMATION; INFORMATIQUE; ACCREDITATION
Background: Health workers are at high risk of acquiring infectious diseases at work, especially in low and
middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation
of occupational health and infection control measures. Amidst increasing interest in international partnerships
to address such issues, how best to develop such collaborations is being actively debated. In 2006, a
partnership developed between occupational health and infection control experts in Canada and institutions in
South Africa (including an institute with a national mandate to conduct research and provide guidance to
protect health workers from infectious diseases and promote improved working conditions). This article
describes the collaboration, analyzes the determinants of success and shares lessons learned.
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Methods: Synthesizing participant-observer experience from over 9 years of collaboration and 10 studies
already published from this work, we applied a realist review analysis to describe the various achievements at
global, national, provincial and hospital levels. Expectations of the various parties on developing new insights,
providing training, and addressing service needs were examined through a micro-meso-macro lens, focusing
on how each main partner organization contributed to and benefitted from working together.
Results: A state-of-the-art occupational health and safety surveillance program was established in South
Africa following successful technology transfer from a similar undertaking in Canada and training was
conducted that synergistically benefited Northern as well as Southern trainees. Integrated policies combining
infection control and occupational health to prevent and control infectious disease transmission among health
workers were also launched. Having a national (South-South) network reinforced by the international (Northsouth) partnership was pivotal in mitigating the challenges that emerged.
Conclusions: High-income country partnerships with experience in health system strengthening - particularly
in much needed areas such as occupational health and infection control - can effectively work through strong
collaborators in the Global South to build capacity. Partnerships are particularly well positioned to sustainably
reinforce efforts at national and sub-national LMIC levels when they adopt a "communities of practice" model,
characterized by multi-directional learning. The principles of effective collaboration learned in this "partnership
of partnerships" to improve working conditions for health workers can be applied to other areas where health
system strengthening is needed.
Personne âgée
NosoBase ID notice : 416197
Surveillance des gastro-entérites aiguës en collectivités pour personnes âgées. Bilan national de cinq
saisons de surveillance hivernale (novembre 2010 - mai 2015)
Septfons A; Barataud D; Chiron E; Léon L; Barret AS; Tillaut H; et al. Surveillance des gastro-entérites aiguës
en collectivités pour personnes âgées. Bilan national de cinq saisons de surveillance hivernale (novembre
2010 - mai 2015). Bulletin épidémiologique hebdomadaire 2016/06/21; 18-19: 334-343.
Mots-clés : SURVEILLANCE; PERSONNE AGEE; GASTRO-ENTERITE; EHPAD; LONG SEJOUR;
HYGIENE DES MAINS; MAISON DE RETRAITE; SIGNALEMENT; INVESTIGATION; CONTROLE
Les épisodes de gastro-entérites aiguës (GEA) sont fréquents dans les établissements pour personnes
âgées. La forte promiscuité des résidents et personnels dans ces collectivités (fréquence des contacts et des
soins, visiteurs), associée au risque de transmission interhumaine, favorise ces épidémies.
C’est dans ce contexte qu’un dispositif de surveillance spécifique des GEA a été mis en place en 2010 en
France afin de permettre l’identification précoce des épisodes épidémiques, de promouvoir l’application
immédiate des mesures de contrôle et de décrire les épisodes.
Cet article dresse le bilan des épidémies de GEA en collectivités pour personnes âgées en France
métropolitaine pour cinq saisons de surveillance, de novembre 2010 à mai 2015.
Sur l’ensemble de la période, 3 549 épisodes de GEA (définis comme la survenue d’au moins 5 cas parmi les
résidents de l’établissement) ont été déclarés dans 3 404 établissements ayant recensé 88 930 résidents
malades. Le taux d’attaque parmi les résidents allait de 28 % à 32 % selon l’année. Le délai de signalement
est passé d’une médiane de cinq jours pour les saisons 2010 à 2012 à une médiane de quatre jours pour les
saisons 2012 à 2015. Une étiologie a été recherchée pour la moitié (48 %) des épisodes déclarés, avec une
identification de norovirus dans 65 % à 81 % de ces épisodes selon l’année. Pour 98 % des épisodes, au
moins une mesure de contrôle a été mise en place quelle que soit la saison. La plupart des mesures
recommandées (renforcement de l’hygiène des mains, arrêt ou limitation des activités collectives pour les
résidents malades…) ont été plus systématiquement appliquées au fil des années. Le taux d’attaque était
significativement plus faible lorsque les mesures de contrôle étaient mises en place moins de trois jours
après le début des signes du premier cas (IRR = 0,90 ; p < 0,001).
Ce dispositif est utile en termes de recensement précoce des épisodes et d’amélioration de la mise en place
des mesures de gestion. Un renforcement des investigations (demande de confirmation biologique, envoi des
prélèvements de selles au Centre national de référence des virus entériques) pourrait néanmoins être mis en
place afin de permettre de mieux caractériser les virus circulants.
NosoBase ID notice : 414457
Les enseignements tirés d’une épidémie prolongée et coûteuse à Norovirus dans un hôpital écossais
de médecine pour personnes âgées : étude de cas
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Danial J; Ballard-Smith S; Horsburgh C; Crombie C; Ovens A; Templeton KE; et al. Lessons learned from a
prolonged and costly norovirus outbreak at a Scottish medicine of the elderly hospital: case study. The journal
of hospital infection 2016/06; 93(2): 127-134.
Mots-clés : NOROVIRUS; PERSONNE AGEE;
PREVENTION; INVESTIGATION; VAPEUR; EHPAD
EPIDEMIE;
COUT;
NETTOYAGE;
INCIDENCE;
Background: Norovirus outbreaks are a major burden for healthcare facilities globally.
Aim: Lessons learned to inform an action plan to improve facilities as well as responses to norovirus within
the medicine of the elderly (MoE) hospital as well as other NHS (National Health Service) Lothian facilities.
Methods: This study investigated the impact of a prolonged outbreak at an MoE hospital in one of the 14
Scottish health boards between February and March 2013.
Findings: In all, 143 patients (14.80 cases per 1000 inpatient bed-days) and 30 healthcare staff (3.10 cases
per 1000 inpatient bed-days) were affected clinically and 63 patients were confirmed virologically. Restricting
new admissions to affected units resulted in 1192 lost bed-days. The cost due to lost bed-days in addition to
staff absence and management of the outbreak was estimated at £341,534 for this incident alone. At certain
points during the outbreak, the whole facility was closed with resulting major impact on the health board's
acute care hospitals.
Conclusion: Due to the outbreak, new measures were implemented for the first time within NHS Lothian that
included floor-by-floor (instead of individual) ward closures, enhanced cleaning with chlorine-based products
throughout the hospital, reduction in bed capacity with enhanced bed-spacing and interruption to direct
admissions from the Board's general practice surgeries, and temporary suspension of visitors to affected
areas. Together with regular communication to staff, patients, relatives, and the public throughout the
outbreak and good engagement of staff groups in management of the incident, the outbreak was gradually
brought under control.
NosoBase ID notice : 414208
Cas groupés de transmission de Staphylococcus aureus résistant à la méticilline dans des
établissements de soins de longue durée établis par le séquençage du génome complet
Stine OC; Burrowes S; David S; Johnson JK; Roghmann MC. Transmission clusters of methicillin-resistant
Staphylococcus aureus in long-term care facilities based on whole-genome sequencing. Infection control and
hospital epidemiology 2016/06; 37(6): 685-691.
Mots-clés : GERIATRIE; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM;
COLONISATION;
INFECTION
NOSOCOMIALE;
PREVALENCE;
BIOLOGIE
MOLECULAIRE;
PRELEVEMENT; TRANSMISSION; ETUDE PROSPECTIVE; GENOMIQUE
Objective: To define how often methicillin-resistant Staphylococcus aureus (MRSA) is spread from resident to
resident in long-term care facilities using whole-genome sequencing.
Design: Prospective cohort study.
Setting: A long-term care facility.
Participants: Elderly residents in a long-term care facility
Methods: Cultures for MRSA were obtained weekly from multiple body sites from residents with known MRSA
colonization over 12-week study periods. Simultaneously, cultures to detect MRSA acquisition were obtained
weekly from 2 body sites in residents without known MRSA colonization. During the first 12-week cycle on a
single unit, we sequenced 8 MRSA isolates per swab for 2 body sites from each of 6 residents. During the
second 12-week cycle, we sequenced 30 MRSA isolates from 13 residents with known MRSA colonization
and 3 residents who had acquired MRSA colonization.
Results: MRSA isolates from the same swab showed little genetic variation between isolates with the
exception of isolates from wounds. The genetic variation of isolates between body sites on an individual was
greater than that within a single body site with the exception of 1 sample, which had 2 unrelated strains
among the 8 isolates. In the second cycle, 10 of 16 residents colonized with MRSA (63%) shared 1 of 3
closely related strains. Of the 3 residents with newly acquired MRSA, 2 residents harbored isolates that were
members of these clusters.
Conclusions: Point prevalence surveys with whole-genome sequencing of MRSA isolates may detect
resident-to-resident transmission more accurately than routine surveillance cultures for MRSA in long-term
care facilities.
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Pneumonie
NosoBase ID notice : 414675
Différencier les complications infectieuses et non-infectieuses associées à la ventilation : un nouveau
défi
O'Horo JC; Kashyap R; Sevilla Berrios R; Herasevich V; Sampathkumar P. Differentiating infectious and
noninfectious ventilator-associated complications: A new challenge. American journal of infection control
2016/06; 44(6): 661-665.
Mots-clés : VENTILATION; INFECTION; PNEUMONIE; MICROBIOLOGIE
Background: The purpose of this study was to develop an electronic search algorithm which reliably
differentiates infectious and noninfectious ventilator-associated events (VAEs). This was a retrospective
cohort study used to derive a predictive model. It took place at a tertiary care hospital campus.
Methods: Participants included all ventilated patients who met the Centers for Disease Control and
Prevention's National Health Safety Network definitions for VAEs between January 1, 2012, and December
31, 2013. There were 164 patients who experienced 185 VAEs in the study period.
Results: The most predictive variables were fever 2 days before VAE onset, oxygenation changes, and
appearance of respiratory secretions. No other variable, including laboratory tests, radiologic findings, and
vital sign values, reached statistical significance. A multivariate regression model was constructed, with 68%
sensitivity and 75% specificity (receiver operator characteristic area under the curve [ROC-AUC], 0.83). This
was modestly better than the clinical pulmonary infection score (CPIS), which had sensitivity of 50%,
specificity of 59%, and ROC-AUC of 0.60.
Conclusions: Although diagnosis of VAEs remains challenging, our data indicate that clinical signs and
symptoms of a VAE may be present up to 2 days before they screen positive. Sputum, fever, and
oxygenation requirements all were indicative, but aggregate models failed to create a sensitive and specific
model for differentiation of VAEs. The existing clinical tool, the CPIS, is also insufficiently sensitive and
specific. Further research is needed to create a clinically viable tool for differentiating VAE types at the
bedside.
NosoBase ID notice : 414672
Une approche systématique pour développer la prévention par faisceau d’interventions (bundle) des
pneumonies acquises sous ventilation
Speck K; Rawat N; Weiner NC; Tujuba HG; Farley D; Berenholtz S. A systematic approach for developing a
ventilator-associated pneumonia prevention bundle. American journal of infection control 2016/06; 44(6): 652656.
Mots-clés : PNEUMONIE; PREVENTION; VENTILATION; VENTILATION ASSISTEE; BUNDLE
Background: Ventilator-associated pneumonia (VAP) is among the most common type of health careassociated infection in the intensive care unit and is associated with significant morbidity and mortality.
Existing VAP prevention intervention bundles vary widely on the interventions included and in the approaches
used to develop these bundles. The objective of this study was to develop a new VAP prevention bundle
using a systematic approach that elicits clinician perceptions on which interventions are most important and
feasible to implement.
Methods: We identified potential interventions to include through a review of current guidelines and literature.
We implemented a 2-step modified Delphi method to gain consensus on the final list of interventions. An
interdisciplinary group of clinical experts participated in the Delphi process, which was guided by a technical
expert panel.
Results: We identified 65 possible interventions. Through the Delphi method, we narrowed that list to 19
interventions that included 5 process and 14 structural measures.
Conclusions: We described a structured approach for developing a new VAP prevention bundle. Obtaining
clinician input on what interventions to include increases the likelihood that providers will adhere to the
bundle.
Précautions complémentaires
NosoBase ID notice : 414674
Compréhension et satisfaction du patient et du soignant lors de l’utilisation des précautions contact
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Chittick P; Koppisetty S; Lombardo L; Vadhavana A; Solanki A; Cumming K; et al. Assessing patient and
caregiver understanding of and satisfaction with the use of contact isolation. American journal of infection
control 2016/06; 44(6): 657-660.
Mots-clés :
PRECAUTION
COMPLEMENTAIRE;
SATISFACTION DU MALADE; ENQUETE
PRECAUTION
CONTACT;
SATISFACTION;
Background: Contact isolation is a method used for limiting the spread of antimicrobial-resistant organisms
when caring for patients. This policy has been linked to several adverse outcomes and less patient
satisfaction. We assessed patient and caregiver understanding and satisfaction with the use of contact
isolation.
Methods: A prospective survey of >500 patients in contact isolation at our institution was performed during
2014. Participants responded to a series of statements relating to contact isolation, using a 5-point Likert
scale. Responses were assessed for overall positivity or negativity and further compared according to floor
type or designation.
Results: Of the patients, 48.7% responded to the survey; 70 caregivers also responded. Patient and caregiver
responses were similar and were positive overall. Most respondents felt safer because of the use of contact
isolation and because it prevented infections. A smaller majority of respondents also thought the policy was
adequately explained to them and adhered to by staff.
Conclusions: In the largest collection of respondents surveyed to date about contact isolation and its impact
on them, the policy was viewed positively, both by patients and caregivers. There is still room for
improvement in the area of patient education regarding the use of contact isolation.
Prévention
NosoBase ID notice : 415061
Les clés prioritaires dans la prévention et le contrôle de l’infection nosocomiale : une enquête auprès
des experts européens et internationaux de la prévention des infections
Dettenkofer M; Humphreys H; Saenz H; Carlet J; Hanberger H; Ruef C; et al. Key priorities in the prevention
and control of healthcare-associated infection: a survey of European and other international infection
prevention experts. Infection 2016/05/25; in press: 6 pages.
Mots-clés :
PREVENTION;
ENQUETE;
MICROBIOLOGIE;
ANTIBIORESISTANCE; SURVEILLANCE; DESINFECTION
CHIRURGIE;
RESISTANCE;
Purpose: Prevention and control of healthcare-associated infection (HCAI) are important within and beyond
Europe. However, it is unclear which areas are considered important by HCAI prevention and control
professionals. This study assesses the priorities in the prevention and control of HCAI as judged by experts in
the field.
Methods: A survey was conducted by the European Society of Clinical Microbiology and Infectious Diseases
focussing on seven topics using SurveyMonkey®. Through a newsletter distributed by email, about 5000
individuals were targeted throughout the world in February and March 2013. Participants were asked to rate
the importance of particular topics from one (low importance) to ten (extraordinary importance), and there was
no restriction on giving equal importance to more than one topic.
Results: A total of 589 experts from 86 countries participated including 462 from Europe (response rate:
11.8%). Physicians accounted for 60% of participants, and 57% had ten or more years' experience in this
area. Microbial epidemiology/resistance achieved the highest priority scoring with 8.9, followed by
surveillance 8.2, and decolonisation/disinfection/antiseptics with 7.9. Under epidemiology/resistance, highly
resistant Gram-negative bacilli scored highest (9.0-9.2). The provision of computerised healthcare information
systems for the early detection of outbreaks was accorded the top priority under surveillance. The prevention
of surgical site and central line infections ranked highest under the category of specific HCAI and HCAI in
certain settings. Differences between regions are described.
Conclusion: These findings reflect the concerns of experts in HCAI prevention and control. The results from
this survey should inform national and international agencies on future action and research priorities.
NosoBase ID notice : 414971
Faisabilité et satisfaction des patients avec des interventions de sevrage tabagique pour la
prévention des infections nosocomiales
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Schulte DM; Duster M; Warrack S; Valentine S; Jorenby D; Shirley D; et al. Feasibility and patient satisfaction
with smoking cessation interventions for prevention of healthcare-associated infections in inpatients.
Substance abuse treatment, prevention, and policy 26/04/2016; 11(15): 1-9.
Mots-clés : PREVENTION; FACTEUR DE RISQUE; TABAGISME; STAPHYLOCOCCUS AUREUS;
METICILLINO-RESISTANCE
Background: Smoking increases hospitalization and healthcare-associated infection. Our primary aim of this
pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation
intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and
infections post discharge were exploratory outcomes.
Methods: Current inpatient smokers from a university hospital facility were randomized to usual care or a face
to face tobacco cessation counseling session where patients' tobacco use and strategies for quitting were
discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1 week and 12
weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus
colonization. P-values were calculated using Fisher's exact and t-tests were used to compare groups.
Results: For the study's primary outcome, participants reported the intervention as being generally acceptable
and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of
satisfaction. No subjects utilized free tobacco cessation services after discharge. 83% of the intervention
group and 93% of the control group smoked at least one cigarette after discharge. Secondary outcomes with
regard to infections showed that, at discharge, 12% of the intervention group (n=17) and 18% of the control
group (n=22) tested positive for S. aureus. After 3 months, 9% of the intervention group developed infection,
41% visited an emergency room, and 24% were readmitted within 3 months post-discharge, compared to 27,
32 and 36% of the control group respectively.
Conclusions: With regards to the primary aim of this study, there were overall high levels of satisfaction with
the intervention, indicating good feasibility and acceptance among patients. However, more intensive
interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge
infections should be explored.
Règlementation
NosoBase ID notice : 416107
Décret n° 2016-806 du 16 juin 2016 relatif aux centres nationaux de référence pour la lutte contre les
maladies transmissibles
Ministère des affaires sociales et de la santé. Décret n° 2016-806 du 16 juin 2016 relatif aux centres
nationaux de référence pour la lutte contre les maladies transmissibles. Journal officiel de la République
française Lois et décrets 2016/06/18; 141: 4 pages.
Mots-clés : MALADIE TRANSMISSIBLE; EPIDEMIOLOGIE; LABORATOIRE; CENTRE DE REFERENCE;
EXPERTISE; SECURITE SANITAIRE; LEGISLATION; CNR; BIOLOGIE MEDICALE; SURVEILLANCE
Le texte insère dans le code de la santé publique des dispositions relatives aux centres nationaux de
références pour la lutte contre les maladies transmissibles, auxquels sont confiés des missions d'expertise,
de conseil, de surveillance et d'alerte en matière sanitaire et sur lesquels s'appuie l'Agence nationale de
santé publique.
Le présent décret précise la répartition des missions des centres nationaux de références, les modalités de
désignation des structures et précise les modalités de pilotage, d'évaluation et de financement de leur
activité.
NosoBase ID notice : 416112
Arrêté du 16 juin 2016 fixant le cahier des charges des centres nationaux de référence pour la lutte
contre les maladies transmissibles
Ministère des affaires sociales et de la santé. Arrêté du 16 juin 2016 fixant le cahier des charges des centres
nationaux de référence pour la lutte contre les maladies transmissibles. Journal officiel de la République
française Lois et décrets 2016/06/18; 141: 3 pages.
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Mots-clés : MALADIE TRANSMISSIBLE; EPIDEMIOLOGIE; LABORATOIRE; CENTRE DE REFERENCE;
CAHIER DES CHARGES; EXPERTISE; SECURITE SANITAIRE; LEGISLATION; CNR; SURVEILLANCE;
ALERTE
Soin intensif
NosoBase ID notice : 415537
La gestion du risque de la transmission de la fièvre hémorragique virale dans une unité de soins
intensifs de haut niveau : l’expérience d’un cas de fièvre hémorragique de Crimée-Congo en Ecosse
Roy KM; Ahmed S; Inkster T; Smith A; Penrice G. Managing the risk of viral haemorrhagic fever transmission
in a non-high-level intensive care unit: experiences from a case of Crimean-Congo haemorrhagic fever in
Scotland. The journal of hospital infection 2016/07; 93(3): 304-308.
Mots-clés : SOIN INTENSIF; FIEVRE HEMORRAGIQUE; TRANSMISSION; CONTROLE; PREVENTION;
RECOMMANDATIONS DE BONNE PRATIQUE
Background: A case of Crimean-Congo haemorrhagic fever (CCHF) was imported into Scotland in 2012.
Aim: To discuss the public health response to the case, and the control measures taken to prevent secondary
transmission.
Methods: Following confirmation of the case, an incident management team (IMT) was convened to ensure
that: (i) all individuals exposed to the case and/or their blood/body fluids were identified, assessed and
followed-up appropriately; and (ii) the appropriate disinfection or disposal of equipment was used to manage
the patient, laboratory specimens obtained from the case, and their environment.
Findings: Contact tracing identified 19 individuals who required follow-up and monitoring. No secondary cases
occurred. Identification of laboratory specimens obtained prior to diagnosis proved challenging. The majority
were traced, temporarily stored in sharps boxes and subsequently incinerated. A small number could not be
recovered and consequently would have been disposed of through the routine hospital waste system.
Biochemical and haematology analysers were decontaminated according to the manufacturers' instructions
and liquid waste was discharged to drains. The patient's mattress, sphygmomanometer and pulse oximeter
probe were incinerated. Decontamination of the clinical environment was undertaken following guidance from
national experts.
Conclusions: While national guidance for the management of cases of viral haemorrhagic fever (VHF)
available at the time in the UK informed the approach taken to manage the risk of secondary transmission, a
number of practical issues relating to infection control aspects of managing a patient with VHF in a non-highlevel isolation unit environment were encountered. Close liaison between national experts and the IMT was
key to the expedient response to the emerging issues.
Staphylococcus aureus
NosoBase ID notice : 415929
Antibiothérapie empirique pour les infections à Staphylococcus aureus méticillino-résistant : une
approche actualisée
VanEperen AS; Segreti J. Empirical therapy in methicillin-resistant Staphylococcus aureus infections: An upto-date approach. Journal of infection and chemotherapy 2016/06; 22(6): 351-359.
Mots-clés :
STAPHYLOCOCCUS
AUREUS;
METICILLINO-RESISTANCE;
ANTIBIOTHERAPIE;
ANTIBIOTIQUE; REVUE DE LA LITTERATURE; VANCOMYCINE; LINEZOLIDE; DAPTOMYCINE;
BACTERIEMIE; PEAU; TISSU MOU; PNEUMONIE; APPAREIL OSTEO-ARTICULAIRE
Methicillin-resistant Staphylococcus aureus (MRSA) continues to be an important pathogen worldwide, with
high prevalence of infection in both community and hospital settings. Timely and appropriate choice of
empirical therapy in the setting of MRSA infection is imperative due to the high rate of associated morbidity
and mortality with MRSA infections. Initial choices should be made based on the site and severity of the
infection, most notably moderate skin and soft tissue infections which may be treated with oral antibiotics
(trimethoprim-sulfamethoxazole, clindamycin, doxycycline/minocycline, linezolid) in the outpatient setting,
versus choice of parenteral therapy in the inpatient setting of more invasive or severe disease. Though the
current recommendations continue to strongly rely on vancomycin as a standard empiric choice in the setting
of severe/invasive infections, alternative therapies exist with studies supporting their non-inferiority. This
includes the use of linezolid in pneumonia and severe skin and skin structure infections (SSSI) and
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daptomycin for MRSA bacteremia, endocarditis, SSSIs and bone/joint infections. Additionally, concerns
continue to arise in regards to vancomycin, such as increasing isolate MICs, and relatively high rates of
clinical failures with vancomycin. Thus, the growing interest in vanomycin alternatives, such as ceftaroline,
ceftobribole, dalbavancin, oritavancin, and tedizolid, and their potential role in treating MRSA infections.
NosoBase ID notice : 414233
Facteurs déterminants pour réussir une décolonisation des porteurs de Staphylococcus aureus
résistant à la méticilline
Von Dach E; Landelle C; Agostinho A; Haustein T; François P; Renzi G; et al. Determinants of successful
methicillin-resistant Staphylococcus aureus decolonization. Infection control and hospital epidemiology
2016/06; 37(6): 732-736.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SARM; COLONISATION;
FACTEUR DE RISQUE; INFECTION NOSOCOMIALE; CAS-TEMOIN
Vaccination
NosoBase ID notice : 415585
Arrêté du 7 juin 2016 supprimant le comité technique des vaccinations
Ministère des affaires sociales et de la santé. Arrêté du 7 juin 2016 supprimant le comité technique des
vaccinations. Journal officiel de la République française Lois et décrets 2016/06/15; 138: 1 page.
Mots-clés : VACCINATION; LEGISLATION
NosoBase ID notice : 413770
Association entre le refus des vaccins et les maladies évitables par la vaccination aux Etats-Unis :
une revue concernant la rougeole et la coqueluche
Phadke VK; Bednarczyk RA; Salmon DA; Omer SB. Association between vaccine refusal and vaccinepreventable diseases in the United States: A review of measles and pertussis. JAMA, the journal of the
American Medical Association 2016/03/15; 35(11): 1149-1158.
Mots-clés : VACCIN; ROUGEOLE; BORDETELLA PERTUSSIS; PEDIATRIE; EPIDEMIE; PREVENTION;
VACCINATION; REVUE DE LA LITTERATURE
Importance: Parents hesitant to vaccinate their children may delay routine immunizations or seek exemptions
from state vaccine mandates. Recent outbreaks of vaccine-preventable diseases in the United States have
drawn attention to this phenomenon. Improved understanding of the association between vaccine refusal and
the epidemiology of these diseases is needed.
Objective: To review the published literature to evaluate the association between vaccine delay, refusal, or
exemption and the epidemiology of measles and pertussis, 2 vaccine-preventable diseases with recent US
outbreaks.
Evidence review: Search of PubMed through November 30, 2015, for reports of US measles outbreaks that
have occurred since measles was declared eliminated in the United States (after January 1, 2000), endemic
and epidemic pertussis since the lowest point in US pertussis incidence (after January 1, 1977), and for
studies that assessed disease risk in the context of vaccine delay or exemption.
Findings: We identified 18 published measles studies (9 annual summaries and 9 outbreak reports), which
described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months)
and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed
vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had
nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical
contraindications; 41.8% of total). Among 32 reports of pertussis outbreaks, which included 10,609 individuals
for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics
had substantial proportions (range, 24%-45%) of unvaccinated or undervaccinated individuals. However,
several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. Nine
reports (describing 12 outbreaks) provided detailed vaccination data on unimmunized cases; among 8 of
these outbreaks from 59% through 93% of unvaccinated individuals were intentionally unvaccinated.
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Conclusions and relevance: A substantial proportion of the US measles cases in the era after elimination
were intentionally unvaccinated. The phenomenon of vaccine refusal was associated with an increased risk
for measles among people who refuse vaccines and among fully vaccinated individuals. Although pertussis
resurgence has been attributed to waning immunity and other factors, vaccine refusal was still associated
with an increased risk for pertussis in some populations.
NosoBase ID notice : 406974
La vaccination annuelle contre la grippe réduit l’hospitalisation totale chez les patients atteints d’une
infection chronique d’hépatite B : une analyse basée sur la population
Su FH; Huang YL; Sung FC; Su CT; Hsu WH; Chang SN; et al. Annual influenza vaccination reduces total
hospitalization in patients with chronic hepatitis B virus infection: A population-based analysis. Vaccine
2016/01/02; 34(1): 120-127.
Mots-clés : HEPATITE B; VACCINATION; GRIPPE; COHORTE; FACTEUR DE RISQUE; PNEUMONIE;
SOIN INTENSIF; MORTALITE
Background: This study evaluated hospitalization and mortality in patients with chronic hepatitis B virus
infection (HBV (+)) and matched comparison patients after stratifying the patients according to annual
influenza vaccination (Vaccine (+)).
Methods: Data from Taiwan's National Health Insurance program from 2000 to 2009 were used to identify
HBV(+)/vaccine(+) (n=4434), HBV(+)/Vaccine(-) (n=3646), HBV(-)/Vaccine(+) (n=8868), and HBV()/Vaccine(-) (n=8868) cohorts. The risk of pneumonia/influenza, respiratory failure, intensive care,
hospitalization, and mortality in the four cohorts was evaluated.
Results: The total hospitalization rate was significantly lower in patients with chronic HBV infection who
received an annual influenza vaccination than in chronic HBV-infected patients who did not receive an
influenza vaccination (16.29 vs. 24.02 per 100 person-years), contributing to an adjusted hazard ratio (HR) of
0.56 (95% confidence interval (CI)=0.50-0.62). The HBV(+)/Vaccine(+) cohort also had lower risks than the
HBV(+)/Vaccine(-) cohort for pneumonia and influenza (adjusted HR=0.79, 95% CI=0.67-0.92), intensive care
unit admission (adjusted HR=0.33, 95% CI=0.25-0.43), and mortality (adjusted HR=0.19, 95% CI=0.15-0.24).
Conclusions: Our results suggest that annual influenza vaccination can reduce the risk of hospitalization and
mortality in patients with chronic HBV infection.
Zika
NosoBase ID notice : 415137
Décret n° 2016-745 du 2 juin 2016 complétant la liste des maladies faisant l'objet d'une transmission
obligatoire de données individuelles à l'autorité sanitaire
Ministère des affaires sociales et de la santé. Décret n° 2016-745 du 2 juin 2016 complétant la liste des
maladies faisant l'objet d'une transmission obligatoire de données individuelles à l'autorité sanitaire. Journal
officiel de la République française Lois et décrets 05/06/2016; 130: 2 pages.
Mots-clés : DONNEE STATISTIQUE; SANTE PUBLIQUE; POLITIQUE DE SANTE; EPIDEMIOLOGIE;
BILHARZIOSE; PARASITOLOGIE; LEGISLATION; MALADIE A DECLARATION OBLIGATOIRE;
SIGNALEMENT; VIRUS ZIKA
Le présent décret ajoute le virus Zika et la schistosomiase ou bilharziose urogénitale autochtone à la liste des
maladies, fixée à l'article D. 3113-6 du code de la santé publique, dont le signalement et la notification à
l'autorité sanitaire sont obligatoires, afin de préserver la santé des populations exposées au virus.
Le décret harmonise également la rédaction de l'article D. 3113-6 du code de la santé publique étendant à
l'ensemble des pathologies la possibilité de suspendre le signalement et la notification dans les départements
ou collectivités dont la situation épidémique le justifie.
Objet : inscription de la schistosomiase ou bilharziose urogénitale et de l’infection à virus Zika à la liste des
maladies pour lesquelles la transmission de données individuelles de signalement ou de notification à
l’autorité sanitaire est obligatoire.
NosoBase ID notice : 415547
Arrêté du 2 juin 2016 relatif au retrait de maladies de la liste de l’article D. 3113-6 du code de la santé
publique
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Ministère des affaires sociales et de la santé. Arrêté du 2 juin 2016 relatif au retrait de maladies de la liste de
l’article D. 3113-6 du code de la santé publique. Journal officiel de la République française Lois et décrets
2016/06/05: 1 page.
Mots-clés : LEGISLATION; SIGNALEMENT; ZIKA
NosoBase ID notice : 414954
Le virus Zika : les implications pour les soins de bouche
Leão JC; Gueiros LA; Lodi G; Robinson NA; Scully C. Zika virus: oral healthcare implications. Oral diseases
2016/05/27; in press: 16 pages.
Mots-clés : VIRUS; ARBOVIRUS; EPIDEMIOLOGIE; ODONTOLOGIE; RISQUE PROFESSIONNEL; SOIN
DE BOUCHE; PRECAUTION STANDARD; TRANSMISSION; PREVENTION; SALIVE; ULCERE; ZIKA
Zika virus (ZIKV) infection has been recognized since 1947, but just recently it became a worldwide major
public health problem. The most common features of ZIKV infection are fever, cutaneous rash, arthralgia, and
conjunctivitis but most affected patients with the clinical disease present with only mild symptoms. However,
severe neurologic complications have been described: there is an occasional association with Guillain-Barre
syndrome, and emerging data indicate an association between vertical transmission of ZIKV infection and
microcephaly but no specific orofacial manifestations have yet been reported. ZIKV is present in body fluids
and has also been demonstrated in the saliva, but there is as yet no reliable evidence to support ZIKV
transmission via this pathway. Transmission in oral healthcare should be effectively prevented using standard
infection control measures. There are currently no specific treatments for ZIKA virus disease and no vaccines
available, so prevention of ZIKV is based on vector control. This article is protected by copyright.
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 Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
[email protected]
php.fr
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
nathalie.vincent@chu
-lyon.fr
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
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