NosoVeille Août 2011

NosoVeille – Bulletin de veille
Février 2017
NosoVeille n°2
Février 2017
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
Il est disponible sur le site de NosoBase à l’adresse suivante :
http://www.cclin-arlin.fr/nosobase
Pour recevoir, tous les mois, NosoVeille dans votre messagerie :
Abonnement / Désabonnement
Sommaire de ce numéro :
Animal
Antibiotique / Antibiorésistance
Bactériémie
Cathétérisme
Chirurgie
Clostridium difficile
Désinfection
Environnement
Epidémie
Hygiène des mains
Personnel
Précautions complémentaires
Prévalence
Prévention
Pseudomonas aeruginosa
Réglementation
Soin intensif
Staphylococcus aureus
Transplantation
Vaccination
Zika
1 / 32
NosoVeille – Bulletin de veille
Février 2017
Animal
NosoBase ID notice : 422666
OXA-23 et ISAba 1-OXA-66 bêta-lactamases de classe D dépistées dans des isolats d'Acinetobacter
baumannii provenant des animaux de compagnie
Ewers C; Klotz P; Leidner U; Stamm I; Prenger-Berninghoff E; Göttig S; et al. OXA-23 and ISAba1-OXA-66
class D β-lactamases in Acinetobacter baumannii isolates from companion animals. International journal of
antimicrobial agents 2017/01; 49(1): 37-44.
Mots-clés : ACINETOBACTER BAUMANNII; ANTIBIORESISTANCE; BETA-LACTAMASE A SPECTRE
ELARGI; CARBAPENEME; ANIMAL; CMI; TYPAGE; TRANSMISSION; CLONAGE
Acinetobacter baumannii is recognised as a major pathogen of nosocomial infections that frequently show
resistance to last-resort antimicrobials. To investigate whether A. baumannii from companion animals harbour
carbapenem resistance mechanisms, 223 clinical isolates obtained from veterinary clinics between 2000 and
2013 in Germany were screened for carbapenem-non-susceptibility employing meropenem-containing
Mueller-Hinton agar plates. Minimum inhibitory concentration (MIC) data were obtained using the VITEK®2
system. Assignment to international clones (ICs) was done by multiplex PCR or repetitive sequence-based
PCR employing the DiversiLab system. Clonality was studied using pulsed-field gel electrophoresis (PFGE)
and multilocus sequence typing (MLST). Genes encoding carbapenemases and aminoglycoside-modifying
enzymes were detected by PCR. In three samples from dogs, carbapenem-resistant A. baumannii carrying
the blaOXA-23 gene on plasmids and located on transposon Tn2008 were identified. The isolates belonged to
sequence type ST1P (clonal complex CC1/IC1/pulsotype II) and ST10P (CC10/IC8/pulsotype IV) according to
the Pasteur MLST scheme, and to ST231Ox (CC109) and ST585Ox (CC447) following the Oxford scheme.
Insertion sequence ISAba1 was identified upstream of blaOXA-66 in 58 A. baumannii isolates. MLST referred
them to ST2P (CC2/IC2/pulsotypes I and III), ST208Ox, ST350Ox and ST556Ox (all CC118), respectively. PFGE
suggested nosocomial spread of these highly related strains, which frequently demonstrated a multidrugresistant phenotype, in one veterinary clinic. These data show that A. baumannii from companion animals
reveal resistance determinants and clonal lineages of strains globally emerging in humans. This suggests an
interspecies transmission and warrants molecular surveillance of A. baumannii in veterinary clinics to mitigate
its further spread.
DOI: https://doi.org/10.1016/j.ijantimicag.2016.09.033
Antibiotique / Antibiorésistance
NosoBase ID notice : 424090
L’évolution des consommations d’antibiotiques en France entre 2000 et 2015
Martin D; Agence nationale de sécurité du médicament et des produits de santé (ANSM). L’évolution des
consommations d’antibiotiques en France entre 2000 et 2015. ANSM 2017/01: 1-41.
Mots-clés : ANTIBIOTIQUE; PRESCRIPTION; GLYCOPEPTIDE; CEPHALOSPORINE;
PENICILLINE; CEFTRIAXOME; DDJ; AGE; PROFESSION LIBERALE; HOPITAL
COLISTINE;
Au début des années 2000, le développement des résistances bactériennes a conduit la France – comme
beaucoup d’autres pays - à mettre en œuvre des actions favorisant un moindre et un meilleur usage des
antibiotiques afin d’en préserver l’efficacité.
Ces actions ont abouti à faire diminuer la consommation d’antibiotiques, tant en ville qu’à l’hôpital. Cette
baisse n’a cependant pas été continue. Depuis plusieurs années, l’ANSM observe une tendance à la reprise,
que les résultats 2015 confirment. L’incidence élevée des pathologies hivernales en 2015 doit bien sûr être
prise en compte, mais elle ne peut que partiellement expliquer la hausse constatée.
Pris dans leur ensemble, ces résultats montrent que les habitudes de prescription et les comportements
peuvent être infléchis. Même si elle se situe toujours parmi les pays dont le niveau de consommation est
élevé, la France n’est plus - pour le secteur de ville - le premier consommateur d’antibiotiques en Europe,
comme c’était le cas au début des années 2000. En 2015, elle se situait au 4e rang pour le secteur
ambulatoire. À l’hôpital, la consommation française se situe désormais à un niveau proche de la moyenne
européenne. Néanmoins des progrès conséquents restent à faire pour renforcer le bon usage des
antibiotiques et limiter leur consommation.
2 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 424186
Evolution clinique et mobilisation des ressources de santé en lien avec les infections à bacilles gramnégatif multirésistants dans des centres hospitaliers
Dicks KV; Anderson DJ; Baker AW; Sexton DJ; Lewis SS. Clinical outcomes and healthcare utilization related
to multidrug-resistant gram-negative infections in community hospitals. Infection control and hospital
epidemiology 2017/01; 38(1): 31-38.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; COLONISATION; BACILLE GRAM
NEGATIF; MORTALITE
Objective: To evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on
mortality and healthcare resource utilization in community hospitals.
Design: Two matched case-control analyses.
Setting: Six community hospitals participating in the Duke Infection Control Outreach Network from January 1,
2010, through December 31, 2012.
Participants: Adult patients admitted to study hospitals during the study period.
Methods: Patients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1)
patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric,
non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization,
length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the
effect of MDR status on each outcome measure.
Results: No mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03
higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04–3.97,
P=.04). There was no difference in hospital direct costs between
Patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients
with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02–$8,274.05, P<.001) and resulted in 3.40
extra hospital days (95% CI, 1.41–5.40, P<.001) than hospitalizations for control patients.
Conclusions: Our study provides novel data regarding the clinical and financial impact of MDR gram-negative
bacterial infections in community hospitals. There was no difference in mortality between patients with MDRGNR infections and patients with nonMDR-GNR infections or control patients.
DOI: https://doi.org/10.1017/ice.2016.230
NosoBase ID notice : 424184
Les bactéries multirésistantes détectées après 48 heures d’admission à l’hôpital peuvent ne pas avoir
été acquises à l’hôpital
Erb S; Frei; Dangel M; Widmer A. Multidrug-resistant organisms detected more than 48 hours after hospital
admission are not necessarily hospital-acquired. Infection control and hospital epidemiology 2017/01; 38(1):
18-23.
Mots-clés : INFECTION
ADMISSION
NOSOCOMIALE;
MULTIRESISTANCE;
COLONISATION;
DEFINITION;
Background: Infections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours
after hospital admission are considered healthcare-acquired according to the definition of the Centers for
Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true
acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such
infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups
(DRGs).
Objective: The goal of the study was to estimate the preventable proportion of healthcare-acquired infections
in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs.
Methods: All hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or
according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine
whether there was evidence for nosocomial transmission. We utilized an additional work-up with
epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of
HAMICs.
Results: Overall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were
classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and
were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL
infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs.
3 / 32
NosoVeille – Bulletin de veille
Février 2017
Conclusions: The CDC definition overestimates the preventable proportion of HAMICs with MDROs by more
than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact
of infection control interventions and to inadequate reimbursement under the DRG system.
DOI: https://doi.org/10.1017/ice.2016.226
NosoBase ID notice : 424188
Analyse multicentrique longitudinale des évolutions cliniques après l’arrêt des mesures de lutte
contre les entérocoques résistants à la vancomycine
Lemieux C; Gardam M; Evans G; John M; Suh KN; van Walraven C; et al. Longitudinal multicenter analysis of
outcomes after cessation of control measures for vancomycin-resistant Enterococci. Infection control and
hospital epidemiology 2017/01; 38(1): 24-30.
Mots-clés : INFECTION NOSOCOMIALE; MULTIRESISTANCE; COLONISATION; ENTEROCOCCUS;
VANCOMYCINE; ANTIBIORESISTANCE
Objective: To assess clinically relevant outcomes after complete cessation of control measures for
vancomycin-resistant enterococci (VRE).
Design: Quasi-experimental ecological study over 3.5 years.
Methods: All VRE screening and isolation practices at 4 large academic hospitals in Ontario, Canada, were
stopped on July 1, 2012. In total, 618 anonymized abstracted charts of patients with VRE-positive clinical
isolates identified between July 1, 2010, and December 31, 2013, were reviewed to determine whether the
case was a true VRE infection, a VRE colonization or contaminant, or a true VRE bacteremia. All deaths
within 30 days of the last VRE infection were also reviewed to determine whether the death was fully or
partially attributable to VRE. All-cause mortality was evaluated over the study period. Generalized estimating
equation methods were used to cluster outcome rates within hospitals, and negative binomial models were
created for each outcome.
Results: The incidence rate ratio (IRR) for VRE infections was 0.59 and the associated P value was .34. For
VRE bacteremias, the IRR was 0.54 and P=.38; for all-cause mortality the IRR was 0.70 and P=.66; and for
VRE attributable death, the IRR was 0.35 and P= 49. VRE control measures were not significantly associated
with any of the outcomes. Rates of all outcomes appeared to increase during the 18-month period after
cessation of VRE control measures, but none reached statistical significance.
Conclusion: Clinically significant VRE outcomes remain rare. Cessation of all control measures for VRE had
no significant attributable adverse clinical impact.
DOI: https://doi.org/10.1017/ice.2016.235
NosoBase ID notice : 424211
Impact de deux politiques différentes de gestion des antibiotiques sur la fréquence d’optimisation
des prescriptions d’antibiotiques chez des patients ayant une bactériémie
Lukaszewicz Bushen J; Mehta JM; Hamilton KW; Binkley S; Timko DR; Lautenbach E; et al. Impact of two
different antimicrobial stewardship methods on frequency of streamlining antimicrobial agents in patients with
bacteremia. Infection control and hospital epidemiology 2017/01; 38(1): 89-95.
Mots-clés : BACTERIEMIE; TRAITEMENT; ANTIBIOTIQUE; AUDIT; BACILLE GRAM NEGATIVE;
STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS; URGENCES HOSPITALIERES; SERVICE; ETUDE
RETROSPECTIVE
Objective: To assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship
methods.
Design: Retrospective cohort study.
Setting: Large academic medical center.
Methods: Frequency and time to antimicrobial streamlining were compared during a prior authorization and a
prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available
or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with
monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.
Results: A total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar
between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P= .12), S. aureus
bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P= .335). Compared
to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gramnegative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those
4 / 32
NosoVeille – Bulletin de veille
Février 2017
on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the
emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with
increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001),
admission through the emergency department (P=.001), and admission to a medical service (P=.011).
Conclusions: Compared with prior authorization, prospective audit increased antimicrobial streamlining for
cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted
to a medical but not surgical service.
DOI: https://doi.org/10.1017/ice.2016.243
NosoBase ID notice : 424285
Facteurs de risque associés au portage fécal de Klebsiella pneumoniae productrices de
carbapénèmases : étude cas-témoins dans un centre hospitalier universitaire espagnol
Madueño A; González García J; Ramos MJ; Pedroso Y; Díaz Z; Oteo J; et al. Risk factors associated with
carbapenemase-producing Klebsiella pneumoniae fecal carriage: A case-control study in a Spanish tertiary
care hospital. American journal of infection control 2017/01; 45(1): 77-79.
Mots-clés :
FACTEUR
DE
RISQUE;
COLONISATION
ANTIBIORESISTANCE; CARBAPENEME; BETA-LACTAMASE
PROSPECTIVE; CAS-TEMOIN; CARBAPENEMASE
DIGESTIVE;
ENTEROBACTERIE;
A SPECTRE ELARGI; ETUDE
Asymptomatic colonization of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is
an important reservoir for transmission that may precede infection. This prospective, observational, casecontrol study was designed to identify risk factors for carbapenemase-producing Klebsiella pneumoniae
(CPKP) fecal carriage. This study included 87 cases and 200 controls. Multivariate analysis identified length
of stay (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.03; P=.03), previous hospitalization (OR,
5.89; 95% CI, 1.73-20.68; P=.01), antibiotic use (OR, 0.20; 95% CI, 0.65-0.62; P=.01), and corticosteroid use
(OR, 0.33; 95% CI, 0.15-0.74; P=.007) as independent risk factors for CPKP rectal carriage. Length of
hospital stay, previous hospitalization, corticosteroid use, and antimicrobial exposure are important risk
factors for CPKP rectal colonization. Adherence to infection control practices and directed surveillance
programs appear to be critical components for CPKP control programs.
DOI: https://doi.org/10.1016/j.ajic.2016.06.024
NosoBase ID notice : 424193
Etat de la prévention des bactéries multirésistantes sur la scène internationale : une enquête du
réseau de recherche de la SHEA (Society for Healthcare Epidemiology of America)
Safdar N; Sengupta S; Musuuza J; Juthani-Mehta M; Drees M; Abbo LM; et al. Status of the prevention of
multidrug-resistant organisms in international settings: a survey of the Society for Healthcare Epidemiology of
America research network. Infection control and hospital epidemiology 2017/01; 38(1): 53-60.
Mots-clés : INFECTION NOSOCOMIALE;
CONTACT; TRANSMISSION; PREVENTION
MULTIRESISTANCE;
ANTIBIOTIQUE;
PRECAUTION
Objective: To examine self-reported practices and policies to reduce infection and transmission of multidrugresistant organisms (MDRO) in healthcare settings outside the United States.
Design: Cross-sectional survey.
Participants: International members of the Society for Healthcare Epidemiology of America (SHEA) Research
Network.
Methods: Electronic survey of infection control and prevention practices, capabilities, and barriers outside the
United States and Canada. Participants were stratified according to their country’s economic development
status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and highincome.
Results: A total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada
completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were
middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76
respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution.
High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64
[61%] vs 25/64 [39%], P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72
[44%], P=.05). Major barriers to preventing MDRO transmission included constrained resources
(infrastructure, supplies, and trained staff) and challenges in changing provider behavior.
5 / 32
NosoVeille – Bulletin de veille
Février 2017
Conclusions: In this survey, a substantial proportion of institutions reported encountering barriers to
implementing key MDRO prevention strategies. Interventions to address capacity building internationally are
urgently needed. Data on the infection prevention practices of low income countries are needed.
DOI: https://doi.org/10.1017/ice.2016.242
NosoBase ID notice : 422831
L'antibiorésistance évolue-t-elle aux hôpitaux ?
Seigal A; Mira P; Sturmfels B; Barlow M. Does Antibiotic Resistance Evolve in Hospitals? Bulletin of
mathematical biology 2017/01; 79(1): 191-208.
Mots-clés :
ANTIBIOTIQUE;
PREVENTION;
ANTIBIORESISTANCE;
EPIDEMIE;
INFECTION
NOSOCOMIALE; STATISTIQUE; MODELISATION; CONCEPT METHODOLOGIQUE; ENVIRONNEMENT
Nosocomial outbreaks of bacteria are well documented. Based on these incidents, and the heavy usage of
antibiotics in hospitals, it has been assumed that antibiotic resistance evolves in hospital environments. To
test this assumption, we studied resistance phenotypes of bacteria collected from patient isolates at a
community hospital over a 2.5-year period. A graphical model analysis shows no association between
resistance and patient information other than time of arrival. This allows us to focus on time-course data. We
introduce a hospital transmission model, based on negative binomial delay. Our main contribution is a
statistical hypothesis test called the Nosocomial Evolution of Resistance Detector (NERD). It calculates the
significance of resistance trends occurring in a hospital. It can inform hospital staff about the effects of various
practices and interventions, can help detect clonal outbreaks, and is available as an R package. We applied
the NERD method to each of the 16 antibiotics in the study via 16 hypothesis tests. For 13 of the antibiotics,
we found that the hospital environment had no significant effect on the evolution of resistance; the hospital is
merely a piece of the larger picture. The p-values obtained for the other three antibiotics (cefepime,
ceftazidime, and gentamicin) indicate that particular care should be taken in hospital practices with these
antibiotics. One of the three, ceftazidime, was significant after accounting for multiple hypotheses, indicating a
trend of decreased resistance for this drug.
DOI: https://doi.org/10.1007/s11538-016-0232-7
NosoBase ID notice : 424204
Programme de gestion des antibiotiques basé sur une consultation systématique en infectiologie
dans un centre de rééducation
Tedeschi S; Trapani F; Giannella M; Cristini F; Tumietto F; Bartoletti M; et al. An antimicrobial stewardship
program based on systematic infectious disease consultation in a rehabilitation facility. Infection control and
hospital epidemiology 2017/01; 38(1): 76-82.
Mots-clés : ANTIBIOTIQUE; CONSOMMATION; DDJ; READAPTATION ET REEDUCATION
FONCTIONNELLES; NEUROLOGIE; CLOSTRIDIUM DIFFICILE; INFECTION; ANTIBIORESISTANCE
Objective: To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption,
Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.
Design: Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from
July 2012 to December 2014) ASP implementation.
Setting: 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.
Intervention. Beginning in July 2012, an ASP was implemented based on systematic bedside infectious
disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and
education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of
CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods
before and after the ASP implementation.
Results: Antibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days
(P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and
fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or
length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001).
Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to
12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBLproducing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis
(P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17%
6 / 32
NosoVeille – Bulletin de veille
Février 2017
(P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40%
(P<.0008).
Conclusions: An ASP based on ID consultation was effective in reducing antibiotic consumption without
affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.
DOI: https://doi.org/10.1017/ice.2016.233
Bactériémie
NosoBase ID notice : 422284
Impact d'une campagne d'hygiène des mains sur les taux de bactériémies nosocomiales à
Staphylococcus aureus résistant à la méthicilline et évaluation économique de cette campagne dans
un centre hospitalier universitaire en Corée du Sud
Chun JY; Seo HK; Kim MK; Shin MJ; Kim SY; Kim M; et al. Impact of a hand hygiene campaign in a tertiary
hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia
and economic evaluation of the campaign. American journal of infection control 2016/12; 44(12): 1486-1491.
Mots-clés : HYGIENE DES MAINS; STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
BACTERIEMIE; INFECTION NOSOCOMIALE; TAUX; PRODUIT DE FRICTION POUR LES MAINS;
PREVENTION; COUT-BENEFICE
Background: Hand hygiene (HH) is the most important factor affecting health care-associated infections.
Methods: We introduced a World Health Organization HH campaign in October 2010. The monthly
procurement of hand sanitizers per 1,000 patient days was calculated, and the monthly incidence of
methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), classified into community- and hospitalonset (HO), was measured from a microbiologic laboratory database. Trends of MRSAB incidence were
assessed using Bayesian structural time series models. A cost-benefit analysis was also performed based on
the economic burden of HO MRSAB in Korea.
Results: Procurement of hand sanitizers increased 134% after the intervention (95% confidence interval [CI],
120%-149%), compared with the preintervention period (January 2008-September 2010). In the same
manner, HH compliance improved from 33.2% in September 2010 to 92.2% after the intervention. The
incidence of HO MRSAB per 100,000 patient days decreased 33% (95% CI, -57% to -7.8%) after the
intervention. Because there was a calculated reduction of 65 HO MRSAB cases during the intervention
period, the benefit outweighed the cost (total benefit [$851,565]/total cost [$167,495] = 5.08).
Conclusions: Implementation of the HH campaign led to increased compliance and significantly reduced HO
MRSAB incidence; it was also cost saving.
DOI: https://doi.org/10.1016/j.ajic.2016.07.009
Cathétérisme
NosoBase ID notice : 423525
Evénements indésirables liés aux cathéters veineux périphériques : évaluation à partir d'une étude
multicentrique épidémiologique en France (Projet Catheval)
Miliani K; Taravella R; Thillard D; Chauvin V; Martin E; Edouard S; et al. Peripheral Venous Catheter-Related
Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project).
PLoS One 2017/01/03; 12(1): 1-17.
Mots-clés : CATHETER VEINEUX CENTRAL; ETUDE PROSPECTIVE; ANALYSE MULTICENTRIQUE;
INCIDENCE; PHLEBITE; HEMATOME; INFECTION NOSOCOMIALE; EPIDEMIOLOGIE
Introduction: Peripheral venous catheters (PVC) are medical devices most frequently used during hospital
care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global
risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the
incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk
factors.
Methods : A prospective observational study was conducted as a part of a research project, called
CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in
Northern France that were invited to participate between June-2013 and June-2014. Each participating ward
included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs
were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several
7 / 32
NosoVeille – Bulletin de veille
Février 2017
practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional
hazard model, based on a marginal risk approach, was used to identify factors associated with the
occurrence of at least one PVCAE.
Results: Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was
52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma
(17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The
most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of
post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk
factors.
Conclusion: Limitation of breaches in healthcare quality including post-removal monitoring should be
reinforced to prevent PVC-related adverse events in hospital settings.
DOI: https://doi.org/10.1371/journal.pone.0168637
NosoBase ID notice : 423587
Etude "Plastic In Patient" : audit prospectif d'observance aux recommandations de surveillance et de
documentation des canules périphériques intraveineuses, dans l'objectif de réduire les taux de
complications liées aux canules
Yagnik L; Graves A; Thong K. Plastic in patient study: Prospective audit of adherence to peripheral
intravenous cannula monitoring and documentation guidelines, with the aim of reducing future rates of
intravenous cannula-related complications. American journal of infection control 2017/01; 45(1): 34-38.
Mots-clés : AUDIT; CATHETER VEINEUX PERIPHERIQUE; OBSERVANCE; SURVEILLANCE;
PRATIQUE; PERSONNEL; PREVENTION; RECOMMANDATIONS DE BONNE PRATIQUE; DOSSIER
PATIENT; ETUDE PROSPECTIVE; INTERVENTION
Background: Peripheral intravenous cannula (PIVC) insertion is a universal intervention for inpatients and is
associated with multiple complications. Effective, simple, reproducible interventions specific to PIVC
complication prevention are few and often extrapolated from central venous catheter complication prevention
strategies. The objective of this study is to improve compliance with documentation and monitoring PIVC
guidelines in the medical ward of a secondary care center.
Methods: This study is a prospective run-in audit of adherence to PIVC documentation and monitoring
guidelines between the dates of August 30-November 14, 2014, with data recollection from December 25,
2014-January 30, 2015, after intervention implementation. Three interventions were implemented. The Plastic
in Patient (PIP) strip is a dedicated column on the journey board, identifying inpatients with PIVCs, prompting
assessment of indication at daily multidisciplinary meetings. PIP row is a prompt in the medical admission
proforma to review PIVC indication. PIP poster is a visual cue on PIVC trolleys highlighting PIVC
management practices.
Results: Baseline demographics were similar in the pre- and postintervention groups. Documentation
significantly improved in the postintervention group (36.4 vs 50%, P=.025). Early identification of nonindicated
PIVCs improved in the postintervention group (88.8% vs 97.1%, P=.018) and a trend toward a reduced PIVCrelated early phlebitis rate (3.7% vs 0, P=.08).
Conclusions: Simple, cost-effective interventions result in improvements in adherence to practice guidelines.
Our results suggest a trend toward reduction in phlebitis rates.
DOI: https://doi.org/10.1016/j.ajic.2016.09.008
Chirurgie
NosoBase ID notice : 423325
Bloc opératoire: Qualité, sécurité et performance
Sfez M; Fabry J; André G; Gravié JF; Quaranta JF. Bloc opératoire: Qualité, sécurité et performance [Dossier
thématique]. Risques & qualité en milieu de soins 2016/12; 13(4): 1-111.
Mots-clés : CHIRURGIE; CHIRURGIE AMBULATOIRE; BLOC OPERATOIRE; ANESTHESIE
REANIMATION; PERFORMANCE; GESTION DE LA QUALITE; CONDITION DE TRAVAIL; PERSONNEL
MEDICAL; INFIRMIER DE BLOC OPERATOIRE DIPLOME D'ETAT; COMPETENCE; EVENEMENT
INDESIRABLE; GESTION DES RISQUES; INFORMATISATION; ROBOTIQUE; QUALITE DES SOINS;
ORGANISATION DES SOINS; CHEMIN CLINIQUE; VIGILANCE SANITAIRE; CONTROLE; TRAVAIL EN
EQUIPE; COMMUNICATION; INSTRUMENTATION; ACCREDITATION; PEDIATRIE; SECURITE
INCENDIE; SIMULATION; SECURITE; BLOC DES ERREURS; CHECK-LIST; SMARTPHONE
8 / 32
NosoVeille – Bulletin de veille
Février 2017
Sommaire :
- La qualité au bloc opératoire
- Qualité, sécurité, production et performance : les concepts
- Renouveler l'approche de la performance hospitalière : regards croisés sur le bloc opératoire
- Productivité au bloc : impact sur les conditions de travail et la sécurité des personnels
- Place des comportements peropératoires des personnels dans la survenue des complications
postopératoires
- De la chirurgie ambulatoire à la réhabilitation améliorée : quelles évolutions au bloc opératoires ?
- Emergence de la robotique chirurgicale : pertinence des indications
- La simulation comme outil d'amélioration de la sécurité et qualité des soins au bloc opératoire
- L'informatisation de la gestion des flux au bloc opératoire : quel impact sur la sécurité des patients ?
- Evaluer les risques (patient) en préopératoire
- Utiliser la cartographie des risques
- Identifier rapidement les risques a priori au bloc opératoire
- Bien utiliser la liste de vérification chirurgicale : expérience au Québec
- Check-list au bloc opératoire : quoi de neuf docteur ?
- Bloc des erreurs : expérience au Groupement Hospitalier Lyon-Est
- Bloc des erreurs : expérience au Centre des Massues, Lyon
- Promouvoir le travail en équipe
- Distractions et interruptions au bloc opératoire : place des smartphones
- Organisation d'une unité de chirurgie ambulatoire : leçons d'une expérience en chirurgie pédiatrique
- Promouvoir la sécurité incendie
- Vers l'accréditation des équipes médicales
NosoBase ID notice : 424181
Association entre micro-organismes aéroportés au bloc opératoire et infections après pose de
prothèse : une étude contrôlée randomisée
Darouiche RO; Green DM; Harrington MA; Ehni BL; Kougias P; Bechara CF; et al. Association of airborne
microorganisms in the operating room with implant infections: a randomized controlled trial. Infection control
and hospital epidemiology 2017/01; 38(1): 3-10.
Mots-clés : CHIRURGIE ORTHOPEDIQUE; INCIDENCE; INFECTION NOSOCOMIALE; MATERIEL
ETRANGER; BLOC OPERATOIRE; TRANSMISSION AERIENNE
Objective: To evaluate the association of airborne colony-forming units (CFU) at incision sites during
implantation of prostheses with the incidence of either incisional or prosthesis-related surgical site infections.
Design: Randomized, controlled trial.
Setting: Primary, public institution.
Patients: Three hundred patients undergoing total hip arthroplasty, instrumented spinal procedures, or
vascular bypass graft implantation.
Methods: Patients were randomly assigned in a 1:1 ratio to either the intervention group or the control group.
A novel device (Air Barrier System), previously shown to reduce airborne CFU at incision sites, was utilized in
the intervention group. Procedures assigned to the control group were performed without the device, under
routine operating room atmospheric conditions. Patients were followed up for 12 months to determine
whether airborne CFU levels at the incision sites predicted the incidence of incisional or prosthesis-related
infection.
Results: Data were available for 294 patients, 148 in the intervention group and 146 in the control group. CFU
density at the incision site was significantly lower in the intervention group than in the control group (P<.001).
The density of airborne CFU at the incision site during the procedures was significantly related to the
incidence of implant infection (P=.021). Airborne CFU densities were 4 times greater in procedures with
implant infection versus no implant infection. All 4 of the observed prosthesis infections occurred in the control
group.
Conclusion: Reduction of airborne CFU specifically at the incision site during operations may be an effective
strategy to reduce prosthesisrelated infections. Trial Registration: clinicaltrials.gov Identifier: NCT01610271.
DOI: https://doi.org/10.1017/ice.2016.240
9 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 424363
Interdiction des gants chirurgicaux poudrés, des gants d'examen poudrés et la poudre absorbante
destinée à lubrifier les gants chirurgicaux
Food and Drug Administration; HHS. Banned Devices; Powdered Surgeon's Gloves, Powdered Patient
Examination Gloves, and Absorbable Powder for Lubricating a Surgeon's Glove. Federal Register 2016/12;
81(243): 91722-91731.
Mots-clés : GANT; LATEX; PERSONNEL; USAGER DE LA SANTE; TOLERANCE; ALLERGIE;
COMPLICATION; CHIRURGIE; LEGISLATION; RISQUE
La FDA a récemment interdit l’usage des gants chirurgicaux, des gants d’examen poudrés et de la poudre
absorbante destinée à lubrifier les gants chirurgicaux. Elle considère qu’il existe un risque trop important pour
la santé des utilisateurs (allergies notamment) et des patients (complications chirurgicales), qui ne peut pas
être suffisamment minimiser par l’information figurant sur les notices.
NosoBase ID notice : 424224
Lien entre prothèse partielle de hanche et un risque accru d’infection et de mortalité en France
Grammatico-Guillon L; Perreau C; Miliani K; L'Hériteau F;Rosset P; Bernard L; et al. Association of partial hip
replacement with higher risk of infection and mortality in France. Infection control and hospital epidemiology
2017/01; 38(1): 123-125.
Mots-clés : PROTHESE TOTALE DE HANCHE; CHIRURGIE ORTHOPEDIQUE; RISQUE; INFECTION
NOSOCOMIALE; MORTALITE; SURVEILLANCE
DOI: https://doi.org/10.1017/ice.2016.234
NosoBase ID notice : 424183
Indice du degré d’invasion comme facteur prédictif d’infection du site opératoire après arthrodèse
lombaire, révision d’arthrodèse ou laminectomie
Hollenbeck BL; McGuire KJ; White AP; Yassa D; Wright SB. Invasiveness index as a predictor of surgical site
infection after spinal fusion, revision fusion, or laminectomy. Infection control and hospital epidemiology
2017/01; 38(1): 11-17.
Mots-clés : CHIRURGIE ORTHOPEDIQUE; INFECTION NOSOCOMIALE; FACTEUR DE RISQUE;
RACHIS; NEUROCHIRURGIE; ETUDE RETROSPECTIVE
Objective: To evaluate invasiveness index as a potential predictor of spine surgical site infection (SSI) after
spinal fusion, revision fusion, or laminectomy.
Design: Retrospective cohort study.
Setting: Single, large, academic medical center.
Patients: Adults undergoing spinal fusion, revision fusion, or laminectomy.
Methods: Data were obtained from electronic hospital databases; cases of SSI were extracted from the
infection control database using National Healthcare Safety Network (NHSN) definitions. For each case, an
invasiveness index, determined by surgical approach, procedure, and number of spine levels treated, was
calculated using current procedural terminology (CPT) billing codes. Statistical analyses were performed
using univariate and multivariate logistic regression models.
Results: In total, 3,143 patients met inclusion criteria, and 43 of these developed SSI. Multivariate regression
showed that advanced age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.005-1.05, for each year of
life) and invasiveness index (medium invasiveness index OR, 5.36; 95% CI, 1.92-14.96; high invasiveness
index OR, 14.1; 95% CI, 4.38-45.43) were significant predictors of infection. In subgroup analyses of spinal
fusion patients, morbid obesity (OR, 2.542; 95% CI, 1.08–5.99), trauma (OR, 2.41; 95% CI, 1.05-5.55), and
invasiveness index (medium invasiveness index OR, 5.39; 95% CI, 1.56-18.61; high invasiveness index OR,
13.44; 95% CI, 3.28-55.01) were significant predictors of SSI. Models containing invasiveness index were
compared to NHSN models and demonstrated similar performance.
Conclusions: Invasiveness index is a predictor of SSI after spinal fusion and performs similarly to NHSN
models. Invasiveness index shows promise as a potential risk stratification tool that is easily calculated and is
available preoperatively.
DOI: https://doi.org/10.1017/ice.2016.244
10 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 422902
Flore microbienne sur les téléphones portables dans un bloc opératoire de chirurgie orthopédique
avant et après la décontamination
Murgier J; Coste JF; Cavaignac E; Bayle-Iniguez X; Chiron P; Bonnevialle P; et al. Microbial flora on cellphones in an orthopedic surgery room before and after decontamination. Orthopaedics & Traumatology:
Surgery & Research 2016/12; 102(8): 1093-1096.
Mots-clés : CONTAMINATION; BLOC OPERATOIRE; SURFACE; EQUIPEMENT; PERSONNEL;
COLONISATION;
DEPISTAGE;
DESINFECTION;
EFFICACITE;
COLONISATION
NASALE;
STAPHYLOCOCCUS AUREUS; TELEPHONE PORTABLE
Introduction: Cell-phones are the typical kind of object brought into the operating room from outside by
hospital staff. A great effort is made to reduce the level of potentially contaminating bacteria in the operating
room, and introducing these devices may run counter to good practice. The study hypothesis was that cellphones are colonized by several strains of bacteria and may constitute a source of nosocomial contamination.
The main study objective was to screen for bacterial colonies on the surfaces of cell-phones introduced in an
orthopedic surgery room. The secondary objective was to assess the efficacy of decontamination.
Material and method: Samples were taken from the cell-phones of hospital staff (surgeons, anaesthetists,
nurses, radiology operators, and external medical representatives) entering the operating room of the
university hospital center orthopedic surgery department, Toulouse (France). Sampling used Count Tact®
contact gel, without wiping the phone down in advance. Both sides of the phone were sampled, before and
after decontamination with a pad imbibed with 0.25% Surfanios ® Premium disinfectant. A nasal sample was
also taken to investigate the correlation between Staphylococcus aureus in the nasal cavities and on the cellphone.
Results: Fifty-two cell-phones were sampled. Before decontamination, the mean number of colony-forming
units (CFU) was 258 per phone (range, 0-1,664). After decontamination, it was 127 (range, 0-800)
(P=0.0001). Forty-nine cell-phones bore CFUs before decontamination (94%), and 39 after (75%) (P=0.02).
Discussion: Cell-phones are CFU carriers and may thus lead to contamination.
DOI: https://doi.org/10.1016/j.otsr.2016.09.014
NosoBase ID notice : 422833
Infections nosocomiales après chirurgie cardiaque et les pratiques actuelles des médecins : étude de
cohorte rétrospective
O'Keefe S; Williams K; Légaré JF. Hospital-Acquired Infections After Cardiac Surgery and Current Physician
Practices: A Retrospective Cohort Study. Journal of clinical medicine research 2017/01; 9(1): 10-16.
Mots-clés : INFECTION NOSOCOMIALE; ANTIBIOTIQUE; CHIRURGIE CARDIAQUE; PREVALENCE;
DEPISTAGE; MORTALITE; DUREE DE SEJOUR; ETUDE RETROSPECTIVE; COHORTE
Background: The management of hospital-acquired infections (HAIs) with respect to physician practices
remains largely unexplored despite increasing efforts to standardize care. In the present study, we report
findings from a 2-month audit of all patients that have undergone cardiac surgery at a large referral center in
Atlantic Canada.
Methods: All patients who underwent cardiac surgical procedures during May and June 2013 at the Queen
Elizabeth II Health Sciences Center in Halifax, Nova Scotia were identified. The prevalence of urinary tract
infections (UTIs), pneumonia, leg harvest site infections, superficial sternal wound infections, deep sternal
wound infections, and sepsis was examined to determine physician approaches in terms of verification rates
(microbiology), time of diagnosis and duration of treatment. Continuous variables were compared using
Student's t-test and categorical variables were analyzed using Fischer's exact test.
Results: A total of 185 consecutive patients underwent cardiac surgical procedures, of which 39 (21%)
developed at least one postoperative infection. The overall prevalence of infection types, from highest to
lowest, was UTI (8%), pneumonia (7%), leg harvest site infection (5%), superficial surgical site infection (4%),
and sepsis (2%). There were no deep sternal wound infections. The overall in-hospital mortality rate was
3.8% with a median length of stay (LOS) of 8 days. The overall infection verification rate was 50% (ranged
from 100% in sepsis to 10% in leg harvest site infections). In all cases, a full course of antibiotics was
administered despite negative microbiology cultures or limited evidence of an actual infection.
Conclusions: HAIs are commonly treated without being verified and treatment is often not discontinued after
negative cultures are received. Our findings highlight the fact that antibiotic treatment is not always supported
11 / 32
NosoVeille – Bulletin de veille
Février 2017
by evidence, and the effect of this could contribute to increased selective pressure for antimicrobial resistant
bacteria.
DOI: https://doi.org/10.14740/jocmr2637w
NosoBase ID notice : 423528
Incidence de la colonisation du tube endotrachéal par l'utilisation de tubes endotrachéaux PneuX
chez des patients après une chirurgie cardiaque
Senanayake EL; Giri R; Gopal S; Nevill A; Luckraz H., Incidence of endotracheal tube colonization with the
use of PneuX endotracheal tubes in patients following cardiac surgery. The journal of hospital infection
2017/01; 95(1): 81-86.
Mots-clés : INCIDENCE; COLONISATION;
INTUBATION OROTRACHEALE
CHIRURGIE
CARDIAQUE;
VENTILATION
ASSISTEE;
Introduction: Ventilator-associated pneumonia (VAP) develops in up to 25% of patients following cardiac
surgery. Colonization of the endotracheal tube (ETT) contributes to VAP. The PneuX ETT has been shown to
halve VAP in high-risk patients undergoing cardiac surgery. This article reports on the secondary analysis of
bacterial colonization in relation to VAP between the PneuX and standard ETTs.
Methods: In this randomized controlled trial, patients were randomized on a 1:1 basis to Group A (PneuX ET,
N=120) or Group B (standard ETT, N=120). Patients aged >70 years with or without impaired left ventricular
function (<50%) undergoing elective and urgent cardiac surgery were included in this study. Incidence of
postoperative VAP and analysis of bacterial colonization within the ETT (N=234) were measured for patients
requiring <24 h, 24-48 h and >48 h of intubation.
Results: Baseline patient demographics were comparable. VAP was lower in Group A compared with Group
B (10.8% vs 21%; P=0.03). The incidence of VAP was lower at each time point for Group A. There was a
lower incidence of ETT colonization in Group A for patients needing >48 h of intubation. There was no
difference in the type of bacterial colonization (P=0.5) or the mean number of colony-forming units [4.35x107)
(1.18x108) and 2.16x108) (1.24x109) in Groups A and B, respectively (P=0.8)].
Conclusion: Colonization of the ETT does not seem to play an important role in early-onset VAP. There is a
tendency for reduced colonization in the PneuX ETT with longer intubation times. This may have an impact
on reducing the incidence of late-onset VAP.
DOI: https://doi.org/10.1016/j.jhin.2016.09.007
Clostridium difficile
NosoBase ID notice : 422879
Bon usage des antibiotiques et décontamination environnementale pour la prévention de la
transmission du Clostridium difficile dans les milieux de soins de santé
Bintz J; Lenhart S; Lanzas C. Antimicrobial Stewardship and Environmental Decontamination for the Control
of Clostridium difficile Transmission in Healthcare Settings. Bulletin of mathematical biology 2017/01; 79(1):
36-62.
Mots-clés : CLOSTRIDIUM DIFFICILE; PREVENTION; CONCEPT METHODOLOGIQUE; MODELISATION;
EFFICACITE; ANTIBIOTIQUE; PRESCRIPTION; CONSOMMATION; ENVIRONNEMENT; COLONISATION;
TRANSMISSION
We implement an agent-based model for Clostridium difficile transmission in hospitals that accounts for
several processes and individual factors including environmental and antibiotic heterogeneity in order to
evaluate the efficacy of various control measures aimed at reducing environmental contamination and
mitigating the effects of antibiotic use on transmission. In particular, we account for local contamination levels
that contribute to the probability of colonization and we account for both the number and type of antibiotic
treatments given to patients. Simulations illustrate the relative efficacy of several strategies for the reduction
of nosocomial colonizations and nosocomial diseases.
DOI: https://doi.org/10.1007/s11538-016-0224-7
12 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 423592
Contamination des mains du personnel de santé par Clostridium difficile et sa contribution potentielle
à la dissémination de l'infection : revue de la littérature
Jullian-Desayes I; Landelle C; Mallaret MR; Brun-Buisson C; Barbut F. Clostridium difficile contamination of
health care workers’ hands and its potential contribution to the spread of infection: Review of the literature.
American journal of infection control 2017/01; 45(1): 51-58.
Mots-clés : CLOSTRIDIUM DIFFICILE; CONTAMINATION; TRANSMISSION; MAIN; PERSONNEL;
COLONISATION; HYGIENE DES MAINS; ENVIRONNEMENT; SURFACE; REVUE DE LA LITTERATURE
Background: Clostridium difficile infection (CDI) can be transmitted from patient to patient by the hands of
health care workers (HCWs); however, the relative importance of this route in the spread of C difficile in the
hospital is currently unknown. Our aim was to review studies examining HCWs’ hand carriage and its
potential role in CDI transmission.
Methods: First, English-speaking references addressing HCWs’ hand sampling obtained from the PubMed
database were reviewed. Second, C difficile outbreaks definitely or probably implicating HCWs were retrieved
from the Outbreak Database Web site (www.outbreak-database.com). Finally, cases of C difficile occurring in
HCWs after contact with an infected patient were retrieved from PubMed.
Results: A total of 11 studies dealing with HCWs’ hand carriage were selected and reviewed. Between 0%
and 59% of HCWs’ hands were found contaminated with C difficile after caring for a patient with CDI. There
were several differences between studies regarding site of hands sampling, timing after contact, and
bacteriologic methods. Only 2 C difficile outbreaks implicating HCWs and 6 series of cases of transmission
from patients to HCWs have been reported.
Conclusions: This review shows that HCWs’ hands could play an important role in the transmission of C
difficile. Hand hygiene and reduction of environmental contamination are essential to control C difficile
transmission.
DOI: https://doi.org/10.1016/j.ajic.2016.08.017
NosoBase ID notice : 424191
Impact de l’irradiation germicide aux ultraviolets pour la désinfection terminale sans contact des
chambres sur l’incidence des infections à Clostridium difficile chez des patients en cancérologiehématologie
Pegues DA; Han J; Gilmar C; McDonnell B; Gaynes S. Impact of ultraviolet germicidal irradiation for no-touch
terminal room disinfection on Clostridium difficile infection incidence among hematology-oncology patients.
Infection control and hospital epidemiology 2017/01; 38(1): 29-44.
Mots-clés : INFECTION NOSOCOMIALE; DESINFECTION; CLOSTRIDIUM DIFFICILE; INCIDENCE;
ULTRA-VIOLET; CHAMBRE DU MALADE; SURFACE; CONTAMINATION; SORTIE; CANCEROLOGIE;
HEMATOLOGIE
Objective: To evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength
C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates on inpatient units with persistently high
rates of CDI despite infection control measures.
Design: Interrupted time-series analysis with a comparison arm.
Setting: 3 adult hematology-oncology units in a large, tertiary-care hospital.
Methods: We conducted a 12-month prospective valuation of UVGI. Rooms of patients with CDI or on contact
precautions were targeted for UVGI upon discharge using an electronic patient flow system. Incidence rates
of healthcare-onset CDI were compared for the baseline period (January 2013-December 2013) and
intervention period (February 2014-January 2015) on study units and non-study units using a mixed-effects
Poisson regression model with random effects for unit and time in months.
Results: During a 52-week intervention period, UVGI was deployed for 542 of 2,569 of all patient discharges
(21.1%) on the 3 study units.
The CDI rate declined 25% on study units and increased 16% on non-study units during the intervention
compared to the baseline period. We detected a significant association between UVGI and decrease in CDI
incidence (incidence rate ratio [IRR], 0.49; 95% confidence interval [CI], 0.26-0.94; P=.03) on the study units
but not on the non-study units. The impact of UVGI use on average room-cleaning time and turnaround time
was negligible compared to the baseline period.
Conclusions: Targeted deployment of UVGI to rooms of high-risk patients at discharge resulted in a
substantial reduction of CDI incidence without adversely impacting room turnaround.
DOI: 10.1017/ice.2016.222
13 / 32
NosoVeille – Bulletin de veille
Février 2017
Désinfection
NosoBase ID notice : 424319
Evaluation de l’impact de nouvelles formulations nettoyantes qui associent des dérivés de pin et des
enzymes sur la réduction du biofilm microbien
Le Hénaff M; Huguet N; Richard A; Vaillant M; Papillon S; Le Gallet A. Evaluation de l’impact de nouvelles
formulations nettoyantes qui associent des dérivés de pin et des enzymes sur la réduction du biofilm
microbien. Hygiènes 2016/12; 24(6): 293-299.
Mots-clés : EVALUATION; BIOFILM; INFECTION NOSOCOMIALE; CONTAMINATION; BIONETTOYAGE;
DESINFECTION; DETERGENT; CONTAMINATION
Objectif : Dans les milieux de l’agroalimentaire ou médicaux, les biofilms microbiens sont à l’origine de
nombreuses contaminations. Ils pourraient notamment être responsables de 65 % des infections
nosocomiales. Ce travail a cherché à objectiver l’efficacité de deux nouvelles formules nettoyantes
enzymatiques sur la réduction de biofilms bactériens.
Matériel et méthodes : Un dispositif « biofilm modèle » a été réalisé en microplaques 96-puits avec trois
microorganismes distincts (Escherichia coli, Staphylococcus aureus, Salmonella livingstone) afin de mesurer
la réduction de la biomasse constituant les biofilms après incubation avec les formules nettoyantes. Les
paramètres d’incubation avec les biofilms sont les suivants : (i) concentration (0,5 ou 1,0 % dans l’eau) ; (ii)
temps (5, 15 ou 60 min) ; et (iii) la température (4, 10, 20 ou 40 °C).
Résultats : À la différence du détergent désinfectant, seules les formulations supplémentées avec des
enzymes permettent une réduction significative des biofilms bactériens (jusqu’à 100 % dans certains cas).
Les effets « dose » ou « durée du contact » des formulations sont peu marqués alors que l’efficacité
augmente avec la température d’incubation.
Conclusion : Les nouvelles formulations nettoyantes qui associent des dérivés de pin et des enzymes ont
montré de grandes capacités à réduire du biofilm mature. Aussi, elles devraient trouver leur place dans de
nouveaux plans de nettoyage/désinfection pour limiter le développement de biofilms sur les sols et surfaces
hautes des industries de l’agroalimentaire et des établissements médicalisés.
Environnement
NosoBase ID notice : 423171
Les déchets à l'hôpital : quoi de neuf dans les poubelles ?
Favier AL. Les déchets à l'hôpital : quoi de neuf dans les poubelles ? Objectif soins & management 2016/12;
251: 38-40.
Mots-clés : DECHET D'ACTIVITE DE SOINS; GESTION DES DECHETS; DEVELOPPEMENT DURABLE;
ECOLOGIE; TRAITEMENT DES DECHETS; ECONOMIE DE LA SANTE; DECHET DOMESTIQUE;
DECHET D'ACTIVITE DE SOIN A RISQUE INFECTIEUX
À l’heure où la question des déchets n’a jamais été aussi brûlante dans notre quotidien et où les évolutions
sont constantes, l’hôpital reste un peu sur ses acquis depuis le Grenelle de l’environnement 2. Une marge de
progression est pourtant encore possible dans différents domaines. Démonstration.
NosoBase ID notice : 423523
Les organismes Gram négative producteurs de BLSE dans l'environnement hospitalier comme
source de matériel génétique pour la résistance dans les infections humaines
Muzslay M; Moore G; Alhussaini N; Wilson AP. ESBL-producing Gram-negative organisms in the healthcare
environment as a source of genetic material for resistance in human infections. The journal of hospital
infection 2017/01; 95(1): 59-64.
Mots-clés : ENVIRONNEMENT; BETA-LACTAMASE A SPECTRE ELARGI; ENTEROBACTERIE;
SURFACE; LAVABO; KLEBSIELLA PNEUMONIAE; ENTEROBACTER; CITROBACTER; PREVALENCE;
TRANSMISSION; SURVEILLANCE
14 / 32
NosoVeille – Bulletin de veille
Février 2017
Background: The increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing
Enterobacteriaceae in the healthcare setting and in the community despite established infection control
guidelines indicates that these microorganisms may possess survival strategies that allow them to persist in
the environment.
Aims: To determine the extent and variation in endemic ESBL-carrying species in different ward
environments, and to investigate the potential for cephalosporin resistance to be transferred from
environmental isolates to human pathogens.
Methods: Conventional microbiological methods were used to sample 1436 environmental surfaces for ESBLproducing bacteria. Transconjugation assays (broth mating experiments) were performed using
environmental ESBL-producing isolates as donors and streptomycin-resistant Escherichia coli (NCTC 50237)
as the recipient.
Findings: The prevalence of ESBL-producing bacteria on surfaces in a non-outbreak setting was low
(45/1436; 3.1%). The sites most likely to be contaminated were the drains of handwash basins (28/105;
26.7%) and floors (14/160; 8.8%). Fifty-nine ESBL-carrying organisms were isolated. Of these, Klebsiella spp.
(33.9%), Enterobacter spp. (20.3%), Pantoea spp. (15.3%) and Citrobacter spp. (13.6%) were the most
common isolates. ESBL determinants were transferred successfully from three representative environmental
isolates (Pantoea calida, Klebsiella oxytoca, Raoultella ornithinolytica) to the human pathogen E. coli.
Conclusion: ESBL-producing Gram-negative isolates were recovered from the hospital environment in the
absence of any ESBL infection on the wards. The drains of handwash basins should be considered potential
long-term reservoirs of multi-drug-resistant bacteria and drug resistance genes. These genes can reside in
various genera of hardy environmental organisms and be a potential source of ESBL for more common
human pathogens.
DOI: https://doi.org/10.1016/j.jhin.2016.09.009
NosoBase ID notice : 423589
Pouvons-nous prédire la contamination aérienne par Aspergillus au cours de travaux de
construction?
Pilmis B; Thépot-Seegers V; Angebault C; Weiss E; Alaabouche I; Bougnoux ME; et al. Could we predict
airborne Aspergillus contamination during construction work? American journal of infection control 2017/01;
45(1): 39-41.
Mots-clés : CONTAMINATION; ASPERGILLUS; PREVENTION; AEROBIOCONTAMINATION; TRAVAUX
HOSPITALIERS; ENVIRONNEMENT; AIR; MYCOLOGIE; CLIMAT
Background: Aspergillus fumigatus is a major opportunistic pathogen causing nosocomial infection. Hospital
outbreaks of invasive aspergillosis have been associated with demolition and building construction. This study
was designed to examine the impact of meteorologic factors and different periods of work on outdoor fungal
airborne concentrations.
Methods: The study was conducted at Necker Enfants Malades Hospital, a 650-bed teaching care hospital
recently involved in a large construction program, including renovation, construction, and demolition. During
the work phases, prospective external air samplings were performed 3 times a week, and meteorologic
parameters were collected every day.
Results: Two hundred and one samples were collected. Aspergillus spp were found in 80.1% of samples, with
a median concentration of 16 colony forming units (CFU)/m 3. A significant increase in the colony count of
molds occurred after demolition. In the multivariate analysis, factors associated with overall fungi
concentration were the type of work construction and temperature. Elevated Aspergillus spp concentrations
(>20 CFU/m3) were associated with higher temperature.
Conclusions: Our findings underline the importance of environmental surveillance. According to our results we
suggest that demolition work should be performed during the winter and fall seasons.
DOI: https://doi.org/10.1016/j.ajic.2016.08.003
NosoBase ID notice : 423596
Détection et caractérisation de la contamination microbienne des surfaces dans des ambulances
d'urgence
Varona-Barquin A; Ballesteros-Peña S; Lorrio-Palomino S; Ezpeleta G; Zamanillo V; Eraso E; et al. Detection
and characterization of surface microbial contamination in emergency ambulances. American journal of
infection control 2017/01; 45(1): 69-71.
15 / 32
NosoVeille – Bulletin de veille
Février 2017
Mots-clés : CONTAMINATION; SURFACE; SECOURS D'URGENCE; TRANSPORT
ENVIRONNEMENT; PREVENTION; PRELEVEMENT; STAPHYLOCOCCUS AUREUS
SANITAIRE;
A cross-sectional study was performed in 10 emergency basic life support ambulances operating in Bilbao,
Spain, to assess surface bacterial contamination. Presence of clinically relevant bacterial contamination
suggests that disinfection of the studied basic life support ambulances was not optimal and represents a
potential risk of infection for the patients transferred in them. It is critical to implement existing infection control
and prevention protocols to resolve this issue.
DOI: https://doi.org/10.1016/j.ajic.2016.05.024
Epidémie
NosoBase ID notice : 424274
Retour d’EXpérience : Signalement d’infections nosocomiales – Epidémie d’infections urinaires
sévères à EBLSE en gériatrie
CClin Sud-Ouest; CClin Arlin. Retour d’EXpérience : Signalement d’infections nosocomiales – Epidémie
d’infections urinaires sévères à EBLSE en gériatrie. CClin Arlin 2017/01; 24: 1-2.
Mots-clés : EPIDEMIE; INFECTION URINAIRE; PERSONNE AGEE; EHPAD; ENTEROBACTERIE; BETALACTAMASE A SPECTRE ELARGI; RETOUR D'EXPERIENCE; EBLSE, EXCRETA
La gestion adéquate des excrétas et les précautions standard préviennent la transmission des EBLSE. Il est
capital d’échanger avec les équipes de soins pour identifier les situations à risque de réservoir et de
transmission.
http://www.cclin-sudouest.com/wp-content/uploads/2015/05/REX-CCLIN-SO-IU_EBLSE_geriatrie24.pdf
NosoBase ID notice : 424213
Incidence des infections et des épidémies à Norovirus en utilisant 2 méthodes de surveillance en
Suède
Fraenkel CJ; Inghammar M; Johansson H; Böttiger B. Incidence of hospital Norovirus outbreaks and
infections using 2 surveillance methods in Sweden. Infection control and hospital epidemiology 2017/01;
38(1): 96-102.
Mots-clés :
NOROVIRUS;
EPIDEMIE;
LABORATOIRE; ETUDE PROSPECTIVE
INCIDENCE;
SURVEILLANCE;
GASTRO-ENTERITE;
Objective: To evaluate 2 different methods of surveillance and to estimate the incidence of norovirus (NoV)
outbreaks in hospitals.
Design: Prospective observational study.
Setting: All 194 hospital wards in southern Sweden during 2 winter seasons (2010–2012).
Methods: Clinical surveillance based on outbreak reports of 2 or more clinical cases, with symptom onset
within 5 days, was compared with laboratory surveillance based on positive NoV results among inpatients. At
least 2 NoV positive patients sampled within 5 days at a ward defined a cluster. Outbreak reports including at
least 1 NoV positive case and clusters including at least 1 NoV positive patient with 5 or more days from ward
admission to sampling were defined as NoV outbreaks.
Results: During the study periods 135 NoV outbreaks were identified; 74 were identified by both clinical and
laboratory surveillance, 18 were identified only by outbreak reports, and 43 were identified only by laboratory
surveillance. The outbreak incidence was 1.0 (95% CI, 0.8–1.2) and 0.5 (95% CI, 0.3–0.6) per 1,000
admissions for the 2 different seasons, respectively. To correctly identify NoV outbreaks, the sensitivity and
positive predictive value of the clinical surveillance were 68% and 88% and of the laboratory surveillance
were 86% and 81%, respectively.
Conclusion: The addition of laboratory surveillance significantly improves outbreak surveillance and provides
a more complete estimate of NoV outbreaks in hospitals. Laboratory surveillance can be recommended for
evaluation of clinical surveillance.
DOI: https://doi.org/10.1017/ice.2016.237
16 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 423519
Contrôle d'épidémies à Enterobactéries productrices de carbapénèmases dans un établissement de
soins aigus : une revue des preuves
French CE; Coope C; Conway L; Higgins JP; McCulloch J; Okoli G; et al. Control of carbapenemaseproducing Enterobacteriaceae outbreaks in acute settings: an evidence review. The journal of hospital
infection 2017/01; 95(1): 3-45.
Mots-clés : ENTEROBACTER; REVUE DE LA LITTERATURE; CARBAPENEME; ENTEROBACTERIE;
DEPISTAGE; PRECAUTION CONTACT; HYGIENE DES MAINS; EPIDEMIE; CONTROLE
Background: In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been
increasing globally and present a major public health challenge.
Aim: To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally;
and (ii) to identify the control measures used during these outbreaks and report on their effectiveness.
Methods: A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and
reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for
2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative
synthesis of the evidence was conducted.
Findings: Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The
number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the
vast majority of outbreaks, multi-component infection control measures were used, commonly including:
patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or
monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient
isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of
control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of
appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high
for these studies.
Conclusion: The findings indicate that CPE outbreaks can be controlled using combinations of existing
measures. However, the quality of the evidence base is weak and further high-quality research is needed,
particularly on the effectiveness of individual infection control measures.
DOI: https://doi.org/10.1016/j.jhin.2016.10.006
NosoBase ID notice : 421186
Evaluation et validité d'une méthode de typage à cadre de lecture ouvert basée sur PCR pour
décortiquer l'épidémiologie moléculaire d'Acinetobacter baumannii dans une étude épidémiologique
d'une épidémie à l'hôpital
Fujikura Y; Yuki A; Hamamoto T; Ichimura S; Kawana A; Ohkusu K; et al. Evaluation and validity of a
polymerase chain reaction-based open reading frame typing method to dissect the molecular epidemiology
for Acinetobacter baumannii in an epidemiologic study of a hospital outbreak. American journal of infection
control 2016/11; 44(11): e275-e278.
Mots-clés : ACINETOBACTER BAUMANNII; EPIDEMIOLOGIE; EPIDEMIE; BIOLOGIE MOLECULAIRE;
PCR; PFGE; TYPAGE
Acinetobacter baumannii is regarded as one of the most important pathogens in hospital outbreaks. To obtain
an efficient and simple epidemiologic method of surveillance during outbreaks, we assessed the applicability
of the polymerase chain reaction-based open reading frames typing (POT) method and compared it with
pulsed-field gel electrophoresis. The POT method was found to have sufficient discriminatory power to
identify the strains and would be widely applicable to epidemiologic surveillance during hospital outbreaks.
DOI: https://doi.org/10.1016/j.ajic.2016.03.059
NosoBase ID notice : 424215
Epidémie à Mycobacterium chimaera associée à des générateurs thermiques : assembler les pièces
du puzzle
Sommerstein R; Schreiber PW; Diekema DJ; Edmond MB; Hasse B; Marschall J ; et al. Mycobacterium
chimaera outbreak associated with heater-cooler devices: piecing the puzzle together. Infection control and
hospital epidemiology 2017/01; 38(1): 103-108.
17 / 32
NosoVeille – Bulletin de veille
Février 2017
Mots-clés : MYCOBACTERIE ATYPIQUE; EPIDEMIE; INFECTION NOSOCOMIALE; CIRCULATION
EXTRA-CORPORELLE; CHIRURGIE CARDIAQUE; CONTAMINATION; EAU; DESINFECTION;
MYCOBACTERIUM CHIMAERA
An outbreak of invasive Mycobacterium chimaera infections associated with heater-cooler devices (HCDs)
has now affected patients in several countries on different continents. Clinical infections are characterized by
delayed diagnosis, inadequate treatment response to antimicrobial agents, and poor prognosis. Outbreak
investigators found M. chimaera in HCD water circuits and air samples while HCDs were running, suggesting
that transmission from the HCD to the surgical site occurs via the airborne route. New HCDs at the
manufacturing site were also contaminated with M. chimaera, and recent whole-genome sequencing data
suggest a point source. Some guidance on screening for M. chimaera colonization in HCD water and exhaust
air is available. In contrast, reliable disinfection procedures are not well described, and it is not yet known
whether eradication of M. chimaera from a contaminated HCD can be achieved. Meanwhile, strict separation
of the HCD from operating room air is necessary to ensure patient safety, and these efforts may require
engineering solutions. While our understanding of the causes and the extent of the M. chimaera outbreak is
growing, several aspects of patient management, device handling, and risk mitigation still require clarification.
DOI: https://doi.org/10.1017/ice.2016.283
Hygiène des mains
NosoBase ID notice : 424318
Plan multimodal pour l’amélioration de l’observance à l’hygiène des mains : les facteurs-clés de
réussite
Lebrun LL; Linder S; Marchetti O; Pirotte-Snoussi MC; Staines A; van Hollebeke I. Plan multimodal pour
l’amélioration de l’observance à l’hygiène des mains : les facteurs-clés de réussite. Hygiènes 2016/12; 24(6):
283-292.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; SOLUTION HYDROALCOOLIQUE; BLOC
OPERATOIRE; PRE-OPERATOIRE; USAGER DE LA SANTE; TRAITEMENT HYGIENIQUE DES MAINS
PAR FRICTION
L’Ensemble hospitalier de la Côte, un hôpital communautaire multisite, a mené un important projet pour
l’amélioration de l’observance à l’hygiène des mains qui a fait l’objet d’une analyse de données récoltées
prospectivement. La cible d’observance est de 85 % des opportunités. Le bilan de l’expérience vécue a
permis d’identifier des facteurs pressentis comme étant déterminants pour le succès du projet. Celuici révèle
que la mise en place d’une stratégie multimodale préconisée par l’Organisation mondiale de la Santé (OMS)
et incluant plusieurs axes d’intervention apparaît comme décisive pour l’augmentation du taux d’observance
globale de 52,8 % à 86,4 % des opportunités dans les cinq indications reconnues par l’OMS. L’identification
du chef de projet sur la base de compétences cliniques et managériales, le pilotage rigoureux du projet, le
soutien de la direction générale et des instances institutionnelles, la participation à une démarche
collaborative, l’implication des cadres de proximité, la proposition d’un large éventail d’outils de formation, le
monitorage du degré d’observance à l’hygiène des mains et le choix de la localisation des distributeurs de
produits de désinfection émergent comme étant les éléments-clés du succès.
NosoBase ID notice : 424320
Pour l’hygiène des mains : Êtes-vous plutôt Savon ou SHA ?
Meunier O; Adé M; Kessler B; Burger S; North S. Pour l’hygiène des mains : Êtes-vous plutôt Savon ou SHA?
Hygiènes 2016/12; 24(6): 309-312.
Mots-clés : HYGIENE DES MAINS; SAVON; SOLUTION HYDROALCOOLIQUE; INFORMATION;
ENQUETE; PERSONNEL; SONDAGE; AIDE-SOIGNANT; MEDECIN; INFIRMIER; EXCRETA
Par un sondage d’opinion auprès des professionnels de santé de leur hôpital, les auteurs ont souhaité
évaluer la place que prennent les SHA dans les opportunités d’hygiène des mains. En effet, on peut se
demander pourquoi le matraquage « publicitaire » de l’équipe opérationnelle d'hygiène (EOH) sur l’usage et
le bon usage des SHA depuis des années ne porte plus ses fruits au vu des consommations qui
n’augmentent plus ? Quel message faut-il faire passer ? Faut-il encore parler du produit, de son intérêt, de
son efficacité… pour convaincre d’éventuels non-utilisateurs ? Faut-il encore parler de la technique et du bon
usage notamment par le respect du volume nécessaire pour un temps de contact suffisant et une activité
18 / 32
NosoVeille – Bulletin de veille
Février 2017
désinfectante ? Faut-il parler des cinq opportunités définies par l’Organisation mondiale de la santé (OMS)
pour un usage au bon moment ? Le résultat de l’enquête déclarative doit permettre aux auteurs d’orienter les
prochaines campagnes de sensibilisation.
NosoBase ID notice : 423591
Faciliter le changement : un guide pair-à-pair sur la transition vers de nouveaux produits d'hygiène
des mains
Amirov CM; Candon HL; Jacob L. Making change easy: A peer-to-peer guide on transitioning to new hand
hygiene products. American journal of infection control 2017/01; 45(1): 46-50.
Mots-clés : HYGIENE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; HYGIENE
HOSPITALIERE; PERSONNEL; CHANGEMENT; ORGANISATION DU TRAVAIL
This report summarizes our experiences planning and implementing the transition to a new commercial line of
hand hygiene products and their dispensing systems in a large academic health care facility in Toronto,
Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this
article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROGHH_HighQuality.pdf).
DOI: https://doi.org/10.1016/j.ajic.2016.05.020
NosoBase ID notice : 422345
Effets des solutions hydroalcooliques pour les hygiènes des mains sur la détection de l'alcool dans
l'air expiré par l'éthylotest au service d'urgence
Emerson BL; Whitfill T; Baum CR; Garlin-Kane K; Santucci K. Effects of alcohol-based hand hygiene
solutions on breath alcohol detection in the emergency department. American journal of infection control
2016/12; 44(12): 1672-1674.
Mots-clés : HYGIENE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; SOLUTION
HYDROALCOOLIQUE; SOIN D'URGENCE; PERSONNEL; ETHYLOTEST; ALCOOL
This study aimed to investigate the effects of alcohol-based hand hygiene solution (ABHS) use by care
providers on point-of-care alcohol breath analyzer interpretation under different clinically relevant conditions.
Among each test condition (foam vehicle with immediate testing, gel vehicle with immediate testing, allowing
hands to dry after the use of ABHS, and donning gloves after the use of ABHS), alcohol was detected in
breath at 1 minute after use of ABHS. Because the use of ABHS by individuals administering breath alcohol
detection may result in false-positive detection of alcohol, staff using these devices should consider traditional
hand hygiene with soap and water.
DOI: https://doi.org/10.1016/j.ajic.2016.05.036
NosoBase ID notice : 424223
Améliorer l’observance et la qualité de l’hygiène des mains en mesurant la charge microbienne et en
utilisant des retours d’expérience en ligne en Allemagne
Günther F; Rudolph K; Frank U; Mutters NT. Improvement of hand hygiene quality and compliance using
bioburden measurement and online feedback in Germany. Infection control and hospital epidemiology
2017/01; 38(1): 119-122.
Mots-clés : HYGIENE DES MAINS; OBSERVANCE; QUALITE; MAIN; STAPHYLOCOCCUS AUREUS;
INCIDENCE
To improve compliance with hand hygiene, a novel method with inclusion of an online reporting system was
developed, comprising measurement of total hand bioburden, anonymous online feedback, and onsite
training. The intervention significantly improved both compliance and quality of hand hygiene and reduced
Staphylococcus aureus incidence.
DOI: https://doi.org/10.1017/ice.2016.238
19 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 422561
Une réadaptation de la chanson "Joyeux anniversaire" : une comptine pour les professionnels de
santé pendant la durée de lavage des mains
Mick J. An alternative to singing "Happy Birthday": Healthcare provider's rhyme for handwashing time.
American journal of infection control 2016/12; 44(12): 1759-1760.
Mots-clés : HYGIENE DES MAINS; PERSONNEL; PRATIQUE; ATTITUDE; PREVENTION
DOI: https://doi.org/10.1016/j.ajic.2016.05.041
NosoBase ID notice : 424284
Observance du personnel de santé aux méthodes des 5 moments pour l'hygiène des mains :
comparaison de 2 méthodes interventionnelles
Moghnieh R; Soboh R; Abdallah D; El-Helou M; Al Hassan S; Ajjour L; et al. Health care workers' compliance
to the My 5 Moments for Hand Hygiene: Comparison of 2 interventional methods. American journal of
infection control 2017/01; 45(1): 89-91.
Mots-clés : HYGIENE DES MAINS; PERSONNEL; INFIRMIER; OBSERVANCE; INTERVENTION; AUDIT;
RETOUR EXPERIENCE; ETUDE PROSPECTIVE
This a prospective study comparing 2 interventions, incentive-based and audit-feedback, for measuring
compliance to the World Health Organization's My 5 Moments for Hand Hygiene among nursing staff in a
Lebanese tertiary care center over 21 weeks. Compliance was not achieved by default. The incentive-driven
intervention helped boost compliance, and the audit-feedback intervention helped achieve high sustainability.
Analysis of health care workers' behavior toward hand hygiene based on the My 5 Moments for Hand
Hygiene concept is necessary to pinpoint difficulties in compliance.
DOI: https://doi.org/10.1016/j.ajic.2016.08.012
NosoBase ID notice : 422351
Couverture des mains par le produit hydroalcoolique est variable : le volume ou la taille de la main
fait une différence
Zingg W; Haidegger T; Pittet D. Hand coverage by alcohol-based handrub varies: Volume and hand size
matter. American journal of infection control 2016/12; 44(12): 1689-1691.
Mots-clés : HYGIENE DES MAINS; PRODUIT DE FRICTION POUR LES MAINS; MAIN; SOLUTION
HYDROALCOOLIQUE; PRODUIT HYDROALCOOLIQUE
Visitors of an infection prevention and control conference performed hand hygiene with 1, 2, or 3 mL
ultraviolet light-traced alcohol-based handrub. Coverage of palms, dorsums, and fingertips were measured by
digital images. Palms of all hand sizes were sufficiently covered when 2 mL was applied, dorsums of medium
and large hands were never sufficiently covered. Palmar fingertips were sufficiently covered when 2 or 3 mL
was applied, and dorsal fingertips were never sufficiently covered.
DOI: https://doi.org/10.1016/j.ajic.2016.07.006
Personnel
NosoBase ID notice : 424283
Effets longitudinaux de la pédagogie par simulation à dose unique avec bilan structuré et retour
d'expérience verbale sur les connaissances et les compétences en aspiration endotrachéale : essai
contrôlé randomisé
Jansson MM; Syrjälä HP; Ohtonen PP; Meriläinen MH; Kyngäs HA; Ala-Kokko TI. Longitudinal effects of
single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning
knowledge and skills: A randomized controlled trial. American journal of infection control 2017/01; 45(1): 8385.
Mots-clés : PRATIQUE; CONNAISSANCE; PERSONNEL; INFIRMIER; FORMATION; ASPIRATION; SOIN
RESPIRATOIRE; SOIN INTENSIF; QUALITE; RETOUR EXPERIENCE; RANDOMISATION
20 / 32
NosoVeille – Bulletin de veille
Février 2017
We evaluated the longitudinal effects of single-dose simulation education with structured debriefing and
verbal feedback on critical care nurses' endotracheal suctioning knowledge and skills. To do this we used an
experimental design without other competing intervention. Twenty-four months after simulation education, no
significant time and group differences or time × group interactions were identified between the study groups.
The need for regularly repeated educational interventions with audiovisual or individualized performance
feedback and repeated bedside demonstrations is evident.
DOI: https://doi.org/10.1016/j.ajic.2016.05.032
NosoBase ID notice : 423584
Utilisation d'équipements de protection individuelle par le personnel de santé : résultats des
simulations et des observations cliniques
Kang J; O'Donnell JM; Colaianne B; Bircher N; Ren D; Smith KJ. Use of personal protective equipment
among health care personnel: Results of clinical observations and simulations. American journal of infection
control 2017/01; 45(1): 17-23.
Mots-clés : PERSONNEL; PREVENTION; EQUIPEMENT DE PROTECTION; CONTAMINATION;
ENQUETE; FORMATION; TENUE VESTIMENTAIRE; GANT; BLOUSE; MASQUE; RESPIRATEUR;
CHAUSSURE; FLUORESCENCE
Background: Very little is known about how health care personnel (HCP) actually use personal protective
equipment (PPE).
Methods: The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical
Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions
(simple and full-body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were
videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an
electronic survey. For a follow-up evaluation simulation, 12 HCP were recruited among simulation
participants.
Results: Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations
during the doffing process with various PPE items: simple set (92.3%) and full-body set (66.2%). Among 11
follow-up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but
the overall contamination level was reduced. Using the contamination information gained during the
simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and
barriers in PPE use from HCP survey responseswere as follows: time-consuming, cumbersomeness, and
PPE effectiveness.
Conclusions: Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE
simulations. Devising better standardized PPE protocols and implementing innovative PPE education are
necessary to ensure HCP safety.
DOI: https://doi.org/10.1016/j.ajic.2016.08.011
NosoBase ID notice : 422367
Accidents d'exposition au sang et aux liquides biologiques dans les établissements de santé chez les
personnes sans risque présumé
Salgado TA; Ream PS; Teles SA; Lima LK; Rezende FR; Cardoso NQ; et al. Accidents with biologic material
in health services among persons with no presumed risk. American journal of infection control 2016/12;
44(12): 1726-1728.
Mots-clés : ACCIDENT D'EXPOSITION AU SANG; SECURITE SANITAIRE; EPIDEMIOLOGIE;
SURVEILLANCE; AIGUILLE; DECHET D'ACTIVITE DE SOINS A RISQUE INFECTIEUX
This study identified persons without presumed risk (PWPR) involved in accidents with blood and body fluids
in 2 health care facilities between 1989 and 2012 in a state in Central Brazil. There were 181 accidents that
occurred with PWPR, predominantly among women. Accidents with blood and body fluids involved needle
and blood, some performed by untrained personnel. Most prematurely terminated clinical and laboratory
monitoring. Accidents with blood and body fluids occur under similar circumstances to health care workers.
DOI: https://doi.org/10.1016/j.ajic.2016.06.011
21 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 424282
Effet de la modification de la structure d'information et de formation sur la sécurité professionnelle
chez le personnel de santé en cas d'exposition au sang et aux liquides biologiques : étude quasiexpérimentale
Sarbaz M; Kimiafar K; Taherzadeh Z; Naderi H; Eslami S. Effect of modifying the information and training
structure on the occupational safety of health care workers in exposure to blood and body fluids: A quasiexperimental study. American journal of infection control 2017/01; 45(1): 80-82.
Mots-clés : RISQUE PROFESSIONNEL; ACCIDENT D'EXPOSITION AU SANG; PERSONNEL;
FORMATION; PREVENTION; CIRCULATION DE L'INFORMATION; INTERNET; INFORMATIQUE;
INTERVENTION
This study was a quasi-experimental design to assess the effect of a Web-based information system on the
occupational exposure to blood and body fluids (BBFs) among health care workers (HCWs). The outcome
was the number of exposure incidents with BBFs among HCWs in both hospital A (intervention) and hospital
B (control). The findings showed that the implementation of the Web-based information system about
infection prevention and control in hospital A decreased exposure incidents with BBFs among the HCWs
(P<.001).
DOI: https://doi.org/10.1016/j.ajic.2016.05.023
NosoBase ID notice : 424207
Connaissances du personnel soignant en maison de retraite des mesures d’hygiène hospitalière et de
gestion des antibiotiques pour des infections déterminées
Trautner BW; Greene MT; Krein SL; Wald HL; Saint S; Rolle AJ; et al. Infection prevention and antimicrobial
stewardship knowledge for selected infections among nursing home personnel. Infection control and hospital
epidemiology 2017/01; 38(1): 83-88.
Mots-clés : HYGIENE HOSPITALIERE; PERSONNEL; CONNAISSANCE; MAISON DE RETRAITE;
SONDAGE URINAIRE; BACTERIURIE; ANTIBIOTIQUE; INFECTION NOSOCOMIALE
Objective: To assess knowledge about infection prevention among nursing home personnel and identify gaps
potentially addressable through a quality improvement collaborative.
Design: Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic
bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated
infections.
Setting: Nursing homes across 14 states participating in the national “Agency for Healthcare Research and
Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary
Tract Infection.”
Participants: Licensed (RNs, LPNs, APRNs, MDs) and unlicensed (clinical nursing assistants) healthcare
personnel.
Methods: Each facility aimed to obtain responses from at least 10 employees (5 licensed and 5 unlicensed).
We assessed the percentage of correct responses.
Results: A total of 184 (78%) of 236 participating facilities provided 1 response or more. Of the 1,626
respondents, 822 (50.6%) were licensed; 117 facilities (63.6%) were for-profit. While 99.1% of licensed
personnel recognized the definition of asymptomatic bacteriuria, only 36.1% knew that pyuria could not
distinguish a urinary tract infection from asymptomatic bacteriuria. Among unlicensed personnel, 99.6% knew
to notify a nurse if a resident developed fever or confusion, but only 27.7% knew that cloudy, smelly urine
should not routinely be cultured. Although 100% of respondents reported receiving training in hand hygiene,
less than 30% knew how long to rub hands (28.5% licensed, 25.2% unlicensed) or the most effective agent to
use (11.7% licensed, 10.6% unlicensed).
Conclusions: This national assessment demonstrates an important need to enhance infection prevention
knowledge among healthcare personnel working in nursing homes to improve resident safety and quality of
care.
DOI: https://doi.org/10.1017/ice.2016.228
22 / 32
NosoVeille – Bulletin de veille
Février 2017
Précautions complémentaires
NosoBase ID notice : 424317
Mise en oeuvre des précautions complémentaires dans les hôpitaux français : résultats de l’audit
national 2014
Ertzscheid MA; Tanguy J. Mise en œuvre des précautions complémentaires dans les hôpitaux français :
résultats de l’audit national 2014. Hygiènes 2016/12; 24(6): 273-281.
Mots-clés : AUDIT; PRECAUTION COMPLEMENTAIRE; CONNAISSANCE; HYGIENE DES MAINS;
CHAMBRE DU MALADE; ENVIRONNEMENT; USAGER DE LA SANTE; BORDETELLA PERTUSSIS;
GALE; PRESCRIPTION; MASQUE; MEDECIN; EXCRETA
L’audit national précautions complémentaires (PC), proposé aux établissements de santé en 2014,
s’inscrivait dans la continuité de l’audit précautions standard 2011, la maîtrise de la diffusion des
entérobactéries et la gestion des excreta. Il explorait les PC contact, gouttelettes et air en termes
d’organisation, moyens et connaissances dans les établissements de santé. L’audit comprenait quatre parties
; « établissement » (677 fiches), « patient » (8 006 fiches), « professionnel » (151 274 fiches) et « médecin »
(8 314 fiches). L’analyse concernait les données de l’année calendaire 2014. Les procédures étaient décrites
pour la majorité des établissements (de 81 % à 91 % selon le critère) à l’excepti on des excreta (33 %). Les
mesures pour les patients en PC dans les services étaient adaptées (de 80 % à 92 % selon les critères)
malgré le défaut récurrent de traçabilité (70 %). Les connaissances des professionnels (mesures à prendre)
et des médecins (précautions à prescrire) étaient respectivement de 54 % et 51 %. Les bonnes réponses des
professionnels variaient selon les critères : hygiène des mains (73 %), protection individuelle (45 %), chambre
du patient (45 %), environnement du patient (63 %), élimination des excreta (36 %) et selon les cas cliniques
: de 48 % pour la coqueluche à 61 % pour la gale. La gestion des excreta était défaillante par manque de
procédures et formations. Le déséquilibre observé entre organisation, moyens et connaissances des
professionnels suggère que des démarches multimodales basées sur les comportements des équipes
soignantes pourraient améliorer la prise en charge des patients en PC.
Prévalence
NosoBase ID notice : 423534
Une enquête de prévalence des infections associées aux soins dans 52 hôpitaux chinois
Chen Y; Zhao JY; Shan X; Han XL; Tian SG; Chen FY; et al. A point-prevalence survey of healthcareassociated infection in fifty-two Chinese hospitals. The journal of hospital infection 2017/01; 95(1): 105-111.
Mots-clés : PREVALENCE; ENQUETE; ANTIBIOTIQUE; SURVEILLANCE; FACTEUR DE RISQUE
Background: Healthcare-associated infection (HCAI) represents a major problem for patient safety worldwide.
Aim: To demonstrate the prevalence, causative agents, and risk factors for HCAI in Chinese hospitals.
Methods: A one-day point-prevalence survey was conducted in 52 Chinese hospitals between October 2014
and March 2015. A web-based software system was developed for data entry and management.
Findings: Among 53,939 patients surveyed, the prevalence of patients with at least one HCAI was 3.7%. Of
2182 HCAI episodes, the most frequently occurring types were lower respiratory tract infections (47.2%),
followed by urinary tract infection (12.3%), upper respiratory tract infection (11.0%), and surgical site infection
(6.2%). The prevalence of patients with at least one HCAI in critical care units was highest (17.1%). Deviceassociated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection,
and central catheter-associated bloodstream infection, accounted for only 7.9% of all HCAIs. The most
frequently isolated micro-organisms were Pseudomonas aeruginosa [206 infections (9.4%)], Acinetobacter
baumannii [172 infections (7.9%)], Klebsiella pneumoniae [160 infections (7.3%)], and Escherichia coli [145
infections (6.6%)]. Of the survey patients (18,206/53,939), 33.8% were receiving at least one antimicrobial
agent at the time of the survey. Risk factors for HCAI included older age (≥80 years), male gender, days of
hospital admission, admission into a critical care unit, and device utilization.
Conclusion: Our study suggests that the overall prevalence of HCAI in surveyed Chinese hospitals was lower
than that reported from most European countries and the USA. More attention should be given to the
surveillance and prevention of non-device-associated HCAI in China.
DOI: https://doi.org/10.1016/j.jhin.2016.08.010
23 / 32
NosoVeille – Bulletin de veille
Février 2017
Prévention
NosoBase ID notice : 422268
Recommandations pour encourager à publier : la littérature sur la prévention des infections est en
tête de peloton
Stone SP; Cookson BD. Endorsing reporting guidelines: Infection control literature gets ahead of the game.
American journal of infection control 2016/12; 44(12): 1446-1448.
Mots-clés : QUALITE; PREVENTION; PUBLICATION; TRAVAIL ECRIT; EPIDEMIOLOGIE; INFECTION
NOSOCOMIALE; RECOMMANDATIONS DE BONNE PRATIQUE; REVUE DE LA LITTERATURE
DOI: https://doi.org/10.1016/j.ajic.2016.06.038
Pseudomonas aeruginosa
NosoBase ID notice : 423597
Détection de cas groupés d'infections ou de colonisations nosocomiales à Pseudomonas aeruginosa
Lefebvre A; Lucet JC; Bertrand X; Chavanet P; Astruc K; Quantin C; et al. Detection of temporal clusters of
health care-associated infections or colonizations with Pseudomonas aeruginosa. American journal of
infection control 2017/01; 45(1): 72-74.
Mots-clés : COLONISATION; PSEUDOMONAS AERUGINOSA; INFECTION NOSOCOMIALE; EAU;
DISTRIBUTION D'EAU; PRELEVEMENT; ENVIRONNEMENT
We investigated temporal clusters of Pseudomonas aeruginosa cases between 2005 and 2014 in 1 French
university hospital, overall and by ward, using the Kulldorff method. Clusters of positive water samples were
also investigated at the whole hospital level. Our results suggest that water outlets are not closely involved in
the occurrence of clusters of P aeruginosa cases.
DOI: https://doi.org/10.1016/j.ajic.2016.05.031
Réglementation
NosoBase ID notice : 424596
Décret n° 2017-129 du 3 février 2017 relatif à la prévention des infections associées aux soins
Ministère des affaires sociales et de la santé. Décret n° 2017-129 du 3 février 2017 relatif à la prévention des
infections associées aux soins. Journal officiel de la République française Lois et décrets 2017/02/05: 5
pages.
Mots-clés : LEGISLATION; INFECTION NOSOCOMIALE; SIGNALEMENT; ESTHETIQUE; ARS;
ANTIBIOTIQUE; PREVENTION; SURVEILLANCE; DEPARTEMENT D’OUTRE-MER; PERSONNEL;
COMMISSION MEDICALE D’ETABLISSEMENT; DECLARATION; INFECTION ASSOCIEE AUX SOINS;
CENTRE D’APPUI POUR LA PREVENTION DES INFECTIONS ASSOCIEES AUX SOINS
Le décret définit les modalités du recueil et du traitement des déclarations des infections associées aux soins.
Il définit l’organisation des structures régionales d’appui pour la prévention de ces infections.
https://www.legifrance.gouv.fr/jo_pdf.do?id=JORFTEXT000033982071
NosoBase ID notice : 423708
Ordonnance n° 2017-9 du 5 janvier 2017 relative à la sécurité sanitaire
Ministère des affaires sociales et de la santé. Ordonnance n° 2017-9 du 5 janvier 2017 relative à la sécurité
sanitaire. Journal officiel de la République française Lois et décrets 2017/01/06; 5: 2 pages.
Mots-clés : SECURITE SANITAIRE; LEGISLATION; VACCINATION; FIEVRE JAUNE; EAU
24 / 32
NosoVeille – Bulletin de veille
Février 2017
https://www.legifrance.gouv.fr/affichTexte.do;jsessionid=6B2D0EF5984E45EAD6D884712DDE72B0.tpdila08
v_1?cidTexte=JORFTEXT000033825587&dateTexte=&oldAction=rechJO&categorieLien=id&idJO=JORFCO
NT000033825306
NosoBase ID notice : 424549
Arrêté du 26 janvier 2017 portant nomination de présidents suppléants du collège d’experts placé
auprès de l’Office national d’indemnisation des accidents médicaux, des affections iatrogènes et des
infections nosocomiales
Ministère des affaires sociales et de la santé. Arrêté du 26 janvier 2017 portant nomination de présidents
suppléants du collège d’experts placé auprès de l’Office national d’indemnisation des accidents médicaux,
des affections iatrogènes et des infections nosocomiales. Journal officiel de la République française Lois et
décrets 2017/01/28: 1 page.
Mots-clés : LEGISLATION; OFFICE NATIONAL D'INDEMNISATION DES ACCIDENTS MEDICAUX DES
AFFECTIONS IATROGENES ET DES INFECTIONS NOSOCOMIALES; NOMINATION; ONIAM
https://www.legifrance.gouv.fr/jo_pdf.do?id=JORFTEXT000033935784
NosoBase ID notice : 424348
Décret n° 2017-90 du 26 janvier 2017 relatif à l'Union nationale des associations agréées d'usagers du
système de santé
Ministère des affaires sociales et de la santé. Décret n° 2017-90 du 26 janvier 2017 relatif à l'Union nationale
des associations agréées d'usagers du système de santé. Journal officiel de la République française Lois et
décrets 2017/01/28; 24: 4 pages.
Mots-clés : USAGER DE LA SANTE; ASSOCIATION DE MALADES; SYSTEME DE SANTE;
LEGISLATION; UNION NATIONALE DES ASSOCIATIONS AGREEES DES USAGERS DU SYSTEME DE
SANTE; UNAASS; UNION REGIONALE DES ASSOCIATIONS AGREEES D'USAGERS DU SYSTEME DE
SANTE
Le décret a pour objet de préciser les missions et les règles de fonctionnement de l'Union nationale des
associations agréées des usagers du système de santé (UNAASS). Cette union est composée des
associations d'usagers du système de santé agréées au niveau national.
Elle comporte un siège national et des délégations territoriales dénommées « unions régionales des
associations agréées d'usagers du système de santé ». Les unions régionales sont composées des
représentants régionaux d'associations agréées au niveau national et des représentants des associations
agréées au niveau régional.
https://www.legifrance.gouv.fr/affichTexte.do;jsessionid=FEF7E0849F8763CC93659CF4337934A6.tpdila13v
_2?cidTexte=JORFTEXT000033935576&dateTexte=&oldAction=rechJO&categorieLien=id&idJO=JORFCON
T000033934945
NosoBase ID notice : 424548
Arrêté du 25 janvier 2017 portant nomination de membres du collège d’experts placé auprès de
l’Office national d’indemnisation des accidents médicaux, des affections iatrogènes et des infections
nosocomiales
Ministère des affaires sociales et de la santé. Arrêté du 25 janvier 2017 portant nomination de membres du
collège d’experts placé auprès de l’Office national d’indemnisation des accidents médicaux, des affections
iatrogènes et des infections nosocomiales. Journal officiel de la République française Lois et décrets
2017/01/28: 1 page.
Mots-clés : LEGISLATION; NOMINATION; OFFICE NATIONAL D'INDEMNISATION DES ACCIDENTS
MEDICAUX DES AFFECTIONS IATROGENES ET DES INFECTIONS NOSOCOMIALES
https://www.legifrance.gouv.fr/jo_pdf.do?id=JORFTEXT000033935781
25 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 423710
Arrêté du 26 décembre 2016 relatif aux conditions de vérification de l'immunisation des
thanatopracteurs en formation pratique et en exercice soumis à l'obligation de vaccination contre
l'hépatite B
Ministère des affaires sociales et de la santé. Arrêté du 26 décembre 2016 relatif aux conditions de
vérification de l'immunisation des thanatopracteurs en formation pratique et en exercice soumis à l'obligation
de vaccination contre l'hépatite B. Journal officiel de la République française Lois et décrets 2017/01/06; 5: 2
pages.
Mots-clés : THANATOPRAXIE; PERSONNEL; VACCINATION; HEPATITE VIRALE; LEGISLATION;
HEPATITE B
https://www.legifrance.gouv.fr/affichTexte.do;jsessionid=6B2D0EF5984E45EAD6D884712DDE72B0.tpdila08
v_1?cidTexte=JORFTEXT000033825622&dateTexte=&oldAction=rechJO&categorieLien=id&idJO=JORFCO
NT000033825306
Soin intensif
NosoBase ID notice : 423527
Examiner l'association entre la charge microbienne des surfaces et les zones fréquemment touchées
en soins intensifs
Adams CE; Smith J; Watson V; Robertson C; Dancer SJ. Examining the association between surface
bioburden and frequently touched sites in intensive care. The journal of hospital infection 2017/01; 95(1): 7680.
Mots-clés : SOIN INTENSIF; SURFACE; CONTAMINATION; MICROORGANISME; INFECTION
NOSOCOMIALE;
STAPHYLOCOCCUS
AUREUS;
LIT;
MOBILIER
DE
CHAMBRE;
GEL
HYDROALCOOLIQUE; METICILLINO-RESISTANCE; NETTOYAGE; APPAREIL CARDIOVASCULAIRE
Background: Critical care patients are at increased risk of infection. Near-patient surfaces act as reservoirs of
microbial soil, which may contain pathogens.
Aim: To correlate soil levels with hand-touch frequency of near-patient sites in an intensive care unit (ICU).
Methods: Five sites around each bed in a 10-bed ICU were screened for total microbial soil (cfu/cm2) and
Staphylococcus aureus every month for 10 months. Selected sites were infusion pump and cardiac monitor,
left and right bedrails, and bed table. Ten 1 h covert audits of hand-touch frequency of these sites were
performed in order to provide an average hand-touch count, which was modelled against soil levels obtained
from microbiological screening.
Findings: Seven of 10 staphylococci were found in conjunction with gross contamination of a specific site
(P=0.005) and the same proportion from three most frequently touched sites (bedrails and bed table). There
was a linear association between four sites demonstrating gross microbial contamination (>12 cfu/cm2) and
mean number of hand-touch counts (P=0.08). The bed table was handled most but was not the most
contaminated site. We suspected that customary placement of alcohol gel containers on bed tables may have
reduced microbiological yield. Removing the gel container from one table confirmed its inhibitory effect on
microbial contamination after rescreening (19% vs 50% >12 cfu/cm2: P=0.007).
Conclusion: Surface bioburden at near-patient sites in ICU is associated with hand-contact frequencies by
staff and visitors. This supports the need for targeted hygienic cleaning in a high-risk healthcare environment.
DOI: https://doi.org/10.1016/j.jhin.2016.11.002
NosoBase ID notice : 423520
Evaluation d'une procédure de nettoyage modifiée dans la prévention de la diffusion d'un clone
d'Acinetobacter baumannii dans une unité de soins intensifs pour brûlés en utilisant un luminomètre
à haute sensibilité
Casini B; Selvi C; Cristina ML; Totaro M; Costa AL; Valentini P; et al. Evaluation of a modified cleaning
procedure in the prevention of carbapenem-resistant Acinetobacter baumannii clonal spread in a burn
intensive care unit using a high-sensitivity luminometer. The journal of hospital infection 2017/01; 95(1): 4652.
26 / 32
NosoVeille – Bulletin de veille
Mots-clés : PREVENTION; ACINETOBACTER BAUMANNII; CARBAPENEME;
EVALUATION; BRULE; NETTOYAGE; CHLORHEXIDINE; ALCOOL; DESINFECTANT
Février 2017
SOIN
INTENSIF;
Background: Enhanced environmental cleaning practices are among the most accepted measures for
controlling the spread of carbapenem-resistant Acinetobacter baumannii (CR-Ab).
Aim: To evaluate the impact of heightened cleaning on an ongoing CR-Ab outbreak in a burn intensive care
unit (BICU) of an Italian teaching hospital, where chlorhexidine-60% isopropyl alcohol was applied as a
complementary disinfectant on high-touch surfaces.
Methods: Compliance with the microbial limit proposed for the BICU by AFNOR-NF-S90-351 (20 colonyforming units/100 cm2) was assessed by plate count, and compared with the results obtained with intracellular
adenosine triphosphate (ATP) detection. Genotyping was performed using pulsed-field gel electrophoresis.
Findings: During the standard cleaning regimen, three out of 23 samples (13%) gave results over the AFNOR
limit and five (21.7%) showed unacceptable ATP levels with 100 relative light units/100 cm2 as the benchmark
limit (sensibility 86.4%, specificity 92.2%). Following improvement of the cleaning procedure, only two
samples out of 50 (4%) did not satisfy the microbiological criteria and seven (14%) exceeded the ATP limit. In
a successive phase, eight of 30 samples collected showed unacceptable results (27%).
Conclusions: Adding chlorhexidine-60% isopropyl alcohol as complementary disinfectant proved to be
effective for reducing environmental microbial contamination, ATP levels and CR-Ab infection/colonization in
patients admitted to the BICU. Real-time monitoring by ATP assay was useful for managing the cleaning
schedule and reducing hospital infections, although the calculated values must be interpreted as cleanliness
indicators rather than risk indicators.
DOI: https://doi.org/10.1016/j.jhin.2016.10.019
NosoBase ID notice : 422376
Une unité de soins intensifs à fonctionnement ouvert et à fonctionnement fermé présente des
différences sur les complications infectieuses dans un centre hospitalier universitaire : analyse
rétrospective des données
El-Kersh K; Guardiola J; Cavallazzi R; Wiemken TL; Roman J; Saad M. Open and closed models of intensive
care unit have different influences on infectious complications in a tertiary care center: A retrospective data
analysis. American journal of infection control 2016/12; 44(12): 1744-1746.
Mots-clés : SOIN INTENSIF; INFECTION; COMPLICATION; ANALYSE; ETUDE RETROSPECTIVE; TAUX;
ORGANISATION FONCTIONNELLE HOSPITALIERE; PNEUMONIE; BACTERIEMIE
Infectious complications in the intensive care unit (ICU) are associated with higher morbidity, mortality, and
increased health care use. Here, we report the results of implementing 2 different models (open vs closed) on
infectious complications in the ICU. The closed ICU model was associated with 52% reduction in ventilatorassociated pneumonia rate (P=.038) and 25% reduction in central line-associated bloodstream infection rate
(P=.631). We speculate that a closed ICU model allows clinical leadership centralization that further facilitates
standardized care delivery that translates into fewer infectious complications.
DOI: https://doi.org/10.1016/j.ajic.2016.04.240
NosoBase ID notice : 423526
Conception des services de soins intensifs et les taux d'infections nosocomiales : une étude
transversale en Allemagne
Stiller A; Schröder C; Gropmann A; Schwab F; Behnke M; Geffers C; et al. ICU ward design and nosocomial
infection rates: a cross-sectional study in Germany. The journal of hospital infection 2017/01; 95(1): 71-75.
Mots-clés : NEONATOLOGIE; INFECTION NOSOCOMIALE; ETUDE TRANSVERSALE; CONTROLE;
CHAMBRE DU MALADE; LOCAUX HOSPITALIERS; ARCHITECTURE; TAUX; SOIN INTENSIF
Background: There is increasing interest in the effects of hospital and ward design on multi-faceted infection
control. Definitive evidence is rare and the state of knowledge about current ward design is lacking.
Objective: To collect data on the current status of ward design for intensive care units (ICUs) and to analyse
associations between particular design factors and nosocomial infection rates.
Methods: In 2015, operational infrastructure data were collected via an online questionnaire from ICUs
participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate
analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to
2015.
27 / 32
NosoVeille – Bulletin de veille
Février 2017
Findings: In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds
were hosted in single-bed rooms with a median size of 18 m2 (interquartile range 15-21 m2), and 73.5% of all
ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate
analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower
respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40%
two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86).
Conclusion: Only minor associations were found between design factors and ICU infection rates. Most were
surrogates for other risk factors.
DOI: https://doi.org/10.1016/j.jhin.2016.10.011
NosoBase ID notice : 424281
Comparaison des infections nosocomiales de 8 unités de soins intensifs de l'hôpital : analyse
rétrospective de 2010 à 2015
Yue D; Song C; Zhang B; Liu Z; Chai J; Luo Y; et al. Hospital-wide comparison of health care-associated
infection among 8 intensive care units: A retrospective analysis for 2010-2015. American journal of infection
control 2017/01; 45(1): e7-e13.
Mots-clés :
SOIN
INTENSIF;
ACINETOBACTER BAUMANNII;
ESCHERICHIA COLI
INFECTION
NOSOCOMIALE;
REANIMATION;
INCIDENCE;
PSEUDOMONAS AERUGINOSA; KLEBSIELLA PNEUMONIAE;
Background: Exploring the distribution of nosocomial pathogens among different categories of intensive care
units (ICUs) is critical to improving the management of health care-associated infection (HAI). Despite both
single- and multicenter studies, the nature of the variations of HAIs within various ICUs remains inadequately
evaluated.
Methods: Data on HAIs at our hospital during the period January 2010-December 2015 were collected from 8
ICUs, namely, respiratory, cardiovascular, neurology, neonatal, hematology, emergency, cardiothoracic
surgery, and neurosurgery ICUs, at a tertiary hospital.
Results: We observed a cumulative HAI incidence of 15.6/1,000 patient-days among 6,254 cases of infection
at the hospital, as well as obvious interunit variations in HAI distribution. Acinetobacter baumannii was the
leading organism of infection in almost every ICU, especially in emergency, neurosurgery, and neonatal ICUs.
The most common pathogens were Pseudomonas aeruginosa in the cardiothoracic surgery, emergency, and
neonatal ICUs; Klebsiella pneumoniae and Escherichia coli in the neurosurgery, emergency, neonatal, and
neurology ICUs; and Candida albicans in both neurology and emergency ICUs.
Conclusions: Our findings revealed that A baumannii and P aeruginosa were the most common pathogens
associated with invasive operations, whereas K pneumoniae and E coli were the most common pathogens in
the medical ICUs.
DOI: https://doi.org/10.1016/j.ajic.2016.10.011
Staphylococcus aureus
NosoBase ID notice : 424195
Souches nosocomiales et communautaires de Staphylococcus aureus résistants à la méticilline:
investigation sur la transmission familiale, les facteurs de risque et la contamination
environnementale
Ng W; Faheem A; McGeer A; Simor AE; Gelosia A; Willey BM; et al. Community- and healthcare-associated
methicillin-resistant Staphylococcus aureus strains: an investigation into household transmission, risk factors,
and environmental contamination. Infection control and hospital epidemiology 2017/01; 38(1): 61-67.
Mots-clés : INFECTION NOSOCOMIALE; INFECTION COMMUNAUTAIRE; SARM; STAPHYLOCOCCUS
AUREUS; METICILLINO-RESISTANCE; COLONISATION; ENVIRONNEMENT; CONTAMINATION;
FAMILLE
Objective: To measure transmission frequencies and risk factors for household acquisition of communityassociated and healthcare-associated (HA-) methicillin-resistant Staphylococcus aureus (MRSA).
Design: Prospective cohort study from October 4, 2008, through December 3, 2012.
Setting: Seven acute care hospitals in or near Toronto, Canada.
Participants: Total of 99 MRSA-colonized or MRSA-infected case patients and 183 household contacts.
28 / 32
NosoVeille – Bulletin de veille
Février 2017
Methods: Baseline interviews were conducted, and surveillance cultures were collected monthly for 3 months
from household members, pets, and 8 prespecified high-use environmental locations. Isolates underwent
pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec typing.
Results: Overall, of 183 household contacts 89 (49%) were MRSA colonized, with 56 (31%) detected at
baseline.MRSA transmission from index case to contacts negative at baseline occurred in 27 (40%) of 68
followed-up households. Strains were identical within households. The transmission risk for HA-MRSA was
39% compared with 40% (P=.95) for community-associated MRSA. HA-MRSA index cases were more likely
to be older and not practice infection control measures (P=.002-.03). Household acquisition risk factors
included requiring assistance and sharing bath towels (P=.001-.03). Environmental contamination was
identified in 78 (79%) of 99 households and was more common in HA-MRSA households.
Conclusion: Household transmission of community-associated and HA-MRSA strains was common and the
difference in transmission risk was not statistically significant.
DOI: https://doi.org/10.1017/ice.2016.245
NosoBase ID notice : 423586
Facteurs de risque différents liés au sexe pour le portage dans la gorge de Staphylococcus aureus
Nowak JE; Borkowska BA; Pawlowski BZ. Sex differences in the risk factors for Staphylococcus aureus throat
carriage. American journal of infection control 2017/01; 45(1): 29-33.
Mots-clés : FACTEUR DE RISQUE; STAPHYLOCOCCUS AUREUS; COLONISATION; PHARYNX; SEXE;
INDICE DE MASSE CORPORELLE; TESTOSTERONE; ADIPOSITE
Background: Male gender and adiposity are considered to be risk factors for Staphylococcus aureus carriage.
We tested whether colonization is related to free testosterone (fT) level and adiposity, measured with body
mass index (BMI) and body fat percentage (BFP), in healthy adults.
Methods: Blood sample and throat swabs were taken twice (at 4-week intervals) from healthy men and
women aged 18-36 years. fT level, height, weight, and BFP were measured. Participants were classified as
persistent carriers, intermittent carriers (excluded from the analyses), and noncarriers. The final sample was
152 participants: 85 men and 67 women.
Results: BFP, but not BMI, correlated positively with S aureus colonization (P=.02) in men. BMI became a
significant predictor of carriage only when comparing groups within and above norms (P=.04). There was no
relationship for BMI nor BFP in women. Higher fT level was related to persistent carriage (P=.02) in women,
there was no relationship for fT level in men.
Conclusion: Risk factors for S aureus carriage are sex dependent. Within-sex variation in colonization is
related to fT level in women, whereas in men it is related to the amount of body fat.
DOI: https://doi.org/10.1016/j.ajic.2016.07.013
NosoBase ID notice : 422333
Réduction d'infection à Staphylococcus aureus résistant à la méthicilline dans les soins de longue
durée est possible tout en maintenant la socialisation des patients : un essai clinique randomisé
prospectif
PetersonLR; Boehm S; Beaumont JL; Patel PA; Schora DM; Peterson KE; et al. Reduction of methicillinresistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization:
A prospective randomized clinical trial. American journal of infection control 2016/12; 44(12): 1622-1627.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; COLONISATION; SOIN DE
LONGUE DUREE; EHPAD; PREVENTION; PREVALENCE; SURVEILLANCE; PCR EN TEMPS REEL;
INFECTION NOSOCOMIALE; PERSONNE AGEE; DÉCOLONISATION
Background: Antibiotic resistance is a challenge in long-term care facilities (LTCFs). The objective of this
study was to demonstrate that a novel, minimally invasive program not interfering with activities of daily living
or socialization could lower methicillin-resistant Staphylococcus aureus (MRSA) disease.
Methods: This was a prospective, cluster-randomized, nonblinded trial initiated at 3 LTCFs. During year 1,
units were stratified by type of care and randomized to intervention or control. In year 2, all units were
converted to intervention consisting of universal decolonization using intranasal mupirocin and a
chlorhexidine bath performed twice (2 decolonization-bathing cycles 1 month apart) at the start of the
intervention period. Subsequently, after initial decolonization, all admissions were screened on site using realtime polymerase chain reaction, and those MRSA positive were decolonized, but not isolated. Units received
29 / 32
NosoVeille – Bulletin de veille
Février 2017
annual instruction on hand hygiene. Enhanced bleach wipe cleaning of flat surfaces was done every 4
months.
Results: There were 16,773 tests performed. The MRSA infection rate decreased 65% between baseline (44
infections during 365,809 patient days) and year 2 (12 infections during 287,847 patient days; P<.001); a
significant reduction was observed at each of the LTCFs (P<.03).
Conclusions: On-site MRSA surveillance with targeted decolonization resulted in a significant decrease in
clinical MRSA infection among LTCF residents.
DOI: https://doi.org/10.1016/j.ajic.2016.04.251
NosoBase ID notice : 423532
Risque d'acquisition de Staphylococcus aureus méticillino-resistant endémique dans une unité de
néonatalogie avec une culture active de surveillance et un programme de décolonisation
Pierce R; Lessler J; Popoola VO; Milstone AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition
risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization
programme. The journal of hospital infection 2017/01; 95(1): 91-97.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; RISQUE; NEONATOLOGIE;
SURVEILLANCE; INFECTION NOSOCOMIALE; COHORTE; SOIN INTENSIF; TRANSMISSION;
COLONISATION; MUPIROCINE
Background: Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated
infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that
drive MRSA transmission.
Aim: To measure the association between colonization pressure from decolonized and non-decolonized
neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA.
Methods: An eight-year retrospective cohort study was conducted in a level-4 NICU that used active
surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were
defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (nondecolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of
incident MRSA colonization associated with colonization pressure exposures. The population-attributable
fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or
untreated patients in this setting.
Findings: Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6%
increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of
acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04).
In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be
attributed to exposures to untreated MRSA carriers.
Conclusion: Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on
contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may
reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and
require further investigation.
DOI: https://doi.org/10.1016/j.jhin.2016.10.022
Transplantation
NosoBase ID notice : 422797
Utilisation d'organes des donneurs présentants une bactériémie, une pneumonie ou une grippe :
résultats d'une enquête auprès des infectiologues
Mehta SR; Logan C; Kotton CN; Kumar D; Aslam S. Use of organs from donors with bloodstream infection,
pneumonia, and influenza: Results of a survey of infectious diseases practitioners. Transplantation infectious
diseases 2016/12/02; in press: 25 pages.
Mots-clés : PNEUMONIE; GRIPPE; TRANSMISSION; INFECTIOLOGIE; ENQUETE; TRANSPLANTATION;
DON D'ORGANE; RISQUE; BACTERIEMIE; INFETION RESPIRATOIRE
Background: Potential organ donors may be admitted with an infection to an intensive care unit, or contract a
nosocomial infection during their stay, increasing the risk of potential transmission to the recipient. Because of
a lack of practice guidelines and large-scale data on this topic, we undertook a survey to assess the
willingness of transplant infectious diseases (ID) physicians to accept such organs.
30 / 32
NosoVeille – Bulletin de veille
Février 2017
Methods: We performed a 10-question survey of ID providers from the American Society of Transplantation
Infectious Disease Community of Practice to determine the scope of practice regarding acceptance of organs
from donors with bloodstream infection, pneumonia, and influenza prior to organ procurement, as well as
management of such infections following transplantation.
Results: Among 60 respondents to our survey, a majority indicated that organs would be accepted from
donors bacteremic with streptococci (76%) or Enterobactericeae (73%) without evidence of drug resistance.
Acceptance rates varied based on infecting organism, type of organ, and center size. Ten percent of
respondents would accept an organ from a donor bacteremic with a carbapenem-resistant organism. Over
90% of respondents would accept an organ other than a lung from a donor with influenza on treatment,
compared to 52% that would accept a lung in the same setting.
Conclusions: This study is the first to our knowledge to survey transplant ID providers regarding acceptance
of organs based on specific infections in the donor. These decisions are often based on limited published
data and experience. Better characterization of the outcomes from donors with specific types of infection
could lead to liberalization of organ acceptance practices across centers. This article is protected by
copyright.
DOI: https://doi.org/10.1111/tid.12645
Vaccination
NosoBase ID notice : 422560
Connaissances, attitudes et pratiques des médecins du travail dans la promotion des vaccinations
recommandées aux personnels de santé
Calabrese G; Gallone MS; Tafuri S. Knowledge, attitudes, and practices of occupational health physicians in
the promotion of vaccinations recommended for health care workers: An Italian study. American journal of
infection control 2016/12; 44(12): 1758-1759.
Mots-clés : VACCINATION; MEDECINE DU TRAVAIL; CONNAISSANCE; ATTITUDE; PRATIQUE;
PERSONNEL; VACCIN; ENQUETE; RISQUE PROFESSIONNEL; SECURITE SANITAIRE
DOI: https://doi.org/10.1016/j.ajic.2016.05.042
NosoBase ID notice : 423000
Rotavirus, échec du vaccin ou erreur de diagnostic ?
Lopez-Lacort M; Collado S; Díez-Gandía A; Díez Domingo J. Rotavirus, vaccine failure or diagnostic error?
Vaccine 2016/11/21; 34(48): 5912-5915.
Mots-clés : ROTAVIRUS; VACCIN; VACCINATION; TECHNIQUE DE DIAGNOSTIC; PEDIATRIE; ENFANT
Immunochromatography (ICG) is highly used in clinical settings for rotavirus (RV) diagnosis. The specificity of
the tests differs by brand type and is not 100%, therefore its use when the prevalence of the disease is low
(i.e. in vaccinated children) may result in a proportion of false positive diagnoses. In some areas, vaccine
effectiveness studies or surveillance is done using ICG. Our objective was to estimate the validity of ICG test
in vaccinated children, and estimate the number of false positive results in the Valencian Region of Spain,
where all RV infections are diagnosed using ICG and are not confirmed by PCR. Population based registries
were used to identify all results from the RV antigen tests performed between January 2008 and June 2012 in
children under 37 months. Hospitalization and vaccination status of the patients were obtained by linking
different databases through a unique identification number. The Positive Predictive Value of the ICG test
depending on the vaccination status of the child, hospitalization and the rotavirus season was estimated by a
Bayesian model of latent classes. Of the 48,833 tests with valid results, 9429 were done in vaccinated
children, and of those 3963 (42%) during the rotavirus season. The prevalence of positive results in
vaccinated varied from 2.9 to 21.4% of the tests depending on the hospitalization and seasonality. The
estimated PPV also varied from 27.1 to 84.6% when stratified by these two parameters. Globally it is
calculated that approximately 267 out of the 520 (51.3%) positives in vaccinated children were false positive
tests. The large percentage of false positives, due to an excessive number of tests in vaccinated and out of
the RV season, if interpreted as vaccine failures, can cause a loss of confidence in the vaccine and lower the
estimates of vaccine effectiveness.
DOI: https://doi.org/10.1016/j.vaccine.2016.10.032
31 / 32
NosoVeille – Bulletin de veille
Février 2017
NosoBase ID notice : 423007
L'hésitation vaccinale et les professionnels de santé
Paterson P; Meurice F; Stanberry LR; Glismann S; Rosenthal SL; Larson HJ. Vaccine hesitancy and
healthcare providers. Vaccine 2016/12/20; 34(52): 6700-6706.
Mots-clés : VACCINATION; VACCIN; PERSONNEL;
CONNAISSANCE; REVUE DE LA LITTERATURE
COMPORTEMENT;
ATTITUDE;
PRATIQUE;
While most people vaccinate according to the recommended schedule, this success is challenged by
individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine
hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and
vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in
Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic
& Embase, and PschInfo. All foreign language articles were included if the abstract was available in English.
A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs,
17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about
evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to
build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The
importance of societal endorsement and support from colleagues was also reported. In the face of emerging
vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The
capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased
workload and limited resources, and often have inadequate information or training support to address parents'
questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as
changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies
included strengthening trust between HCPs, health authorities and policymakers, through more shared
involvement in the establishment of vaccine recommendations.
DOI: https://doi.org/10.1016/j.vaccine.2016.10.042
Zika
NosoBase ID notice : 422557
Dialogue ("chat") en direct sur Twitter concernant la maladie de Zika
Wiwanitkit V. Zika live Twitter chat. American journal of infection control 2016/12; 44(12): 1756-1757.
Mots-clés : VIRUS; ARBOVIRUS; INTERNET;
L'INFORMATION; ZIKA
DOI: https://doi.org/10.1016/j.ajic.2016.08.019
RESEAU
NUMERIQUE;
CIRCULATION
DE
Responsables de la rubrique NosoVeille : N. Sanlaville, S. Yvars, 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]
32 / 32