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Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


1

/
29







NosoVeille


3


Mars 2011




dacteurs

:
Nathali
e Sanlaville
,
Sandrine Yvars
,
Annie Treyve





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://nosobase.chu
-
lyon.fr/
Outils/sommaire_OutilsDoc.html



Pour recevoir, tous les mois,
NosoVeille

dans votre messagerie

:

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/
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S
ommaire de ce numéro


Antibiorésistance

Antibiotique

Bactériémie

Candida

Cathéter

Chirurgie

Coût

Environnement

Epidémiologie

Grippe

Hémodialyse

Hépatite

Hygiène des mains

Infection urinaire

Maternité

Pédiatrie


P
ersonnel

Prévention

Réanimation


glementation

Sondage urinaire

S
taphylococcus

aureus





Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


2

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29


A
ntibiorésistance


NosoBase n° 29638

Efficacité d'un nouveau schéma de décolonisation pour l'éradication d'entérobactéries productrices
de bêta
-
lactamases à spectre étendu


B
uehlmann
M; B
ruderer

T; F
rei
R; W
idmer

AF
.

Effectiveness of a new decolonisation regimen for

eradication of extended
-
spectrum beta
-
lactamase
-
producing

enterobacteriaceae
.

The Journal of hospital
infection

2011/02
;
77(2
)
:

113
-
117
.


Mots
-
clés :
ENTEROBACTERIE; BETA
-
LACTAMASE A SPECTRE ELARGI; EFFICACITE; TRAITEMENT;

ETUDE PROSPECTIVE; COHORTE; DEPISTAGE; CHLORHEXIDINE; ANTIBIOTIQUE; COLONISATION;

ESCHERICHIA COLI
;
KLEBSIELLA PNEUMONIAE
; SURVEILLANC
E
; IDENTIFICATION; CONTROLE


Gram
-
negative bacteria expressing extended
-
spectrum

ß
-
lactamases (ESBL) have emerged worldwide.
ESBL

colonisation can persist for years and may favour ESBL

transmission. Interventions include contact
isolation

precautions and restriction of antibiotic use,

but

decolonisation (DC) for ESBL is not established.
We

performed a prospective controlled open
-
label cohort
-
study

from 1/2000 to 1/2008 to determine the
effectiveness of a

standardised DC programme. ESBL
-
positive patients routinely

underwent screening fr
om
rectum, throat, and urine. DC

included: chlorhexidine 0.2% mouth rinse three times daily

(throat
colonisation), paromomycin 4.1g daily (intestinal

colonisation), and oral antibiotics for urinary tract

colonisation. ESBL elimination was defined as =1 set

of

negative follow
-
up screenings (throat, rectal, urine).
Of

100 enrolled patients, 83% of patients were infected and

17% colonised with ESBL.
Escherichia coli

(71%) and

Klebsiella pneumoniae

(25%) were the most frequent

pathogens. Overall, 76% (76/100) o
f
patients became

negative for ESBL at follow
-
up. Fifty
-
five percent (42/76)

of the successfully treated
patients received systemic

treatment for infection. Of those who completed DC, 83%

(15/18) were free of
ESBL at follow
-
up. DC success

correlated with t
he number of risk factors and colonised

sites. DC may be
beneficial in a selected group of

patients, potentially shortening duration of ESBL

colonisation and
subsequently reducing the risk for

transmission.




NosoBase n° 29812

Prévalence élevée de carbapénémases de type KPC
-
2 couplées

à des bêta
-
lactamases à spectre
élargi de type CTX
-
M dans

des souches de
Klebsiella pneumoniae

isolées dans un centre

hospitalier universitair
e en Chine


C
hen
S; H
u
F; X
u

X; L
iu

Y; W
u

W; Z
hu

D; W
ang

H
.
High prevalence of KPC
-
2 type carbapenemase coupled
with

CTX
-
M type extended
-
spectrum beta
-
lactamases in

carbapenem
-
resistant
Klebsiella pneumoniae

in a
teaching

hospital in China
.
Antimicrobial agents and chemotherapy

2011
;
in press:

6 pages
.


Mots
-
clés

:
PREVALENCE; ANTIBIORESISTANCE; CARBAPENEME; CENTRE

HOSPITALIER
UNIVERSITAIRE; BETA
-
LACTAMASE A SPECTRE ELARGI;

KLEBSIELLA PNEUMONIAE
; DEPISTAGE;
SURVEILLANCE; CMI


Carbapenems such as imipenem and meropenem are the

first
-
line agents for the treatment of serious
nosocomial

infections caused by multidrug
-
resistant Enterobacteriaceae

clinical isolates. However,
carbapenem
-
resistant phenomenon

is emerging among a wide va
riety of these species (2).

Carbapenemases are widely spread in recent year and

predominantly contribute to carbapenems resistance
amongst

Enterobacteriaceae, especially for
Klebsiella pneumoniae

and
Citrobacter freundi
. For screening
the

carbapenem
-
resist
ant Enterobacteriaceae clinical isolates,

we conducted a surveillance study of
carbapenem
-
resistant

Enterobacteriaceae isolates in order to investigate the

frequency and prevalence of
KPC
-
type carbapenemase genes in

Huashan hospital (
Fudan
University,
Shanghai,
China), a

1,300
-
bed
tertiary care hospital. We hereby report a high

prevalence of carbapenem
-
resistant
K. pneumoniae

isolates

carring the KPC
-
2 type carbapenemase gene or KPC
-
2 type

carbapenemase gene c
oupled with CTX
-
M
-
type

Extended
-
spectrum
bêta
-
lactamases (ESBLs) gene.







Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


3

/
29


NosoBase n° 29640

Programme de gestion des antibiotiques : cadre légal, structures de soins et indicateurs dans des
hôpitaux du Sud
-
ouest de la France,

2005
-
2008


D
umartin

C; R
ogues
AM; A
madeo

B; P
efau

M; V
enier

AG;

Parneix P;
et al.

Antibiotic stewardship
programmes: legal framework and

structure and process indicator in Southwestern
French
hospitals, 2005
-
2008
.
The Journal of hospital infection

2011/02
;
77(2
)
:

123
-
128
.


Mots
-
clés : ANTIBIOTIQUE
;
INDICATEUR
;
LEGISLATION
;
ETUDE RETROSPECTIVE
;
RECOMMANDATION
;
ANTIBIOPROPHYLAXIE
;
PRESCRIPTION
;
PHARMACIE
;
INFORMATION
;

INFORMATIQUE; SURVEILLANCE


French hospitals are required to implement antibiotic

stewardship programmes (ABS) to improve antibiotic
use. We

analysed the legal framework on ABS and assessed its impact

on hospitals' ABS development in
Southwestern France. For

each official text, required measures, date of issue, means

of control and

incentives were analysed. Annual

retrospective surveys were conducted in 84 hospitals from

2005 to 2008
to monitor implementation of ABS components:

organisation, resources and actions. Evolution of

individual
measures and of a structure and process

indic
ator (SPI) reflecting ABS was described for each

hospital.
From 2002, official texts issued by health

authorities set out requirements on ABS, based on previous

professional guidelines. Incentives and means of control

were reinforced in 2006 and in 2007 wi
th
mandatory

reporting of SPI for public disclosure. ABS implementation

improved during the course of the
study period. In 2008, at

least 98% of hospitals had implemented formularies,

antibiotic committees, surgical
prophylaxis guidelines, and

monitored an
tibiotic use; antibiotic advisors were

appointed in 85% of hospitals.
Little progress was made

regarding time dedicated by pharmacists to antibiotic

management and restrictive
dispensation using stop
-
orders.

Computerised tools, continuing education and aud
its

remained under
-
used.
SPI values were higher in private

hospitals and rehabilitation centres than in others.

Official texts and the
SPI public disclosure increased

professionals' and hospital managers' commitment to develop

ABS,
resulting in improvements. However, some actions still

need to be reinforced. It appears crucial to monitor

practical implementation to better approach ABS

effectiveness and to adapt requirements.



NosoBase n° 29658

Faible colonisation par des entérocoques résistant à la vancomycine de l'appareil digestif de
patients français hospitalisés : étude nationale prospective en 2006


F
ortineau

N; B
ourdon

N; L
eclercq

R; V
achee

A; D
elarbre

JM;

Maugat S;
et al.

Low carriage of vancomycin
-
resistant enterococci in the

digestive tract of french hospitalised patients: a

nationwide prospective study in
2006
.
The Journal of hospital infection

2011/02
;
77(2
)
:

179
-
181
.


Mots
-
clés

:
COLONISATION DIGESTIVE;
ENTEROCOCCUS
;
VANCOMYCINE
;
ANTIBIORESISTANCE
;

ETUDE PROSPECTIVE
;
ENTEROCOCCUS RESISTANT A LA VANCOMYCINE
;
FRANCE




Antibiotique


NosoBase n° 29608

Facteurs associés à la prévalence de l'utilisation des

antibiotiques pour le traitement des infections

nosocomiales dans 393 hôpitaux français : une analyse des

variations régionales


A
madeo

B; D
umartin
C; V
enier
AG; F
ourrier
-
R
eglat

A;

C
oignard

B; R
ogues

AM
.
Factors associated with the
prevalence of antibiotic use

for the treatment of hospital
-
acquired infections at 393

french hospitals: a
regional variation analysis
.
Infection control and hospital epidemiology

2011/02
;
32
(
2
)
:

155
-
162
.


Mots
-
clés

:
ANTIBIOTIQU
E; CONSOMMATION; PREVALENCE; TRAITEMENT; FACTEUR

DE RISQUE;
AGE; CATHETER VEINEUX; INFECTION URINAIRE; SITE

OPERATOIRE; DEFICIT IMMUNITAIRE; SOIN
INTENSIF;

FLUOROQUINOLONE; ANALYSE MULTIVARIEE; FRANCE


Objective: The present study investigated regional

variations in antibiotic use for the treatment of

hospital
-
acquired infections (HAIs) in
France by means of a

multilevel analysis, to identify targets for quality

improvement.

Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


4

/
29


Methods: Data were obtained from the 2001 and

2006 French na
tional point
-
prevalence surveys of HAIs
and

antibiotic use. The present study was conducted using data

from 393 nonteaching public hospitals. Data
included

patient characteristics calculated at the hospital level

(mean age and proportion of patients with t
he
following:

HAI, presence of a vascular catheter, presence of a urinary

catheter, surgical procedure, and
immunodeficiency) and

hospital characteristics (size and presence of an intensive

care unit). The regional
effect was measured using a random

interc
ept on a regional variable.

Results: Overall, the

prevalence of antibiotic use was 5.35% for both study

years. The most commonly used
antibiotics for HAIs were

fluoroquinolones (2001, 1.33%; 2006, 1.35%) and

combinations of penicillins with a
â
-
lactamase i
nhibitor

(2001, 0.92%; 2006, 1.02%). Mapping of antibiotic use

showed wide variation between
regions. The regional effect

explained 3% of antibiotic variation in the unadjusted

analysis. In the
multivariable analysis, hospital size,

high prevalence of pati
ents with immunodeficiency, and

infection
characteristics explained 45% of the variability

in antibiotic use. The regional effect was not retained in

the final model.

Conclusion: The pattern of antibiotic use

for HAIs differed over time, and regional vari
ations were

mostly
explained by patient characteristics; there was no

regional effect. Models that take data hierarchy into

account are essential to better approach antibiotic use and

develop releva
nt strategies for improvement.



NosoBase n° 29820

Approches générales pour le contrôle de micro
-
organismes

multirésistant aux antibiotiques autres
que
Staphylococcus

aureus

méticillino
-
résistant (SARM)


H
ebert
C; W
eber
SG
.
Common approaches to the control of multidrug
-
resistant

organisms other than
methicillin
-
resistant
Staphylococcus

aureus

(MRSA)
.
Infectious disease clinics of
n
orth America

2011/03
;

25(1
)
:

181
-
200
.


Mots
-
clés

:
MULTIRESISTANCE; CONTROLE;
ENTEROCOCCUS
; VANCOMYCINE;

ANTIBIORESISTANCE;
CLOSTRIDIUM DIFFICILE
; BACILLE GRAM

NEGATIF; HYGIENE DES MAINS;
PRECAUTION COMPLEMENTAIRE;

SURVEILLANCE; ANTIBIOTIQUE; BIBLIOGRAPHIE


Antibiotic resistance will continue to be a problem as long

as selective ant
ibiotic pressure gives a
competitive

advantage to resistant strains and contaminated hands pass

these strains along to new and
vulnerable hosts.

Comprehensive infection control strategies are vital.

Despite a relative dearth of
prospective randomized studi
es

of transmission prevention measures and antimicrobial

stewardship for the
control of VRE, MDRGN, and
C difficile
,

there is a growing amount of evidence supporting

specific
interventions. It is imperative that the rigorous

examination of the performance
and consequences of these

strategies continue to determine which are the most

influential. Given the limits of the available evidence,

clinicians and other leaders must continue to balance the

benefit of these potentially life
-
saving strategies
against

any

unintended consequences and the expenses that are

associated with their implementation.



NosoBase n° 29810

Contrôle d'une épidémie régionale d'infections à

Enterococcus faecium

vanA rési
stant aux
glycopeptides dans

l'e
st de la France, 2004
-
2009


H
enard

S; G
endrin
V; S
imon
L; J
ouzeau

N; V
ernier

N; T
hiolet JM;
et al.

Control of a regional outbreak of
vanA

glycopeptide
-
resistant
Enterococcus faecium
, Eastern

France, 2004
-
2009
.
International journal of
hygiene and environmental health

2011
;
in press:

6 pages
.


Mots
-
clés

:
CONTROLE; EPIDEMIE;
ENTEROCOCCUS FAECIUM
; GLYCOPEPTIDE;

PRECAUTION
STANDARD; COLONISATION; ANTIBIORESISTANCE;

DEPISTAGE; STRUCTURE DE SOINS;
PROTOCOLE


At the end of 2004, an outbreak of glycopeptide
-
resistant

enterococci (GRE) spread from the Nancy
Teaching Hospital

to more than 40 facilities in the
Lorraine region. Because

this outbreak appeared to be
uninhibited, a regional task

force was set

up to organize and co
-
ordinate the management

of the outbreak,
visiting the affected facilities to

publicize the existing recommendations and take stock of

the problems
encountered in the field. The task force then

proposed control measures specific to th
e region. The

proposed measures included promoting the use of

alcohol
-
based hand
-
rub solutions, isolation measures,

enhanced screening policies, cohorting GRE
-
colonized

patients and contacts in special wards with
Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


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-
lyon.fr


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29


dedicated staff

where possible, or failing
that, isolating them in single

rooms with additional "contact"
precautions, maintaining

these precautions for GRE
-
colonized patients until a

negative stool sample was
obtained after antibiotic

treatment (which is a more restrictive definition of

"cleared"
than usually employed),
regional co
-
ordination of

the follow
-
up of GRE
-
colonized patients with the weekly

publication of a list of
institutions that were or had been

affected to allow isolation measures to be adopted as soon

as known
-
GRE
-
colonized patient
were readmitted. It was not

possible to determine the efficacy of each individual

measure on the course of the outbreak. Nevertheless, we

observed that the number of new GRE
-
colonized
patients

started to decrease following their implementation.

Ultimately,

1077 GRE colonizations were
recorded in

Lorraine, and the outbreak is now under control.




NosoBase n° 29114

Consommation des antibiotiques rapportée via les bilans

standardisé
s de lutte contre les infections
nosocomiales et

relation avec l'ICATB


H
enard
S; R
ahib

D; L
eon
L; A
madeo

B; D
umartin
C; C
avalie

P;

et al.

Antimicrobial consumption reported
through standardized

reports on infection control activities, relationship with

th
e ICATB public reporting
indicator
.
Médecine et maladies infectieuses

2011
;
in press
:

9 pages
.


Mots
-
clés

:
ANTIBIOTIQUE; CONSOMMATION; BILAN STANDARDISE; ICATB;

SCORE; DDJ; ANALYSE
MULTIVARIEE


Objectifs : Décrire l'évolution de la consommation des

anti
biotiques entre 2006 et 2008 dans les
établissements de

santé (ES) français et étudier ses relations avec la

politique de bon usage des
antibiotiques.


Méthode : Utilisation des bilans standardisés des activités

de lutte contre les infections nosocomiales
de
2006 à 2008

(consommations des antibiotiques, politique de bon usage

des antibiotiques des ES). Étude
des tendances par analyse

linéaire pour données corrélées avec intercept aléatoire

sur l'ES, ajustant la
consommation des antibiotiques sur le

statut j
uridique et l'activité des ES.


Résultats : Après exclusion des ES non concernés par

l'indicateur composite du bon usage des
antibiotiques

(ICATB) (7,2 %), des valeurs nulles ou manquantes (21,2 %)

ou aberrantes (23,4 %), l'analyse
a porté sur 4062

observa
tions (48,2 %). Entre 2006 et 2008, la consommation

globale des antibiotiques était
de 343 doses définies

journalières (DDJ) pour 1000 journées d'hospitalisation

(JH) et variait peu.
Cependant, l'analyse multivariée

montrait une augmentation de 5,7 DDJ/100
0 JH par an (p <

0,001) et il
existait une association positive entre

consommation des antibiotiques et score ICATB, en

particulier ses
sous
-
scores ICATB
-
action et

ICATB
-
organisation.

Conclusion : L'absence de diminution des consommations

antibiotiques hos
pitalières est cohérente avec les
autres

données nationales disponibles, mais l'exclusion d'une

proportion importante des données limite la
portée de cette

analyse. Les relations entre politique de bon usage et

consommation des antibiotiques
restent diffic
iles à

préciser, du fait d'un recul limité (trois ans) et de la

nature composite de l'indicateur ICATB
ne reflétant que

partiellement la politique de bon usage des antibiotiques.




Bactériémie


NosoBase n° 29604

Bactérié
mies sur cathéters veineux centraux insérés par

voie périphérique chez des patients adultes


A
jenjo

MC; M
orley

JC; R
usso

AJ; M
cmullen

KM; R
obinson
C;

W
illiams
RC;
et al.

Peripherally inserted
central venous catheter
-
associated

bloodstream infections in hos
pitalized adult patients
.
Infection control
and hospital epidemiology

2011/02
;
32
(
2
)
:

125
-
130
.


Mots
-
clés

:
CATHETER VEINEUX CENTRAL; BACTERIEMIE; INCIDENCE; TAUX;

SOIN INTENSIF;
ETUDE RETROSPECTIVE; CENTRE HOSPITALIER

UNIVERSITAIRE


Background: Limited data on the risk of peripherally

inserted central venous catheter
-
associated
bloodstream

infections (PICC BSIs) in hospitalized patients are

available. In 2007, dedicated intravenous
therapy nurses

were no longer available to place diff
icult peripheral

intravenous catheters or provide PICC
care
Barnes
-
Jewish

Hospital.

Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


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-
lyon.fr


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Objectives: To determine the hospital
-
wide incidence of

PICC BSIs and to assess the effect of discontinuing

intravenous therapy service on PICC use a
nd PICC BSI rates.

Setting: A 1,252
-
bed tertiary care teaching

hospital.

Methods. A 31
-
month retrospective cohort study was

performed. PICC BSIs were defined using National
Healthcare

Safety Network criteria.

Results: In total, 163 PICC BSIs were identifie
d (3.13 BSIs

per 1,000 catheter
-
days). PICC use was higher
in intensive

care units (ICUs) than non
-
ICU areas (PICC utilization

ratio, 0.109 vs 0.059 catheter
-
days per
patient
-
day for ICU

vs non
-
ICU; rate ratio [RR], 1.84 [95% confidence interval

{CI}, 1.78
.1.91]). PICC BSI
rates were higher in ICUs (4.79

vs 2.79 episodes per 1,000 catheter
-
days; RR, 1.7 [95% CI,

1.10.2.61]).
PICC use increased hospital
-
wide after the

intravenous therapy service was discontinued (0.049 vs

0.097
catheter
-
days per patient
-
day;

), but PICC BSI rates

did not change (2.68 vs 3.63 episodes per 1,000

catheter
-
days; ). Of PICC BSIs, 73% occurred in non
-
ICU

patients.

Conclusions: PICC use and PICC BSI rates were higher in

ICUs; however, most of the PICC BSIs occurred
in non
-
ICU

areas. Reduction in intravenous therapy services was

associated with increased PICC use
across the hospital, but

PICC BSI rates did not increase.



NosoBase n° 29603


Impact de la prise en compte de plusieurs cathéters

concomitants sur les bactériémies sur cathéters
centraux :

des données concrètes pour étayer cette question


A
slakson
RA; R
omig

M; G
alvagno

SM; C
olantuoni
E; C
osgrove
SE; P
erl

TM;
et al.
Effect of accounting for
multiple concurrent catheters on

central line
-
associated bloodstream infection rates:

practical data
supporting a theoretical concern
.
Infection control and hospital epidemiology

2011/02
;
32
(
2
)
:

121
-
124
.


Mots
-
clés

:
CATHETER VEINE
UX CENTRAL; BACTERIEMIE; TAUX; SOIN INTENSIF;

CHIRURGIE


Background:

Central line.associated bloodstream infection

(CLABSI) rates are gaining importance as they
become

publicly reported metrics and potential pay
-
for
-
performance

indicators. However, the cur
rent
conventional method by

which they are calculated may be misleading and unfairly

penalize high
-
acuity care
settings, where patients often

have multiple concurrent central venous catheters (CVCs).

Objective:

We compared the conventional method of

calculating CLABSI rates, in which the number of

catheter
-
days is used (1 patient with n catheters for 1 day

has 1 catheter
-
day), with a new method that
accounts for

multiple concurrent catheters (1 patient with n catheters

for 1 day has n catheter
-
days),
to
determine whether the

difference appreciably changes the estimated CLABSI rate.

Design:
Cross
-
sectional survey.

Setting
:

Academic, tertiary

care hospital.

Patients
:

Adult patients who were

consecutively admitted from June 10 through July 9, 2009,

to a
cardiac
-
surgical intensive care unit and a surgical

intensive and surgical intermediate care unit.

Results:
Using the conventional method, we counted 485 catheter
-
days

throughout the study period, with a
daily mean of 18.6

catheter
-
days (95% confidence in
terval, 17.2.20.0

catheter
-
days) in the 2 intensive care
units. In contrast,

the new method identified 745 catheter
-
days, with a daily

mean of 27.5 catheter
-
days
(95% confidence interval,

25.6.30.3) in the 2 intensive care units. The difference

was statist
ically significant
(). The new method that

accounted for multiple concurrent CVCs resulted in a 53.6%

increase in the number
of catheter
-
days; this increased

denominator decreases the calculated CLABSI rate by 36%.

Conclusions:

The undercounting of cathete
r
-
days for

patients with multiple concurrent CVCs that occurs
when the

conventional method of calculating CLABSI rates is used

inflates the CLABSI rate for care settings
that have a high

CVC burden and may not adjust for underlying medical

illness. Additio
nal research is
needed to validate and

generalize our findings.



NosoBase n° 29736

Epidémiologie, microbiologie et évolutions des bactériémies

associées aux soins et d'origine
communautaire : étude de

cohorte multicentrique


K
ollef

MH; Zilberberg MD; Shorr AF; Vo

L; S
chein

J; M
icek

ST;
et al.

Epidemiology, microbiology and
outcomes of

healthcare
-
associated and community
-
acquired bacteremia: a

multicenter cohort study
.

The Journal of infection

2011/02
;
62
(
2
)
:

130
-
135
.


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-
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Mots
-
clés

:
EPIDEMIOLOGIE; MICROBIOLOGIE; BACTERIEMIE; COHORTE; ETUDE

RETROSPECTIVE;
DEFICIT IMMUNITAIRE; HEMODIALYSE; MAISON DE

RETRAITE; MORTALITE; RISQUE; FACTEUR DE
RISQUE; DUREE DE

SEJOUR;
STAPHYLOCOCCUS AUREUS
;
ESCHERICHIA COLI



O
bjectives
: Classically, infecti
ons have been considered

either nosocomial or community
-
acquired.

Healthcare
-
associated infection represents a new

classification intended to capture patients who have

infection onset outside the hospital, but who, nonetheless,

have interactions with the h
ealthcare system.
Regarding

bloodstream infection (BSI), little data exist

differentiating healthcare
-
associated bacteremia
(HCAB)

from community
-
acquired bacteremia (CAB). We studied the

epidemiology and outcomes
associated with HCAB.

M
ethods
: We conducted a multicenter, retrospective chart

review at 7 US hospitals, of consecutive patients
admitted

with a BSI during 2006, who met pre
-
defined selection

criteria. We defined HCAB as a BSI in a
patient who met =1

of the criteria: 1) hospitalizatio
n within 6 months; 2)

immunosuppression; 3) chronic
hemodialysis; or 4) nursing

home residence. The rest were classified as CAB. We

examined patient
demographics, severity of illness, and

in
-
hospital mortality rates by HCAB vs. CAB status. A

bootstrap
logi
stic regression model was developed to

quantify the independent association between HCAB and

hospital mortality.

R
esults
: Of the total 1143 patients included, HCAB

accounted for 63.7%, with the percentage ranging from
49.0%

to 78.1% across centers. HCAB pa
tients were older (58.5 ±

17.5 vs. 55.0 ± 19.9 years, p = 0.003)
and slightly more

likely to be male (56.1% vs. 50.2%, p = 0.044) than those

with CAB. HCAB was associated
with a higher mean Acute

Physiology Score (12.6 ± 6.2 vs. 11.4 ± 5.7, p = 0.009) and

recent hospitalization
was the most prevalent criteria for

defining HCAB (76.5%). Hospital LOS was longer in the HCAB

(median 8,
IQR 5
-
15 days) than CAB (median 7, IQR 4
-
13

days) group (p = 0.030). In a multivariable model, the risk

of
hospital death was 3
-
fold higher for HCAB compared to

CAB (adjusted odds ratio 3.13, 95% CI 1.75
-
5.50, p
< 0.001,

AUROC = 0.812).


C
onclusions
: HCAB accounts for a substantial proportion of

all patients with BSIs admitted to the hospital.
HCAB is

associated with a higher mort
ality rate than CAB.

Physicians should recognize that HCAB is
responsible for

many BSIs presenting to the hospital and may represent a

distinct clinical group from CAB.



NosoBase n° 29737

Epidémiologie des bactériémies à
Haemophilus influenzae

:

étude de population dans plusieurs
pays


L
aupland

KB; S
chonheyder

HC; O
stergaard

C; K
nudsen
JD;

V
aliquette

L; G
albraith
J;
et al.
Epidemiology of
Haemophilus influenzae

bacteremia: a

multi
-
national population
-
based assessment
.
The Journal of infection

2011/02
;
62
(
2
)
:

142
-
148
.


Mots
-
clés

:
EPIDEMIOLOGIE; BACTERIEMIE;
HAEMOPHILUS INFLUENZAE
;

SURVEILLANCE;
INCIDENCE; MORTALITE; FACTEUR DE RISQUE;

PERSONNE AGEE; AGE; COHORTE


O
bjectives
:
H
aemophilus influenzae

is an important cause of

invasive infection but contemporary data in
non
-
selected

populations is limited.

M
ethods
: Population
-
based surveillance for
Haemophilus

influenzae

bacteremia was conducted in seven
regions in

Australia,
Canada, and
Denmark during 2000
-
2008.

R
esults
: The overall annual incidence rate was 1.31 per

100,000 population and type specific rates were
0.08 for
H.

influenzae

serotype b (Hib), 0.22
for H. influenzae

seroty
pes a, c
-
f (Hiac
-
f), and 0.98 per 100,000
for

non
-
typeable
H. influenzae

(NTHi).
Very young and old

patients were at highest risk. The serotypes
causing

disease varied according to age with nearly all cases in

the elderly due to NTHi. The presence of
comor
bid medical

illness was common with 14%, 16%, and 29% patients having

Charlson comorbidity
scores of 1, 2, and =3, respectively.

The 30
-
day all
-
cause case
-
fatality rate was 18%. Factors

independently
associated with death at 30
-
days in logistic

regression
analysis included male gender, hospital
-
onset

disease, older age, and lower respiratory tract, central

nervous system, or unknown focus of infection.

C
onclusions
:
Haemophilus influenzae

is an important cause

of morbidity and mortality particularly with NTH
i
in the

elderly. These data serve as a baseline to assess the

future effectiveness of new preventative
interventions.





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NosoBase n° 29816

La bactériémie est un facteur de risque indépendant de

mortalité dans les pneumonies
nosocomiales : étude

d'observation prospective multicentrique


M
agret
M; L
isboa

T; M
artin
-
L
oeches

I; M
anez

R; N
auwynck

M;

Wrigge H;
et al.
Bacteremia is an
independent risk factor for mortality in

nosocomial pneumonia: a prospective and observational

multicentre
study
.
Critical care

2011
;
in press
:

19 pages
.


Mots
-
clés

:
BACTERIEMIE; FACTEUR DE RISQUE; PNEUMONIE; MORTALITE; ETUDE

PROSPECTIVE;
EUROPE; SOIN INTENSIF;
STAPHYLOCOCCUS AUREUS
;

METICILLINO
-
RESISTANCE;
ACINETOBACTER BAUMANNII
;

VENTILATION ASSISTEE


I
ntroduction
:

Since positive blood cultures are uncommon in

patients with nosocomial pneumonia (NP), the
responsible

pathogens are usually isolated from respiratory samples.

Studies on bacteremia associated with
hospital acquired

pneumonia (HAP) have reported fatality
rates of up to 50%.

The purpose of the study is to
compare risk factors,

pathogens and outcomes between bacteremic nosocomial

pneumonia (B
-
NP) and
non
-
bacteremic nosocomial pneumonia

(NB
-
NP) episodes.


M
ethods
: This is a prospective, observational and

multicenter study (27 intensive care units in nine
European

countries). Consecutive patients requiring invasive

mechanical ventilation (MV) for an admission
diagnosis of

pneumonia or on mechanical ventilation for >48 hours

irrespective of admission diagnos
is were
recruited.

R
esults
: A total of 2436 patients were evaluated; 689

intubated patients presented with NP, 224 of them
developed

HAP and 465 ventilation acquired pneumonia (VAP). Blood

samples were extracted in 479
(69.5%) patients, 70 (14.6%)

being po
sitive. B
-
NP patients had higher SAPS II score

(51.5 +/
-

19.8 vs 46.6
+/
-

17.5, p=0.03) and were more

frequently medical patients (77.1% vs 60.4%, p=0.01).

Mortality in the
intensive care unit was higher in B
-
NP

patients compared to NB
-
NP patients (57.1% v
s 33%,

p<0.001). B
-
NP patients had a more prolonged mean intensive

care unit length of stay after pneumonia onset than NB
-
NP

patients (28.5 +/
-

30.6 vs 20.5 +/
-

17.1 days, p=0.03).

Logistic regression analysis confirmed that
medical

patients (OR=5.72; 95%C
I 1.93
-
16.99, p=0.002),

Methicillin
-
resistant
Staphylococcus aureus

(MRSA) etiology

(OR=3.42; 95%CI 1.57
-
5.81, p=0.01),
A. baumannii

etiology

(OR= 4.78; 95%CI 2.46
-
9.29,
p<0.001) and days of MV

(OR=1.02; 95%CI 1.01
-
1.03, p<0.001) were independently

associa
ted with B
-
NP
episodes. Bacteremia (OR=2.01; 95%CI

1.22
-
3.55, p=0.008), diagnostic category (medical patients

(OR=3.71; 95%CI 2.01
-
6.95, p=0.02) and surgical patients

(OR=2.32; 95%CI 1.10
-
4.97, p=0.03) and higher
SAPS II score

(OR=1.02; 95%CI 1.01
-
1.03, p=
0.008) were independent risk

factors for mortality.

C
onclusions
: B
-
NP episodes are more frequent in patients

with medical admission, MRSA and
A. baumannii
etiology and

prolonged MV, and is independently associated with higher

mortality rates.



NosoBase n° 29647

Candidémies : épidémiologie et évolution dans un seul établissement entre 1991 et 2008


O
rtega
M; M
arco

F; S
oriano

A; A
lmela
M; M
artinez

JA; L
op
ez

J;
et al.

Candida

species

bloodstream
infection: epidemiology and

outcome in a single institution from 1991 to 2008
.
The Journal of hospital
infection

2011/02
;
77(2
)
:

157
-
161
.


Mots
-
clés :

CANDIDA
;

EPIDEMIOLOGIE
;
CENTRE HOSPITALIER UNIVERSITAIRE
;
HEMOCULTURE
;

SURVEILLANCE; ETUDE PROSPECTIVE; INCIDENCE; MORTALITE;
CANDIDA ALBICANS
;
CANDIDA
PARAPSILOSIS
;
CANDIDA KRUSEI


Candidaemia remains a major cause of morbidity and

mortality in the healthcare setting.
Candida spp.

bloodstream infection episodes
prospectively recorded

through a blood culture surveillance programme in a
single

institution from 1991 to 2008 were included in the study.

Data regarding candidaemia episodes were
analysed,

including specific fungal species and patient survival at

30 days

after diagnosis. There were 529
candidaemia

episodes during the study period (495 were nosocomial

infections). The incidence of
candidaemia caused by

non
-
Candida albicans

Candida spp.

(52%) was higher than the

incidence of
candidaemia caused by
C. albicans

(48%). The

overall crude 30 day mortality rate was 32%. Patients with

Candida parapsilosis

candidaemia had the lowest mortality

rate (23%).
Candida krusei

candidaemia was
most commonly

associated with haematological malignancy (61%; P<0.001),

s
tem cell transplantation (22%;
P=0.004), neutropenia (57%;

P=0.001) and prior use of antifungal azole agents (26%;

P<0.001). Patients
with
C. krusei

candidaemia had the

highest crude 30 day mortality in this series (39%).

Epidemiological
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studies are import
ant to define clinical

and microbiological candidaemia characteristics and to

guide
empirical treatment in every setting.



Candida


NosoBase n° 29821

Infections fongiques nosocomiales : épidémiologie, lutte

contre le risque infectieux et prévention


A
langaden
GJ
.
Nosocomial fungal infections: epidemiology, infection

control, and prevention
.
Infectious
disease clinics of n
orth America

2011/03
;
25
(
1
)
:

201
-
225
.


Mots
-
clés

:
BIBLIOGRAPHIE; MYCOLOGIE; CONTROLE;
CANDIDA
; LEVURE;

ASPERGILLUS
;
CHAMPIGNON FILAM
ENTEUX; CATHETER;

ENVIRONNEMENT; PREVENTION; EPIDEMIOLOGIE


Nosocomial fungal infections, especially candidemias and

invasive aspergillosis, can result in significant
morbidity

and mortality in the critically ill and severely

immunocompromised patients. Implementation of
recommended

infection control strategies can prevent catheter
-
related

candidemia and minimize exposure
of severely

immunocompromised patients to airborne
Aspergillus

spores

within the hospital environment. In
s
elect patient

populations at high risk for invasive fungal infections,

antifungal prophylaxis should be
considered.



Cathéter


NosoBase n° 29723

Colonisations ou infections liées aux cathéters chez des

patients de réanimation : le nombre de
cathéters simu
ltanés

est
-
il un facteur de risque ?


L
egriel

S; M
ongardon
N; T
roche
G; B
runeel

F; B
edos

JP
.
Catheter
-
related colonization or infection in
critically

ill patients: is the number of simultaneous catheters a

risk factor?

American journal of infection
control

2011/02
;
39
(
1
)
:

83
-
85
.


Mots
-
clés

:
CATHETER; SOIN INTENSIF; FACTEUR DE RISQUE; ETUDE

PROSPECTIVE;
COLONISATION; DUREE DE SEJOUR; CATHETER

ARTERIEL; CATHETER VEINEUX CENTRAL;
DIALYSE RENALE



NosoBase n° 29685

Epidémie nosocomiale à
Staphylococcus epidermidis

méticillino
-
résistant et résistant au linezolide
associée à des infections sur cathéters chez des patients de réanimation


S
eral
C
;
S
aenz
Y
;
A
lgarate

S
;
D
uran

E
;
L
uque
P
;
T
orres
C
;
et al.
Nosocomial outbreak of methicillin
-

and
linezolid
-
resistant
Staphylococcus epidermidis

associated with catheter
-
related infections in intensive care
unit patients
.

International journal of medical microbiology

2011; in press: 5 pages.


Mots
-
clés

:
CATHETER
;
SOIN INTENSIF
;
STAPHYLOCOCCUS EPIDERMIDIS
;

EPIDEMIE
;
ANTIBIORESISTANCE
;
METICILLINO
-
RESISTANCE
;
LINEZOLIDE
;
BIOLOGIE MOLECULAIRE
;

CENTRE HOSPITALIER UNIVERSITAIRE
;
STAPHYLOCOCCUS


Total of 128 isolates associated with catheter
-
related infections
was recovered from 101 intensive care unit
patients in a Spanish hospital during March 2008 to August 2009, and 27 of these isolates (from 21 patients)
were typed as methicillin
-

and linezolid
-
resistant
Staphylococcus epidermidis
. Thirteen of these 21 pati
ents
(62%) had received linezolid during the 3 months preceding
S. epidermidis

recovery. Two closely related
pulsotypes (P1a and P1b) were identified among the 27 studied isolates that belonged to the sequence type
ST2 and harboured the mecA gene and the S
CCmecIII type. The strains recovered from patients 1
-
4
(pulsotype P1a) showed the nucleotide mutation G2474T inside the amplified fragment of the 23S rRNA
region and carried the aac(6')
-
Ie
-
aph(2?)
-
Ia, ant(4'), and catA genes, whereas the strains from patie
nts 5
-
21
(pulsotype P1b) showed the mutation G2603T and carried the aac(6')
-
Ie
-
aph(2?)
-
Ia gene. None of the
strains amplified the cfr gene. The
ica gene and the IS256 element were detected in all strains. The
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emergence of 2 closely related methici
llin
-

and linezolid
-
resistant
S. epidermidis

strains with 2 different
mutations in the 23S rRNA region (G2474T and G2603T) is reported in this study as a cause of a
nosocomial outbreak. The presence of G2474T or G2603T point mutations suggests that there a
re multiple
potential sites within domain V of the 23S rRNA region at which mutations could confer resistance to
linezolid in the clinical isolates. To our knowledge, this is the first report in which the G2474T mutation has
been detected in domain V of th
e 23S rRNA gene of clinical
S. epidermidis
.



Chirurgie


NosoBase n° 29742

Prévention des infections du site opératoire sternal.

Y
-
a
-
t
-
il de la place pour une amélioration ?


B
eckmann
A; D
oebler

K; S
chaefer
E; K
oetting

J; G
astmeier

P;

G
raf

K
.
Sternal surgical site infection
prevention
-

is there any

room for improvement?

European journal of cardio
-
thoracic surgery

2011
;
in press:

5 pages
.


Mots
-
clés

:
SITE OPERATOIRE; PREVENTION; CHIRURGIE CARDIO
-
VASCULAIRE;

QUALITE;
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE;

DEPISTAGE; ANTIBIOPROPHYLAXIE;
DEPILATION; ANTISEPTIQUE;

PANSEMENT; PRE
-
OPERATOIRE; SURVEILLANCE; GANT


Objective: The objectives of this multicenter study are to

evaluate current clinical practices in cardiac surgery

concerning t
he prevention and management of sternal wound

infections, to identify room for improvement,
and to

support implementation of systematic measures.

Methods: As a part of a campaign for infection prevention

in cardiac surgery in
Germany, a mult
iple
-
choice

questionnaire with two main sections was developed and

submitted to all cardiac surgery units in
Germany
(79). The

project was realized in cooperation with the German Society

for Thoracic and Cardiovascular
Surgery, the BQS I
nstitute

for Quality and Patient Safety, and the
National
Reference

Center for Nosocomial
Infection Surveillance.

Results: A representative number (54 of 79 or 68%) of

German cardiac surgery centers participated in the
surv
ey,

in which heterogeneous procedures and various standards for

prevention were observed.
Surveillance, standards, and

advanced training regarding hygiene measures are present in

almost all
participating hospitals. Methicillin
-
resistant

Streptococcus aureu
s

(MRSA) screening is performed in 81.5%

(44/54) of all participating departments. A little less

than one
-
tenth (7.4%) perform decolonization measures
on

all patients, while 85.2% perform decolonization measures

only on MRSA
-
positive patients. Application
of

perioperative antibiotic prophylaxis ranges from

single
-
shot application to 3 days of treatment. Longer

treatment is expensive and time
-
intensive, and also

increases the risk of
Clostridium difficile
-
associated

diarrhea. Nearly three
-
quarters (70.4%) of all

participating hospitals perform preoperative hair removal 1

day
before surgery. Common techniques are clipping machines

(53.7%), razors (40.7%), clipping machines and
depilatory

cream (1.9%), or depilatory cre
am only (1.9%). Remanent

(37.0%) and non
-
remanent
disinfectants (55.6%) are used for

preoperative skin disinfection. The time of the first

wound
-
dressing
change varies from the day of surgery (1.9%)

over the first (42.6%) or second (46.3%) day after surger
y

to
up to 3 or more days after surgery (9.3%).

Conclusions: The results of the evaluation show that basic

measures for infection prevention in cardiac
surgery in

Germany are well implemented. Nevertheless, a relevant

heterogeneity in t
he use of special
measures was observed,

although research
-
based guidelines for infection prevention

in surgery do exist and
many studies have demonstrated the

usefulness and feasibility of these measures.



NosoBase n° 29776

Infections sur prothèses articulaires : défis pour le

diagnostic et le traitement


P
eel
TN; B
uising
KL; C
hoong

P
.
Prosthetic joint infection: challenges of diagnosis and

treatment
.
ANZ
journal of surgery

2011/02
;
81(1
-
2
)
:

32
-
39
.


Mots
-
clés

:
TRAITEMENT; DIAGNOSTIC; CHIRURGIE ORTHOPEDIQUE; MATERIEL

ETRANGER;
EPIDEMIOLOGIE; PREVENTION; BIOFILM; INCIDENCE;

FACTEUR DE RISQUE; MICROBIOLOGIE;
STAPHYLOCOCCUS
;

BIBLIOGRAPHIE; BIOLOGIE MOLECULAIRE; PROTHESE TOTALE D
E

HANCHE;
PROTHESE TOTALE DE GENOU


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-
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-
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29


Arthroplasty for arthritis has led to remarkable

improvement in patient quality of life and alleviation of

symptoms. A major complication of this surgery is

infection. This review examines current understanding of

epidemiology, diagnosis, treatment and prevention of

prosthetic joint infections. In particular, this article

focuses on the role of biofilm formation in the

pathogenesis of device infections and the diagnostic and

treatment challenges associated with this

process.



Coût


NosoBase n° 29636


Variations dans la méthodologie analytique pour l'estimation des coûts des infections
nosocomiales.
Revue systématique


F
ukuda

H; L
ee
J; I
manaka

Y
.
Variations in analytical methodology for estimating costs

of hospital
-
acquired
infections: a systematic review
.
The Journal of hospital infection

2011/02
;
77(2
)
:

93
-
105
.


Mots
-
clés :
METHODOLOGIE; COUT
; BIBLIOGRAPHIE


Quantifying the additional costs of hospital
-
acquired

infections (COHAI) is essential for develo
ping

cost
-
effective infection control measures. The

methodological approaches to estimate these costs include

case
reviews, matched comparisons and regression analyses.

The choice of cost estimation methodologies can
affect the

accuracy of the resulting estimates, however, with

regression analyses generally able to avoid the
bias

pitfalls of the other methods. The objective of this study

was to elucidate the distributions and trends in
cost

estimation methodologies in published s
tudies that have

produced COHAI estimates. We conducted
systematic searches

of peer
-
reviewed publications that produced cost estimates

attributable to hospital
-
acquired infection in MEDLINE from

1980 to 2006. Shifts in methodologies at 10
-
year intervals

we
re
analysed using Fisher's exact test. The most frequent

method of COHAI estimation methodology was
multiple matched

comparisons (59.6%), followed by regression models (25.8%),

and case reviews (7.9%).
There were significant increases

in studies that used
regression models and decreases in

matched
comparisons through the 1980s, 1990s and post
-
2000

(P=0.033). Whereas regression analyses have
become more

frequently used for COHAI estimations in recent years,

matched comparisons are still used in
more than hal
f of

COHAI estimation studies. Researchers need to be more

discerning in the selection of
methodologies for their

analyses, and comparative analyses are needed to identify

more accurate estimation
methods. This review provides a

resource for analysts to ov
erview the distribution, trends,

advantages and
pitfalls of the various existing COHAI

estimation methodologies.



NosoBase n° 29605


L'aspiration
glottique en continu est
-
elle

coût
-
efficace pour prévenir les pneumonies sous
ventilation

assistée ?


Hallais C; Merle V; Guitard PG; Moreau A; Josset V; Thillard D;
et al.

Is continuous subglottic suctioning
cost
-
effective for the

prevention of ventilator
-
associated pneumonia?

Infection control and hospital
epidemiology 2011/02; 32(2): 131
-
135.


Mots
-
clés

: PNEUMONIE; ASPIRATION; PREVENTION; VENTILATION ASSISTEE; COUT
-
EFFICACITE;
SOIN INTENSIF; INCIDENCE; CENTRE HOSPITALIER UNIVERSITAIRE


Objective:

To establish whether continuous subglottic

suctioning (CSS) could be cost
-
effective.

Design:
Cost
-
benefit analysis, based on a hypothetical replacement

of conventional ventilation (CV) with
CSS.

Setting:
A

surgical intensive care unit (SICU) of a tertia
ry care

university hospital in
France.

Patients
:

All consecutive

patients receiving ventilation in the SICU in 2006.

M
ethods:
Efficacy data for CSS were obtained from the literature and

applied to the SICU of our hospital.
Costs for CV
and CSS

were provided by the hospital pharmacy; costs for

ventilator
-
associated pneumonia
(VAP) were obtained from

the literature. The cost per averted VAP episode was

calculated, and a sensitivity
analysis was performed on VAP

incidence and on the number of tubes required for each

patient.

Results:

At our SICU in 2006, 416 patients

received mechanical ventilation for 3,487 ventilation
-
days,

and 32 VAP episodes were observed (7.9 episodes per 100

ventilated patients; incidence de
nsity, 9.2
episodes per

10,000 ventilation
-
days). Based on the hypothesis of a 29%

reduction in the risk of VAP with
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CSS than CV, 9 VAP

episodes could have been averted. The additional cost of

CSS for 2006 was estimated
to be .10,585.34. The cost per

avert
ed VAP episode was .1,176.15. Assuming a VAP cost of

.4,387, a total
of 3 averted VAP episodes would neutralize

the additional cost. For a low VAP incidence of 6.6%, the

cost
per averted VAP would be .1,323. If each patient

required 2 tubes during ventilat
ion, the cost would be

.1,383.69 per averted VAP episode.

Conclusion
:
Replacement of CV with CSS was

cost
-
effective even when assuming the most pessimistic

scenario of VAP incidence and costs.



NosoBase n° 29601

Estimation de la proportion d'infections associées aux

soins raisonnablement évitables, de la
mortalité associée

et des coûts induits


Umscheid CA; Mitchell MD; Doshi JA; Agarwal R; Williams K; Brennan PJ.
Estimating the proportion of
healthcare
-
associated

infections that are reasonably preventable and the related

mortality and costs
.
Infection control and hospital epidemiology

2011/02
;
3
2(2
)
:

101
-
114
.


Mots
-
clés : PREVENTION; COUT; MORTALITE; INCIDENCE


Objective:

To estimate the proportion of

healthcare
-
associated infections (HAIs) in US hospitals

that are
.reasonably preventable,. along with their related

mortality and costs.

Methods:

To estimate preventability of

catheter
-
associated bloodstream infections (CABSIs),

catheter
-
associated urinary tract infections (CAUTIs),

surgical site infections (SSIs), and ventilator
-
associated

pneumonia (VAP), we used a federally sponsored systematic

r
eview of interventions to reduce HAIs.
Ranges of

preventability included the lowest and highest risk

reductions reported by US studies of
.moderate. to .good.

quality published in the last 10 years. We used the most

recently published national
data to dete
rmine the annual

incidence of HAIs and associated mortality. To estimate

incremental cost of
HAIs, we performed a systematic review,

which included costs from studies in general US patient

populations. To calculate ranges for the annual number of

preventab
le infections and deaths and annual
costs, we

multiplied our infection, mortality, and cost figures with

our ranges of preventability for each
HAI.Results.&#8195;As

many as 65%.70% of cases of CABSI and CAUTI and 55% of

cases of VAP and
SSI may be preventable with current

evidence
-
based strategies. CAUTI may be the most

preventable HAI.
CABSI has the highest number of

preventable deaths, followed by VAP. CABSI also has the

highest cost
impact; costs due to preventable cas
es of VAP,

CAUTI, and SSI are likely less.

Conclusions:

Our findings

suggest that 100% prevention of HAIs may not be attainable

with current
evidence
-
based prevention strategies; however,

comprehensive implementation of such strategies could

prevent hundr
eds of thousands of HAIs and save tens of

thousands of lives and billions of dollars
.



Environnement


NosoBase n° 29793

Le développement durable à l'hôpital


F
avier
AL
.
Objectif soins

2011/01
;
(
192
)
:

16
-
17
.


Mots
-
clés

:
STRUCTURE DE SOINS
;
DECHET
;
USAGE UNIQUE
;
DECHET LIQUIDE


Règne du jetable et de l'usage unique, l'hôpital est un milieu qui génère des tonnes de déchets. C'est
également un endroit où sont utilisées des quantités importantes de solvants et de produits chimiques. Un
tableau qui ne se
mble pas très favorable à une cohabitation entre l'hygiène et le développement durable à
l'hôpital. Qu'en est
-
il vraiment ?



NosoBase n° 29857

La désinfection des loaux


G
autier
C; V
an de

S
teene

S
.
Le moniteur hospitalier

2011/02
;
(
233
)
:

38
-
41
.


Noso
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29


Mots
-
clés

:
DESINFECTION
;
RECOMMANDATION
;
LOCAL
;
NETTOYAGE
;
SURFACE
;
MICRO
-
ORGANISME
;
BIONETTOYAGE
;
VAPEUR
;
DETERGENT
;
ASPERGILLUS
;
CLOSTRIDIUM DIFFICILE
;

DESINFECTION PAR VOIE AERIENNE



Les recommandations élaborées par le CCLIN Sud
-
Ouest en 2010 (Référence NosoBase n° 29321)
apportent un éclairage nouveau sur la désinfection des locaux. Dans quel cas doit
-
on en effet désinfecter ou
simplement nettoyer ? Cet article apporte des éléments d
e réponse.



NosoBase n° 29610

Contrôler les légionelles dans l'eau de boisson à l'hôpital

: une synthèse reposant sur des preuves
des méthodes de

déinfection


Lin

YE; S
tout

JE; Y
u

VL
.
Controlling
Legionella

in hospital drinking water: an

evidence
-
based review of
disinfection methods
.
Infection control and hospital epidemiology

2011/02
;
32(2
)
:

166
-
173
.


Mots
-
clés

:
LEGIONELLA
; DESINFECTION; DESINFECTANT; EAU POTABLE;

CHLORE; ULTRA
-
VIOLET


Hospital
-
acquired Legionnaires. disease is directly linked

to the presence of

Legionella

in hospital drinking
water.

Disinfecting the drinking water system is an effective

preventive measure. The efficacy of any
disinfection

measures should be validated in a stepwise fashion from

laboratory assessment to a controlled
multiple
-
hospital

evaluation over a prolonged period of time. In this review,

we evaluate systemic disinfecti
on
methods (copper
-
silver

ionization, chlorine dioxide, monochloramine, ultraviolet

light, and hyperchlorination),
a focal disinfection method

(point
-
of
-
use filtration), and short
-
term disinfection

methods in outbreak
situations (superheat
-
and
-
flush with o
r

without hyperchlorination). The infection control

practitioner should
take the lead in selection of the

disinfection system and the vendor. Formal appraisals by

other hospitals
with experience of the system under

consideration is indicated. Routine perfo
rmance of

surveillance cultures
of drinking water to detect

Legionella
and monitoring of disinfectant concentrations

are necessar
y to ensure
long
-
term efficacy.



NosoBase n° 29637


Norovirus à l'hôpital : introduction et dissémination des virus dans l'environnement hospitalier


M
orter
S; B
ennet

G; F
ish
J
; R
ichards
J; A
llen

DJ; N
awaz

S;

et al.
Norovirus in the hospital setting: virus
introduction and

spread within the hospital environment
.
The Journal of hospital infection

2011/02
;
77(2
)
:

106
-
112
.


Mots
-
clés : NOROVIRUS
;
VIRUS
;
ENVIRONNEMENT
;
CONTAMINATION
;
EFFICACITE
;
BIONETTOYAGE
;
SURFACE
;
ORDINATEUR
;
DISTRIBUTEUR

SANITAIRE
;
DISPOSITIF MEDICAL


Norovirus (NoV) strains were collected over a four
-
month

period during 2009
-
2010 from hospitalised
patients with

symptoms of gastroenteritis. These were characterised in

order to estimate how many strains
were introduced into the

hospital from the communit
y. In addition, environmental

swabbing was performed
after clinical cleaning of bays or

wards accommodating infected patients. This was performed

in order to
assess the efficiency of cleaning and identify

any NoV contamination in the environment. A total o
f eight

distinct genetic clusters of NoV GII
-
4 genotype were

identified during the four
-
month period, with some
wards

experiencing multiple outbreaks with different GII
-
4

strains during the season. NoV was detected from
31.4% of

environmental swabs post cl
eaning. Notes trolleys, computer

keyboards, soap and alcohol
dispensers, blood pressure

equipment, pulse oximeters and tympanic thermometers were

identified as NoV
reservoirs but contamination was also

found on surfaces around the bedside environment, and

furniture,
fixtures and fittings associated with toilets

and shower rooms. The combination of detailed virus

characterisation and environmental swabbing is a powerful

tool for infection control audits to determine the
size and

scope of an outbreak and to m
onitor the efficiency of

clinical cleaning.



NosoBase n° 29779




Surveillance reposant sur la stratification du risque de la

contamination bactérienne d'ambulances
urbaines


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-
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Noh H; Shin SD; K
i
m
NJ; Ro YS; Oh HS; Joo

SI;
et al
.
Risk stratification
-
based surveillan
ce of bacterial

contamination in metropolitan ambulances

Journal of Korean medical science

2011/01
;
26
(
1
):
124
-
130
.


Mots
-
clés

:
SURVEILLANCE; RISQUE; CONTAMINATION; BACTERIE; AMBULANCE;

PREVALENCE;
SURFACE; PRELEVEMENT; ANTIBIORESISTANCE;

STAPHYLOCOCCUS AUREUS
;
KLEBSIELLA
PNEUMONIAE
; URGENCE;

DISPOSITIF MEDICAL;
STAPHYLOCOCCUS


We aimed to know the risk
-
stratification
-
based prevalence

of bacterial contamination of ambulance vehicle
surfaces,

equipment, and materials. This study was performe
d in a

metropolitan area with fire
-
based single
-
tiered Basic Life

Support ambulances. Total 13 out of 117 ambulances (11.1%)

were sampled and 33 sites
per each ambulance were sampled

using a soft rayon swab and aseptic containers. These

samples were
then p
lated onto a screening media of blood

agar and MacConkey agar. Specific identification with

antibiotic
susceptibility was performed. We categorized

sampling sites into risk stratification
-
based groups

(Critical,
Semi
-
critical, and Non
-
critical equipment)

r
elated to the likelihood of direct contact with patients.

mucosa.
Total 214 of 429 samples showed positive results

(49.9%) for any bacteria. Four of these were pathogenic

(0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these

were environmental flora (
49.0%).
However, the prevalence

(positive/number of sample) of bacterial contamination in

critical, semi
-
critical
airway, semi
-
critical breathing

apparatus group was as high as 15.4% (4/26), 30.7% (16/52),

and 46.2%
(48/104), respectively. Despite current
formal

guidelines, critical and semi
-
critical equipments were

contaminated with pathogens and normal flora. This study

suggests the need for strict infection control and

prevention for ambulance services.



NosoBase n° 29840




Observation et quantification des flux d'air dans la lutte

contre le risque infectieux lié aux infections
aéroportées

ou transmission par aérosols : vue d'ensemble des approches


Tang JW; Noakes CJ; Ni
elsen PV; Eames I; Nicolle A; Li

Y;

et al.

Observing and quantifying airflows in the
infection control

of aerosol
-

and airborne
-
transmitted diseases: an overview

of approaches
.
The Journal of
hospital infection

2011/03
;
77(3
)
:

213
-
222
.


Mots
-
clés : AEROSOL; TRANSMISSION; PREVENTION; EFFICACITE; BIBLIOGRAPHIE


With concerns about the potential for the aerosol and

airborne transmission of infectious agents, particularly

influenza, more attention is being focused on the

effectiveness of i
nfection control procedures to prevent

hospital
-
acquired infections by this route. More recently a

number of different techniques have been applied
to examine

the temporal
-
spatial information about the airflow patterns

and the movement of related,
suspende
d material within this

air in a hospital setting. Closer collaboration with

engineers has allowed
clinical microbiologists, virologists

and infection control teams to assess the effectiveness of

hospital
isolation and ventilation facilities. The

characteri
stics of human respiratory activities have also

been
investigated using some familiar engineering

techniques. Such studies aim to enhance the effectiveness

of
such preventive measures and have included experiments

with human
-
like mannequins using various t
racer

gas/particle techniques, real human volunteers with

real
-
time non
-
invasive Schlieren imaging, numerical

modelling using computational fluid dynamics, and small

scale physical analogues with water. This article
outlines

each of these techniques in a non
-
technical manner,

suitable for a clinical readership without
specialist

airflow or engineering knowledge.




Epidémiologie


NosoBase n° 29822

Informatique et épidémiologie dans la lutte contre le

risque infectieux


W
oeltje

KF; L
autenbach

E
.
Informatics and epidemiology in infection control
.
Infectious disease clinics of
n
orth America

2011/03
;
25(1
)
:

261
-
270
.


Mots
-
clés :
INFORMATIQUE; EPIDEMIOLOGIE; SURVEILLANCE; PREVALENCE;

INCIDENCE


Te
chnology offers the promise of increased efficiency in

surveillance, but the tradeoffs inherent in adopting
new

methods must be understood. The understanding of

these trade
-
offs requires a firm grounding in basic

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principles of epidemiology. Just as health
care

epidemiologists must balance surveillance efforts with

interventions, they must also balance new technology with

traditional techniques. The challenge is
determining how to

strike the proper balance and the success is achieving an

efficient

and effect
ive infection
prevention program. Such a program

leads to the best patient outcomes, which is the real

reward.



Grippe


NosoBase n° 29759

Avis relatif aux recommandations pour la prévention de la

transmission en cas de suspicion de
grippe


H
aut conseil de la sant
é

publique

2011/01/21
:

3 pages
.


Mots
-
clés

:
GRIPPE; TRANSMISSION; PREVENTION;
VIRUS INFLUENZA TYPE A
;

APPAREIL
RESPIRATOIRE; PRECAUTION STANDARD; PRECAUTION

COMPLEMENTAIRE; MASQUE; TENUE
VESTIMENTAIRE; GANT; AEROSOL;

BIONETTOYAGE; IN
TUBATION; VENTILATION ASSISTEE;
ASPIRATION;

ENDOSCOPIE; COLONISATION NASALE



NosoBase n° 29725

Etude sur la préparation à une pandémie grippale : étude de

méthodes énergétiques pour
décont
aminer les filtres des

respirateurs contaminés par des aérosols et des

gouttelettes de H1N1


H
eimbuch
BK; W
allace

WH; K
inney
K; L
umley

AE; W
u

CY; W
oo
MH;
et al.
A pandemic influenza
preparedness study: use of energetic

methods to decontaminate filtering facepiece respirators

contaminated
with H1N1 aerosols and droplets
.
American journal of infection control

2011/02
;
39
(
1
)
:

e1
-
e9
.


Mots
-
clés

:
GRIPPE; CONTAMINATION; MASQUE; EPIDEMIE; GESTION DES

RISQUES; PREVENTION;
EFFIC
ACITE; DESINFECTION;

ULTRA
-
VIOLET; VAPEUR; REUTILISABLE; VIRUS; AEROSOL
; VIRUS

INFLUENZA TYPE A


B
ackground
: A major concern among health care experts is a

projected shortage of N95 filtering facepiece
respirators

(FFRs) during an influenza pandemic. One option for

mitigating an FFR shortage is to
decontaminate and reuse

the devices. Many parameters, including biocidal efficacy,

filtration performance,
pressure drop, fit, and residual

toxicity, must be evaluated to
verify the effectiveness of

this strategy. The
focus of this research effort was on

evaluating the ability of microwave
-
generated steam, warm

moist heat,
and ultraviolet germicidal irradiation at 254

nm to decontaminate H1N1 influenza virus.

M
ethods
: Six c
ommercially available FFR models were

contaminated with H1N1 influenza virus as aerosols
or

droplets that are representative of human respiratory

secretions. A subset of the FFRs was treated with
the

aforementioned decontamination technologies, whereas the

remaining FFRs were used to evaluate the
H1N1 challenge

applied to the devices.


R
esults
: All 3 decontamination technologies provided >4
-
log

reduction of viable H1N1 virus. In 93% of our
experiments,

the virus was reduced to levels below the limit of

dete
ction of the method used.

C
onclusions
: These data are encouraging and may contribute

to the evolution of effective strategies for the

decontamination and reuse of FFRs.



NosoBase n° 29717

Evénements indésirables associés à la vaccination contre
la

grippe H1N1 2009 et taux de couverture
vaccinale chez le

personnel hospitalier


Park SW; Lee JH; Kim
ES; K
wak
YG; M
oon
CS; Y
eom
JS;
et al.
Adverse events associated
with the 2009
H1N1 influenza

vaccination and the vaccination coverage rate in health

care workers
.
American journal of
infection control

2011/02
;
39(1
)
:

69
-
71
.


Mots
-
clés

:
VACCIN; GRIPPE; TAUX; PERSONNEL; CENTRE HOSPITALIER

UNIVERSITAIRE;
TOLERANCE; EFFET INDESIRABLE;
VIRUS

INFLUENZA TYPE A


Noso
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Bulletin de veille

Mars 2011


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-
Est


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-
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29


We prospectively examined the 2009 H1N1 influenza

vaccination coverage rate and the adverse events
related to

the monovalent vaccine in Korean health care workers. The

H1N1 vaccination co
verage rate was
91.7%. There were no

significant adverse events discouraging the vaccination.



NosoBase n° 29688

Risque de présenter un syndrome grippal (ILI) dans un centre hospitalier un
iversitaire au cours
d'épidémies de grippe communautaire en 2004
-
2005, 2005
-
2006 et 2006
-
2007


V
anhems
P
;
V
oirin
N
;
R
oche

S
;
E
scuret

V
;
R
egis
C
;
G
orain
C
; et al.
Risk of influenza
-
like illness in an acute
health care setting during community influenza epidemics in 2004
-
2005, 2005
-
2006, and 2006
-
2007.
A
prospective study
.
Archives of internal medicine 2011/01/24
;
2
(
171
):
151
-
157
.


Mots
-
clés

:
RISQUE
;
GRIPPE
;
EPIDEMIE
;
SURVEILLANCE
;
TRANSMISSION
;
USAGER
;
PERSONNEL
;

ETUDE PROSPECTIVE
;
INFECTION COMMUNAUTAIRE
;
CENTRE HOSPITALIER UNIVERSITAIRE


B
ackground
: The person
-
to
-
person transmission of influenza
-
like illness (
ILI
) and influenza has been
described mostly in long
-
term care units. Studies in acute hospital settings are rare and mostly retrospective.

M
ethods
: We prospectively estimated the relative risk (RR) of hospital
-
acquired (HA)
ILI during
hospitalization ac
cording to in
-
hospital exposures to contagious individuals. Surveillance of ILI and
laboratory
-
confirmed influenza was undertaken at
Edouard
Herriot
Hospital (1100 beds) during 3 influenza
seasons. A total of 21 519 patients

and 2153 health care workers (HCWs) from 2004 to 2007 were included.
The RR of HA
-
ILI in patients was calculated according to exposure to other contagious patients and HCWs.

R
esults
: For patients exposed to at least 1 contagious HCW compared with those wi
th no documented
exposure in the hospital, the RR of HA
-
ILI was 5.48 (95% confidence interval [CI], 2.09
-
14.37); for patients
exposed to at least 1 contagious patient, the RR was 17.96 (95% CI, 10.07
-
32.03); and for patients exposed
to at least 1 contagiou
s patient and 1 contagious HCW, the RR was 34.75 (95% CI, 17.70
-
68.25).

C
onclusions
: Hospitalized patients exposed to potentially infectious patients and HCWs with
ILI inside the
hospital are at greater risk for HA
-
ILI. Such results identify prioritie
s regarding preventive measures for
seasonal or pandemic influenza.



Hémodialyse


NosoBase n° 29813

Prévalence, persistance et microbiologie de la colonisation

nasale à
Staphylococcus aureus

parmi
des patients

d'hémodialyse en ambulatoire dans un grand ce
ntre

hospitalier de New York


A
lexander

EL; M
organ
DJ; K
esh
S; W
eisenberg
SA; Z
aleskas
JM; K
altsas

A;
et al.
Prevalence, persistence,
and microbiology of
Staphylococcus

aureus

nasal carriage among hemodialysis outpatients at a

major New
York hospital
.
Diagnostic microbiology and infectious disease

2011
;
in press
:

8 pages
.


Mots
-
clés

:
PREVALENCE;
STAPHYLOCOCCUS AUREUS
; MICROBIOLOGIE;

COLONISATION NASALE;
HEMODIALYSE; AMBULATOIRE;

SURVEILLANCE; FACTEUR DE RISQUE; VANCOMYCINE;
DAPTOMYCINE


The study aimed to determine the natural history of

Staphylococcus aureus

nasal colonization in
hemodialysis

outpatients. Surveillance cultures were taken from patients

presenting for hemodialysis or
routine care to identify
S.

aureus

nasal carriers. A pro
spective cohort study was

performed to identify risks
for persistent colonization.

Detailed microbiologic and molecular studies of colonizing

isolates were
performed. Only 23/145 (15.9%) dialysis

patients were persistently colonized, and only HIV
-
positive

status
was associated with persistence (P = 0.05). Prior

hospitalization was the only risk factor for

methicillin
-
resistant
S. aureus

carriage (OR 2.5, P =

0.03). In isolates from patients with =42 days of

vancomycin
exposure, vancomycin minimum bactericid
al

concentrations (MBCs) increased with duration of exposure.

Among dialysis patients,
S. aureus

colonization was limited

and transient; only HIV status was associated
with

persistence. Nevertheless, duration of vancomycin exposure

was associated with incr
easing
vancomycin MBCs. Vancomycin

exposure in
S. aureus

carriers may be involved in

increasing resistance.




Noso
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Bulletin de veille

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-
Est


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-
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NosoBase n° 29940

Gestion des bactériémies à Cocci à Gram positif et hémodialyse


F
itzgibbons

LN; P
uls
DL; M
ackay
K; F
orrest
GN
.
Management of gram
-
positive coccal bacteremia and

H
emodialysis
.

American journal of kidney diseases

2011
;
in press:

17 pages
.


Mots
-
clés :
BACTERIEMIE; HEMODIALYSE; COCCI GRAM POSITIF; CATHETER; ANTIBIOTIQUE;

STAPHYLOCOCCUS AUREUS
; STAPHYLOCOQUE A COAG
ULASE NEGATIVE
;
ENTEROCOCCUS
;

PREVENTION
;
DIAGNOSTIC
;
BIOLOGIE MOLECULAIRE
;
TRAITEMENT
;
BIBLIOGRAPHIE


Gram
-
positive cocci are the most common cause of

bloodstream infections in hemodialysis patients, with

Staphylococcus aureus

and coagulase
-
negative staph
ylococci

causing most infections. Management of
these infections

often is complicated by limited vascular access options, as

well as an increasing prevalence
of drug
-
resistant bacteria

in hemodialysis centers, including the emergence of strains

of methicil
lin
-
resistant
S aureus with vancomycin

heteroresistance and increasing rates of

vancomycin
-
resistant enterococci, both
of which have

limited antibiotic treatment options. This article

describes the management of these infections
based on the

organism and its susceptibility profile, including catheter

management, antibiotic lock
therapies, and systemic

antibiotic choices. Although coagulase
-
negative

staphylococci bacteremia often
may be managed with

preservation of the catheter, antibiotic lock

therapy, and

intravenous antibiotics, this is
rarely the case with
S

aureus
bacteremia because of frequent relapse and the risk

of complications,
including endocarditis. Enterococcal

bacteremia requires more individualization of care, but

catheters are
le
ss likely to be salvaged, especially when

vancomycin
-
resistant Enterococcus is the causative

organism.
Finally, strong infection control policies in the

hemodialysis unit, conversion from catheter to

arteriovenous
access when possible, and appropriate use
of

antibiotics are essential factors in the prevention of

these
bloodstream infections.




NosoBase n° 29718

Prévention des infections en hémodialyse

: résumé du guide d’élimination de l’A
PIC


R
ebmann

T; B
arnes

SA
.
Preventing infections in hemodialysis: an executive summary

of the APIC
e
limination guide
.
American journal of infection control

2011/02
;
39
(
1
)
:

72
-
75
.


Mots
-
clés

:
PREVENTION; HEMODIALYSE
; EPIDEMIOL
OGIE; SURVEILLANCE; RISQUE;
TRANSMISSION; HYGIENE DES MAINS; ENVIRONNEMENT; EAU; PERSONNEL; CATHETER


This article is an executive summary of the APIC Hemodialysis Infection Elimination Guide.
Infecti
on
preventionists are encouraged to obtain the original, full
-
length APIC Elimination Guide for more thorough
coverage of hemodialysis infection prevention.



Hépatite


NosoBase n° 29744

Enquête phylogénétique de la transmission nosocomiale du

virus de l'h
épatite C dans un service
d'oncologie


D
encs
A; H
ettmann
A; M
artyin
T; J
ekkel
C; B
anyai
T; T
akacs

M
.
Phylogenetic investigation of nosocomial
transmission of

hepatitis C virus in an oncology ward
.
Journal of medical virology

2011/03
;
83(3
)
:

428
-
436
.


Mots
-
clés :
ENQUETE; TRANSMISSION; VIRUS; HEPATITE C; CANCEROLOGIE;

PCR; IDENTIFICATION



NosoBase n° 29785

Evaluation de l'observance du protocole destiné à la

prévention de l'hépatite B p
érinatale en Italie


S
pada

E; T
osti

ME; Z
uccaro
O; S
troffolini

T; M
ele
A
.
Evaluation of the compliance with the protocol for

preventing perinatal hepatitis B infection in
Italy
.
Journal of infection

2011
;
(
62
)
:

165
-
171
.


Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


18

/
29


Mots
-
clés

:
OBSE
RVANCE; PROTOCOLE; DEPISTAGE; PREVENTION; VIRUS;

HEPATITE B;
ACCOUCHEMENT; OBSTETRIQUE; GROSSESSE;

PREVALENCE; VACCIN


O
bjective
: To evaluate the compliance with the protocol for

preventing perinatal hepatitis B infection in
Italy,

including HBsAg screening of pregnant women and

immunization of newborns to infected mothers.

M
ethods
: Women consecutively delivering, over 6 months in

2008
-
2009, in public and private hospitals of 13
Italian

regions were re
cruited. Data on socio
-
demographic

characteristics, HBsAg prenatal screening and
newborns

immunization were collected.

R
esults
: 17,260 pregnant women were enrolled. Of them

16,858 (97.7%) attended prenatal screening.
Delivering in a

public hospital and in
hospitals located in
South Italy

were both independent predictors of
non
-
adherence to HBsAg

screening. Foreign pregnant women were also less likely to

be screened. Overall,
HBsAg prevalence was 0.86%; it was

0.4% for Italian women and 2.5% for foreign

women.

Differences in
prevalence by country of origin and

education were statistically significant. Of 138 newborns

from HBsAg
positive mothers 131 received passive/active

immunization; 7 newborns received just vaccine.


C
onclusion
: In this study complian
ce with the protocol for

preventing perinatal hepatitis B was very good.
Further

efforts are needed to improve adherence to prenatal

screening in public hospitals, in hospital located
in

southern
Italy and among foreign women. HBV spread

in
Italy

is progressively declining, also involving
immigrant

population.



NosoBase n° 29823

Incidence et voies de transmission de l’hépatite C aigu
ë

aux Etats
-
Unis, 1982
-
2006


W
illiams

IT;
B
ell
BP; K
uhnertw
; A
lter

MJ
.
Incidence and transmission patterns of acute hepatitis C in

the
United States, 1982
-
2006
.
Archives of internal medicine

2011/02/14
;
171(3
)
:

242
-
248
.


Mots
-
clés :
INCIDENCE; TRANSMISSION; HEPATITE C
; SURVEILLANCE; INFECTION
COMMUNAUTAIRE; FACTEUR DE RISQUE; TRANSFUSION; EXPOSITION AU SANG; PERSONNEL;
RISQUE PROFESSIONNEL


B
ackground
: Monitoring disease incidence and transmission

patterns is important to characterize

groups at
risk for

hepatitis C virus (HCV) infection. Clinical cases generally

represent about 20% to 30% of all newly
acquired

infections.

M
ethods
: We used sentinel surveillance to determine

incidence and transmission patterns for acute hepatitis
C

in th
e
United States using data from 25 years of

population
-
based surveillance in the general community.

Acute cases of hepatitis C were identified from 1982

through 2006 by a stimulated passive surveillance
system in

4 to 6
US counties. Cases were defined by a discrete onset

of symptoms, alanine
aminotransferase (ALT) levels greater

than 2.5 times the upper limit of normal (.ULN), negative

findings for
serologic markers for acute hepatitis A and B,

and positive findings for

antibody to HCV or HCV RNA.

Incidence and frequency of reported risk factors were the

main outcome measures.

R
esults
: Of 2075 patients identified, the median age was 31

years, 91.5% had ALT values greater than 7 .
ULN, 77.3%

were jaundiced, 22.5% were hos
pitalized, and 1.2% died.

Incidence averaged 7.4 per 100 000
individuals (95%

confidence interval [CI], 6.4
-
8.5 per 100 000) during 1982

to 1989 then declined averaging
0.7 per 100 000 (95% CI,

0.5
-
1.0 per 100 000) during 1994 to 2006. Among 1748

patients interviewed
(84.2%), injection drug use (IDU) was

the most commonly reported risk factor. The average number

of IDU
-
related cases declined paralleling the decline in

incidence, but the proportion of IDU
-
related cases rose

from
31.8% (402 of 1266)
during 1982 to 1989 to 45.6% (103

of 226) during 1994 to 2006. Among IDU
-
related
cases

reported during 1994 to 2006, 56 of 61 individuals (91.8%)

had been in a drug treatment program
and/or incarcerated.

C
onclusions
: The incidence of acute HCV declined

sub
stantially over the 25 years of population
-
based

surveillance. Despite declines, IDU is the most common risk

factor for new HCV infection.



Hygiène des mains


NosoBase n° 29707

Etude prospective multicentrique destinée à évaluer la

tolérance cutané
e des

t
echniques standard
pour l'hygiène

des mains


Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


19

/
29


C
hamorey
E; M
arcy
PY; D
andine
M; V
eyres
P; N
egrin
N;

V
andenbos

F;
et al.
A prospective multicenter
study evaluating skin tolerance

to standard hand hygiene techniques
.
American journal of infection control

2011/02
;
39
(
1
)
:

6
-
13
.


Mots
-
clés

:
ETUDE PROSPECTIVE; PERSONNEL; MAIN; DERMATOLOGIE; PRODUIT

DE FRICTION
POUR LES MAINS; SAVON DOUX; TOLERANCE; FACTEUR

DE RISQUE; LAVAGE SIMPLE DES
MAINS; TRAITEMENT HYGIENIQUE

DES MAINS PAR FRICTION


We performed a prospective multicenter study to assess the

dryness and irritation of the hands in health
care

facilities, and to evaluate whether that disinfection with

an alcohol
-
based hand rub (ABHR) is better
tolerated than

classic handwashing with mild

soap and water. Our study was

conducted in 9 sites in the
summer and winter. A team of

investigators evaluated dryness and irritation. This study

takes into account
most of the individual and environmental

risk factors (age, sex, use of a protective agent
,

constitutional
factors, personal factors, external factors,

institution, function, and number of consecutive working

days).
The results from the 1932 assessments collected show

that traditional handwashing is a risk factor for
dryness

and irritation, whe
reas the use of ABHR causes no skin

deterioration and might have a protective
effect,

particularly in intensive use. These results provide a

strong argument to counter the rear
-
guard
resistance to the

use of ABHRs.



NosoBase n° 29708

Etude de la durabilité de l'adhésion à l'hygiène des mains

avant le contact avec le patient dans le
service des

urgences : évaluation un an après l'intervention


Di
M
artino

P; B
an

KM; B
artoloni

A; F
owler

KE; S
aint
S;

M
annelli
F
.
Assessing the sustainability of hand
hygiene adherence

prior to patient contact in the emergency department: a

1
-
year postintervention
evaluation
.
American journal of infection control

2011/02
;
39(1
)
:

14
-
18
.


Mots
-
clés

:
OBSERVANCE; HYG
IENE DES MAINS; URGENCE; EVALUATION;

QUALITE; SECURITE;
MEDECIN; INFIRMIER; PERSONNEL


B
ackground
: Health care
-
associated infection is one of the

most important patient safety problems in the
world. While

many methods exist to prevent health care
-
associate
d

infection, most experts believe that
improving hand hygiene

is paramount. We previously published the results of a

successful before
-
and
-
after
hand hygiene interventional

study performed in the pediatric emergency department of

the
Meyer
Hospital in
Florence,
Italy. The goal of the

current study is to assess the longer term sustainability

of the previously
described intervention.

M
ethods
: Direct observation was used to assess hand hygiene

compliance for both

doctors and nurses in
the emergency

department using the same methods and observers as

previously employed.

R
esults
: In addition to the 420 preintervention and 463

immediately postintervention observations previously

reported, we observed another 456 clin
ician
-
patient

interactions approximately 1 year after the intervention.

Among all health care workers, there was no significant

difference between hand hygiene compliance
immediately

postintervention (44.9%) compared with 1 year after the

intervention (45.
2%). Adherence
among nurses, however,

increased from 40.7% to 49.8% (P = .03), whereas adherence

among doctors
decreased from 50.5% to 36.5% (P = .008).

C
onclusion
: The overall effects of the intervention were

sustained over a 1
-
year period, although a mar
ked

difference was observed between nurses and doctors.



NosoBase n° 29706

La déviance positive : un programme pour une amélioration

soutenue de l'observance de l'hygiène
des mains


M
arra
AR; G
uastelli

LR; P
ereira
de
A
raujo
CM; S
araiva
D
os
S
antos

JL; F
ilho

MA; V
illa
S
ilva
C;
et al.

Positive deviance: a program for sustained improvement in

hand hygiene compliance
.
American journal of
infection control

2011/02
;
39
(
1
)
:

1
-
5
.


Mots
-
clés

:
HYGIENE DES MAINS; OBSERVANCE; INCIDENCE; EPIDEMIOLOGIE;

PRODUIT DE
FRICTION POUR LES MAINS; GEL HYDROALCOOLIQUE;

PERSONNEL; SOIN INTENSIF


Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


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-
lyon.fr


20

/
29


B
ackground
: There is a paucity of data evaluating whether

positive deviance (PD) can sustain improvement
in hand

hyg
iene compliance.

Methods: An observational study comparing the effect of PD

on compliance with hand hygiene was
conducted in two 20
-
bed

stepdown units (SDUs) at a private tertiary care hospital.

In a 3
-
month baseline
period (April
-
June 2008), hand

hygiene
counts were performed by electronic handwashing

counters.
Between July 1, 2008, and November 30, 2009,

(East SDU) and between September 30, 2008, and
December

2009 (
West SDU), PD was applied in both units.

Results: There was more than a 2
-
fold differe
nce in the

number of alcohol gel aliquots dispensed per month
from

April 2008 (before PD) to November 2009 (last month in PD)

in the
East SDU. There was also a 2
-
fold
difference in the

number of alcohol gel aliquots dispensed per month from

September 2008 (before PD) to
December 2009 (last month in

PD) in theWest SDU. The difference in the rate of health

care
-
associated
infections (HAIs) between the baseline

period and 2009 was statistically significant in the East

SDU (5.8 vs
2.8 per 1,000 d
evice
-
days; P = .008) and in the

West SDU (3.7 vs 1.7 per 1,000 device
-
days; P = .023).

Conclusions: PD was responsible for a sustained improvement

in hand hygiene in the inpatient setting and
was associated

with a decrease in the incidence of device
-
associated HAIs.



NosoBase n° 29709

Opportunités pour l'hygiène des mains à l'hôpital : où et

quand (HOW2) ? Etude de comparaison de
performances HOW2



Steed C; Keely JW; Blackhurst D; Boeker S; Diller T; Alper P;
et al.
Hospital hand hygiene opportunities:
where and when (HOW2)?

The HOW2 benchmark study
.
American journal of infection control 2011/02;

39(1): 19
-
26.


Mots
-
clés

: HYGIENE DES MAINS; SOIN INTENSIF; MEDECINE GENERALE; URGENCE; CENTRE
HOSPITALIER UNIVERSITAIRE; CENTRE HOSPITALIER GENERAL; METHODOLOGIE; OBSERVANCE


Background: Measurement and monitoring of health care

workers. hand hygiene compliance (ie,

actions/oppo
rtunities) is a key component of strategies to

eliminate hospital
-
acquired infections. Little data
exist

on the expected number of hand hygiene opportunities (HHOs)

in various hospital settings, however.
The purpose of this

study was to estimate HHOs in 2
types of hospitals
-
large

teaching and small community
-
and 3 different clinical

areas
-
medical
-
surgical intensive care units, general

medical wards, and emergency
departments.

Methods: HHO data were collected through direct

observations using the World Healt
h Organization.s

monitoring methodology. Estimates of HHOs were developed

for 12
-
hour AM/PM shifts and 24
-
hour time
frames.

Results: During 436.7 hours of observation, 6,640 HHOs were

identified. Estimates of HHOs ranged from 30
to 179 per

patient
-
day on i
npatient wards and from 1.84 to 5.03 per

bed
-
hour in emergency departments.
Significant differences

in HHOs were found between the 2 hospital types and among

the 3 clinical areas.

Conclusion: This study is the first to use the World Health

Organization.s d
ata collection methodology to
estimate HHOs

in general medical wards and emergency departments. These

data can be used as
denominator estimates to calculate hand

hygiene compliance rates when product utilization data are

available.



Infection urinaire


No
soBase n° 29818

Infections urinaires


C
henoweth
CE
.
Urinary tract infections
.
Infectious disease clinics of n
orth America

2011/03
;
25(1
)
:

103
-
115
.


Mots
-
clés :
INFECTION URINAIRE; PREVENTION; CATHETER; BIBLIOGRAPHIE;

EPI
DEMIOLOGIE;
FACTEUR DE RISQUE; DIAGNOSTIC; SURVEILLANCE;

SONDAGE URINAIRE; CATHETER IMPREGNE


Health care
-
associated urinary tract infections (UTI)

account for up to 40% of infections in hospitals and 23%
of

infections in the intensive care unit (ICU). Mos
t UTIs

develop in patients with indwelling urinary catheters.

Urinary catheters interfere with normal host immune

defenses and allow formation of biofilm, which enables

Noso
Veille


Bulletin de veille

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-
Est


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-
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29


bacterial

colonization and affects the specific etiologic organisms

found in catheter
-
a
ssociated UTI (CAUTI).
These factors

have important implications for prevention of UTI in the

catheterized patient.



Maternité


NosoBase n° 29910

Antisepsie de la peau saine pour la mise en place des

cathéters vasculaires, la ré
alisation d'actes
chirurgicaux

et les soin
s du cordon chez le nouveau
-
né â
gé de moins de

trente jours et le prématuré


Société Française d
'H
ygi
è
ne

H
ospitali
è
re
.

2011/01
;
1
-
6
.


Mots
-
clés

:
ANTISEPTIQUE
;
PEAU
;
NOUVEAU
-
NE
;
PREMATURE
;
CATHETER
;
SOIN CUTANE
;

CHIRURGIE
;
PRATIQUE
;
SFHH



Pédiatrie


NosoBase n° 29602

Infections chez des enfants sous assistance circulatoire


T
se
-
C
hang

A; M
idodzi

W;
J
offe

AR; R
obinson
JL
.
Infections in children receiving extracorporeal life

S
upport
.
Infection control and hospital epidemiology

2011/02
;
32(2
)
:

115
-
120
.


Mots
-
clés

:
PEDIATRIE; INFECTION; FACTEUR DE RISQUE; ETUDE

RETROSPECTIVE; BACTERIEMIE;
TAUX
; SOIN INTENSIF; CARDIOLOGIE


Objective
:

To describe risk factors for and the outcome of

infections in children receiving extracorporeal life

support (ECLS) and to determine the need for removal of

foreign bodies with bloodstream infections (BSIs)
in

children receiving ECLS.

Design
:

Retrospective cohort

study.

Setting:
Tertiary care children.
s hospital.

Patients:

Children receiving ECLS from May 1997 through May

2007.

Methods:

For patients with documented infections,

medical records were examined for demographic,
clinical,

and laboratory details. Patients with and without

documented infection
s were compared with regard
to

demographic characteristics and ECLS course.

Results
:

One

hundred seventeen patients underwent ECLS for a total of

878 days (median, 5.12 days).
Thirty
-
five patients (29.9%)

developed 55 infections, including 21 BSIs (38.2%),

20

urinary tract infections
(36.4%), 6 ventilator
-
associated

pneumonia episodes (10.9%), 2 viral infections (3.6%), and

6 miscellaneous
infections (10.9%). The rates (in cases per

1,000 ECLS
-
days) were 23.9 for BSI, 22.8 for urinary tract

infection, and 6
.8 for ventilator
-
associated pneumonia.

There were no significant differences in the
demographic

characteristics, indications for ECLS, or ECLS course

between infected and uninfected
patients, except for the

median duration of ECLS (10.1 vs 3.8 days; ). On
e death was

attributed to infection.
Resolution of BSI occurred without

removal of foreign bodies in 18 (85.7%) of 21 children.


Conclusions
:

Longer duration of ECLS was the only

identified risk factor for infection. Mortality was not

statistically significantly different between infected and

uninfected patients. Most BSIs that occurred during
ECLS

cleared without removal of foreign bodies.



Personnel


NosoBase n° 29761

Surveillance des accidents avec exposition au sang dans les

é
tablissements de santé français en
2009
-

Résultats


INVS; GERES; RAISIN
.
2011
;
1
-
87
.


Mots
-
clés

:
SURVEILLANCE
;
EXPOSITION AU SANG
;
PREVENTION
;
DIAGNOSTIC SEROLOGIQUE
;

INCIDENCE
;
CHIMIOPROPHYLAXIE
;
RISQUE PROFESSIONNEL
;
METHODOLOGIE

Noso
Veille


Bulletin de veille

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-
Est


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-
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29



Sous l'égide du Ré
seau d'alerte, d'investigation et de surveillance des infections nosocomiales et avec le
Groupe d'étude sur le risque d'exposition des soignants aux agents infectieux, les méthodes de surveillance
des accidents exposant au sang (AES) font l'objet d'un cons
ensus et d'un réseau national depuis 2002. Tout
AES déclaré au médecin du travail du 1er janvier 2008 au 31 décembre 2008 est documenté de manière
volontaire, anonyme et standardisée. En 2008, 16 282 AES ont été recensés dont 65 % notifiés par les
personne
ls paramédicaux et 80,6 % sont des accidents percutanés essentiellement par piqûre.
L'observance du port du gant (67,8 %) et la proximité du collecteur (70,9 %) s'améliorent. Cependant, le
respect des précautions standard a fait défaut dans 45,8 % des AES
percutanés, responsable d'un nombre
encore élevé d'accidents évitables. La connaissance du statut du patient source demeure dans 20 % des
cas inconnue. La prescription de la chimioprophylaxie antirétrovirale diminue (3,4 % en 2008 versus 6,3 %
en 2002). La

couverture nationale du réseau en 2008 (25,6 % des établissements de santé et 50,7 % des
lits) augmente. L'incidence est de 7,4 AES pour 100 lits d'hospitalisation. Sur la base des 434 809 lits
d'hospitalisation recensés en France, 32 176 AES auraient été

déclarés en 2008 aux médecins du travail
des établissements de santé français. En mettant en perspective ces résultats avec ceux de 2004
(incidence de 8,9 et 41 429 AES estimés
), cela représente une baisse d’
environ 9 250 AES. Même si
l'estimation est emp
irique, cela laisse penser que des progrès importants en termes de sécurité des soins
ont été consentis. Poursuivre et accentuer cette dynamique est l'objectif du Programme national de
prévention des infections nosocomiales 2009
-
2013.



NosoBase n° 29716

Relation entre la surface de la main et la contamination de

la main


Ren S; Ni

X; Xu H; Den J; Wang Y; Sun J;
et al.
The relationship between hand area and hand
c
ontamination
.
American journal of infection control

2011/02
;
39(1
)
:

66
-
68
.


Mots
-
clés

:
CONTAMINATION;
MAIN; PERSONNEL; CENTRE HOSPITALIER REGIONAL


Although the number of colony
-
forming units (CFUs) on the

hands of health care workers (HCWs) is a
critical

measurem
ent in research studies of hand contamination, few

studies have investigated the
c
orrelation between hand area

and CFU count. In the present study, we calculated the area

and measured
the numbers of CFU on the right hand of 197

HCWs. Our data indicate that

close relationship between

hand
area and CFU count.



Prévention


NosoBase n° 29826







Fiche technique n°8
-

Mesures pour la prévention de la

diffusion du virus varicelle
-
zona dans les
établissements

de santé


CCLIN Paris
-
N
ord
2011/01
:
2 pages
.


Mots
-
clés

:
VARICELLE
; PREVENTION;
ZONA; HERPES ZOSTER VIRUS



NosoBase n° 29817

Construire un programme de prévention des infections réussi

: composants clé, processus et
économie


C
ook
E; M
archaim
D;
K
aye
KS
.
Building a successful infection prevention program: key

components,
processes, and economics
.
Infectious disease clinics of n
orth America

2011/03
;
25(1
)
:

1
-
19
.


Mots
-
clés

:
PREVENTION; BIBLIOGRAPHIE; COUT; EPIDEMIOLOGI
E; PERSONNEL;

MEDECIN
HYGIENISTE; SURVEILLANCE; ENQUETE


Infection control is the discipline responsible for

preventing nosocomial infections. There has been an

increasing focus on prevention rather than control of

hospital
-
acquired infections. Individuals

working in

infection control have seen their titles change from

infection control practitioner to infection control

Noso
Veille


Bulletin de veille

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-
Est


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-
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professional and most recently to infection preventionist

(IP), emphasizing their critical role in protecting

patients. The responsibil
ities of IPs span multiple

disciplines including medicine, surgery, nursing,

occupational health, microbiology, pharmacy, sterilization

and disinfection, emergency medicine, and
information

technology. This article discusses the structure and

responsibilit
ies of an infection control
program and the

regulatory pressures and opportunities the program faces.




Réanimation


NosoBase n° 29743





Analyse de séries d'espaces de temps distribués versus une

analyse de corrélation linéaire
(Pearson's r) dans la

relation entre la consommation d'antibiotiques

anti
-
Pseudomonas
et la
résistance d'isolats de
Pseudomonas aeruginosa

dans une seule unité de réanimation d'un centre

hospitalier universitaire


Erdeljic V; Francetic I; Bosnjak Z; Budimir A; Kalenic S; Bielen L;
et al.
Distributed lags time series analysis
versus linear

correlation analysis (Pearson's r) in identifying the

relationship between antipseudomonal
antibiotic consumption

and the suscept
ibility of
Pseudomonas aeruginosa

isolates

in a single intensive care
unit of a tertiary hospital
.
The Journal of infection 2011; in press: 5 pages.


Mots
-
clés

:
PSEUDOMONAS AERUGINOSA
; SOIN INTENSIF; ANALYSE; STATISTIQUE; ANTIBIOTIQUE;
CONSOMMATION; CENTR
E HOSPITALIER UNIVERSITAIRE; ETUDE RETROSPECTIVE; TAUX;
CIPROFLOXACINE; MEROPENEME; CEFEPIME


The relationship between antibiotic consumption and

selection of resistant strains has been studied mainly
by

employing conventional statistical methods. A time d
elay in

effect must be anticipated and this has rarely
been taken

into account in previous studies. Therefore, distributed

lags time series analysis and simple
linear correlation

were compared in their ability to evaluate this

relationship. Data on monthly antibiotic
consumption for

ciprofloxacin, piperacillin/tazobactam, carbapenems and

cefepime as well as
Pseudomonas

aeruginosa
susceptibility

were retrospectively collected for the period April 2006 to

July 2007. Using
distribu
ted lags analysis, a significant

temporal relationship was identified between ciprofloxacin,

meropenem and cefepime consumption and the resistance rates

of P. aeruginosa isolates to these
antibiotics. This effect

was lagged for ciprofloxacin and cefepime [
1 month

(R=0.827, P=0.039) and 2
months (R=0.962, P=0.001),

respectively] and was simultaneous for meropenem (lag 0,

R=0.876, P=0.002).
Furthermore, a significant concomitant

effect of meropenem consumption on the appearance of

multidrug
-
resistant P. aerug
inosa strains (resistant to

three or more representatives of classes of antibiotics)

was
identified (lag 0, R=0.992, P<0.001). This effect was

not delayed and it was therefore identified both by

distributed lags analysis and the Pearson's correlation

coeff
icient. Correlation coefficient analysis was not
able

to identify relationships between antibiotic consumption

and bacterial resistance when the effect was
delayed. These

results indicate that the use of diverse statistical

methods can yield significantly
different
results, thus

leading to the introduction of possibly inappropriate

infection control measures.



NosoBase n° 29791

Epidémiologie, pronostic et complications infectieuses

nosocomiales des pancréatites aiguës
graves en réanimation

: étude prospective multicentrique à partir de la base de

données CClin Sud
-
Est


J
ung
B; C
arr
J; C
hanques
G; C
isse

M; P
errigault

PF; S
avey
A;
et al.
Severe and acute pancreatitis admitted
in intens
ive care: a

prospective epidemiological multiple centre study using

CClin network database
.
Annales françaises d'anesthésie et de réanimation

2011
;
in press
:

8 pages
.


Mots
-
clés

:
EPIDEMIOLOGIE; SOIN INTENSIF; PANCREAS; ANALYSE

MULTICENTRIQUE;
VENTILATION; CCLIN; INCIDENCE; VENTILATION

ASSISTEE; PNEUMONIE; BACTERIEMIE;
INFECTION URINAIRE;

MORTALITE; CATHETER VEINEUX CENTRAL


Objectifs : Décrire les caractéristiques épidémiologiques,

l

incidence de survenue des infections
nosocomi
ales

extra
-
abdominales et le devenir des patients hospitalisés

en

réanimation pour pancréatite
aiguë grave.

Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


24

/
29


Type d

étude : Analyse rétrospective de données acquises

prospectivement, observationnelle,
multicentrique (65

centres).

Patients et méthode : Penda
nt une durée de deux ans, tous

les patients traités admis consécutivement en
réanimation

pour pancréatite aiguë grave dans les unités participant au

recueil des infections nosocomiales
du réseau CClin Sud
-
Est

ont été inclus. Les patients, dont la durée de
séjour était

inférieure à 48 heures,
n’
étaient pas inclus. Les

caractéristiques démographiques, les infections

nosocomiales extra
-
abdominales
et le devenir des patients

ont été décrits.

Résultats : Pendant la durée de l

étude, 510 patients ont

été inclus r
eprésentant 2 % des patients séjournant
plus de

48 heures en réanimation dans les 65 services participant à

l
’étude. Le taux d’
attaque global des
infections

nosocomiales extra
-
abdominales (pneumonie, bactériémie,

infections urinaires ou liés aux
cathéters)


était de 23 % chez l

ensemble des patients et de 33 % chez

les 294 patients intubés. La mortalité
en réanimation était

de 20 % chez l

ensemble des patients et de 34 % chez les

patients ayant été intubés.

Conclusion : La pancréatite aiguë grave représente

2 % des

séjours supérieurs ou égaux à 48 heures en
réanimation. Il

s

agit d

une pathologie grave, fréquemment associée à la

survenue d

infections nosocomiales
et à une mortalité

élevée. Cette étude observationnelle décrivant

l’
épidé
miologie des infections

n
osocomiales extra

pancréatiques pourrait être utilisée pour réaliser des

calculs d

effectifs avant la
réalisation d

étude

multicentrique interventionnelle.



NosoB
ase n° 29748

Développement et mise en place d'un projet d'amélioration

des performances dans des unités de
réanimation pour

adultes. Vue d'ensemble de l'étude sur l'amélioration des

traitements des
pneumonies nosocomiales en réanimation

intitulée "Improvin
g medicine through pathway
assessment of

critical therapy in hospital
-
acquired pneumonia

(IMPACT
-
HAP)"


M
angino

JE; P
eyrani

P; F
ord
KD; K
ett

DH; Z
ervos
MJ; W
elch
VL;
et al.
Development and implementation of
a performance improvement

project in adult intensive care units: overview of the

improving medicine through
pathway assessment of critical

therapy in hospital
-
acquired pneumonia (IMPACT
-
HAP) study
.
Critical care

2011
;
in press
:

36 pages
.


Mots
-
clés

:
SOIN INTENSIF; QUALITE; TRAITEM
ENT; PNEUMONIE; AGE;

INDICATEUR;
RECOMMANDATION; FORMATION; OBSERVANCE;

ANTIBIOTIQUE; FACTEUR DE RISQUE;
PRESCRIPTION


I
ntroduction
: The American Thoracic Society and Infectious

Diseases Society of America (ATS/IDSA)
published guidelines

for managing hospital
-
acquired pneumonia (HAP),

ventilator
-
associated pneumonia
(VAP), and

healthcare
-
associated pneumonia (HCAP) in 2005. Although

recommendations were evidence
based, collective guidelines

had not been validated in clinical practice and d
id not

provide specific tools for
local implementation. We

initiated a performance improvement project designated

Improving Medicine
Through Pathway Assessment of Critical

Therapy in Hospital
-
Acquired Pneumonia (IMPACT
-
HAP) at four

academic centers in the
United States. Our objectives were

to develop and implement the project, and to
assess

compliance with quality indicators in adults admitted to

intensive care units (ICUs) with HAP, VAP, or
HCAP.

M
ethods
: The project was conducted in three phases over 18

c
onsecutive months beginning February 1,
2006: 1) a 3
-
month

planning period for literature review to create the

consensus pathway for managing
nosocomial pneumonia in

these ICUs, data collection form, quality performance

indicators, and internet
-
based repos
itory; 2) a 6
-
month

implementation period for customizing ATS/IDSA guidelines

into center
-
specific guidelines via educational forums; and

3) a 9 month post
-
implementation period for continuing

education and data collection. Data from the first two

phases w
ere combined (pre
-
implementation period)
and

compared with data from the post
-
implementation period.

R
esults
: We developed a consensus pathway based on ATS/IDSA

guidelines and customized it at the local
level to

accommodate formulary and microbiologic cons
iderations. We

implemented multimodal educational
activities to teach ICU

staff about the guidelines and continued education

throughout post
-
implementation.
We registered 432 patients

(pre
-

vs post
-
implementation, 274 vs 158).
Diagnostic

criteria for nosoc
omial
pneumonia were more likely to be

met during post
-
implementation (247/257 [96.1%] vs 150/151

[99.3%]; P
= 0.06). Similarly, empiric antibiotics were

more likely to be compliant with ATS/IDSA guidelines during

post
-
implementation (79/257 [
30.7%] vs 66/151 [43.7%]; P =

0.01), an effect that was sustained over quarterly

intervals (P = 0.0008). Between
-
period differences in

compliance with obtaining cultures and use of de
-
escalation

were not statistically significant.

Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


25

/
29


C
onclusions
: Developing a

multi
-
center performance

improvement project to operationalize ATS/IDSA
guidelines

for HAP, VAP, and HCAP is feasible with local consensus

pathway directives for implementation
and with quality

indicators for monitoring compliance with guidelines.




NosoBase n° 29689

Intervention multidirectionnelle pour l'amélioration de la qualité dans un réseau d'unités de
réanimation. Essai randomisé


S
cales
DC
;
D
ainty
K
;
H
ales

B
;
P
into
R
;
F
owler

RA
;
A
dhikari
NK
;
et al.
A multifaceted intervention for quality
improvement in a network of intensive care units.
A cluster randomized trial
.

JAMA

2011/01/26; 4
(
305
):
363
-
372
.


Mots
-
clés

:
SOIN INTENSIF
;
QUALITE
;
RESEAU
;
RANDOMISATION
;
EFFICACITE
;
CENTRE
HOSPI
TALIER GENERAL
;
PRATIQUE
;
PREVENTION
;
PNEUMONIE
;
CATHETER
;
BACTERIEMIE
;

ALIMENTATION ENTERALE
;
ULCER;
FORMATION
;
INFORMATION


C
ontext
: Evidence
-
b
ased practices improve intensive care unit (ICU) outcomes, but eligible patients may not
receive them. Community hospitals treat most critically ill patients but may have few resources dedicated to
quality improvement.

O
bjective
: To determine the effective
ness of a multicenter quality improvement program to increase delivery
of 6 evidence
-
based ICU practices.

Design:

SETTING, AND PARTICIPANTS: Pragmatic cluster
-
randomized trial among 15 community hospital
ICUs in
Ontario,
Canada. A to
tal of 9269 admissions occurred during the trial (November 2005 to October
2006) and 7141 admissions during a decay
-
monitoring period (December 2006 to August 2007).

I
ntervention
: We implemented a videoconference
-
based forum including audit and feedback, e
xpert
-
led
educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. We
randomized ICUs into 2 groups. Each group received this intervention, targeting a new practice every 4
months, while acting as control for t
he other group, in which a different practice was targeted in the same
period. MAIN MEASURE OUTCOMES: The primary outcome was the summary ratio of odds ratios (ORs)
for improvement in adoption (determined by daily data collection) of all 6 practices during

the trial in
intervention vs control ICUs.

R
esults
: Overall, adoption of the targeted practices was greater in intervention ICUs than in controls
(summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00
-
7.74). Improved delivery in intervention
ICUs

was greatest for semirecumbent positioning to prevent ventilator
-
associated pneumonia (90.0% of
patient
-
days in last month vs 50.0% in first month; OR, 6.35; 95% CI, 1.85
-
21.79) and precautions to prevent
catheter
-
related bloodstream infection (70.0% of p
atients receiving central lines vs 10.6%; OR, 30.06; 95%
CI, 11.00
-
82.17). Adoption of other practices, many with high baseline adherence, changed little.

C
onclusion
: In a collaborative network of community ICUs, a multifaceted quality improvement interven
tion
improved adoption of care practices.



NosoBase n° 29619

Politiques concernant les visites dans des unités de

réanimation : étude sur l'ensemble des unités
de


animation des Pays
-
Bas

S
preen
AE; S
chuurmans
MJ
.
Visiting policies in the adult intensive care units: a

complete survey of Dutch
ICUs
.
Intensive and critical care nursing

2011/02
;
27
(
1
)
:

27
-
30
.


Mots
-
clés

:
USAGER; SOIN INTENSIF; INFIRMIER; PERSONNEL; QUES
TIONNAIRE;

VISITE;
PROTOCOLE


Objectives: Treatment in an intensive care unit (ICU) is

not only very stressful for the patient but also for the

family as well. An open visiting policy, defined as a

policy that imposes no restrictions on visiting hours,

duration of visits and/or number of visitors, seems to fit

very well both patient and family needs. The purpose
of

this article is to give an overview of the current

situation of Dutch ICUs visiting policies.

Design: Nationwide, telephone
-
based questionnai
re survey.

Participants: (Head)nurses of all ICUs.

Results: The results of this study show that none of the

ICUs have an open visiting policy, defined as a
policy that

imposes no restrictions on visiting time, duration of

visits and/or number of visitors.
The majority
of the Dutch

ICUs (85.7%) has restricted visiting policies. Responses

were obtained from 100% of the ICUs.

Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


26

/
29


Conclusion: Despite several international guidelines,

research and literature about unrestricted visiting hours

on the ICUs, none of the

ICUs in this study operates with

such a visiting policy. If we take these results into

account then the question rises if ICUs are aware of these

patients and family needs on the ICUs.



Réglementation


Noso
Base n° 29756

Circulaire n° DGOS/PF2/2011/41 du
02/02/2011 relative à la

stratégie nationale d'audit des pratiques
en hygiène

hospitalière : thème "les précautions standard"


M
inist
è
re du travail, de l'
e
mploi et de
la santé. N
on parue au Journal officiel

2011/02
;
15 pages
.


Mots
-
clés

:
LEGISLATION; AUDIT
; PRECAUTION STANDARD; EVALUATION DES PRATIQUES
PROFESSIONNELLES; CCLIN; GREPHH


Incitation des établissements de santé à la réalisation d’un audit des pratiques en hygiène hospitalière sur
une thématique nationale.



NosoBase n° 29757

Décret n° 2011
-
121 du 28/01/2011 relatif aux opérations

funéraires


M
inist
ère de l'i
nt
é
rieur, de l'
o
utre
-
m
er, des
c
ollectivit
és
t
erritoriales et de l'
i
mmigrat
ion.
Journal officiel

2011/01/30
;
11 pages
.


Mots
-
clés

:
LEGISLATION
; MORGUE; TRANSMISSION; INFECTION; TRANSPORT; STRUCTURE DE
SOINS



Sondage urinaire


NosoBase n° 29611

Etude des connaissances et opinions des patients concernant

l'utilisation des sondes urinaires à
demeure


G
reer

SF; S
ethi
AK; H
ecker

MT; M
ckinney
BL; D
umford

III DM;

D
onskey
CJ
.
Survey of patients' knowledge
and opinions regarding the

use of indwelling urinary catheters
.
Infection control and hospital epidemiology

2011/02
;
32
(
2
)
:

174
-
176
.


Mots
-
clés

:
SONDAGE URINAIRE; INFECTION URINAIRE; LIT; CONNAISSANCE
; USAGER


In a survey of patients with short
-
term indwelling urinary

catheters, 47% were aware that catheters cause
urinary

tract infections, 89% believed that catheters were not

overused, and 68% preferred catheter
placement rather than

use of a bedside commode, bedpan, or diaper. Patient

education is needed regarding
the risks of urinary

catheters.




Staphylococcus aureus


NosoBase n° 29920

U
ne souche de
Staphylococcus aureus

sensible à la méticilline multirésistant aux antibiotiques (MR
-
SAMS)
responsable d’une épidémie
dans un centre de traitement pour les brûlés : importance du
typage moléculaire en routine


B
oers
SA; V
an

E
ss
I; E
user

SM; J
ansen
R; T
empelman
F;

D
iederen

B
.
An outbreak of a multiresistant
methicillin
-
susceptible

Staphylococcus aureus

(MR
-
MSSA) strain in a burn centre:

the importance of routine
molecular typing
.
Burns

2011
;
in press:

6 pages
.


Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


27

/
29


Mots
-
clés :


STAPHYLOCOCCUS AUREUS
;

MULTIRESISTANCE
;
BRULE
;
EPIDEMIE
;
TYPAGE
;

BIOLOGIE MOLECULAIRE
;
PREVALENC
E
;

GENOTYP
E
;

DEPISTAG
E
;

COLONISATION NASALE
;

PERSONNEL


Here we report an outbreak among 17 patients caused by a

single strain of a Multiresistant Methicillin
-
Susceptible

Staphylococcus aureus

(MR
-
MSSA) in a burn centre. The

MR
-
MSSA strains were resistant to
penicillin,

ciprofloxacin, erythromycin, clindamycin and

co
-
trimoxazole. Further analysis showed an
increased

prevalence of MR
-
MSSA carriership in
S. aureus

colonized

patients admitted to the burn centre,
from 0% in 2005

(0/118), 3.3% in 2006 (4/121), 6.1% in 2007 (6/99), to 7.8%

in 2008 (7/90). Molecular
typing with Amplified Fragment

Length Polymorphism showed t
hat all MR
-
MSSA isolates

derived from burn
centre patients had a unique genotype,

and was different compared to isolates derived from other

hospital
patients. All healthcare workers (HCWs) who worked

in the burn centre during the outbreak were screened
for

nasal carriage with MR
-
MSSA. One HCW tested positive for a

genotype of MR
-
MSSA that was
indistinguishable from the

genotype found in samples of the burned patients. No new

cases of MR
-
MSSA
colonization or infection were identified

after the colonized HCW
stopped working at the burn centre.

The
routine practice of molecular typing of collected
S.

aureus

strains from both patients and HCWs will help to

detect nosocomial spread in a burn centre, and opens the

possibility of a rapid, almost pre
-
emptive
respons
e.




NosoBase n° 29644


Mention d'infection à
Staphylococcus aureus

méticillino
-
sensible et méticillino
-
résistant sur les
certificats de décès dans des hô
pitaux irlandais


C
ollins

CJ; F
raher

MH; O'C
onnell

K; F
ennell

J; F
itzgerald
SF; O'Sullivan N;
et al.

Reporting of meticillin
-
resistant and

susceptible

Staphylococcus aureus

on death certificates in Irish

hospitals
.
The Journal of
hospital infection

2011/02
;
77(2
)
:

143
-
147
.


Mots
-
clés:
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE
; MORTALITE; HEMOCULTURE;

MORTALITE


The
documentation of infection with meticillin
-
resistant

Staphylococcus aureus

(MRSA) on death certificates
has been

the subjec
t of considerable public discussion. Using data

from five tertiary referral hospitals in
Ireland, we

compared the
documentation of MRSA and

meticillin
-
susceptible
S. aureus

(MSSA) on death

certificates in those patients who died in hospital within

30 days of having MRSA or MSSA isolated from
blood

cultures. A total of 133 patients had MRSA or MSSA isolated

from blood cultures within 30 days of
death during the

study period. One patient was e
xcluded as the death

certificate information was not
available; the other 132

patients were eligible for inclusion. MRSA and MSSA were

isolated from blood
cultures in 59 (44.4%) and 74 (55.6%)

cases respectively. One patient was included as a case in

both
categories as both MRSA and MSSA were isolated from a

blood culture. In 15 (25.4%) of the 59 MRSA
cases, MRSA was

documented on the death certificate. In nine (12.2%) of the

74 patients with MSSA cases,
MSSA was documented on the

death certificate. MRSA wa
s more likely to be documented on

the death
certificate than MSSA (odds ratio: 2.46; 95%

confidence interval: 1.01
-
6.01; P < 0.05). These findings

indicate that there may be inconsistencies in the way

organisms and infections are documented on death

certif
icates in
Ireland and that death certification data

may underestimate the mortality related to certain

organisms. In particular, there appears to be an

overemphasis by certifiers on the
documentation of MRSA

compared with MSSA.



NosoBase n° 29819

Contrôle de
Staphylococcus aureus

méticillino
-
résistant


L
ee

AS; H
uttner

B; H
arbarth
S
.
Control of methicillin
-
resistant
Staphylococcus aureus
.
Infectious disease
clinics of North America

2011/03
;
25
(
1
)
:

155
-
179
.


Mots
-
clés

:
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE; CONTROLE;

EPIDEMIOLOGIE;
PREVENTION; SURVEILLANCE; DEPISTAGE; HYGIENE

DES MAINS; PRECAUTION STANDARD;
CHLORHEXIDINE;

ANTIBIOTIQUE; ENVIRONNEMENT; CONTAMINATION; BIBLIOGRAPHIE;

RESEAU


Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


28

/
29


Progress in medical therapies has been significant over the

last few decades but brings with it difficult
challenges,

including an increased risk of acquisition and infection

with multiresi
stant pathogens, in
particular MRSA. The

control of MRSA is paramount in the health care setting and

an important public
health issue that has become

a subject of increasing public and political interest.

Successful strategies for
MRSA control require a

mu
ltifaceted approach as well as leadership and

administrative

support to facilitate
implementation of evidence
-
based

interventions. There must also be flexibility to adapt and

institute these
measures in the context of local

epidemiology

and available resou
rces.




NosoBase n° 29606


Impact des modèles de transfert de patients entre

établissements de santé sur les taux de
transmission

nosocomiale de
Staphylococcus aureus

résistants à la

méticilline : une simulation
avec
la méthode Monte
-
Carlo


L
esosky

M; M
cgeer

A; S
imor

A; G
reen

K; L
ow

DE; R
aboud

J
.
Effect of patterns of transferring patients
among

healthcare i
nstitutions on rates of nosocomial

methicillin
-
resistant
Staphylococcus aureus

transmission: a

Monte Carlo simulation
.
Infection control and hospital epidemiology

2011/02
;
32(2
)
:

136
-
147
.


Mots
-
clés :
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE;

TRANSMISSION; TAUX;
TRANSPORT; STATISTIQUE


Objective: To determine the effect of the rate and pattern

of patient transfers among institutions within a
single

metropolitan area on the rates of methicillin
-
resistant

Staphylococcus aureus

(MRSA) transmission

among patients in

hospitals and nursing homes.

Methods: A stochastic,

discrete
-
time, Monte Carlo simulation was used to model the

rate and spread of
MRSA transmission among patients in

medical institutions within a single metropolitan area.

Admission,
di
scharges, transfers, and nosocomial

transmission were simulated with respect to different

interinstitutional
transfer strategies and various

situational scenarios, such as outlier institutions with

high transmission rates.
Results: The simulation results

i
ndicated that transfer patterns and transfer rate changes

do not affect
nosocomial MRSA transmission. Outlier

institutions with high transmission rates affect the

systemwide rate
of nosocomial infections differently,

depending on institution type.

Conclus
ion: It is worth

effort to understanding disease
-
transmission dynamics and

interinstitutional transfer
patterns for the management of

recently introduced diseases or strains. Once endemic in a

system, other
strategies for transmission control need to

be implemented.



NosoBase n° 29711

Prévalence et facteurs de risque de colonisation et

d'infection à
Staphylococcus aureus

méticillino
-
résistant

parmi des nouveau
-
nés dans une unité de r
éanimation

néonatale de niveau III


M
araqa
NF; A
igbivbalu

L; M
asnita
-
I
usan
C; W
ludyka

P;

S
hareef

Z; B
ailey

C;

et al.

Prevalence of and risk
factors for methicillin
-
resistant

Staphylococcus aureus

colonization and infection among

infants at a level III
neonatal intensive care unit
.
American journal of infection control

2011/02
;
39
(
1
)
:

35
-
41
.


Mots
-
clés

:
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE; SOIN

INTENSIF;
NEONATALOGIE; FACTEUR DE RISQUE; NOUVEAU
-
NE;

COLONISATION; PREVALENCE;
SURVEILLANCE

Background: Methicillin
-
resistant
Staphylococcus aureus


(MRSA) is a well
-
known nosocomial pathogen of
neonatal

intensive care unit (NICU) patients and can cause both

serious infections in preterm neonates and
prolong
ed MRSA

outbreaks in NICUs.

Objectives: Our objectives were to determine the prevalence

of and identify risk factors for MRSA
colonization and

infection in the NICU and the impact of an active

surveillance program on MRSA in the
NICU.

Methods: We collected

weekly nasal MRSA surveillance

cultures on 2,048 infants admitted to NICU over 3
years.

Data on these infants were collected retrospectively.

Characteristics of MRSA colonized and infected
infants were

analyzed and compared.

Results: MRSA colonization was

detected in 6.74% of

infants, and MRSA infection occurred in 22% of those

colonized. Using clinical cultures alone, only 41 (27.5%)

of 149 MRSA affected infants were identified. The
majority

(75%) developed MRSA infection within 17 days of

colonization. For every 10
-
day increment in
NICU stay, the

odds ratio of being infected and colonized with MRSA

increased by 1.32 and 1.29,
Noso
Veille


Bulletin de veille

Mars 2011


CCLIN Sud
-
Est


cclinse@chu
-
lyon.fr


29

/
29


respectively. Colonization was

significantly associated with longer NICU stay, low birth

weight, low
gestational age
, and multiple gestation status.

Conclusion: Colonization is a risk factor for infection

with MRSA in NICUs. Clinical cultures underestimate
MRSA

affected infants in NICUs, whereas active surveillance

cultures could detect MRSA affected infants
earlier and

limit nosocomial spread.



NosoBase n° 29710

Coût du dépistage de
Staphylococcus aureus

méticillino
-
résistant chez des patients de réanimation
dans

d
es hôpitaux


N
yman
JA; L
ees

CH; B
ockstedt
LA; F
ilice

GA; L
exau
C; L
esher
LJ;
et al.
Cost of screening intensive care
unit patients for

methicillin
-
resistant
Staphylococcus aureus

in hospitals
.
American journal of infection control

2011/02
;
39(1
)
:

27
-
34
.


Mo
ts
-
clés

:
STAPHYLOCOCCUS AUREUS
; METICILLINO
-
RESISTANCE; SOIN

INTENSIF; COUT;
DEPISTAGE; PREVENTION; TRANSMISSION;

EFFICACITE; ANALYSE; SENSIBILITE


Background: The objective of this study is to determine the

costs per hospital admission of screening
intensive care

unit patients for methicillin
-
resistant
Staphylococcus

aureus

(MRSA) and isolating those who
are colonized.

Methods: Data on the costs of the intervention come from

the
Minneapolis
Veterans
Affairs
Medical
Center,
a 279
-
bed

teaching hospital and outpatient facility. A microcosting

approach is used to determine the
intervention costs for 3

different laboratory testing protocols. The costs of caring

for
MRSA
-
infected patients
come from the experience of 241

Minneapolis
Veterans
Affairs
Medical
Center patients with

MRSA
infections in 2004 through 2006. The effectiveness of

the intervention comes from the ex
tant literature. To

capture the effect of screening on reducing transmission of

MRSA to other patients and its effect on costs, a
Markov

simulation model was employed.

Results: The intervention was cost saving compared with no

intervention for all 3 labora
tory processes
evaluated and

for all of the 1
-
way sensitivity analyses considered.


Conclusion: Because of the high cost of caring for a MRSA

patient, interventions that reduce the spread of

infections
-
such as screening intensive care unit patients

upon ad
mission studied here
-
are likely to pay for

themselves.



NosoBase n° 29614


Contamination des mains par
Staphylococcus aureus

résistant

à la méticilline
après contact
avec
les surfaces de l'environnement ou

la peau des patients colonisés


S
tiefel
U; C
adnum

JL; E
ckstein
BC; G
uerrero
DM; T
ima

MA;

D
onskey

CJ
.
Contamination of hands with
methicillin
-
resistant

Staphylococcus aureus

after contact with environmental

surfaces and after contact with
the skin of colonized

patients
.
Infection control and hospital epidemiology

2011/02
;
32(2
)
:

185
-
187
.


Mots
-
clés

:
CONTAMINATION;
STAPHYLOCOCCUS AUREUS
;

METICILLINO
-
RESISTANCE;
COLONISATION; SURFACE; PEAU


In a study of 40 methicillin
-
resistant
Staphylococcus

aureus

(MRSA) carriers, hand contamination was
equally

likely after contact with commonly examined skin sites and

commonly touched environmental
surfaces in patient rooms

(40% vs 45%). These findings su
ggest that contaminated

surfaces may be an
important source of MRSA transmission.