NosoVeille Août 2011

Transcription

NosoVeille – Bulletin de veille
Janvier 2012
NosoVeille n°1
Janvier 2012
Rédacteurs : Nathalie Sanlaville, Sandrine Yvars, Annie Treyve
Ce bulletin de veille est une publication mensuelle qui recueille les publications scientifiques publiées au
cours du mois écoulé.
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Abonnement / Désabonnement
Sommaire de ce numéro
Acinetobacter baumannii
Antibiorésistance
Aspergillose
Cathétérisme
Chirurgie
CNR
Clostridium difficile
EHPAD / Personne âgée
Environnement
Escarres
Escherichia coli
Gestion des risques
Grippe
Hygiène des mains
Infection urinaire
Maladie de Creutzfeldt-Jakob
Maternité
Néonatologie
Norovirus
Pédiatrie
Personnel
Pneumonie
Pseudomonas aeruginosa
Staphylococcus aureus
Acinetobacter baumannii
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Janvier 2012
NosoBase n° 32570
Acinetobacter baumannii producteur de carbapénèmase NDM-2 dans les Emirats Arabes Unis
Ghazawi A; Sonnevend A; Bonnin RA; Poirel L; Nordmann P; Hashmey R; et al. NDM-2 carbapenemaseproducing Acinetobacter baumannii in the United Arab Emirates. Clinical microbiology and infection 2011; in
press: 10 pages.
Mots-clés : ACINETOBACTER BAUMANNII; CARBAPENEME; ANTIBIORESISTANCE
Screening 155 carbapenem non-susceptible Acinetobacter baumannii strains recovered in Abu Dhabi
hospitals identified two metallo-ß-lactamase bla(NDM) gene-carrying isolates. They were isolated 4 months
apart from the urine of a cancer patient previously treated in Egypt, Lebanon and in the United Arab Emirates.
They were clonally related and carried the bla(NDM-2) gene recently identified in A. baumannii in Egypt and
Israel. Sequences surrounding the bla(NDM-2) gene showed significant similarities with those associated with
bla(NDM-1) in Enterobacteriaceae and A. baumannii. Repeated isolation of bla(NDM-2) -positive A.
baumannii in the Middle East raises the possibility of the local emergence and spread of a unique clone.
NosoBase n° 32692
Epidémie d’infections à Acinetobacter calcoaceticus - Acinetobacter baumannii complex porteurs de
structures génétiques associées à différents gènes de carbapénémases dans une unité de
réanimation
Lee YT; Fung CP; Wang FD; Chen CP; Chen TL; Cho WL. Outbreak of imipenem-resistant Acinetobacter
calcoaceticus - Acinetobacter baumannii complex harboring different carbapenemase gene-associated
genetic structures in an intensive care unit. Journal of microbiology immunology and infection 2012; in press:
9 pages.
Mots-clés : EPIDEMIE; CARBAPENEME; IMIPENEME; ANTIBIORESISTANCE; ACINETOBACTER;
ACINETOBACTER BAUMANNII; SOIN INTENSIF; EPIDEMIOLOGIE; BIOLOGIE MOLECULAIRE;
GENOTYPE; PFGE; PCR; ENVIRONNEMENT; TRANSMISSION; GENETIQUE
Background and purpose: To investigate the clinical and molecular epidemiology of the imipenem-resistant
Acinetobacter calcoaceticus-Acinetobacter baumannii (IRAcb) complex during an outbreak in an intensive
care unit (ICU).
Methods: Forty-six clinical and 11 environmental isolates of the IRAcb complex were collected from the ICU
of Taipei Veterans General Hospital, Taiwan between December 2003 and March 2004. These isolates were
genotyped using pulsed-field gel electrophoresis (PFGE). Carbapenemase genes and their associated
genetic structures were analyzed using PCR. Clinical data obtained from the patients were also reviewed and
analyzed.
Results: The isolates were identified at the genomic species level as A. baumannii (42 clinical and five
environmental isolates) and Acinetobacter genomic species 13TU (four clinical and six environmental
isolates). Both species were comprised of two pulsotypes, but those of A. baumannii were closely related
(83% similar). IS1008-ISAba3-bla(OXA-58-like) and ISAba1-bla(OXA-51-like) were identified in 22 and 21
clinical isolates of A. baumannii, respectively (one isolate contained both). The ISAba3-bracketed bla(OXA58-like) gene was detected in all isolates of Acinetobacter genomic species 13TU. Patient transfers between
different sections of the ICU were important factors that contributed to the spread of the two pulsotypes of A.
baumannii. However, among the A. baumannii isolates identified, only those carrying IS1008-ISAba3bla(OXA-58-like) could be found in the environment, indicating an additional route of transmission. The prior
use of carbapenem or cefepime was associated with the subsequent infection with A. baumannii carrying the
ISAba1-bla(OXA-51-like) gene, while prior piperacillin/tazobactam use was associated with the subsequent
infection with A. baumannii carrying the IS1008-ISAba3-bla(OXA-58-like) gene.
Conclusion: A. baumannii isolates carrying different carbapenemase genes and their associated genetic
structures might be transmitted or selected in different ways.
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Janvier 2012
Antibiorésistance
NosoBase n° 32568
Communication de la commission au parlement européen et au conseil - Plan d'action pour combattre
les menaces croissantes de la résistance aux antimicrobiens
Commission européenne; Direction générale de la santé et des consommateurs 2011. Commission
européenne: 1-17.
Mots-clés : ANTIBIOTIQUE; ANTIBIORESISTANCE; EUROPE; PREVENTION; SURVEILLANCE
L’accroissement de la résistance aux médicaments antimicrobiens représente l’une des grandes nouvelles
menaces pour la santé humaine. Pour parer à cette menace, il convient de mettre l’accent sur une démarche
globale. La Commission européenne propose la mise en place d’un plan d’action de cinq ans pour lutter
contre la résistance aux antimicrobien. Ce plan se décline en douze actions clés.
NosoBase n° 32373
Surveillance de la consommation globale des antibiotiques à l'hôpital : la meilleure méthode est-elle
de faire une stratification basée sur la taille de l'hôpital ?
Couderc C; Lacave L; L'Heriteau F; Astagneau P. Surveillance of overall hospital antibiotic consumption: is
stratification according to hospital size the best method? Infection control and hospital epidemiology 2011/12;
32(12): 1223-1225.
Mots-clés : SURVEILLANCE; ANTIBIOTIQUE; CONSOMMATION; STRATIFICATION; STRUCTURE DE
SOINS
NosoBase n° 32689
Gestion des carbapénèmes : l’ertapénème affecte-t-il la sensibilité des Pseudomonas aux autres
carbapénèmes ? Revue de preuves
Nicolau DP; Carmeli Y; Crank CW; Goff DA; Graber CJ; Lima AL; et al. Carbapenem stewardship: does
ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence. International
journal of antimicrobial agents 2012/01; 39(1): 11-15.
Mots-clés : CARBAPENEME; ERTAPENEME;
MEROPENEME; BIBLIOGRAPHIE
PSEUDOMONAS;
DDJ;
ANTIBIORESISTANCE;
The group 2 carbapenems (imipenem, meropenem and, more recently, doripenem) have been a mainstay of
treatment for patients with serious hospital infections caused by Pseudomonas aeruginosa,
Enterobacteriaceae and other difficult-to-treat Gram-negative pathogens as well as mixed aerobic/anaerobic
infections. When ertapenem, a group 1 carbapenem, was introduced, questions were raised about the
potential for ertapenem to select for imipenem- and meropenem-resistant Pseudomonas. Results from ten
clinical studies evaluating the effect of ertapenem use on the susceptibility of Pseudomonas to carbapenems
have uniformly shown that ertapenem use does not result in decreased Pseudomonas susceptibility to these
antipseudomonal carbapenems. Here we review these studies evaluating the evidence of how ertapenem use
affects P. aeruginosa as well as provide considerations for ertapenem use in the context of institutional
stewardship initiatives.
NosoBase n° 32423
Dissémination globale des enterobactéries productrices de carbapénèmases
Nordmann P; Naas T; Poirel L. Global spread of carbapenemase-producing enterobacteriaceae. Emerging
infectious diseases 2011/10; 17(10): 1791-1798.
Mots-clés : CMI; ENTEROBACTERIE; CARBAPENEME; ANTIBIORESISTANCE
Carbapenemases increasingly have been reported in Enterobacteriaceae in the past 10 years. Klebsiella
pneumoniae carbapenemases have been reported in the United States and then worldwide, with a marked
endemicity at least in the United States and Greece. Metallo-enzymes (Verona integron-encoded metallo-ßlactamase, IMP) also have been reported worldwide, with a higher prevalence in southern Europe and Asia.
Carbapenemases of the oxacillinase-48 type have been identified mostly in Mediterranean and European
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Janvier 2012
countries and in India. Recent identification of New Delhi metallo-ß-lactamase-1 producers, originally in the
United Kingdom, India, and Pakistan and now worldwide, is worrisome. Detection of infected patients and
carriers with carbapenemase producers is necessary for prevention of their spread. Identification of the
carbapenemase genes relies mostly on molecular techniques, whereas detection of carriers is possible by
using screening culture media. This strategy may help prevent development of nosocomial outbreaks caused
by carbapenemase producers, particularly K. pneumoniae.
NosoBase n° 32577
Dissémination européenne d'un clone de Klebsiella pneumoniae productrices d'OXA-48
Potron A; Kalpoe J; Poirel L; Nordmann P. European dissemination of a single OXA-48-producing Klebsiella
pneumoniae clone. Clinical microbiology and infection 2011/12; 17(12): E24-E26.
Mots-clés : KLEBSIELLA PNEUMONIAE; EUROPE; ANTIBIORESISTANCE; PCR; IDENTIFICATION;
CARBAPENEME
A Klebsiella pneumoniae isolate with decreased susceptibility to carbapenems was isolated in April 2011 in a
hospital in Amsterdam (the Netherlands) and later found to be the source of an important outbreak in a
Rotterdam hospital. The strain, belonging to sequence type (ST) 395, carried the bla(OXA-48) gene located
onto a c 62-kb conjugative plasmid, together with the extended-spectrum ß-lactamase gene bla(CTX-M-15) .
It was closely related or identical to other OXA-48-positive Klebsiella pneumoniae isolates belonging to the
same ST type and identified in France and Morocco. This study sheds light on the European dissemination of
a single OXA-48 K. pneumoniae clone.
Aspergillose
NosoBase n° 32574
Tendances épidémiologiques des aspergilloses invasives en France : réseau SAIF (surveillance des
aspergilloses invasives en France) 2005-2007
Lortholary O; Gangneux JP; Sitbon K; Lebeau B; De Monbrison F; Le Strat Y; et al. Epidemiological trends in
invasive aspergillosis in France: the SAIF network (2005-2007). Clinical microbiology and infection 2011/12;
17(12): 1882-1889.
Mots-clés : ASPERGILLUS; EPIDEMIOLOGIE; RESEAU; SURVEILLANCE; ETUDE PROSPECTIVE;
FACTEUR DE RISQUE; MORTALITE; INCIDENCE; ASPERGILLUS FUMIGATUS; TRAITEMENT;
VORICONAZOLE; AZOLE
A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable
invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic
hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models
were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients
included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant
alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)),
15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia
(34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic
lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors
consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%)
and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (=69%) for
acute leukaemia and allogeneic stem cell transplantation than for the others (<42%; p <10(-3)). When positive
(n=245), cultures mainly yielded Aspergillus fumigatus (79.7%). First-line antifungal therapy consisted of
voriconazole, caspofungin, lipid formulations of amphotericin, or any combination therapy (52%, 14%, 8% and
19.9%, respectively). Twelve-week overall mortality was 44.8% (95% CI, 39.8-50.0); it was 41% when firstline therapy included voriconazole and 60% otherwise (p <0.001). Independent factors for 12-week mortality
were older age, positivity for both culture and galactomannan and central nervous system or pleural
involvement, while any strategy containing voriconazole was protective.
Cathétérisme
NosoBase n° 32690
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Janvier 2012
Bactériémies à Corynebacterium striatum associées à des infections de cathéters veineux centraux
Chen FL; Hsueh PR; Teng SO; Ou TY; Lee WS. Corynebacterium striatum bacteremia associated with
central venous catheter infection. Journal of microbiology immunology and infection 2012; in press: 4 pages.
Mots-clés : BACTERIEMIE; CATHETER VEINEUX CENTRAL; BACILLE GRAM POSITIF;
CORYNEBACTERIUM; HEMODIALYSE; MORTALITE; HEMOCULTURE; BIOLOGIE MOLECULAIRE
Corynebacterium striatum (C striatum) has been considered a contaminant of blood culture in past decades.
Here we report the case of a patient with acute deterioration of chronic renal failure. She received
hemodialysis and died from C striatum bacteremia. By using a randomly amplified polymorphic DNA (RAPD)
method, we found that an association existed between C striatum from the bloodstream and that from the
central venous catheter. We suggest that C striatum could be a pathogen of bloodstream infection in patients
with such a catheter in place.
NosoBase n° 32693
Antiseptique à la povidone iodée alcoolique ou à base de chlorhexidine pour la prévention des
infections liées aux cathéters veineux centraux : comparaison lors de l’utilisation
Girard R; Comby C; Jacques D. Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the
prevention of central venous catheter-related infections: in-use comparison. Journal of infection and public
health 2012; in press: 8 pages.
Mots-clés : ANTISEPTIQUE; ALCOOL; POLYVIDONE IODEE; CHLORHEXIDINE; PREVENTION;
CATHETER VEINEUX CENTRAL; INCIDENCE; SURVEILLANCE; RESEAU; CONSOMMATION;
EVALUATION; INCIDENCE; RISQUE; SOIN INTENSIF
Purpose: To make a field comparison of the effectiveness, ease of use, and cost of a chlorhexidine antiseptic
solution (CBA) and an alcohol-based povidone-iodine solu-tion (PVP-IA) for the prevention of central venous
catheter (CVC)-related infections in an intensive care unit, with the aim of identifying the superior antisepsis
agent.
Materials and methods: We measured the CVC colonization and infection incidence for PVP-IA (Betadine
alcoolique®) and for CBA (Biseptine®) during two successive 1-year periods of routine surveillance (REA
RAISIN network). A questionnaire on the ease of CBA use was administered. Consumption data were
obtained from the hospital pharmacy. Results: The study included 806 CVC (CBA period: 371). Upon
switching from PVP-IA to CBA, we recorded a significant reduction in colonization incidence/100 catheter
days (1.12 vs. 1.55, p = 0.041), nonsignificant differences concerning CVC-related infection incidence/100
catheter days (0.28 vs. 0.26, p = 0.426), and a nonsignificant reduction in CVC-related bacteremia/100
catheter days (0.14 vs. 0.30, p = 0.052). PVP-IA users were at significantly higher risk of CVC colonization or
infection based on a multivariate Cox model analysis (relative risk [95% CI]: 1.48 [1.01—2.15], p = 0.043).
The main drawbacks of CBA use were its low cleansing activity and its colorless solution. No cost advantage
was found.
Conclusions: Our field study revealed no major clinical advantage of CBA use in CVC infection and no cost
advantage in addition to limited ease of use.
NosoBase n° 32368
Epidémiologie des bactériémies sur cathéters centraux dans un service de réanimation pédiatrique
Niedner MF; Huskins WC; Colantuoni E; Muschelli J; Harris JM; Rice TB; et al. Epidemiology of central lineassociated bloodstream infections in the pediatric intensive care unit. Infection control and hospital
epidemiology 2011/12; 32(12): 1200-1208.
Mots-clés : BACTERIEMIE; CATHETER VEINEUX CENTRAL; EPIDEMIOLOGIE; PEDIATRIE; SOIN
INTENSIF; CANCEROLOGIE; COHORTE; FACTEUR DE RISQUE; STATISTIQUE; INCIDENCE
Objective. Describe central line-associated bloodstream infection (CLA-BSI) epidemiology in pediatric
intensive care units (PICUs).
Design. Descriptive study (29 PICUs); cohort study (18 PICUs).
Setting. PICUs in a national improvement collaborative.
Patients-Participants. Patients admitted October 2006 to December 2007 with 1 or more central lines.
Methods. CLA-BSIs were prospectively identified using the National Healthcare Safety Network definition and
then readjudicated using the revised 2008 definition. Risk factors for CLA-BSI were examined using ageadjusted, time-varying Cox proportional hazards models.
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Janvier 2012
Results. In the descriptive study, the CLA-BSI incidence was 3.1/1,000 central line-days; readjudication with
the revised definition resulted in a 17% decrease. In the cohort study, the readjudicated incidence was
2.0/1,000 central line-days. Ninety-nine percent of patients were CLA-BSI-free through day 7, after which the
daily risk of CLA-BSI doubled to 0.27% per day. Compared with patients with respiratory diagnoses (most
prevalent category), CLA-BSI risk was higher in patients with gastrointestinal diagnoses (hazard ratio [HR],
2.7 [95% confidence interval {CI}, 1.43-5.16]; [Formula: see text]) and oncologic diagnoses (HR, 2.6 [CI, 1.066.45]; [Formula: see text]). Among all patients, including those with more than 1 central line, CLA-BSI risk was
lower among patients with a central line inserted in the jugular vein (HR, 0.43 [CI, 0.30-0.95]; [Formula: see
text]).
Conclusions. The 2008 CLA-BSI definition change decreased the measured incidence. The daily CLA-BSI
risk was very low in patients during the first 7 days of catheterization but doubled thereafter. The risk of CLABSI was lower in patients with lines inserted in the jugular vein and higher in patients with gastrointestinal and
oncologic diagnoses. These patients are target populations for additional study and intervention.
NosoBase n° 32585
Amélioration de cathéters imprégnés d'antibiotiques avec une activité à spectre élargi contre des
bactéries résistantes aux antibiotiques et des champignons
Raad I; Mohamed JA; Reitzel RA; Jiang Y; Raad S; Al Shuaibi M; et al. Improved antibiotic impregnated
catheters with extended spectrum activity against resistant bacteria and fungi. Antimicrobial agents and
chemotherapy 2011; in press: 27 pages.
Mots-clés : CATHETER; ANTIBIOTIQUE; CATHETER IMPREGNE; RESISTANCE; ANTIBIORESISTANCE;
MYCOLOGIE; BACTERIE; BIOFILM; EFFICACITE; RIFAMPICINE; MINOCYCLINE; CHLORHEXIDINE
CATHETER VEINEUX CENTRAL; PREVENTION; STAPHYLOCOCCUS AUREUS; ENTEROCOCCUS
FAECIUM; CANDIDA
Minocycline/rifampin (M/R) central venous catheters (M/R CVC) have been shown to be efficacious in
reducing catheter-related bloodstream infections (CRBSI) and inhibiting the biofilm adherence of resistant
Gram-positive and Gram-negative pathogens with the exception of Pseudomonas aeruginosa and Candida.
To expand the spectrum of antimicrobial activity, a novel second generation M/R-catheter was developed by
adding chlorhexidine (CHX-M/R). CVC and peripherally inserted central catheters (PICC) were impregnated
with CHX-M/R and compared with first generation M/R catheters, chlorhexidine/silver sulfadiazine treated
CVCs (CHX/SS-CVC), chlorhexidine treated PICCs and uncoated catheters. A biofilm catheter colonization
model was used to assess the efficacy of catheters against methicillin-resistant Staphylococcus aureus
(MRSA), vancomycin-resistant Enterococcus faecium (VRE), P. aeruginosa, Candida albicans and Candida
glabrata. CHX-M/R impregnated CVC was the only antimicrobial catheters that completely inhibited the
biofilm colonization of all resistant bacterial and fungal organisms tested at all time intervals and were
significantly superior to uncoated catheters (all p values = 0.003). Furthermore, CHX-M/R coated CVC had a
significantly more effective and prolonged antimicrobial activity up to 3 weeks against MRSA, and P.
aeruginosa compared to M/R, CHX/SS and uncoated CVC (p < 0.0001). Similarly, CHX-M/R coated PICC
was also superior to M/R coated and chlorhexidine PICC in preventing biofilm of MRSA, VRE, P. aeruginosa
and Candida species (all p-values= 0.003). Our study shows that novel CHX-M/R catheters have unique
properties in completely inhibiting biofilm colonization of MRSA, VRE, and P. aeruginosa and fungi in a
manner superior to the M/R and chlorhexidine treated catheters.
Chirurgie
NosoBase n° 32370
Validation de l’ensemble des données administratives d’une population pour la détection des ISO
après césarienne
Daneman N; Ma X; Eng-Chong M; Callery S; Guttmann A. Validation of administrative population-based data
sets for the detection of cesarean delivery surgical site infection. Infection control and hospital epidemiology
2011/12; 32(12): 1213-1215.
Mots-clés : CESARIENNE; SITE OPERATOIRE; PMSI; INFORMATIQUE; INDICATEUR
We validated population-based hospital, emergency room, and physician claim databases for the detection of
surgical site infections against the reference standard of clinical surveillance. Although these data sets are
highly specific and could be used to define research cohorts, their low sensitivity and positive predictive value
make them inadequate for use as quality indicators.
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Janvier 2012
NosoBase n° 32661
Incidence et facteurs de risque de sepsis chez des patients de chirurgie : étude de cohorte
Elias AC; Matsuo T; Grion CM; Cardoso LT; Verri PH. Incidence and risk factors for sepsis in surgical
patients: a cohort study. Journal of critical care 2012; in press: 8 pages.
Mots-clés : INCIDENCE; FACTEUR DE RISQUE; CHIRURGIE; SEPSIS; COHORTE; SOIN INTENSIF;
ETUDE PROSPECTIVE; MORTALITE; ANALYSE MULTIVARIEE
Purpose: The aim of the study was to evaluate risk factors for infection and sepsis in surgical patients
admitted to the intensive care unit (ICU).
Materials and methods: Data were prospectively collected from a cohort of surgical patients from January
2005 to December 2007. We analyzed the incidence of infection and sepsis and certain other variables from
the pre-, intra-, and postoperative periods as risk factors for infection and sepsis.
Results: We studied 625 surgical patients. The mortality rate was 18.2%, and the mean age of the subjects
was 53.1 ± 18.8 years. The incidences of severe sepsis and septic shock were 5% and 11.5%, respectively.
A multivariate analysis showed that the following variables were associated with sepsis in the postoperative
period: urgent surgery (odds ratio, 2.63; 95% confidence interval [CI], 1.50-4.63), fluid resuscitation (odds
ratio, 1.90; 95% CI, 1.18-3.05), vasoactive drugs (odds ratio, 2.58; 95% CI, 1.61-4.14), and mechanical
ventilation (odds ratio, 5.51; 95% CI, 3.07-9.89). A Sequential Organ Failure Assessment was associated with
infection or sepsis upon ICU admission (area under the curve, 0.737 ± 0.019; 95% CI, 0.748-0.825).
Conclusions: This study showed that sepsis has high incidence and mortality in surgical patients admitted to
the ICU. Urgent surgeries, mechanical ventilation, fluid resuscitation, and vasoactive drugs in the
postoperative period and Sequential Organ Failure Assessment at ICU admission were risk factors for sepsis.
NosoBase n° 32703
Recommandations sur les installations nécessaires pour les procédures chirurgicales mineures et les
interventions d’accès minimal
Humphreys H; Coia JE; Stacey A; Thomas M; Belli AM; Hoffman P; et al. Guidelines on the facilities required
for minor surgical procedures and minimal access interventions. The Journal of hospital infection 2012; in
press: 7 pages.
Mots-clés : RECOMMANDATION; CHIRURGIE; BLOC OPERATOIRE; SITE OPERATOIRE; AIR;
FILTRATION; RADIOLOGIE; RADIOLOGIE INTERVENTIONNELLE; ARCHITECTURE; DECHET;
DISPOSITIF MEDICAL; INSTRUMENT; USAGE UNIQUE; HYGIENE DES MAINS; MASQUE; FORMATION;
AUDIT; PRATIQUE
There have been many changes in healthcare provision in recent years, including the delivery of some
surgical services in primary care or in day surgery centres, which were previously provided by acute
hospitals. Developments in the fields of interventional radiology and cardiology have further expanded the
range and complexity of procedures undertaken in these settings. In the face of these changes there is a
need to define from an infection prevention and control perspective the basic physical requirements for
facilities in which such surgical procedures may be carried out. Under the auspices of the Healthcare Infection
Society, we have developed the following recommendations for those designing new facilities or upgrading
existing facilities. These draw upon best practice, available evidence, other guidelines where appropriate, and
expert consensus to provide sensible and feasible advice. An attempt is also made to define minimal access
interventions and minor surgical procedures. For minimal access interventions, including interventional
radiology, new facilities should be mechanically ventilated to achieve 15 air changes per hour but natural
ventilation is satisfactory for minor procedures. All procedures should involve a checklist and operators should
be appropriately trained. There is also a need for prospective surveillance to accurately determine the postprocedure infection rate. Finally, there is a requirement for appropriate applied research to develop the
evidence base required to support subsequent iterations of this guidance.
NosoBase n° 32707
Méthodes de prélèvement d’air destinées à évaluer la contamination microbienne dans des blocs
opératoires : résultats d’une étude comparative dans un département d’orthopédie
Napoli C; Tafuri S; Montenegro L; Cassano M; Notarnicola A; Lattarulo S; et al. Air sampling methods to
evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics
department. The Journal of hospital infection 2012; in press: 5 pages.
7 / 29
Janvier 2012
Mots-clés
: PRELEVEMENT;
AIR;
CONTAMINATION;
BLOC OPERATOIRE;
CHIRURGIE
ORTHOPEDIQUE; CENTRE HOSPITALIER UNIVERSITAIRE; STAPHYLOCOCCUS AUREUS
Aim: To evaluate the level of microbial contamination of air in operating theatres using active [i.e. surface air
system (SAS)] and passive [i.e. index of microbial air contamination (IMA) and nitrocellulose membranes
positioned near the wound] sampling systems.
Methods: Sampling was performed between January 2010 and January 2011 in the operating theatre of the
orthopaedics department in a university hospital in Southern Italy.
Findings: During surgery, the mean bacterial loads recorded were 2232.9colony-forming units (cfu)/m(2)/h
with the IMA method, 123.2cfu/m(3) with the SAS method and 2768.2cfu/m(2)/h with the nitrocellulose
membranes. Correlation was found between the results of the three methods. Staphylococcus aureus was
detected in 12 of 60 operations (20%) with the membranes, five (8.3%) operations with the SAS method, and
three operations (5%) with the IMA method.
Conclusion: Use of nitrocellulose membranes placed near a wound is a valid method for measuring the
microbial contamination of air. This method was more sensitive than the IMA method and was not subject to
any calibration bias, unlike active air monitoring systems.
NosoBase n° 32365
Epidémie d'infections du site opératoire à Pseudomonas aeruginosa après arthroscopie : Texas, 2009
Tosh PK; Disbot M; Duffy JM; Boom ML; Heseltine G; Srinivasan A; et al. Outbreak of Pseudomonas
aeruginosa surgical site infections after arthroscopic procedures: Texas, 2009. Infection control and hospital
epidemiology 2011/12; 32(12): 1179-1186.
Mots-clés : PSEUDOMONAS AERUGINOSA; EPIDEMIE; SITE OPERATOIRE; ARTHROSCOPIE;
INVESTIGATION; CAS TEMOIN; LABORATOIRE; INSTRUMENT; DESINFECTION; STERILISATION
Setting. Seven organ/space surgical site infections (SSIs) that occurred after arthroscopic procedures and
were due to Pseudomonas aeruginosa of indistinguishable pulsed-field gel electrophoresis (PFGE) patterns
occurred at hospital X in Texas from April 22, 2009, through May 7, 2009.
Objective. To determine the source of the outbreak and prevent future infections.
Design. Infection control observations and a case-control study.
Methods. Laboratory records were reviewed for case finding. A case-control study was conducted. A case
patient was defined as someone who underwent knee or shoulder arthroscopy at hospital X during the
outbreak period and subsequently developed organ/space SSI due to P. aeruginosa. Cultures of
environmental and surgical equipment samples were performed, and selected isolates were analyzed by
PFGE. Surgical instrument reprocessing practices were reviewed, and surgical instrument lumens were
inspected with a borescope after reprocessing to assess cleanliness.
Results. The case-control study did not identify any significant patient-related or operator-related risk factors.
P. aeruginosa grew from 62 of 388 environmental samples. An isolate from the gross decontamination sink
had a PFGE pattern that was indistinguishable from that of the case patient isolates. All surgical instrument
cultures showed no growth. Endoscopic evaluation of reprocessed arthroscopic equipment revealed retained
tissue in the lumen of both the inflow/outflow cannulae and arthroscopic shaver handpiece. No additional
cases occurred after changes in instrument reprocessing protocols were implemented. After this outbreak, the
US Food and Drug Administration released a safety alert about the concern regarding retained tissue within
arthroscopic shavers.
Conclusions. These SSIs were likely related to surgical instrument contamination with P. aeruginosa during
instrument reprocessing. Retained tissue in inflow/outflow cannulae and shaver handpieces could have
allowed bacteria to survive sterilization procedures.
Clostridium difficile
NosoBase n° 32651
Aérosolisation potentielle de Clostridium difficile après que la chasse d'eau ait été tirée : rôle des
couvercles des toilettes dans la réduction du risque de contamination environnementale
Best EL; Sandoe J; Wilcox MH. Potential for aerosolization of Clostridium difficile after flushing toilets: the role
of toilet lids in reducing environmental contamination risk. The Journal of hospital infection 2012/01; 80(1): 15.
8 / 29
Mots-clés : RISQUE; CONTAMINATION;
ENVIRONNEMENT; SANITAIRE; WC
Janvier 2012
CLOSTRIDIUM
DIFFICILE;
AEROSOL;
PREVENTION;
Background: Toilet facilities in healthcare settings vary widely, but patient toilets are commonly shared and do
not have lids. When a toilet is flushed without the lid closed, aerosol production may lead to surface
contamination within the toilet environment. AIM: To substantiate the risks of airborne dissemination of C.
difficile following flushing a toilet, in particular when lids are not fitted.
Methods: We performed in-situ testing, using faecal suspensions of C. difficile to simulate the bacterial
burden found during disease, to measure C. difficile aerosolization. We also measured the extent of splashing
occurring during flushing of two different toilet types commonly used in hospitals.
Findings: C. difficile was recoverable from air sampled at heights up to 25 cm above the toilet seat. The
highest numbers of C. difficile were recovered from air sampled immediately following flushing, and then
declined 8-fold after 60 min and a further 3-fold after 90 min. Surface contamination with C. difficile occurred
within 90 min after flushing, demonstrating that relatively large droplets are released which then contaminate
the immediate environment. The mean numbers of droplets emitted upon flushing by the lidless toilets in
clinical areas were 15-47, depending on design. C. difficile aerosolization and surrounding environmental
contamination occur when a lidless toilet is flushed.
Conclusion: Lidless conventional toilets increase the risk of C. difficile environmental contamination, and we
suggest that their use is discouraged, particularly in settings where CDI is common.
NosoBase n° 32706
Les admissions à partir d’établissements de soins de longue durée et les sorties vers ces
établissements influencent-elles le poids des infections à Clostridium difficile dans les hôpitaux ?
Ricciardi R; Nelson J; Griffith JL; Concannon TW. Do admissions and discharges to long-term care facilities
influence hospital burden of Clostridium difficile infection? The Journal of hospital infection 2012; in press: 6
pages.
Mots-clés : CLOSTRIDIUM DIFFICILE; SEJOUR; DIAGNOSTIC; SORTIE; ANALYSE MULTIVARIEE;
COHORTE
Background: Substantial geographical clustering of Clostridium difficile infection (CDI) outbreaks in hospitals
in the USA have previously been demonstrated. AIM: To test the hypothesis that hospital burden of CDI is
associated with admission from and discharge to long-term care facilities (LTCFs).
Methods: Hospital discharge data from 19 states in the USA were used to identify all patients discharged with
a diagnosis of CDI from 1 January 2002 to 31 December 2004. For every hospital, the proportion of
discharges with a diagnosis of CDI was calculated, and those above the 90th percentile were classified as
'high CDI' hospitals. We tested the association between this measure of hospital burden of CDI and the rates
of admission from and discharges to LTCFs. We adjusted for other hospital level characteristics, casecomplexity and local population characteristics.
Findings: We identified 38,372,951 discharges during the three-year study period. Of all discharges, 274,311
(0.71%) had a primary or secondary diagnosis of CDI. Hospitals had a mean CDI burden of 7.8 cases per
1000 discharges. High CDI hospitals (N = 610; 10.0%) had a mean CDI burden of 34.8 cases per 1000
discharges. Compared to other hospitals, high CDI hospitals were more likely to have a high proportion of
admissions from or discharges to LTCFs. This association persisted after adjustments for other hospital
characteristics, case-complexity, and area population characteristics.
Conclusion: A high rate of admission from or discharge to LTCFs is associated with an increased hospital
burden of CDI.
CNR
NosoBase n° 32723
Arrêté du 26/12/2011 fixant la liste des centres nationaux de référence pour la lutte contre les
maladies transmissibles et des laboratoires associés
Ministère du travail, de l’emploi et de la santé. Journal officiel 2011/12/30: 5 pages.
Mots-clés : LEGISLATION; LABORATOIRE; TRANSMISSION; AGENT TRANSMISSIBLE NON
CONVENTIONNEL;
HEPATITE;
BRUCELLA;
GRIPPE;
STREPTOCOCCUS;
ROUGEOLE;
9 / 29
Janvier 2012
STAPHYLOCOCCUS; STREPTOCOCCUS PNEUMONIAE; LEGIONELLA; NEISSERIA MENINGITIDIS;
BORDETELLA PERTUSSIS; LISTERIA; ESCHERICHIA COLI; BACILLUS ANTHRACIS
Abroge l'arrêté du 22/01/2009 (référence NosoBase n°23592), l'arrêté du 24/11/2009 (référence NosoBase
n°26051) et l'arrêté du 09/12/2010 (référence NosoBase n°29485)
EHPAD
NosoBase n° 32643
Maîtrise du risque infectieux en EHPAD - Fiches techniques / pratiques - Version 1
CCLIN Ouest; CCLIN Est; CCLIN Sud-Est; CCLIN Paris-Nord; CCLIN Sud-Ouest 2011/12:134 pages.
Mots-clés : EHPAD; RECOMMANDATION; FORMATION; SURVEILLANCE; ANTIBIOTIQUE; TENUE
VESTIMENTAIRE;
ALIMENTATION;
ENVIRONNEMENT;
CIRCUIT;
LINGE;
DECHET;
EAU;
LEGIONELLOSE; LOCAL; DESINFECTION; CHAMBRE; DISPOSITIF MEDICAL; SOIN; PRECAUTION
STANDARD; EXPOSITION AU SANG
La prise de conscience du risque infectieux dans les EHPAD est relativement récente. Plusieurs enquêtes
tant en France qu’en Europe ont montré la réalité des infections associées aux soins (IAS) chez les résidents
des structures d’hébergement. Actuellement, nous pouvons penser que la fréquence des IAS tourne autour
de 4 à 11 % selon les critères de définitions, qui, il faut le reconnaître, ne font pas l’unanimité et
nécessiteraient d’être revues. Depuis quelques années, différents groupes professionnels ont participé à
l’amélioration de la prévention du risque infectieux -RI- dans les EHPAD, en lien avec les professionnels et
les représentants des sociétés savantes. Le GREPHH a publié en janvier 2011 un manuel d’autoévaluation
pour la maîtrise du risque infectieux en EHPAD. Sous l’égide des CCLINS, a été constitué un groupe
multidisciplinaire, rassemblant des professionnels de CCLIN d’ARLIN et d’EHPAD, groupe chargé de réaliser
un document, sous forme de fiches techniques qui permettront aux établissements de se les approprier.
Présentées de façon anonyme, ces fiches pourront servir à constituer le guide de base des pratiques de
prévention du RI de l’établissement. L’objectif du groupe de travail était en priorité de mettre à disposition des
documents validés, pratiques et actualisés. La majorité de ces fiches sont des documents élaborés en
collaboration avec des professionnels de CCLIN, d’ARLIN, d’EHPAD ou des organismes comme la HAS.
Tous les aspects de la prévention du risque infectieux en EHPAD pour sa maîtrise sont envisagés en 7
chapitres, depuis l’organisation des moyens jusqu’à la prévention des accidents d’exposition au sang. Deux
chapitres particulièrement importants concernent la gestion de l’environnement et la gestion des soins. Ces
fiches qui viennent en complément du guide d’auto-évaluation du GREPHH sont proposées aux
établissements médico-sociaux dans le cadre du Programme National de Prévention des Infections médicosocial 2011-2013.
NosoBase n° 32709
Le risque nutritionnel en tant que facteur prédictif d’infection associée aux soins chez des patients
âgés hospitalisés en secteurs de soins aigus
Gamaletsou MN; Poulia KA; Karageorgou D; Yannakoulia M; Ziakas PD; Zampelas A; et al. Nutritional risk as
predictor for healthcare-associated infection among hospitalized elderly patients in the acute care setting. The
Journal of hospital infection 2012; in press: 5 pages.
Mots-clés : RISQUE; ALIMENTATION; PERSONNE AGEE; CENTRE HOSPITALIER UNIVERSITAIRE;
ANALYSE MULTIVARIEE; GERIATRIE
Background: Poor nutritional status is associated with high rates of healthcare-associated infections (HCAIs)
among hospitalized elderly patients. Early recognition of patients at risk for HCAIs is important. The Geriatric
Nutritional Risk Index (GNRI) is a screening tool able to predict nutrition-related complications. AIM: To
examine the use of GNRI as a predictor of HCAIs in the acute care setting.
Methods: A total of 248 consecutive patients aged >65 years, admitted as emergencies to the medical ward
of an acute care hospital, were enrolled. On admission, clinical and laboratory assessment, anthropometric
measurements, performance status, and GNRI score estimation were performed. HCAIs were recorded
during admission.
Findings: On admission, 53.8% of the patients were not at risk, 37.2% at low or medium risk and 8.9% at high
risk for nutrition-related complications, as stratified by using the GNRI. During hospitalization 23.7% of the
patients developed HCAIs. Patients with HCAIs had higher mortality (P < 0.001) and longer hospital stay (P <
0.001). In multivariate analysis, a performance status >1 [hazard ratio (HR): 2.08; 95% confidence interval
10 / 29
Janvier 2012
(CI): 1.07-4.02; P = 0.03] and diabetes (HR: 2.57; 95% CI: 1.37-4.84; P = 0.003) were associated with
increased risk for HCAIs, whereas GNRI score (per unit increase) had a protective effect (HR: 0.97; 95% CI:
0.95-0.99; P = 0.01).
Conclusion: GNRI can accurately stratify hospitalized elderly patients according to risk for developing HCAIs.
Well-nourished patients (GNRI >98) were significantly more likely to remain free from HCAIs during
hospitalization (P = 0.003).
NosoBase n° 32710
Comparaison de l’efficacité du nettoyage entre le désinfectant en cours d’utilisation et l’eau
électrolysée en maison de retraite
Meakin NS; Bowman C; Lewis MR; Dancer SJ. Comparison of cleaning efficacy between in-use disinfectant
and electrolysed water in an english residential care home. The Journal of hospital infection 2012; in press: 6
pages.
Mots-clés : DESINFECTANT; EFFICACITE;
QUATERNAIRE; SURFACE; CONTAMINATION
NETTOYAGE;
ETUDE
PROSPECTIVE;
AMMONIUM
Background: Infection control in hospitals and care homes remains a key issue. They are regularly inspected
regarding standards of hygiene, but visual assessment does not necessarily correlate with microbial
cleanliness. Pathogens can persist in the inanimate environment for extended periods of time.
Aim: This prospective study compared the effectiveness of a novel sanitizer containing electrolysed water, in
which the active ingredient is stabilized hypochlorous acid (Aqualution.), with the effectiveness of the
quaternary ammonium disinfectant in current use for microbial removal from hand-touch surfaces in a care
home. The study had a two-period crossover design.
Methods: Five surfaces were cleaned daily over a four-week period, with screening swabs taken before and
after cleaning. Swabs were cultured in order to compare levels of surface microbial contamination [colonyforming units (cfu)/cm(2)] before and after cleaning with each product.
Findings: Cleaning with electrolysed water reduced the mean surface bacterial load from 2.6 [interquartile
range (IQR) 0.30-30.40] cfu/cm(2) to 0.10 (IQR 0.10-1.40) cfu/cm(2) [mean log(10) reduction factor 1.042,
95% confidence interval (CI) 0.79-1.30]. Cleaning with the in-use quaternary ammonium disinfectant
increased the bacterial load from 0.90 (IQR 0.10-8.50) cfu/cm(2) to 93.30 (IQR 9.85-363.65) cfu/cm(2) (mean
log(10) reduction -1.499, 95% CI -1.87 to -1.12) (P < 0.0001). Using two proposed benchmark standards for
surface microbial levels in hospitals, electrolysed water resulted in a higher 'pass rate' than the in-use
quaternary ammonium disinfectant (80-86% vs 15-21%, P < 0.0001).
Conclusion: Electrolysed water exerts a more effective bacterial kill than the in-use quaternary ammonium
disinfectant, which suggests that it may be useful as a surface sanitizer in environments such as care homes.
Environnement
NosoBase n° 32556
Décret n° 2011-1727 du 02/12/2011 relatif aux valeurs-guides pour l'air intérieur pour le formaldéhyde
et le benzène
Ministère de l’écologie, du développement durable, des transports et du logement. Journal officiel
2011/12/04: 2 pages
Mots-clés : FORMALDEHYDE; AIR; ENVIRONNEMENT
NosoBase n° 32699
Décontamination à la vapeur de peroxyde d'hydrogène de surfaces contaminées artificiellement par
le calicivirus félin substituts des norovirus
Bentley K; Dove BK; Parks SR; Walker JT; Bennett AM. Hydrogen peroxide vapour decontamination of
surfaces artificially contaminated with norovirus surrogate feline calicivirus. The Journal of hospital infection
2012; in press: 6 pages.
Mots-clés : SURFACE; PEROXYDE D'HYDROGENE; PREVENTION; DECONTAMINATION; NOROVIRUS;
VAPEUR; PEROXYDE D'HYDROGENE; MATERIAU
11 / 29
Janvier 2012
Background: Noroviruses are a leading cause of gastrointestinal disease and are of particular concern in
healthcare settings such as hospitals. As the virus is reported to be environmentally stable, effective
decontamination following an outbreak is required to prevent recurrent outbreaks.
Aim: To investigate the use of hydrogen peroxide vapour to decontaminate a number of surfaces that had
been artificially contaminated with feline calicivirus (FCV), a surrogate for norovirus. The surfaces tested were
representative of those found in hospital wards.
Methods: FCV was used to contaminate materials representative of a hospital setting (stainless steel, glass,
vinyl flooring, ceramic tile and PVC plastic cornering). The carriers were exposed to 30% (w/w) hydrogen
peroxide vapour at 5-min intervals over 20min, after which postexposure viral titres were measured.
Findings: Hydrogen peroxide vapour reduced the viral titre by 4 log(10) on all surfaces tested within 20min of
exposure. The reduction in viral titre took longest to achieve on stainless steel (20min), and the quickest
effect was seen on vinyl flooring (10min). For glass, plastic and ceramic tile surfaces, the desired reduction in
viral titre was seen within 15min of exposure. Hydrogen peroxide vapour allows for large-scale
decontamination of areas following outbreaks of infectious organisms.
Conclusion: Hydrogen peroxide vapour is effective against FCV and is active on a range of surfaces.
Therefore, it may represent a suitable decontamination system for use following a hospital outbreak of
norovirus.
NosoBase n° 32669
Un système de ventilation inadéquat dans un hôpital augmente le risque de Mycobacterium
tuberculosis nosocomial
Hubad B; Lapanje A. Inadequate hospital ventilation system increases the risk of nosocomial Mycobacterium
tuberculosis. The Journal of hospital infection 2012/01; 80(1): 88-91.
Mots-clés : AIR; FILTRATION; MYCOBACTERIE; LABORATOIRE; PREVENTION; PERSONNEL; RISQUE;
MYCOBACTERIUM TUBERCULOSIS
The ambient air in nine locations in a pulmonary hospital and a tuberculosis diagnostic laboratory was
analysed to determine the hazard posed by Mycobacterium tuberculosis. In four locations, between 6 and 20
M. tuberculosis cell equivalents/m(3) were detected. The results indicated that inadequately ventilated
corridors had the highest cell equivalents. In these areas healthcare workers were less aware of infection
hazard compared to areas with known sources of M. tuberculosis and the wearing of protective masks and
passive ventilation were not in place. Based on these results, further infection prevention and control
measures need to be implemented.
NosoBase n° 32662
Réduction de la contamination de surfaces et de biofilms d'Enterococcus sp. et Staphylococcus
aureus à l'aide de vapeurs d'agrumes
Laird K; Armitage D; Phillips C. Reduction of surface contamination and biofilms of Enterococcus sp. and
Staphylococcus aureus using a citrus-based vapour. The Journal of hospital infection 2012/01; 80(1): 61-66.
Mots-clés : CONTAMINATION; BIOFILM; SURFACE; VAPEUR; DESINFECTION; STAPHYLOCOCCUS
AUREUS; ENTEROCOCCUS; ENVIRONNEMENT
Background: Antibiotic-resistant organisms such as meticillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococcus sp. (VRE) are an ongoing problem in hospitals. Essential oil vapours
(EOs) have been shown to reduce environmental bacterial contamination.
AIMS: To assess the efficacy of Citri-V., a vaporized blend of citrus EOs (orange: bergamot, 1:1 v/v) (Belmay,
Northampton, UK), at removing Enterococcus sp. and S. aureus from stainless steel surfaces; and to
investigate its effect on the formation of bacterial biofilms.
Methods: A microplate assay was used to assess the effect of the citrus vapour on the formation of biofilms
and their metabolic activity. Biofilm removal from stainless steel surfaces was measured by a colorimetric
assay and by digital microscopy.
Findings: The citrus vapour reduced VRE and MRSA on stainless steel surfaces by 1.5-3log(10) after 24h
exposure. Staphylococcal biofilms were reduced both during and after formation, whereas enterococcal
biofilms were significantly reduced (P=0.05) only after formation. Metabolic activity decreased by up to 72% in
strains tested. Two-dimensional digital microscopy showed reductions in biofilm coverage of the stainless
steel disc by as much as 99.5%.
Conclusion: Citrus vapour has potential for application in the clinical environment, for instance as a secondary
disinfectant to reduce surface contamination by VRE and MRSA.
12 / 29
Janvier 2012
NosoBase n° 32713
Comparaison des bactéries isolées sur des tenues de chirurgiens hospitaliers neuves, à usage
unique, lavées en lingerie ou en dehors des lingeries
Nordstrom JM; Reynolds KA; Gerba CP. Comparison of bacteria on new, disposable, laundered, and
unlaundered hospital scrubs. American journal of infection control 2012; in press: 5 pages.
Mots-clés : TENUE VESTIMENTAIRE; CHIRURGIE; BLOC OPERATOIRE; LINGERIE; USAGE UNIQUE;
COCCI GRAM POSITIF; STAPHYLOCOCCUS AUREUS; ESCHERICHIA COLI
Background: As a cost-saving measure, an increasing number of hospitals allow personnel to launder their
uniforms, lab coats, and operating room scrubs at home. With rising nosocomial infection rates and
increasing levels of multidrug-resistant bacteria in hospital settings, uniform contamination may be an
environmental factor in the spread of infection.
Methods: We quantified the number and identity of bacteria found on swatches cut from unwashed operating
room, hospital-laundered, home-laundered, new cloth, and new disposable scrubs.
Results: Of the 29 unwashed hospital operating room scrub swatches analyzed, 23 (79%) were positive for
some type of gram-positive cocci, with 3 (10%) of those classified as Staphylococcus aureus, and 20 (69%)
were positive for coliform bacteria, 3 of which were Escherichia coli. Home-laundered scrubs had a
significantly higher total bacteria count than hospital-laundered scrubs (P = .016). There was no statistical
difference in the bacteria counts between hospital-laundered scrubs and unused new and disposable scrubs.
In the home-laundered scrubs 44% (18/41) were positive for coliform bacteria, but no isolates were
Escherichia coli.
Conclusions: Significantly higher bacteria counts were isolated from home-laundered scrubs and unwashed
scrubs than from new, hospital-laundered, and disposable scrubs.
NosoBase n° 32620
Impact de la réduction de la contamination de l'environnement et des équipements sur les taux
d'Enterococcus résistant à la vancomycine
Perugini M; Nomi SM; Lopes GK; Belei RA; Van Der Heijden IM; Mostachio A; et al. Impact of the reduction of
environmental and equipment contamination on vancomycin-resistant enterococcus rates. Infection 2011/12;
39(6): 587-593.
Mots-clés : VANCOMYCINE; CONTAMINATION; ENTEROCOCCUS; TAUX; ANTIBIORESISTANCE;
ENVIRONNEMENT; EQUIPEMENT; SURFACE; ENTEROCOCCUS FAECIUM; BACTERIEMIE; INFECTION
URINAIRE; OBSERVANCE; PRECAUTION COMPLEMENTAIRE; PRECAUTION CONTACT
More than 1,500 perirectal swab cultures and 552 environmental and equipment cultures were collected
during the study period. Enterococcus faecium was the most frequent species isolated, being responsible for
71% of the positive cultures. Fifty infections were documented, with bloodstream infections (18, 36%) being
the most frequent, followed by urinary tract infection (15, 30%). An educational intervention was given to 136
healthcare workers (HCWs), and a questionnaire regarding vancomycin-resistant Enterococcus (VRE)
transmission was also performed pre- and post-intervention. Overall, 858 opportunities of patient care were
evaluated. The compliance with contact precautions did not improve; however, in general, the proportion of
correct answers regarding VRE increased significantly when comparing pre- and post-intervention periods (p
< 0.05). On the other hand, the proportion of environmental and equipment contaminated by VRE decreased
significantly from pre- (23.2%) to post-intervention (8.2%) (p < 0.001) and was associated with a significant
decrease in VRE infection from 7.7 to 1.9 when comparing the pre- and post-intervention periods. The use of
vancomycin (defined daily dose [DDD]) did not change significantly over the study period (p = 0.970), and the
use of teicoplanin increased (p < 0.001). Seventy-six percent of E. faecium belong to type and subtype A by
pulsed-field gel electrophoresis (PFGE). This predominant type was found in the environment and caused
colonization and infection. In conclusion, the present study showed that reduction of the proportion of
environmental and equipment contamination was associated with a decrease of colonization and infection
due to VRE, and that the strategy to control VRE dissemination should be based on local problems.
NosoBase n° 32695
Fusarium sp. retrouvées dans le réseau de distribution d’eau d’un centre hospitalier universitaire
français
Sautour M; Edel-Hermann V; Steinberg C; Sixt N; Laurent J; Dalle F; et al. Fusarium species recovered from
the water distribution system of a french university hospital. International journal of hygiene and
environmental health 2012 in press: 7 pages.
13 / 29
Janvier 2012
Mots-clés : EAU; CENTRE HOSPITALIER UNIVERSITAIRE; MYCOLOGIE; FUSARIUM; EAU DU ROBINET;
PRELEVEMENT; BIOLOGIE MOLECULAIRE; TRAVAUX HOSPITALIERS; ARCHITECTURE
Dijon Hospital is a French tertiary care institution undergoing major renovation, and different microbiological
controls revealed the presence of Fusarium spp. in the water distribution system. Because some Fusarium
spp. can cause life-threatening opportunistic infections in immunocompromised patients, an 8-month survey
was conducted in two hospital sites in order to evaluate the prevalence of the fungi in the water system. In 2
units of one hospital site, 100% of the samples of tap-water were positive, with high concentrations of
Fusarium spp. (up to 10(5)cfu/L). In the second hospital site, 94% of samples were positive, but generally with
lower concentrations. The analysis of translation elongation factor 1a (TEF) sequences of 146 isolates
revealed the presence of two different Fusarium species: F. oxysporum was detected in all units explored of
both hospital sites, and F. dimerum only in one unit of one hospital site. For both species, we suggest that the
fungi discovered could be particularly adapted to an aquatic environment.
NosoBase n° 32697
Efficacité virucide de la désinfection à la vapeur de peroxyde d’hydrogène
Tuladhar E; Terpstra P; Koopmans M; Duizer E. Virucidal efficacy of hydrogen peroxide vapour disinfection.
The Journal of hospital infection 2012; in press: 6 pages.
Mots-clés : PEROXYDE D'HYDROGENE; DESINFECTION; EFFICACITE; VIRUCIDIE; TEST; VAPEUR;
VIRUS; NOROVIRUS; GRIPPE
Background: Viral contamination of surfaces is thought to be important in transmission. Chemical disinfection
can be an effective means of intervention, but little is known about the virucidal efficacy of hydrogen peroxide
vapour (HPV) against enteric and respiratory viruses.
Aim: To measure the virucidal efficacy of HPV against respiratory and enteric viruses on materials
representing those found in institutions and homes.
Methods: Poliovirus, human norovirus genogroup II.4 (GII.4), murine norovirus 1, rotavirus, adenovirus and
influenza A (H1N1) virus dried on to stainless steel, framing panel and gauze carriers were exposed to HPV
127ppm for 1h at room temperature in an isolator. Poliovirus was also exposed to HPV at different locations
in a room. The virucidal effect was measured by comparing recoverable viral titres against unexposed
controls. Polymerase chain reaction was used to evaluate the effect of HPV on viral genome reduction.
Findings: HPV disinfection resulted in complete inactivation of all viruses tested, characterized by >4 log(10)
reduction in infectious particles for poliovirus, rotavirus, adenovirus and murine norovirus on stainless steel
and framing panel carriers, and >2 log(10) reduction for influenza A virus on stainless steel and framing panel
carriers, and for all viruses on gauze carriers. Complete inactivation of poliovirus was demonstrated at several
locations in the room. Reductions in viral genomes were minimal on framing panel and gauze carriers but
significant on stainless steel carriers; human norovirus GII.4 genome was most resistant to HPV treatment.
Conclusion: HPV could be an effective virucidal against enteric and respiratory viruses contaminating inhouse environments.
NosoBase n° 32542
Evaluation de la qualité de la désinfection réalisée par les lave-bassins
Malot J; Shum J; Croize J; Lagier A; Ducki S; Mallaret MR. Evaluation of the quality of bedpan washer
disinfection. Hygiènes 2011/11; XIX(5): 277-283.
Mots-clés :
DESINFECTION;
LAVE-BASSIN;
QUALITE;
TRANSMISSION;
PRELEVEMENT;
MICROBIOLOGIE; STAPHYLOCOQUE A COAGULASE NEGATIVE; PSEUDOMONAS AERUGINOSA;
STAPHYLOCOCCUS; METICILLINO-RESISTANCE; ENTEROCOCCUS FAECIUM
Objectif: Dans le contexte de diffusion d'entérobactéries multirésistantes aux antibiotiques, l'objectif était
d'évaluer la qualité de désinfection obtenue par lave-bassins.
Matériel et méthode: Une enquête a concerné les lave-bassins thermiques d'un centre hospitalier de 2000
lits. Pour chaque appareil étaient notés la présence de liquide anticalcaire, le degré d'entartrage des buses et
l'état de fonctionnement ; des prélèvements étaient réalisés en trois points du lave-bassins (paroi, fond de
cuve, buses) et sur trois matériels désinfectés (prélèvements de surface). Selon le résultat des cultures
(numération en unités formant colonies et présence de microorganisme indicateur), les prélèvements étaient
classés en cible, alerte ou action. Clostridium difficile n'était pas recherché.
14 / 29
Janvier 2012
Résultats: Les prélèvements ont concerné 72 lave-bassins et 216 matériels désinfectés. Sept des 72 lavebassins (10 %) comportaient des microorganismes indicateurs (S. aureus, E. faecium, P. aeruginosa, S.
paucimobilis) au niveau des buses (n = 4), des parois verticales (n = 2) ou du fond de cuve (n = 4). Six des
sept appareils présentaient un entartrage important ou un dysfonctionnement technique ou ne comportaient
pas de liquide anticalcaire. Sur les matériels, 195/216 prélèvements (88 %) étaient en niveau cible ; 21/216
(12 %) étaient en alerte ou action sans aucune bactérie pathogène, les numérations reflétant une
contamination environnementale survenant après la désinfection.
Conclusion: La désinfection obtenue par lave-bassins est satisfaisante ; la maintenance des appareils est un
point important pour garantir l'efficacité des lave-bassins. L'étude serait à compléter en analysant l'efficacité
sur Clostridium difficile.
Escarres
NosoBase n° 32606
Prévention des escarres en établissement de soins de longue durée - Analyse coût-efficacité
Pham B; Stern A; Chen W; Sander B; John-Baptiste A; Thein HH; et al. Preventing pressure ulcers in longterm care – A cost-effectiveness analysis. Archives of internal medicine 2011/11/14; 171(20): 1839-1847.
Mots-clés : PREVENTION; SOIN DE LONGUE DUREE; PEAU; ESCARRE; COUT-EFFICACITE; COUT;
RISQUE
Background: Pressure ulcers are common in many care settings, with adverse health outcomes and high
treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current
prevention practice in long-term care facilities.
Methods: We used a validated Markov model to compare current prevention practice with the following 4
quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional
supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry
skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included
lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated
according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 =
US$0.84).
Results: Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated
number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1
and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident,
respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for
strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that
improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1%
(strategy 2).
Conclusions: The clinical and economic evidence supports pressure redistribution mattresses for all long-term
care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be costeffective, but firm conclusions are limited by the available clinical evidence.
Escherichia coli
NosoBase n° 32541
Escherichia coli producteur de bêta-lactamase à spectre étendu : quelle est la part d'acquisition
hospitalière ?
Pujol S; Cholley P; Sauget M; Gbaguidi-Haore H; Pazart L; Bertrand X; et al. Extended spectrum betalactamase (ESBL) producing Escherichia coli: extent of acquisition in hospitals. Hygiènes 2011/11; XIX(5):
269-276.
Mots-clés : ESCHERICHIA COLI; BETA-LACTAMASE A SPECTRE ELARGI; CENTRE HOSPITALIER
UNIVERSITAIRE; CAS TEMOIN; TYPAGE; COLONISATION; TRANSMISSION; ETUDE RETROSPECTIVE;
PRECAUTION COMPLEMENTAIRE; DEPISTAGE
Face à l'augmentation de l'incidence des infections nosocomiales à E. coli producteur de bêta-lactamase à
spectre étendu (BLSE), notre objectif était d'identifier les cas possibles d'acquisition hospitalière des souches
15 / 29
Janvier 2012
de E. coli BLSE durant une période de neuf mois dans notre centre hospitalier universitaire. L'étude reposait
sur l’analyse de la distribution spatio-temporelle des cas, le typage moléculaire des souches et l'identification
des gènes de résistance BLSE. Enfin une analyse cas/témoins devait permettre d'identifier les facteurs
statistiquement associés aux cas. Sur un total de 64 cas d’infections à E. coli BLSE durant une période de
neuf mois, le typage moléculaire a montré un total de 51 clones isolés chez un seul patient parmi les 61
souches typables. Seuls trois cas possibles pour un total de sept patients pouvaient relever d'une
transmission croisée intra-hospitalière. Au total, la diversité clonale des souches des sept patients et la
diversité des BLSE impliquées écartaient formellement cette hypothèse pour cinq de ces sept patients. Un
seul cas de transmission croisée de gène de résistance était possible. L'étude cas/témoin a montré que seul
un score de Charlson élevé était significativement associé à l'acquisition d'une colonisation/infection à E. coli
à BLSE. Au total, au vu de nos résultats, il apparaît peu faisable d'établir une stratégie de dépistage ciblé
alors qu'une stratégie de dépistage à grande échelle aurait un rapport coût/bénéfice très discutable.
Gestion des risques
NosoBase n° 30572
Vers une culture de la sécurité des soins
Dumartin C. Le moniteur hospitalier 2011/11; 240: 46-50.
Mots-clés : SIGNALEMENT; CCLIN; ARLIN; ARS; LEGISLATION
Au 1er janvier 2012, le télésignalement remplacera la fiche de signalement des infections nosocomiales
« sentinelles ». L’occasion d’une mise au point sur les apports et les perspectives d’évolution de ce dispositif.
NosoBase n° 32645
Surcoût des événements indésirables associés aux soins à l'hôpital - Premières estimations à partir
de neuf indicateurs de sécurité des patients
Nestrigue C; Or Z. DREES Etudes et Résultats 2011/11; 784: 1-8.
Mots-clés : COUT; DUREE DE SEJOUR; INDICATEUR; USAGER; SECURITE; PMSI; ESCARRE;
SEPTICEMIE; INFECTION; SOIN
Cette étude fournit de premières estimations nationales du coût de prise en charge d’une partie des
événements indésirables associés aux soins qui surviennent à l’hôpital, en exploitant les données
hospitalières collectées en routine. Neuf indicateurs de sécurité des patients, permettant d’identifier des
événements indésirables nécessitant une attention particulière et sur lesquels il est possible d’intervenir en
amont, ont été retenus. Les résultats montrent que 0,5 % des séjours hospitaliers sont associés à l’un ou
l’autre de ces neuf événements indésirables. Il existe toutefois de fortes disparités de surcoûts, ceux-ci
pouvant varier d’un peu plus de 500 euros pour les traumatismes obstétricaux à environ 20 000 euros pour
les septicémies. Ces surcoûts sont étroitement corrélés avec la durée des séjours et l’intensité des soins. En
2007, le coût total de prise en charge de ces neuf événements indésirables est estimé à 700 millions d’euros,
concentré à 90 % sur quatre événements indésirables (désordres physiologiques et métaboliques post
opératoires, septicémies post opératoires, escarres, et embolies pulmonaires post opératoires). Les
événements indésirables examinés dans cette étude sont associés à une augmentation significative du coût
et de la durée de séjour à l’hôpital. Cette question nécessite donc d’être explorée dans la perspective
d’améliorer la qualité des soins tout en renforçant le rapport coût-efficience des établissements.
Grippe
NosoBase n° 32557
Avis relatif à la stratégie à adopter concernant le stock - Etat de masques respiratoires
Haut Conseil de la Santé Publique. HCSP 2011: 1-6.
Mots-clés : MASQUE; RECOMMANDATION; GRIPPE; STOCKAGE; SRAS; APPAREIL RESPIRATOIRE;
HYGIENE DES MAINS; URGENCE;CONSULTATION; RADIOLOGIE; GANT; TENUE VESTIMENTAIRE;
INTUBATION; VENTILATION ASSISTEE; ASPIRATION; BRONCHOSCOPIE; AEROSOL; PRELEVEMENT;
NEZ; PRECAUTION COMPLEMENTAIRE
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Janvier 2012
NosoBase n° 32544
Evaluation d'une formation en ligne sur le bon usage des masques lors de la préparation à la
pandémie grippale
Gaspard P; Noiriel P; Gunther D; Claudel O; Lachat D; Ebele F; et al. Online training in the use of masks
when making preparations for an influenza pandemic. Hygiènes 2011/11; XIX(5): 293-300.
Mots-clés : EVALUATION ;FORMATION; MASQUE; GRIPPE; MASQUE; INTERNET; PRECAUTION AIR;
PRECAUTION GOUTTELETTE; CONNAISSANCE; QUESTIONNAIRE; INFIRMIER; PUERICULTRICE;
AIDE SOIGNANTE; CADRE INFIRMIER
La formation des professionnels est un aspect important dans les démarches de prévention des risques
infectieux associés aux soins. Dans le cadre de la préparation à la pandémie, une action de formation en
ligne a été développée au niveau du centre hospitalier de Rouffach concernant le bon usage des masques.
Ce travail présente l'élaboration et le suivi de l'utilisation par enquête de satisfaction des agents d'une action
de formation en ligne. Tous les agents de l'établissement avaient reçu la consigne de suivre la formation par
leur responsable hiérarchique. Les résultats montrent une bonne adhésion de l'ensemble des professionnels
de l'établissement avec un taux de validation du suivi par feuille d'émargement de 64,2 % (859/1337). Dans
les services de soins, la participation des catégories infirmières et aides-soignantes est respectivement de
79,2 % et 83,4 %. Le suivi des consultations sur Internet (1272 consultations) a permis de montrer que le
suivi de la formation s'était étalé sur neuf semaines. L'analyse de la chronologie journalière met en évidence
un suivi régulier sur toutes les tranches horaires entre 10h00 et 18h00. Les équipes de nuits ont également
consulté ce lien entre 19h00 et 1h00 du matin. L'évaluation de la satisfaction des agents montre également
une bonne adhésion des professionnels au projet mais l'organisation dans les services demandera à être
mieux définie pour les futures formations : consultation en groupe, modalité de remontée des questions,
accès au poste, temps définis pour ce suivi... En conclusion, les agents ont adhéré à l'action de formation en
ligne et pour un établissement de santé, réussir le déploiement de cet outil est un enjeu stratégique dans la
formation et l'actualisation des connaissances de ces professionnels.
NosoBase n° 32361
Transmission du virus de la grippe pandémique A (H1N1) 2009 parmi le personnel soignant Californie du Sud, 2009
Jaeger JL; Patel M; Dharan N; Hancock K; Meites E; Mattson C; et al. Transmission of 2009 pandemic
influenza A (H1N1) virus among healthcare personnel - Southern California, 2009. Infection control and
hospital epidemiology 2011/12; 32(12): 1149-1157.
Mots-clés : TRANSMISSION; GRIPPE; VIRUS; PERSONNEL; VIRUS INFLUENZA TYPE A; EPIDEMIE;
MASQUE; COHORTE; AMBULATOIRE; QUESTIONNAIRE; SEROTYPIE
Objective: In April 2009, 2009 pandemic influenza A (H1N1) (hereafter, pH1N1) virus was identified in
California, which caused widespread illness throughout the United States. We evaluated pH1N1 transmission
among exposed healthcare personnel (HCP) and assessed the use and effectiveness of personal protective
equipment (PPE) early in the outbreak. DESIGN. Cohort study.
Setting: Two hospitals and 1 outpatient clinic in Southern California during March 28-April 24, 2009.
Participants: Sixty-three HCP exposed to 6 of the first 8 cases of laboratory-confirmed pH1N1 in the United
States.
Methods: Baseline and follow-up questionnaires were used to collect demographic, epidemiologic, and
clinical data. Paired serum samples were obtained to test for pH1N1-specific antibodies by
microneutralization and hemagglutination-inhibition assays. Serology results were compared with HCP work
setting, role, and self-reported PPE use.
Results: Possible healthcare-associated pH1N1 transmission was identified in 9 (14%) of 63 exposed HCP; 6
(67%) of 9 seropositive HCP had asymptomatic infection. The highest attack rates occurred among outpatient
HCP (6/19 [32%]) and among allied health staff (eg, technicians; 8/33 [24%]). Use of mask or N95 respirator
was associated with remaining seronegative ([Formula: see text]). Adherence to PPE recommendations for
preventing transmission of influenza virus and other respiratory pathogens was inadequate, particularly in
outpatient settings.
Conclusions: pH1N1 transmission likely occurred in healthcare settings early in the pandemic associated with
inadequate PPE use. Organizational support for a comprehensive approach to infectious hazards, including
infection prevention training for inpatient- and outpatient-based HCP, is essential to improve HCP and patient
safety.
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Janvier 2012
Hygiène des mains
NosoBase n° 32367
Une main sale dans un gant de latex : une étude sur l'observance des pratiques d'hygiène des mains
lors du port de gants
Fuller C; Savage J; Besser S; Hayward A; Cookson B; Cooper B; et al. "The dirty hand in the latex glove": a
study of hand hygiene compliance when gloves are worn. Infection control and hospital epidemiology
2011/12; 32(12): 1194-1199.
Mots-clés : HYGIENE DES MAINS; GANT; OBSERVANCE; AUDIT; TRANSMISSION MANUPORTEE;
GERIATRIE; SOIN INTENSIF; RECOMMANDATION; OMS
Background and objective: Wearing of gloves reduces transmission of organisms by healthcare workers'
hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand
hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized
assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when
appropriate and whether hand hygiene compliance differed when gloves were worn.
Design: Observational study.
Participants and setting: Healthcare workers in 56 medical or care of the elderly wards and intensive care
units in 15 hospitals across England and Wales.
Methods: We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 onehour sessions. Observers also recorded whether gloves were or were not worn for individual contacts.
Results: Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of
3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand
hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was
50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and
whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly
associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79];
[Formula: see text]).
Conclusion. The rate of glove usage is lower than previously reported. Gloves are often worn when not
indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were
worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization
indications for gloving and associated hand hygiene.
NosoBase n° 32711
Etude des contaminants bactériens trouvés sur des feuilles d'essuie-mains non utilisées et postcontamination possible après lavage des mains : étude pilote
Gendron L; Trudel L; Moineau S; Duchaine C. Evaluation of bacterial contaminants found on unused paper
towels and possible postcontamination after handwashing: a pilot study. American journal of infection control
Mots-clés : CONTAMINATION ;ESSUIE-MAINS; TRANSMISSION; LAVAGE DES MAINS; HYGIENE DES
MAINS; MICROBIOLOGIE; GENOTYPE; AEROSOL; BACILLUS; CLOSTRIDIUM
Background: Bacterial contamination is a concern in the pulp and paper industry. Not only is the machinery
contaminated but also can be the end-paper products. Bacterial transmission from unused paper towels to
hands and surfaces is not well documented.
Methods: The culturable bacterial community of 6 different unused paper towel brands was determined by
culture methods and by sequencing the 16S ribosomal DNA of bacterial contaminants. Next, we investigated
the possible airborne and direct contact transmissions of these bacterial contaminants during hand drying
after washing.
Results: Between 10(2) and 10(5) colony-forming units per gram of unused paper towels were isolated from
the different paper towel brands. Bacteria belonging to the Bacillus genus were by far the most abundant
microorganisms found (83.0%), followed by Paenibacillus (15.6%), Exiguobacterium (1.6%), and Clostridium
(0.01%). Paper towels made from recycled fibers harbored between 100- to 1,000-fold more bacteria than the
virgin wood pulp brand. Bacteria were easily transferred to disposable nitrile gloves when drying hands with
paper towels. However, no evidence of bacterial airborne transmission was observed during paper towel
dispensing.
Conclusion: This pilot study demonstrated that a large community of culturable bacteria, including toxin
producers, can be isolated from unused paper towels and that they may be transferred to individuals after
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Janvier 2012
handwashing. This may have implications in some industrial and clinical settings as well as in
immunocompromised individuals.
NosoBase n° 32543
Evaluation des pratiques d'utilisation des gants de soins au cours d'actes de nursing
Thiriet L; Jeunesse K; Gizzi A; Ibarissene B. Evaluation of the use of gloves during hands-on nursing.
Hygiènes 2011/11; XIX(5): 285-291.
Mots-clés : EVALUATION; GANT; SOIN; TRANSMISSION MANUPORTEE; AUDIT; EVALUATION DES
PRATIQUES PROFESSIONNELLES; MESUSAGE; PRECAUTION STANDARD; HYGIENE DES MAINS;
TOILETTE DU PATIENT; SOLUTION HYDRO-ALCOOLIQUE; QUESTIONNAIRE; DECHET DOMESTIQUE
Le mésusage des gants participe à la non-maîtrise de la transmission croisée. Nous avons réalisé une
évaluation des pratiques professionnelles afin de déterminer précisément le niveau de respect des
précautions standard dans notre établissement. Deux cent quarante observations ont été conduites dans le
cadre de deux situations de nursing (toilette, et change de la protection du patient), selon la méthode de
l'audit de pratiques. Nous avons constaté le respect très partiel du changement de gants en cas d'interruption
de tâches, ainsi qu'un retrait trop tardif des gants à l'issue du soin. Le respect des règles d'hygiène des
mains, mesuré en parallèle, a mis en évidence un déficit flagrant du recours aux solutions hydroalcooliques
au décours du soin. À l'issue de cette évaluation, nous avons mis en place un plan d'action visant à améliorer
la réceptivité des agents aux formations dispensées par l'unité d'hygiène hospitalière : des ateliers pratiques
mettant en scène des situations de soins à risque de transmission croisée ont été développés. Une seconde
évaluation des pratiques professionnelles centrée sur la toilette du patient alité a été initiée afin de mesurer
plus précisément le niveau d'application des précautions standard.
Infection urinaire
NosoBase n° 32666
Epidémie d'infections urinaires nosocomiales à Myroides odoratimimus dans un centre hospitalier
tunisien
Ktari S; Mnif B; Koubaa M; Mahjoubi F; Ben Jemaa M; Mhiri MN; et al. Nosocomial outbreak of Myroides
odoratiminus urinary tract infection in a tunisian hospital. The Journal of hospital infection 2012/01; 80(1): 7781.
Mots-clés : INFECTION URINAIRE; EPIDEMIE; BACILLE GRAM
ANTIBIORESISTANCE; CENTRE HOSPITALIER UNIVERSITAIRE; PFGE
NEGATIF;
UROLOGIE;
We report a nosocomial outbreak of urinary tract infection caused by Myroides odoratimimus, previously
called Flavobacterium odoratum, in the urology unit of a Tunisian hospital. From May to November 2010,
seven isolates of M. odoratimimus were recovered from urine. Pulsed-field gel electrophoresis clearly
differentiated these isolates into two possibly related clones from two different periods. All patients but one
had urinary calculi and underwent endourological surgery. All Myroides isolates were resistant to all
antibiotics tested. Three patients were successfully treated with ciprofloxacin and rifampicin. Clinicians should
be aware that M. odoratimimus may induce serious and prolonged nosocomial outbreaks of urinary tract
infections.
Maladie de Creutzfledt-Jakob
NosoBase n° 32316
Instruction n° DGS/R13/2011/449 du 01/12/2011 relative à l'actualisation des recommandations visant
à réduire les risques de transmission d'agents transmissibles non conventionnels lors des actes
invasifs
Ministère du travail, de l'emploi et de la santé. Non parue au Journal officiel 2011: 22 pages.
Mots-clés : LEGISLATION; TRANSMISSION; AGENT TRANSMISSIBLE NON CONVENTIONNEL; MALADIE
DE CREUTZFELDT-JAKOB; DISPOSITIF MEDICAL; NETTOYAGE; DESINFECTION; CHIRURGIE; USAGE
UNIQUE; EOH;
STERILISATION;
VAPEUR; DECHET LIQUIDE;
LAVEUR-DESINFECTEUR;
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Janvier 2012
NEUROCHIRURGIE; CHIRURGIE OPHTALMOLOGIQUE; INTUBATION; JAVEL; ACIDE PERACETIQUE;
CONDUITE A TENIR
La présente instruction a pour objet d’actualiser les recommandations visant à réduire les risques de
transmission d’agents transmissibles non conventionnels lors des actes invasifs.
NosoBase n° 32659
Efficacité limitée de la stérilisation à la vapeur pour inactiver l’infectivité du vCJD
Fernie K; Hamilton S; Somerville RA. Limited efficacy of steam sterilization to inactivate vCJD infectivity. The
Journal of hospital infection 2012/01; 80(1): 46-51.
Mots-clés : STERILISATION; VAPEUR; TRANSMISSION; MALADIE DE CREUTZFELDT-JAKOB; AGENT
TRANSMISSIBLE NON CONVENTIONNEL; AUTOCLAVE; SURFACE
Background: The transmission of bovine spongiform encephalopathy (BSE) to humans as variant CreutzfeldtJakob Disease (vCJD) raised concerns about potential secondary transmissions due to the resistance of the
agents causing transmissible spongiform encephalopathies (TSEs), sometimes known as prions, to
commonly used methods of sterilization, notably steam sterilization (or autoclaving). It has been suggested
that surgical instruments and other medical devices might retain sufficient infected tissue debris after cleaning
and steam sterilization to infect patients on whom they are subsequently used. AIM: To determine whether
concerns about the lack of efficacy of steam sterilization of vCJD were justified.
Methods: The reduction in infectivity of brain macerates of vCJD brain after steam sterilization using the
standard temperatures and time recommended for autoclaving in UK hospitals (134-137°C for 3min) was
measured.
Findings: Reductions in titre of 10(2.3) to >10(3.6) ID(50) were found. In three of four samples, infectivity was
recovered after steam sterilization.
Conclusion: As noted previously, TSE strains derived from BSE sources appear to be more resistant to steam
sterilization and other forms of heat inactivation than other TSE sources.
Maternité
NosoBase n° 32447
Instruction du 25/11/2011 relative aux biberons stérilisés à l'oxyde d'éthylène
Ministère du travail, de l’emploi et de la santé; Direction générale de la santé; Direction générale de l’offre de
soins. Non parue au Journal officiel 2011/11/25: 2 pages.
Mots-clés : LEGISLATION; OXYDE D'ETHYLENE; BIBERONNERIE; MATERNITE; STERILISATION;
NOUVEAU-NE; NEONATOLOGIE; ASEPSIE; LAIT
NosoBase n° 32602
Avis relatif à la définition des indications de recours indispensables aux biberons et tétines stériles
pour l'alimentation des nouveau-nés et des nourrissons hospitalisés
Haut conseil de la santé publique (HCSP). HCSP 2011/12/02: 1-3.
Mots-clés : BIBERONNERIE; ALIMENTATION; RECOMMANDATION; STERILISATION; OXYDE
D'ETHYLENE; NEONATALOGIE; RISQUE; USAGE UNIQUE; STAPHYLOCOCCUS AUREUS;
PSEUDOMONAS AERUGINOSA; BACILLUS CEREUS; ENTEROBACTERIE
NosoBase n° 32579
Sensibilité au virus Varicella-Zoster parmi des femmes enceintes de la province de Lecce, Italie
Guido M; Tinelli A; De Donno A; Quattrocchi M; Malvasi A; Campilongo F; et al. Susceptibility to VaricellaZoster among pregnant women in the province of Lecce, Italy. Journal of clinical virology 2012/01; 53(1): 7276.
Mots-clés : VIRUS; VARICELLE; PREVALENCE; VACCIN; GROSSESSE; HERPES ZOSTER VIRUS
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Janvier 2012
Background: Varicella is predominantly a childhood disease, considered a mild self-limiting disease that can
have serious complications for a pregnant woman and her developing fetus.
Objectives: We investigated the susceptibility to Varicella-Zoster Virus (VZV) among pregnant women in the
province of Lecce.
Study design: A cross-sectional study was carried out in Departments of Gynecology and Obstetrics of the
Province of Lecce, where 539 pregnant women were recruted, and face-to-face interviews were conducted.
Varicella IgG tests were performed.
Results: The prevalence of varicella susceptibility among pregnant mothers was 10.6%. The prevalence of
IgG antibodies increases significantly with increasing age, from 62.5% in the age group 15-19 years to 94.4%
in the age group 40-49 years.
Discussion: In the Italian National Vaccination Plan 2005-2007, varicella vaccine is only recommended for
childbearing women. A safe and effective vaccine is available and no abnormalities have been observed
among infants born to susceptible women who received varicella vaccines during pregnancy. Such a high
number of susceptible women indicates that preventive and informative programs should be introduced, even
among those who do not plan to become pregnant. Routine counselling, varicella IgG antibody screening and
varicella vaccination should be considered if they have no history of the infection, to reduce the risk of fetal
complications and the cost of healthcare associated with the infection.
NosoBase n° 32578
Maladies infectieuses durant la grossesse
Logan S; Price L. Infectious disease in pregnancy. Obstetrics Gynaecology and Reproductive Medicine
2011/12; 21(12): 331-338.
Mots-clés : GROSSESSE; FACTEUR DE RISQUE; DEPISTAGE; PREVENTION; ANTIBIOTIQUE; VIRUS;
APPAREIL GENITAL FEMININ; INFECTION URINAIRE; APPAREIL RESPIRATOIRE; HEPATITE;
TUBERCULOSE; VIRUS DE L'IMMUNODEFICIENCE HUMAINE
Most infections during pregnancy will not cause long-term harm, but those that do should be recognized and
treated in conjunction with infectious diseases specialists and neonatologists where appropriate. Mothers may
die from obstetric sepsis, more commonly in the developing world, and some infections, notably influenza and
varicella, run a more severe course in pregnancy. Importantly, despite an overall reduction in the number of
maternal deaths in the last UK confidential enquiry, the number of women dying from infection has increased.
Maternal infection can also lead to fetal congenital anomalies, stillbirth, preterm deliveries, intrauterine growth
restriction and neonatal infection. This review outlines prevention and screening for infections, maternal
infection syndromes, important organisms with their clinical effects and management in pregnancy, and those
infections that may lead to congenital abnormalities.
Néonatologie
NosoBase n° 32698
Epidémie de conjonctivite à Adenovirus serotype 8 chez des enfants prématurés d’une unité de
réanimation en néonatologie
Ersoy Y; Otlu B; Turkcuoglu P; Yetkin F; Aker S; Kuzucu C. Outbreak of adenovirus serotype 8 conjunctivitis
in preterm infants in a neonatal intensive care unit. The Journal of hospital infection 2012; in press: 6 pages.
Mots-clés : SOIN INTENSIF; NEONATALOGIE; EPIDEMIE; VIRUS; ŒIL; CONJONCTIVE; PREMATURE;
CENTRE HOSPITALIER UNIVERSITAIRE; BIOLOGIE MOLECULAIRE; PCR; CAS TEMOIN; FACTEUR DE
RISQUE; CONTAMINATION; DISPOSITIF MEDICAL
Background: Adenovirus keratoconjunctivitis outbreaks have rarely been reported in preterm infants. An
outbreak of adenovirus conjunctivitis occurred between 15 January and 25 February at a neonatal intensive
care unit of a university hospital in Turkey. AIM: To describe the evolution, investigation and management of
the outbreak.
Methods: Adenovirus type 8 was identified in 14 samples by polymerase chain reaction analysis. A casecontrol study was performed to determine the risk factors.
Findings: Fifteen preterm neonates, five healthcare workers (HCWs) and four parents suffered from
conjunctivitis signs such as lacrimation, swelling and redness of the eye. A retinopathy of prematurity (ROP)
examination was found to be the most important risk factor for adenovirus conjunctivitis (odds ratio: 17.5; 95%
confidence interval: 1.9-163.0; P=0.012). The eyelid speculum (blepharostat) used during the ROP
examination was not sterilized between each patient and was found to be the cause of contamination.
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Conclusion: The outbreak was controlled by measures such as barrier precautions, hand hygiene, sterilization
of the blepharostat, suspending patient transfer to other units, and excluding infected HCWs for at least 15
days.
NosoBase n° 32590
Des robinets électroniques responsables d'infections à Pseudomonas aeruginosa dans une unité de
réanimation néonatale
Yapicioglu H; Gokmen Tg; Yildizdas D; Koksal F; Ozlu F; Kale-Cekinmez E; et al. Pseudomonas aeruginosa
infections due to electronic faucets in a neonatal intensive care unit. Journal of paediatrics and child health
Mots-clés : PSEUDOMONAS AERUGINOSA; SOIN INTENSIF; NEONATALOGIE; ROBINET D'EAU;
SANITAIRE
Aim: To evaluate the role of electronic faucets in a newborn intensive care unit during a Pseudomonas
aeruginosa outbreak.
Methods: After three patients had P. aeruginosa bacteremia, environmental cultures including those from
patient rooms, incubator, ventilators, total parenteral nutrition solutions, disinfection solutions, electronic and
hand-operated faucet filters/water samples after removing filters and staff hands were taken.
Results: Only filters of electronic faucets and water samples after removing filters and one liquid hand soap
showed P. aeruginosa (3-7 . 106 cfu/mL). We have removed the electronic faucets and new elbow-operated
faucets were installed. Pulsed-field gel electrophoresis analysis of outbreak-blood culture isolates from two
patients and isolates from electronic water faucets/one liquid hand soap indicated the presence of 90.7%
genetically related subtype, probably from the same clone. Water cultures from new faucets were all clean
after installation and after 7 months.
Conclusion: We suggest that electronic faucets may be considered a potential risk for P. aeruginosa in
hospitals, especially in high-risk units.
Norovirus
NosoBase n° 32531
Recommandations pour la gestion des épidémies à norovirus dans les services de soins aigus, en santé
publique et dans les établissements medico-sociaux
British Infection Association (BIA); Health Protection Agency; Infection Prevention Society (IPS); NHS
Confederation. Guidelines for the management of norovirus outbreaks in acute and community health and
social care settings; BIA 2011: 1-42.
Mots-clés : RECOMMANDATION; NOROVIRUS; INFECTION COMMUNAUTAIRE; ENVIRONNEMENT;
HYGIENE DES MAINS; LINGERIE; INCIDENCE; EPIDEMIE; CONTROLE; DEFINITION; SORTIE;
DESINFECTION; SURVEILLANCE; MAISON DE RETRAITE; EHPAD
Pédiatrie
NosoBase n° 32652
Tendances des infections associées aux soins chez des enfants : études annuelles de prévalence
dans un centre hospitalier de recherches en Italie, 2007-2010
Cioffi Degli Atti Ml; Cuttini M; Rava L; Ceradini J; Paolini V; Ciliento G; et al. Trend of healthcare-associated
infections in children: annual prevalence surveys in a research hospital in Italy, 2007-2010. The Journal of
hospital infection 2012/01; 80(1): 6-12.
Mots-clés : PEDIATRIE; PREVALENCE; ANALYSE MULTIVARIEE; DUREE DE SEJOUR; PREVENTION
Background: Annual prevalence surveys of healthcare-associated infections (HAIs) between 2007 and 2010
were conducted in the largest tertiary care children's hospital in Italy. During this period, actions to improve
HAI prevention were implemented, including strengthened isolation measures; adoption of care bundles for
invasive procedures; hand hygiene promotion using the World Health Organization multimodal strategy; and
promotion of appropriate antimicrobial use.
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Janvier 2012
Aim: To determine the impact of these measures on HAI rates.
Methods: A total of 1506 patients were surveyed. Information on patient demographics, mechanical
ventilation, central line and urinary catheterization in the preceding 48 h, and surgery in the previous 30 days
were abstracted from medical charts. The type and date of onset of HAIs, and microbiological data were
recorded. Univariate and multivariate logistic analysis were used to evaluate changes in HAI rates over time,
and the influence of ward type and patient characteristics.
Findings: There were significant (P < 0.001) reductions in the prevalence of patients developing HAI (from
7.6% to 4.3%) and in the prevalence of total HAIs (from 8.6 to 4.3 per 100 patients). Factors independently
associated with increased HAI risk were hospitalization in intensive care ward, length of stay >30 days,
presence of invasive device, and age 6-11 years.
Conclusion: This HAI prevention strategy was influential in decreasing infections among hospitalized children.
Repeated prevalence surveys are an effective tool for monitoring HAI frequency, increasing awareness
among the healthcare personnel, and contributing to the establishment of effective infection control.
Personnel
NosoBase n° 32545
Prévention des infections associées aux soins : représentations et freins chez des étudiants de
troisième année d'instituts de formation en soins infirmiers d'Aquitaine
Ambrogi V; Opeicle A; Quintard B; Parneix P; Nunes J; Leroyer C; et al. Healthcare associated infection
control: attitudes and reluctance to comply with recommendations among third-year student nurses. Hygiènes
2011/11; XIX(5): 301-306.
Mots-clés : PREVENTION; ETUDIANT; PERCEPTION; RECOMMANDATION; INFIRMIER; HYGIENE DES
MAINS; OBSERVANCE; GANT; CATHETER VEINEUX PERIPHERIQUE; MULTIRESISTANCE;
DESINFECTION DES MAINS PAR FRICTION; BIJOU; EXPOSITION AU SANG; SONDAGE URINAIRE
Si les personnels sont convaincus de l'importance du respect des recommandations en hygiène hospitalière,
celles-ci ne sont pas toujours respectées sur le terrain. Notre objectif était d'étudier les représentations des
infections associées aux soins et les freins à l'application des recommandations chez les étudiants en soins
infirmiers de troisième année. L'échantillon étudié était issu de cinq instituts de formation volontaires. Un
autoquestionnaire a été renseigné à la fin d'un enseignement par 434 étudiants. L'encadrement lors des
stages était perçu comme moins fréquent pour l'hygiène des mains, les précautions standard et
complémentaires, que pour les actes techniques. La présence du cadre sur le lieu de stage favorisait la
compliance aux règles d'hygiène. Les freins les plus fréquents étaient : complexité du protocole, manque de
moyens mais aussi peur de la marginalisation ou de la sanction en cas de positionnement différent. Le
manque de prise de conscience, l'insuffisance de formation ou la difficulté de lutter contre les infections
associées aux soins étaient plus rarement cités. Ces représentations sont proches de celles observées chez
des professionnels lors d'une précédente recherche : revendications professionnelles et mise en cause des
pratiques de santé. Les freins à l'observance des recommandations semblent donc s'installer précocement
dans le parcours de formation du professionnel.
NosoBase n° 32589
Guide pour la prophylaxie postexposition (PPE) à des liquides biologiques dans le contexte du travail
– octobre 2011
Direction des communications du Ministère de la santé et des services sociaux du Québec 2011/10: 1-56.
Mots-clés : PERSONNEL; EXPOSITION AU SANG; HEPATITE; HEPATITE B; HEPATITE C; VIH;
TRANSMISSION; QUESTIONNAIRE; INFORMATION; EPIDEMIOLOGIE; PSYCHOLOGIE
A la demande du ministère de la Santé et des Services sociaux du Québec, un groupe de travail a procédé à
la révision des recommandations sur la prise en charge des personnes exposées accidentellement à du sang
et à d’autres liquides biologiques susceptibles de transmettre des infections à diffusion hématogène publiées
en 2006. Ces recommandations visent à améliorer l’évaluation et le suivi des personnes exposées et à
uniformiser les approches dans ce domaine. Elles sont destinées aux intervenants du réseau de la santé qui
auront à apprécier les risques associés à ces expositions et à appliquer les mesures en postexposition. Un
état de situation de la transmission de virus hématogènes chez les travailleurs de la santé est présenté à la
section 1. Les soins immédiats à offrir à la personne exposée sont décrits à la section 2 alors que la section 3
est consacrée à l’évaluation de l’exposition. Le risque d’acquisition professionnelle et la prise en charge de la
personne exposée sont abordés à la section 4. La section 5 se rapporte aux aspects psychologiques, la
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Janvier 2012
section 6 aux aspects juridiques et éthiques et la section 7, enfin, aux aspects organisationnels. Celle-ci fait
état des principes à respecter dans l’organisation des services de postexposition afin de satisfaire aux
exigences scientifiques, éthiques et juridiques de la prise en charge et du suivi des personnes exposées. Ces
recommandations visent d’abord et avant tout la prise en charge des personnes exposées accidentellement à
des liquides biologiques dans le contexte de leurs activités professionnelles. Les indications pour
l’intervention auprès des personnes exposées en milieu communautaire sont présentées dans le Guide pour
la prise en charge des personnes exposées au VIH, au VHB et au VHC dans la communauté publié par le
Ministère en 2010. Il convient enfin de souligner que ce guide s’inspire largement de deux documents :
Recommandations visant la prise en charge des travailleurs exposés au sang et aux autres liquides
biologiques, publié par le ministère de la Santé et des Services sociaux en 1999, et Updated U.S. Public
Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and
Recommendations for Postexposure Prophylaxis, publié par les Centers for Disease Control and Prevention
américains en 2005.
NosoBase n° 32705
Les niveaux de dotation en personnel et de charge de travail influencent-ils le risque de nouvelles
acquisitions de Staphylococcus aureus méticillino-résistant dans une unité de réanimation bien doté
en ressources
Kong F; Cook D; Paterson DL; Whitby M; Clements A. Do staffing and workload levels influence the risk of
new meticillin-resistant Staphylococcus aureus acquisitions in a well-resourced intensive care unit? The
Journal of hospital infection 2012; in press: 5 pages.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE; SOIN INTENSIF; RISQUE;
PERSONNEL; ANALYSE MULTIVARIEE; OBSERVANCE; PREVENTION
Background: There is limited knowledge of existing relationships between new meticillin-resistant
Staphylococcus aureus (MRSA) acquisitions, staffing and workload levels in Australia.
Aim: The temporal relationship between staffing and workload levels and new MRSA acquisitions was
explored in an intensive care unit (ICU) of an Australian metropolitan tertiary hospital to determine whether
these variables could be used as predictors of new MRSA acquisitions.
Method: Sixty-one ICU patients with new laboratory-confirmed MRSA acquisition (colonizations or infections)
were identified from January 2003 to December 2006. Univariate logistic regression models were constructed
with the occurrence of one or more new MRSA acquisitions in the ICU in a given week as the binary outcome,
and multiple staffing and bed occupancy variables (aggregated by week) as predictors, entered at lag
intervals from zero to six weeks. A multivariate logistic regression used backward stepwise elimination,
retaining variables with P < 0.20. A receiver operator characteristic (ROC) analysis cross-validated the model
with data from January to December 2007.
Findings: The final model contained two variables: total nursing hours (per 100) at a one-week lag [odds ratio:
0.90; confidence interval (CI): 0.90-0.91; P = 0.04] and the ratio of elective cancellations to elective
admissions at a two-week lag (not significant). The area under the ROC was 0.46 (CI: 0.25-0.67).
Conclusion: ICU staffing and workload indicators did not predict prospectively risk of new MRSA acquisition in
any given week, possibly because of the ICU's strict staffing policy, low overall MRSA acquisition rate and
good compliance with infection control procedures.
NosoBase n° 32702
Sous-effectif, surpopulation, infirmier inapproprié. Ration de patients ventilés et d’infections
nosocomiales – Quel paramètre est le meilleur reflet des déficits ?
Schwab F; Meyer E; Geffers C; Gastmeier P. Understaffing, overcrowding, inappropriate nurse: ventilated
patient ratio and nosocomial infections: which parameter is the best reflection of deficits? The Journal of
hospital infection 2012; in press: 7 pages.
Mots-clés : PERSONNEL; INFIRMIER; VENTILATION ASSISTEE; FACTEUR DE RISQUE; BACTERIEMIE
PNEUMONIE; SOIN INTENSIF; DUREE DE SEJOUR
Background: In stressed and high-throughput systems, periodic overcrowding (high bed occupancy) and
understaffing (low nurse:patient ratio) are widely described risk factors for nosocomial infections. AIM: The
impact of bed occupancy (patient:bed ratio), nurse:patient ratio and nurse:ventilated patient ratio on
nosocomial bloodstream infections (BSI) and pneumonia were investigated in 182 intensive care units (ICU).
Methods: The ICUs reported monthly data on device use and nosocomial device-associated infections to the
German hospital surveillance system for nosocomial infections in 2007. Information on the number of
healthcare workers on the ward per 24h in 2007 and structure parameters was obtained by questionnaires.
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Janvier 2012
The association between occupancy or staff parameters and the number of nosocomial infections per month
was analysed using generalized estimating equation models.
Findings: In total, 1313 cases of pneumonia and 513 cases of BSI were reported from 182 ICUs with 1921
surveillance months and 563,177 patient-days. Fewer nosocomial infections were associated with a higher
nurse:ventilated patient ratio [adjusted incidence rate ratio 0.42 (95% confidence interval 0.32-0.55) for
months with nurse:ventilated patient ratios >75th percentile compared with =25th percentile]. Interestingly, the
nurse:patient ratio was not a significant parameter with respect to the occurrence of BSI and pneumonia. High
bed occupancy (>75th percentile) was associated with fewer nosocomial infections.
Conclusion: A staffing parameter that reflects the intensity of care, such as the nurse:ventilated patient ratio,
may enable better evaluation of workload and resources, especially at a time when nursing resources are
being reduced but nosocomial infections are increasing.
Pneumonie
NosoBase n° 32611
Transmission de Pneumocystis : quel risque environnemental et nosocomial ?
Choukri F; Derouin F. Airborne transmission of Pneumocystis: environment hazard and nosocomial risk
Journal des anti-infectieux 2011/12; 13(4): 246-253.
Mots-clés : PNEUMOCYSTIS; TRANSMISSION;
JIROVECII; PNEUMONIE; COLONISATION
TRANSMISSION
AERIENNE;
PNEUMOCYSTIS
Le genre Pneumocystis désigne des micromycètes atypiques et opportunistes infectant les mammifères. Son
cycle se déroule au niveau de l'alvéole pulmonaire et comporte différentes formes dont la taille est comprise
entre 2 et 8 microns : formes trophiques, prékystes et kystes matures. Pneumocystis jirovecii désigne
l'espèce infectant l'homme. Chez les patients immunodéprimés, P. jirovecii est responsable de
pneumopathies interstitielles sévères, ou pneumonie à Pneumocystis (PPC), fatale en l'absence de
traitement. P. jirovecii peut aussi coloniser des sujets immunocompétents, y compris les personnels
soignants. Chez les patients ayant une pathologie pulmonaire chronique sous-jacente, la colonisation
contribue à la dégradation des fonctions respiratoires. La transmission de Pneumocystis s'effectue par voie
aérienne et des épidémies de PPC nosocomiales ont été décrites. Pneumocystis ne pouvant être cultivé, la
mise en évidence du champignon dans l'air peut être réalisée par la détection de son ADN. Des études
récentes ont montré que l'ADN de Pneumocystis pouvait être retrouvé et quantifié dans l'environnement des
patients hospitalisés atteints de PPC, avec une diffusion pouvant s'étendre au-delà de leurs chambres. La
morphologie des stades aériens de Pneumocystis n'est, cependant, toujours pas connue. Différents
arguments expérimentaux et épidémiologiques indiquent que les sujets colonisés contribuent à la
transmission de P. jirovecii, mais aucune étude n'a été réalisée, à ce jour, sur l'excrétion et la diffusion de
Pneumocystis à partir de ces sujets. Ces nouvelles données sur la diffusion et le génotypage de
Pneumocystis conduisent à actualiser les recommandations de prévention de la transmission de P. jirovecii
en milieu hospitalier.
NosoBase n° 32612
Les probiotiques dans la prévention des pneumopathies acquises sous ventilation mécanique
Clavel M; Pichon N. Probiotics as preventive measures against ventilator-associated pneumonia. Journal des
anti-infectieux 2011/12; 13(4): 254-258.
Mots-clés :
PREVENTION;
BIBLIOGRAPHIE
VENTILATION
ASSISTEE;
PNEUMOPATHIE;
SOIN
INTENSIF;
Les pneumopathies acquises sous ventilation mécanique (PAVM) représentent la première cause d'infection
nosocomiale dans les services de réanimation. Les PAVM sont responsables d'une augmentation de la
mortalité, de la durée de ventilation mécanique, de la durée de séjour en réanimation et d'un surcoût
hospitalier. La prévention de la colonisation des voies aérodigestives est un axe majeur dans la prévention
des PAVM. Les probiotiques sont des agents microbiens vivants qui pourraient intervenir dans la prévention
de cette colonisation et ainsi diminuer l'incidence des PAVM. Les études cliniques publiées sont
contradictoires mais une méta-analyse récente montre que l'administration d'un probiotique est associée à
une diminution de l'incidence des PAVM. L'analyse des résultats fait apparaître de nombreuses disparités
entre ces études. En effet, le type d'études, les critères diagnostiques de PAVM, les probiotiques utilisés, la
voie et le nombre d'administration quotidienne, la population concernée sont variables d'une étude à l'autre et
favorisent ainsi la confusion. Les probiotiques pourraient avoir un effet protecteur sur la colonisation à
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Janvier 2012
Pseudomonas aeruginosa mais les données sont insuffisantes. En revanche, l'administration d'un probiotique
ne semble pas agir sur la mortalité globale en réanimation ou sur la durée de la ventilation mécanique. Il
existe un rationnel solide pour continuer à effectuer des études sur la prévention des PAVM par l'utilisation
des probiotiques tout en effectuant une surveillance stricte des effets secondaires infectieux potentiels.
NosoBase n° 32582
Pneumonies nosocomiales à Pneumocystis jirovecii : leçons tirées de cas groupés chez des
receveurs de transplantation rénale
Phipps LM; Chen SC; Kable K; Halliday CL; Firacative C; Meyer W; et al. Nosocomial Pneumocystis jirovecii
pneumonia: lessons from a cluster in kidney transplant recipients. Transplantation 2011/12/27; 92(12): 13271334.
Mots-clés : PNEUMONIE; PNEUMOCYSTIS; PNEUMOCYSTIS JIROVECII; TRANSPLANTATION;
TRANSPLANTATION RENALE; ENQUETE; EPIDEMIOLOGIE; GENOTYPE; INCIDENCE; FACTEUR DE
RISQUE; CONTROLE; TRANSMISSION; ANTIBIOTIQUE
Background : Pneumocystis jirovecii pneumonia (PJP) is an important infection-related complication, whose
mode of transmission remains uncertain.
Methods .: We investigated a nosocomial cluster of 14 PJP cases (11 confirmed and 3 probable) in kidney
transplant recipients using epidemiological and genotyping methods.
Results : Poisson regression calculated an incidence density ratio of 42.8 (95% confidence interval [CI], 14.1129.3) versus background 0.64 cases of 1000 patient-years (P<0.001). All patients presented with respiratory
failure, 10 required ventilation, two died, and six transplants failed, costing $31,854 (±SD $26,048) per
patient. Four-locus multilocus sequence typing analysis using DNA extracts from 11 confirmed cases
identified two closely related genotypes, with 9 of 11 sharing an identical composite multilocus sequence
typing genotype. Contact tracing found colocalization of cases within clinic waiting areas, suggesting personto-person transmission. Minimal and maximal PJP incubation periods were 124±83 to 172±71 days,
respectively. Oropharyngeal washes from outpatient staff and ambient air samples were negative for P.
jirovecii DNA. Cohort analysis (14 cases vs. 324 unaffected clinic control patients) identified independent risk
factors including previous cytomegalovirus infection (odds ratio [OR], 65.9; 95% CI, 7.9-550; P<0.001),
underlying pulmonary disease (OR, 10.1; 95% CI, 2.3-45.0; P=0.002), and transplant dysfunction (OR=1.61
per 10 mL/min/1.73 m, 95% CI, 1.15-2.25, P=0.006). The outbreak was controlled by reintroduction of
trimethoprim/sulfamethoxazole prophylaxis to all potentially exposed clinic patients and its extension to 12
months in recent recipients.
Conclusions : Nosocomial PJP clusters are likely due to interhuman transmission by airborne droplets to
susceptible hosts. Prompt recognition and a strategy of early preemptive blanket PJP prophylaxis to all
exposed transplant clinic recipients from the third confirmed case are recommended to limit outbreak
escalation.
Pseudomonas aeruginosa
NosoBase n° 32716
Pseudomonas aeruginosa - Dossier scientifique
Garnotel E. Revue francophone des laboratoires 2011/10; 435: 33-83.
Mots-clés : PSEUDOMONAS AERUGINOSA; EPIDEMIOLOGIE; ANTIBIORESISTANCE; PFGE;
MUCOVISCIDOSE; STRUCTURE DE SOINS; BETALACTAMINE; BETA-LACTAMASE A SPECTRE
ELARGI; CARBAPENEME; AMINOSIDE; SENSIBILITE; BIOLOGIE MOLECULAIRE; EVALUATION;
QUESTIONNAIRE
Extrait du sommaire du dossier :
- Bertrand X, Slekovec C, Cholley R, et al. Epidemiologie des infections à Pseudomonas aeruginosa
(Référence NosoBase n°32717)
- Mérens A, Delacour H, Plésiat P, et al. Pseudomonas aeruginosa et résistance aux antibiotiques (Référence
NosoBase n°32719)
- De Bentzmann S, Plésiat P. Pseudomonas aeruginosa : une virulence complexe (Référence NosoBase
n°32721)
- QCM – Evaluez-vous ! (référence NosoBase n°32722)
NosoBase n° 32364
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Janvier 2012
Emergence de Pseudomonas aeruginosa résistant au glutaraldéhyde
Tschudin-Sutter S; Frei R; Kampf G; Tamm M; Pflimlin E; Battegay M; et al. Emergence of glutaraldehyderesistant Pseudomonas aeruginosa. Infection control and hospital epidemiology 2011/12; 32(12): 1173-1178.
Mots-clés : PSEUDOMONAS AERUGINOSA; GLUTARALDEHYDE; RESISTANCE; PERSONNEL;
DESINFECTION; ENDOSCOPIE; INFECTION RESPIRATOIRE BASSE; BACTERIEMIE; EPIDEMIE
Objective : In November 2009, routine sampling of endoscopes performed to monitor the effectiveness of the
endoscope-cleaning procedure at our hospital detected Pseudomonas aeruginosa. Herein we report the
results of the subsequent investigation.
Design and methods: The investigation included environmental cultures for source investigation, molecular
analysis by pulsed-field gel electrophoresis (PFGE) to reveal the identity of the strains, and determination of
the bactericidal activity of the glutaraldehyde-based disinfectant used for automated endoscope reprocessing.
In addition, patient outcome was analyzed by medical chart review, and incidence rates of clinical samples
with P. aeruginosa were compared.
Setting: The University Hospital of Basel is an 855-bed tertiary care center in Basel, Switzerland.
Approximately 1,700 flexible bronchoscopic, 2,500 gastroscopic, 1,400 colonoscopic, 140 endoscopic
retrograde cholangiopancreatographic, and 140 endosonographic procedures are performed annually.
Results: P. aeruginosa was detected in samples obtained from endoscopes in November 2009 for the first
time since the initiation of surveillance in 2006. It was found in the rinsing water and in the drain of 1 of the 2
automated endoscope reprocessors. PFGE revealed 2 distinct P. aeruginosa strains, one in each
reprocessor. The glutaraldehyde-based disinfectant showed no activity against the 2 pseudo-outbreak strains
when used in the recommended concentration under standard conditions. After medical chart review, 6
patients with lower respiratory tract and bloodstream infections were identified as having a possible
epidemiological link to the pseudo-outbreak strain.
Conclusions: This is the first description of a pseudo-outbreak caused by P. aeruginosa with reduced
susceptibility to an aldehyde-based disinfectant routinely used in the automated processing of endoscopes.
Soins intensifs
NosoBase n° 32601
Exploration de l'influence de l'application de directives de contrôle du risque infectieux sur le risque
de développer des infections associées aux soins dans l'unité de réanimation : étude rétrospective
El-Masri MM; Oldfield M. Exploring the influence of enforcing infection control directives on the risk of
developing healthcare associated infections in the intensive care unit: a retrospective study. Intensive and
critical care nursing 2011; in press: 6 pages.
Mots-clés : RISQUE; SOIN INTENSIF; PREVENTION; PROTOCOLE; ETUDE RETROSPECTIVE; SRAS;
HYGIENE DES MAINS; BIONETTOYAGE; PERSONNEL; DEPISTAGE
Background: Although strict adherence to infection control strategies is recognised as the simplest and most
cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the
direct impact that such adherence may have on the risk of developing such infections has always been a
challenge.
Purpose: The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak.
Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of
infection control strategies during the SARS outbreak may have had on the risk of HAIs.
Methods: A retrospective chart review was conducted on the medical records of 400 intensive care patients
who were admitted to the ICU three months before and during the 2003 SARS outbreak.
Results: The rate of HAIs was higher in the pre-SARS period than the SARS period. Specifically, 61.7% of all
reported infections were diagnosed in the pre-SARS period. The rate of HAIs in the pre-SARS period was
14.5% as opposed to 9% during the SARS period. Adjusted logistic regression analysis suggested that the
odds of HAIs were 2.2 times higher in the pre-SARS period as compared to the SARS period (OR=2.2;
95%CI=1.08-4.49).
Conclusion: Our findings suggest that strict enforcement of infection control strategies may have a positive
impact on the efforts to minimise the risk of HAIs. These findings carry a clinical significance that shall not be
ignored with regard to our overall efforts to minimise the risk of developing HAIs in the ICU.
NosoBase n° 31896
Infections associées aux soins et politique concernant les visites dans une unité de réanimation
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Janvier 2012
Malacarne P; Corini M; Petri D. Health care-associated infections and visiting policy in an intensive care unit.
American journal of infection control 2011/12; 39(10): 898-900.
Mots-clés : SOIN INTENSIF; PROTOCOLE; USAGER; VISITE; TAUX; CENTRE HOSPITALIER
UNIVERSITAIRE
A frequent objection to the unrestricted visiting policy in intensive care units (ICUs) is the risk of acquired
infections. In a mixed 8-bed ICU, an adopted shift from a restricted to a partially unrestricted visiting policy did
not result in an increase in ICU-acquired infections.
NosoBase n° 32609
Impact du dépistage et de la décontamination sur la prévention des infections du site opératoire à
Lepelletier D; Lucet JC. Impact of Staphylococcus aureus screening and decolonization in preventing surgical
site infections. Journal des anti-infectieux 2011/12; 13(4): 209-216.
Mots-clés : DEPISTAGE; PREVENTION; STAPHYLOCOCCUS AUREUS; SITE OPERATOIRE;
COLONISATION NASALE; DECONTAMINATION; MUPIROCINE; FACTEUR DE RISQUE; CHIRURGIE;
COUT; BIBLIOGRAPHIE
Dans les 20 dernières années, il a été démontré que les patients présentant un haut niveau de portage nasal
de Staphylococcus aureus (SA) ont un risque d'infections associées à ce microorganisme de trois à six fois
plus élevé que chez les non-porteurs et ou ceux porteurs à faible niveau, notamment chez les patients
dialysés. Chez les patients opérés, SA est le pathogène le plus fréquemment responsable d'infections du site
opératoire (ISO), notamment en chirurgie propre. L'impact du dépistage nasal et de la décontamination du
portage de SA sur la diminution des ISO a fait l'objet de nombreuses recherches cliniques ces dernières
années dont nous faisons la synthèse dans cette revue. L'évolution des données de la littérature permet de
recommander la mise en place d'un dépistage rapide des patients chirurgicaux, et la décontamination nasale
par la mupirocine. Cependant et malgré son efficacité, cette stratégie ne représente qu'une des mesures à
mettre en oeuvre pour réduire le taux des ISO d'origine endogène, certaine ISO à SA survenant chez des
patients non détectés porteurs de SA à l'admission.
NosoBase n° 32656
Dépistage universel de Staphylococcus aureus méticillino-résistant en établissements pour soins
aigus : étude multicentrique sur les facteurs de risque et l'évolution
Reilly JS; Stewart S; Christie P; Allardice GM; Stari T; Matheson A; et al. Universal screening for meticillinresistant Staphylocossus aureus in acute care: risk factors and outcome from a multicentre study. The
Journal of hospital infection 2012/01; 80(1): 31-35.
Mots-clés : STAPHYLOCOCCUS AUREUS; METICILLINO-RESISTANCE;
DEPISTAGE; ETUDE PROSPECTIVE; COHORTE; COLONISATION
FACTEUR
DE
RISQUE;
Background: A Health Technology Assessment (HTA) model on effectiveness of meticillin-resistant
Staphylococcus aureus (MRSA) screening in Scotland suggested that universal screening using chromogenic
agar was the preferred option in terms of effectiveness and cost. AIM: To test the model's validity through a
one-year pilot-study.
Method: A large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals
in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were
subjected to multivariable analyses, and trends before and after implementation of screening were compared.
Findings: The initial colonization prevalence of 5.5% decreased to 3.5% by month 12 of the study (P <
0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age,
and source of admission (home, other hospital or care home). Around 2% of all admissions with no prior
history of MRSA infection or colonization tested positive. Those who were screen positive on admission and
not previously known positive were 12 times more likely than those who screened negative to develop
infection, increasing to 18 times if they were both screen positive and previously known positive. MRSA
infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209).
28 / 29
Janvier 2012
Conclusion: The risk factors identified for colonization and infection indicate that a universal clinical risk
assessment may have a role in MRSA screening.
Pour tout renseignement, contacter le centre de coordination de lutte contre les infections nosocomiales de
votre inter-région :
CCLIN Est
Tél : 03.83.15.34.73
Fax : 03.83.15.39.73
[email protected]
CCLIN Ouest
Tél : 02.99.87.35.31
Fax : 02.99.87.35.32
[email protected]
CCLIN Paris-Nord
Tél : 01.40.27.42.00
Fax : 01.40.27.42.17
CCLIN Sud-Est
Tél : 04.78.86.49.50
Fax : 04.78.86.49.48
[email protected]
p.fr
[email protected]
CCLIN Sud-Ouest
Tél : 05.56.79.60.58
Fax : 05.56.79.60.12
[email protected]
29 / 29

NosoVeille Août 2011

Transcription

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