Veille documentaire Médecine du travail du

Transcription

Veille documentaire Médecine du travail du personnel hospitalier - Novembre 2005 - CHU Rouen
Veille documentaire
Médecine du travail du personnel hospitalier
- Literature Follow-up : occupational health for Healthcare Workers -
Objectif
L'objectif de ce travail est de fournir un outil de veille aux médecins du travail concernant les nouvelles
connaissances scientifiques relative à la santé au travail des personnels de soins. La priorité est
donnée aux documents en français. Ce travail est réalisé par les documentalistes de l'équipe CISMeF
et le service de médecine du travail et de pathologie professionnelle du CHU de Rouen (Dr JF
Gehanno), dans le cadre d'un projet financé par la Caisse Nationale de retraites des agents des
Collectivités Locales. Les résultats proposés sont issus de la surveillance mensuelle d'une sélection
de périodiques, de sites Internet d'organismes spécialisés et des bases de données CISMeF, PubMed
et BDSP.
Pour obtenir un document, vous pouvez vous adresser à la BIUM (http://www.bium.univ-paris5.fr/) ou
à l'INIST-CNRS (http://www.inist.fr/) .
Novembre 2005
A la Une ce mois-ci :
Cochrane Database Syst Rev. 2005 Oct 19;4:CD000100.
Vaccines for preventing hepatitis B in health-care workers.
Chen W, Gluud C, Chen W Md Ph D Candidate.
Voir la référence page 12.
1. Allergies .................................................................................................................................. p.2
2. Bonnes pratiques
3. Conditions de travail et santé psychologique ......................................................................... p.2
4. Hygiène et gestion des risques .............................................................................................. p.4
5. Infections nosocomiales ......................................................................................................... p.6
6. Risques biologiques ............................................................................................................... p.6
6.1 Accident d'exposition au sang ................................................................................. p.7
6.2 Contamination soignant-soigné
6.3 Transmission aérienne
6.4 Transmission de contact........................................................................................ p.10
6.5 Vaccination ............................................................................................................ p.11
7. Risques chimiques ............................................................................................................... p.13
8. Risques physiques ............................................................................................................... p.15
8.1 Rayonnements ionisants ....................................................................................... p.15
8.2 Troubles musculo-squelettiques ............................................................................ p.16
9. Violence ................................................................................................................................ p.18
10. Autres ................................................................................................................................. p.19
1
1. Allergies
- Documents en français :
- Documents en anglais :
Ann Acad Med Singapore. 2005 Jun;34(5):376-82.
Latex sensitisation in healthcare workers in Singapore.
Tang MB, Leow YH, Ng V, Koh D, Goh CL.
National Skin Centre, 1 Mandalay Road, Singapore 308205.
INTRODUCTION: Epidemiological data on latex sensitisation among Asian healthcare workers is
lacking. The aim of the study is to determine the rate of latex sensitisation in our healthcare workers.
MATERIALS AND METHODS: We recruited 313 healthcare workers, of which 46.6% were operating
theatre staff and 53.4% were non-operating theatre staff. Seventy-one administrative staff served as
controls. All participants answered a self-administered questionnaire relating to latex exposure and
glove-related symptoms. Latex sensitisation was determined by skin prick testing to latex and latexspecific IgE detection. RESULTS: The prevalence of latex sensitisation among healthcare workers
was 9.6%, with no difference between operating theatre and nonoperating theatre staff. Glove-related
symptoms were reported in 13.7% of all healthcare workers, of which 22.9% were sensitised to latex.
Only 26.7% of latex-sensitised healthcare workers had glove-related symptoms while the rest were
asymptomatic. The most common symptoms were itch and hand eczema but the most important
discriminating symptom was contact urticaria. Personal history of atopy was more common in
sensitised healthcare workers (40.0%) compared to non-sensitised workers (31.8%). Only 1 out of 9
(11.2%) symptomatic latex-sensitised subjects had sought previous medical attention for the problem.
CONCLUSIONS: Latex sensitisation among healthcare workers in Singapore should be considered a
significant occupational health risk, as it is in the West. Increased screening and awareness of this
problem is essential to identify those at risk.
MeSH Terms: Adult - Allied Health Personnel - Female - Humans - Latex
Hypersensitivity/epidemiology* - Male - Middle Aged - Occupational Diseases/epidemiology* Research Support, Non-U.S. Gov't - Singapore/epidemiology - Skin Tests - Urticaria/etiology
2. Bonnes pratiques
3. Conditions de travail et santé psychologique
JOURNAL DE PEDIATRIE ET DE PUERICULTURE, Vol. 18,3, p.150-153, 2005/06
La douleur des équipes soignantes.
QUINIOU (Y.)
La situation d'un périnatal défaillant où s'entremêlent anté-et néonatal porte déjà en soi violence,
maltraitance et souffrance, paradoxe des progrès fulgurants de la médecine qui soigne le foetus,
permet à une grossesse à risque de se développer, fait vivre et bien vivre certains prématurissimes
alors que d'autres meurent ou demeurent handicapés.
Les violences subies ou agies ainsi que la souffrance touchent tous les acteurs, y compris ceux qui
soignent.
Pour les soignants, la répétition, la simultanéité et la sommation des évènements viennent majorer la
souffrance. (Tiré du texte).
Mots-clés BDSP : SOUFFRANCE, PROFESSION SANTE, EQUIPE SOINS, EPUISEMENT
PROFESSIONNEL, STRESS, FOETUS, ACCOUCHEMENT, NOUVEAU NE, RISQUE,
PREMATURITE, RELATION SOIGNANT SOIGNE, PERINATALOGIE
RISQUES ET QUALITE, Vol. 2, 2, p. 112-116, 2005/06
Mobiliser les acteurs jusqu'où ? Le syndrome d'épuisement professionnel au bloc opératoire.
DUALE (C.), TAHERI (H.), SCHOEFFLER (P.)
2
Le syndrome d'épuisement professionnel ou "burnout syndrom" est une entité comportementale pour
laquelle l'intérêt est récent dans le monde médical.
Elle recouvre des réalités différentes sous-tendues par des déterminants d'organisation générale de
l'établissement et de l'équipe soignante associés à des facteurs individuels, dont il est difficile de dire
s'ils préexistent ou sont induits par les conditions de travail.
La capacité individuelle d'adaptation au stress est la composante la plus apparente.
Les modalités d'expression du syndrome varient suivant chacun des éléments et selon les réponses
que les individus et le groupe auquel il appartient peuvent apporter.
Les stratégies de réponse peuvent être complémentaires mais combinent presque toujours des axes
individuels et des axes institutionnels.
Un effort de communication avec les professionnels vulnérables est un axe prioritaire.
La connaissance de ce syndrome permet d'en anticiper la survenue et d'en atténuer les
conséquences, tant pour les individus qui y sont exposés que pour la sécurité des patients.
Mots-clés BDSP : BLOC OPERATOIRE, INFIRMIER BLOC OPERATOIRE, EPUISEMENT
PROFESSIONNEL
Lancet. 2005 Aug 27-Sep 2;366(9487):742-4.
Changes in mental health of UK hospital consultants since the mid-1990s.
Taylor C, Graham J, Potts HW, Richards MA, Ramirez AJ.
Cancer Research UK London Psychosocial Group, Institute of Psychiatry, King's
College London, St Thomas' Campus, London SE1 7EH, UK.
We assessed changes in the mental health of UK hospital consultants from five specialties, on the
basis of surveys done in 1994 (880 participants) and 2002 (1308 participants). The proportion of
consultants with psychiatric morbidity rose from 27% (235) in 1994 to 32% (414) in 2002. The
prevalence of emotional exhaustion increased from 32% (284) in 1994 to 41% (526) in 2002.
Multivariate analyses showed that increased job stress without a comparable increase in job
satisfaction accounted for the decline in mental health, which was especially marked in clinical and
surgical oncologists. Action is needed to improve the working lives of consultants.
MeSH Terms: Burnout, Professional/epidemiology - Great Britain - Humans - Job Satisfaction Medical Staff, Hospital/psychology* - Mental Disorders/epidemiology* - Mental Health - Prevalence Research Support, Non-U.S. Gov't - Specialties, Medical - Stress, Psychological/epidemiology*
J Neurosci Nurs. 2005 Aug;37(4):179.
Posttraumatic stress disorder in nursing.
Stewart-Amidei C.
MeSH Terms: Burnout, Professional/prevention & control* - Burnout, Professional/psychology Humans - Nurses/psychology* - Occupational Health* - Self Care - Social Support - Stress Disorders,
Post-Traumatic/prevention & control* - Stress Disorders, Post-Traumatic/psychology
Publication Types: Editorial
Surgery. 2005 Aug;138(2):150-7.
Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multiinstitutional study.
Zare SM, Galanko JA, Behrns KE, Sieff EM, Boyle LM, Farley DR, Evans SR, Meyer AA, Farrell TM.
Department of Surgery, Boston VA Health Care System, MA, USA.
BACKGROUND: The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our
published data from the preceding year indicated significant impairment in psychologic well-being
among surgery residents. The purpose of this study was to determine whether psychologic well-being
and academic performance of surgery residents improved after inception of the 80-hour workweek.
METHODS: A single-blinded survey of general surgery residents (n=130) across 4 US training
programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom
Checklist-90-R and Perceived Stress Scale) and the American Board of Surgery In-Training
Examination; comparison was done with preceding year and societal data. Primary outcomes were
"psychologic distress" and "perceived stress." Secondary outcomes were "somatization," "depression,"
"anxiety," "interpersonal sensitivity," "hostility," "obsessive-compulsive behavior," "phobic anxiety,"
"paranoid ideation," "psychoticism." and "academic performance." The impact of demographic
variables was assessed. RESULTS: Mean psychologic distress improved from the preceding year (P
< .01) but remained elevated, compared with societal norms (P < .001). The proportion of residents
meeting the criteria for clinical psychologic distress (>or=90th percentile) decreased from 38% before,
3
to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P < .0001)
without improvement from the preceding year. Overall academic performance was unchanged.
Previously elevated secondary psychologic outcomes improved after July 2003 (P < .05), although
obsessive-compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to
normalize. Male gender and single status were independent risk factors for psychologic distress.
CONCLUSIONS: Inception of the 80-hour workweek is associated with reduced psychologic distress
among surgery residents. The perception of stress and academic performance remains unchanged.
MeSH Terms: Adult - Affective Symptoms/prevention & control - Affective Symptoms/psychology Attitude of Health Personnel - Burnout, Professional/prevention & control - Burnout,
Professional/psychology* - Education, Medical, Graduate/organization & administration - Female Humans - Internship and Residency/organization & administration* - Male - Medical Staff,
Hospital/organization & administration - Medical Staff, Hospital/psychology* - Personnel Staffing and
Scheduling* - Research Support, Non-U.S. Gov't - Surgery/education* - Work Schedule
Tolerance/psychology*
Gen Hosp Psychiatry. 2005 Jul-Aug;27(4):285-91.
The relationship between interpersonal problems and occupational stress in physicians.
Falkum E, Vaglum P.
DPS Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway. [email protected]
OBJECTIVE: This article examined the associations between occupational stress and interpersonal
problems in physicians. METHOD: A nationwide representative sample of Norwegian physicians
received the 64-item version of the Inventory of Interpersonal Problems (IIP-64) (N=862, response
rate=70%) and six instruments measuring occupational stress. Comparison of means, correlation and
reliability statistics and multiple regression analyses were applied. RESULTS: The IIP-64 total score
had a significant impact on job satisfaction, perceived unrealistic expectancies, communication with
colleagues and nurses and on stress from interaction with patients. Being overly subassertive was
related to low job satisfaction. Being overly expressive was linked to the experience of unrealistic
expectancies from others and lack of positive feedback, whereas overly competitive physicians tended
to have poorer relationships with both colleagues and nurses. CONCLUSIONS: Addressing
interpersonal problems in medical school and postgraduate training may be a valuable measure to
prevent job stress and promote quality of care.
MeSH Terms: Female - Humans - Interpersonal Relations* - Job Satisfaction - Male - Norway Occupational Diseases* - Physicians/psychology* - Questionnaires - Specialties, Medical - Stress,
Psychological* - Workplace/psychology*
4. Hygiène et gestion des risques
Pierre-Bénite : C.CLIN Sud-Est. 2005/06
Conduite à tenir en cas de contage tuberculeux en établissement de santé.
Ce document apporte une démarche pratique pour la réalisation d'une enquête avec les documents
techniques suivants : - Une lettre type rappel des sujets contacts (annexe 1) - Une fiche de
consultation des sujets contacts - Suivi post-contact agent bacillaire - Un exemple de rapport
synthétique du contage tuberculeux patient (annexe 3) ou personnel (annexe 4) - Un rappel - Fiche
technique : masques (annexe 5) - Un rappel - Fiche technique : isolement (annexe 6).
Mots-clés BDSP : TUBERCULOSE, EPIDEMIOLOGIE, DEPISTAGE, PERSONNEL, HOPITAL,
REGLEMENTATION, INFECTION NOSOCOMIALE, HYGIENE HOSPITALIERE
Autres mots-clés CONDUITE A TENIR
RISQUES ET QUALITE, Vol. 2, 1, p.34-41, 2005/03
Évaluation des risques professionnels en établissement sanitaire et social : enjeux, principes
et mise en oeuvre.
MOULAIRE (M.)
Dans le secteur de la santé, les professionnels sont particulièrement exposés aux risques du travail.
Des textes réglementaires ont posé l'obligation d'évaluation de ces risques et institué un "document
unique" qui doit rassembler les preuves d'une identification globale et exhaustive des dangers pour les
travailleurs, et de l'évaluation des risques encourus.
La circulaire n 6DRT du 18 avril 2002 a apporté des éléments méthodologiques pour l'élaboration de
cette démarche.
4
Cet article présente la méthode utilisée au Centre Hospitalier d'Aubenas pour élaborer le document
unique.
La réalisation d'une cartographie des risques a permis dans un premier temps une vision globale des
risques par unité de travail et par famille de risques.
L'évaluation d'un niveau de risque résiduel pour chaque situation à risque identifiée a permis ensuite
de déterminer des priorités d'action et l'élaboration d'un plan d'amélioration adapté.
Mots-clés BDSP RISQUE PROFESSIONNEL, ETABLISSEMENT SANITAIRE, HOPITAL, RISQUE,
EVALUATION, IDENTIFICATION, ANALYSE, AMELIORATION, REGLEMENTATION, OBJECTIF,
ETHIQUE, CULTURE ENTREPRISE, PARTICIPATION, CREATION, PROJET, POSTE TRAVAIL,
SERVICE, METHODOLOGIE, ETABLISSEMENT SOCIAL, France
Curr Opin Infect Dis. 2005 Aug;18(4):320-5.
Hospital disinfection: efficacy and safety issues.
Dettenkofer M, Block C.
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg
University Hospital, Freiburg, Germany. [email protected]
PURPOSE OF REVIEW: To review recent publications relevant to hospital disinfection (and cleaning)
including the reprocessing of medical instruments. RECENT FINDINGS: The key question as to
whether the use of disinfectants on environmental surfaces rather than cleaning with detergents only
reduces nosocomial infection rates still awaits conclusive studies. New disinfectants, mainly
peroxygen compounds, show good sporicidal properties and will probably replace more problematical
substances such as chlorine-releasing agents. The safe reprocessing of medical devices requires a
well-coordinated approach, starting with proper cleaning. New methods and substances show
promising activity for preventing the transmission of prions. Different aspects of virus inactivation have
been studied, and the transmissibility, e.g. of norovirus, shows the need for sound data on how
different disinfectant classes perform. Biofilms or other forms of surface-adherent organisms pose an
extraordinary challenge to decontamination. Although resistance to biocides is generally not judged to
be as critical as antibiotic resistance, scientific data support the need for proper use, i.e. the avoidance
of widespread application, especially in low concentrations and in consumer products. SUMMARY:
Chemical disinfection of heat-sensitive instruments and targeted disinfection of environmental surfaces
are established components of hospital infection control. To avoid danger to staff, patients and the
environment, prudent use as well as established safety precautions are required. New technologies
and products should be evaluated with sound methods. As emerging resistant pathogens will
challenge healthcare facilities in the future even more than at present, there is a need for welldesigned studies addressing the role of disinfection in hospital infection control.
MeSH Terms: Disinfection/methods* - Equipment Contamination/prevention & control - Hospitals Humans - Infection Control/methods* - Occupational Exposure - Personnel, Hospital - Risk
Publication Types: Review
J Occup Environ Med. 2005 Jul;47(7):740-9.
Organizational safety culture/climate and worker compliance with hazardous drug guidelines:
lessons from the blood-borne pathogen experience.
McDiarmid MA, Condon M.
Occupational Health Program, University of Maryland School of Medicine, Baltimore, Maryland 21201,
USA. [email protected]
BACKGROUND: The health risks posed to health care workers (HCW) handling antineoplastic and
other hazardous drugs (HDs) are well established. However, despite nearly 20 years of professional
practice standards, compliance with safe handling procedures is poor. METHOD: We present
documentation of undercompliance with recommended safety procedures for HDs. Then, we examine
a similar problem, HCW compliance with blood-borne pathogen universal precautions (UP) and its
partial solution tied to the strength of a facility's safety culture. Lessons learned here may be
applicable to the HD issue. RESULTS: It is proposed that analyzing a facility's safety culture may
enlarge our understanding of the barriers contributing to HD under-compliance and suggest strategies
to improve it. CONCLUSION: The Safety Culture paradigm offers many targets for intervention to
enhance and promote worker compliance with safe HD handling practices thus mitigating internal
exposure.
MeSH Terms: - Blood-Borne Pathogens* - Health Personnel* - Humans - Occupational
Diseases/etiology - Occupational Diseases/prevention & control* - Practice Guidelines - Protective
Clothing/utilization* - Safety/standards* - United States - United States Occupational Safety and
5
Health Administration/standards*
5. Infections nosocomiales
CMAJ. 2005 May 24;172(11):1453-6.
Neonatal exposure to active pulmonary tuberculosis in a health care professional.
Sen M, Gregson D, Lewis J.
Division of Respirology, University of Western Ontario, London Health Sciences Centre and St.
Joseph's Health Centre, London, Ont. [email protected]
Nosocomial transmission of tuberculosis (TB) is a recognized risk. Although many outbreaks of TB in
health care settings have been reported, there are few cases of nosocomial transmission to neonates.
We report our experience in investigating and managing the exposure over 16 days of 124 neonates,
301 visitors and 219 health care workers to a health care worker with active TB in a neonatal intensive
care unit.
MeSH Terms: Adult - Canada/epidemiology - Cross Infection* - Disease Transmission, Patient-toProfessional* - Humans - Incidence - Infant - Infant, Newborn - Infant, Newborn, Diseases - Infection
Control - Intensive Care Units, Neonatal* - Male - Neonatal Screening - Personnel, Hospital - Public
Health - Retrospective Studies - Risk Factors - Tuberculin Test - Tuberculosis,
Pulmonary/epidemiology - Tuberculosis, Pulmonary/transmission*
6. Risques biologiques
16ème Journée annuelle du GERES, Paris, 14 septembre 2005
Communications en ligne
Les risques infectieux professionnels - Transmission virale (VIH, VHC,VHB) du soignant au soigné communications libres - La gestion des risques infectieux professionnels en milieu de soins - projets
innovants en matière de matériels de sécurité - posters
http://www.geres.org/06_acpr/06_joge.htm
In DMT (Documents pour le médecin du travail), n 103, p.400-401, 3ème trimestre 2005
Epidémie de grippe aviaire et risques en milieu professionnel
Infection par le VIH et travail. 25 ans après le début de la pandémie
DURAND E.
Le syndrome d'immunodéficience humaine acquise (SIDA) a été décrit pour la première fois au début
des années 1980. Les progrès observés ces dernières années ont transformé la prise en charge et le
pronostic de cette infection. L'allongement de la durée de vie des personnes atteintes dans les pays
occidentaux fait percevoir dorénavant le SIDA comme une maladie chronique. L'insertion
professionnelle des personnes atteintes ne se fait pas toujours sans difficultés même si de
nombreuses avancées ont pu avoir lieu.
Ce dossier, en 4 parties indépendantes, fait le point sur l'infection par le VIH et travail en abordant
tous les aspects qui peuvent y être liés :
- Infection par le VIH ;
- Questions soulevées en milieu de travail ;
- Prévention du risque professionnel ;
- VIH et emploi.
Article de périodique
Accès au texte intégral : http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObjectaccesParReference/DMT_TC%20103/$File/Visu.html
6
Clin Infect Dis. 2005 Nov 15;41(10):1423-30. Epub 2005 Oct 6.
Risk factors for hepatitis C virus transmission to health care workers after occupational
exposure: a European case-control study.
Yazdanpanah Y, De Carli G, Migueres B, Lot F, Campins M, Colombo C, Thomas T, Deuffic-Burban
S, Prevot MH, Domart M, Tarantola A, Abiteboul D, Deny P, Pol S, Desenclos JC, Puro V, Bouvet E.
Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de
Tourcoing, Tourcoing, France. [email protected]
Background. Additional studies are required to identify risk factors for hepatitis C virus (HCV)
transmission to health care workers after occupational exposure to HCV.Methods. We conducted a
matched case-control study in 5 European countries from 1 January 1991 through 31 December 2002.
Case patients were health care workers who experienced seroconversion after percutaneous or
mucocutaneous exposure to HCV. Control subjects were HCV-exposed health care workers who did
not experience seroconversion and were matched with case patients for center and period of
exposure.Results. Sixty case patients and 204 control subjects were included in the study. All case
patients were exposed to HCV-infected fluids through percutaneous injuries. The 37 case patients for
whom information was available were exposed to viremic source patients. As risk factors for HCV
infection, multivariate analysis identified needle placement in a source patient's vein or artery (odds
ratio [OR], 100.1; 95% confidence interval [CI], 7.3-1365.7), deep injury (OR, 155.2; 95% CI, 7.13417.2), and sex of the health care worker (OR for male vs. female, 3.1; 95% CI, 1.0-10.0). Source
patient HCV load was not introduced in the multivariate model. In unmatched univariate analysis, the
risk of HCV transmission increased 11-fold for health care workers exposed to source patients with a
viral load >6 log(10) copies/mL (95% CI, 1.1-114.1), compared with exposures to source patients with
a viral load </=4 log(10) copies/mL.Conclusion. In this study, HCV occupational transmission was
found to occur after percutaneous exposures. The risk of HCV transmission after percutaneous
exposure increased with deep injuries and procedures involving hollow-bore needle placement in the
source patient's vein or artery. These results highlight the need for widespread adoption of
needlestick-prevention devices in health care settings, together with other preventive measures.
6.1 Accident d'exposition au sang
Med Mal Infect. 2005 Jul-Aug;35(7-8):396-401.
Comportement et conditions de travail exposant au sang: analyse des pratiques dans trois
etablissements de soins du Maroc.
Djeriri K, Charof R, Laurichesse H, Fontana L, El Aouad R, Merle JL, Catilina P, Beytout J, Chamoux
A.
Service sante-travail-environnement, CHU de Clermont-Ferrand, Place Henri-Dunant, 63000
Clermont-Ferrand, France. [email protected]
OBJECTIVE: As in other countries, Moroccan health-care workers are exposed to occupational blood
exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and
hygiene conditions determining the OBE risk for health-care workers. WORKERS AND METHODS: In
March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an
anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals
and health centers, as well as in a Rabat public medical analysis laboratory. RESULTS: The
participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of
41.4 years (+/-7 years). Health-care workers answered that: occupational hygiene and safety were
inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was
frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of
OBE was 1.5 (+/-4.3) per capita. If we consider the whole career of health-care workers, the incidence
reached about 14.3+/-28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule.
CONCLUSION: The study shows that there is a need to improve occupational hygiene and safety
conditions for Moroccan health-care workers in order to reduce OBE hazards.
MeSH Terms: Adult - Blood* - Blood-Borne Pathogens - Containment of Biohazards*/methods Containment of Biohazards*/statistics & numerical data - Cross-Sectional Studies - English Abstract Female - Gloves, Protective/utilization - Health Knowledge, Attitudes, Practice* - Hospitals,
Urban/statistics & numerical data - Humans - Hygiene/standards - Laboratories/statistics & numerical
data - Laboratory Personnel* - Male - Medical Waste Disposal/methods - Medical Waste
7
Disposal/standards - Medical Waste Disposal/statistics & numerical data - Morocco - Needlestick
Injuries/prevention & control - Occupational Diseases/epidemiology* - Occupational Exposure* Occupational Health/statistics & numerical data - Personnel, Hospital*/psychology - Questionnaires
Publication Types: Multicenter Study
In Hygiènes 2005, Volume XIII - n 4
Découverte d’une virémie à virus de l’hépatite B chez un obstétricien, dans la prise en charge
d’un accident d’exposition au sang : rappel de 134 patientes
Lettre à la rédaction
G. Cherbonnel, F. Descotte, C. Cyvoct, J.-M. Germain, E. Bouvet
À l'occasion d’un bilan réalisé suite à un accident d’exposition au sang (AES) chez un obstétricien, la
découverte d’un portage du virus de l’hépatite B chez ce dernier a déclenché une enquête
épidémiologique concernant 134 patientes ayant fait l’objet d’un acte invasif avec intervention de ce
praticien. Une cellule de crise et de suivi a dû mettre au point une stratégie d'action vis-à-vis des
patientes, de l’opérateur et du personnel. Après neuf mois d’enquête, 133 patientes ont été
retrouvées, dont une probablement contaminée et guérie. Cette enquête repose le problème du
portage de certains virus par le personnel de santé et montre tout l’intérêt de la déclaration de tous les
AES et du respect de la procédure de leur prise en charge. Outre le problème de l’avenir
professionnel du praticien qui reste posé, une notion est apparue essentielle aux personnes
rappelées: la transparence dont a fait preuve l’établissement tout en agissant dans la discrétion et le
respect du secret médical
Transmission Maladie, Personnel de santé-Malade - Virus Hépatite B - Accident travail - Sang Chirurgie
HYGIENES, vol. 13, 3, p.207-214, 2005/06
Évaluation des connaissances et pratiques des infirmières vis-à-vis du risque d'accident
d'exposition au sang : résultats d'une enquête multicentrique en Picardie (2002).
Une enquête par auto-questionnaire a été réalisée en octobre 2002 dans les huit établissements
publics et privés adhérents au réseau sectoriel d'hygiène hospitalière regroupés autour du centre
hospitalier de Creil (Picardie) pour évaluer le niveau de connaissance des infirmières sur le risque
d'accident d'exposition au sang (AES) et identifier les pratiques à risque.
Parmi les 305 infirmières ayant répondu, 24,6% déclaraient avoir reçu une formation sur les AES.
Le risque de contamination par les trois principaux virus hématogènes (VIH, VHB, VHC) était connu
par 90% des infirmières et 75,4% ont dit penser à ce risque au cours de leur pratique quotidienne,
98% des infirmières se savaient vaccinées contre l'hépatite B mais seulement 21,3% connaissaient
leur taux d'anticorps protecteurs post-vaccinal contre l'hépatite B.
L'existence d'un protocole institutionnel relatif à la conduite à tenir en cas d'AES était connu par 70%
d'entre elles mais 37% ne connaissaient pas son emplacement.
Les pratiques à risque restaient assez nombreuses, même parmi les infirmières déclarant avoir reçu
une formation : 21,3% recapuchonnaient les aiguilles, 18,7% ne portaient pas de gants pour les
prélèvements sanguins, 6,6% n'amenaient jamais le conteneur à objets piquants/coupants à portée de
mains lors des soins et 30,7% déclaraient forcer sur l'ouverture de ce conteneur en cas de difficulté
lors de l'introduction d'objets souillés.
En cas d'AES, 50,5% des infirmières connaissaient la nécessité d'un nettoyage de la plaie et 63,3%
d'une antisepsie avec un produit chloré.
De façon générale, les résultats ont montré une connaissance insuffisante des mesures de prévention
et de la conduite à tenir en cas d'AES. (R.A.).
Mots-clés BDSP : EVALUATION, INFIRMIER, ENQUETE, PREVENTION, PLAIE, SOINS,
INFECTION NOSOCOMIALE, HYGIENE HOSPITALIERE, EXPOSITION SANG
Séroconversions professionnelles par le VIH et le VHC chez le personnel de santé en France.
Situation au 31 décembre 2004
LOT F., MIGUERES B., ABITEBOUL D.
Cet article propose une analyse des résultats du recensement des contaminations professionnelles
par le VIH et le VHC, réalisée par l'Institut de veille sanitaire (InVS), et de ceux de l'étude menée par
le GERES (Groupe d'étude sur le risque d'exposition des soignants aux agents infectieux) sur les
facteurs de risque de contamination professionnelle par le VHC.
8
Accès au texte intégral : http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObjectaccesParReference/TF%20143/$File/TF143.pdf
Curr Opin Infect Dis. 2005 Aug;18(4):331-6.
Protection of healthcare workers from bloodborne pathogens.
Beekmann SE, Henderson DK.
Department of Pathology, The University of Iowa College of Medicine, Iowa City,
Iowa, USA. [email protected]
PURPOSE OF REVIEW: For decades, healthcare workers have been known to be at risk from
acquiring a variety of bloodborne pathogen infections as a result of occupational exposure. Primary
prevention of exposures, as recommended by universal precautions guidelines, remains the
cornerstone of protecting healthcare workers. Nonetheless, a substantial number of parenteral
exposures continue to occur. Updated developments are summarized here, and recommendations for
the protection of healthcare workers from bloodborne pathogens are provided. RECENT FINDINGS:
The predominant evidence suggests that total percutaneous injuries have decreased over the last
decade. Thoughtful adherence to universal precautions remains the primary means of preventing
occupational exposures and thus of reducing occupational risk of infection with bloodborne pathogens.
A number of studies have provided additional evidence for the efficacy of safety devices in reducing
specific subsets of injuries when combined with education and administrative interventions. Barriers to
and positive predictors of universal precautions compliance have been identified. Postexposure
prophylaxis remains the second line of defense; several authorities have now recommended three
antiretroviral agents in this setting. SUMMARY: In summary, almost two decades of experience with
universal/standard precautions has resulted in a decrease in parenteral injuries, but much work
remains to be done. Vaccines, effective infection control procedures, safer procedures, and safer
devices will all be necessary, along with a better understanding of factors that influence healthcare
worker behaviors that result in injury. In addition, a number of issues relating to the postexposure
management of occupational exposures with bloodborne pathogens need to be better understood.
MeSH Terms: Anti-Infective Agents/therapeutic use - Blood-Borne Pathogens* - Health Personnel* Hepatitis B/prevention & control - Hepatitis C/prevention & control - Humans - Infection
Control/methods - Occupational Diseases/prevention & control - Occupational Exposure/prevention &
control* - Practice Guidelines - World Health
Substances: Anti-Infective Agents
Int J STD AIDS. 2005 Oct;16(10):671-672.
The risk of needle stick accidents during surgical procedures: HIV-1 viral load in blood and
bone marrow.
Regez RM, Kleipool AE, Speekenbrink RG, Frissen PH.
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam,
The Netherlands.
Health-care workers are at risk to acquire HIV through occupational exposure to blood of HIV-infected
patients. The mean risk after a percutaneous exposure is approximately 0.3%. A large inoculum and a
source patient with a high plasma viral load increases the transmission risk. To ensure the safety of
the operating team, we try to reduce HIV viral load in plasma prior to high-risk interventions
(cardiothoracic and orthopaedic surgery). However, in 15.7% of the exposures occurring in the
operating room, the possible source material is bone marrow. To make more accurate exposure risk
assessments, we measured HIV-1 RNA in both plasma and bone marrow of five HIV-infected patients
undergoing surgery. We found that the plasma viral load was not different from the viral load in bone
marrow.
6.2 Contamination soignant-soigné
6.3 Transmission aérienne
9
6.4 Transmission de contact
In Swiss-NOSO, Volume 12, Numéro 1, 2005
Rougeole et plan stratégique institutionnel en cas d'épidémie
Stéphane Hugonnet, Ilker Uçkay, Olivier Rutschmann, Laurent Kaiser, Nadia Bessire, Pierre
Brennenstuhl, Carmen Aramburu, Philippe Sudre, Bernard Vermeulen, Claire-Anne Siegrist et Didier
Pittet, Genève
Entre début janvier et mi-février 2005, 15 cas de rougeole ont été notifiés à la Direction générale de la
santé (DGS) du canton de Genève. Par comparaison, un seul cas avait été notifié pour toute l'année
2004. Cette flambée épidémique a affecté en premier lieu des adultes jeunes: les cas avaient entre 17
et 44 ans. A l'exception de deux patients, aucun n'était vacciné, or il est considéré que l'immunité ne
soit établie qu'après deux doses vaccinales ou après avoir contracté la maladie. Plusieurs cas sont
survenus chez des professionnels de la santé après contact avec des patients rougeoleux encore non
diagnostiqués. Il a par exemple suffit qu'un patient soit hospitalisé pendant moins d'une journée dans
un centre d'urgence pour que 3 médecins et une infirmière soient contaminés. Deux cas additionnels
de transmission nosocomiale ont également été observés.
Accès au texte intégral : http://www.chuv.ch/swiss-noso/f121a2.htm
Infection Control and Hospital Epidemiology, septembre, vol.26, n 9, p.752-760
L'épidémie d'hépatite C au centre d'hémodialyse de Béziers principalement due à une
contamination interpatients via les mains des soignants
Anne Savey, MD; Fernando Simon, MD; Jacques Izopet, MD, PhD; Agnès Lepoutre, MD; Jacques
Fabry, MD; Jean-Claude Desenclos, MD, PhD
La plus importante épidémie d'hépatite C survenue chez des dialysés -22 cas en 2001 au centre
d'hémodialyse de Béziers (Hérault)- a eu pour principale origine une contamination de patient à
patient via les mains des professionnels de santé, conclut l'enquête menée sur ce sujet. Les résultats
de cette enquête, qui n'excluent pas non plus complètement une transmission verticale via un appareil
de dialyse utilisé auparavant par un patient infecté par le virus de l'hépatite C (VHC), ont été publiés
dans la revue Infection Control and Hospital Epidemiology de septembre.
"Le 20 décembre 2001, un centre privé d'hémodialyse dans le sud de la France [prenant
régulièrement en charge environ 70 patients] a notifié au Centre de coordination de la lutte contre les
infections nosocomiales (C.Clin) Sud-Est 9 cas de séroconversions vis-à-vis du VHC trouvés après un
dépistage de routine entre septembre et décembre 2001", rapportent le Dr Anne Savey, du C.Clin
Sud-Est, et ses collègues.
Le 17 janvier 2002, 13 cas supplémentaires de nouvelles infections par le VHC ont été identifiés et le
centre a été fermé le 22 janvier 2002 par Bernard Kouchner, qui était alors ministre délégué à la
Santé, suite à un grand battage médiatique. L'unité a ouvert à nouveau ses portes deux mois après sa
fermeture, ajoutent les auteurs.
Ainsi, sur les 61 patients qui ont été traités dans le centre en 2001 et qui n'étaient pas infectés par le
VHC, 22, soit 36,1%, ont été infectés par le VHC probablement entre le 23 mars et le 25 décembre
2001, avec un taux de densité d'incidence de 70 pour 100 patient-années.
Il s'agit de "la plus grosse épidémie d'hépatite C jamais rapportée parmi des patients recevant des
dialyses", commentent les auteurs en soulignant qu'ils n'ont trouvé aucune exposition ni aucun facteur
de risque communs pour expliquer la survenue des cas.
Six patients étaient connus en 2001 pour être infectés chroniquement par le VHC. L'analyse
phylogénétique a permis de trouver 4 différents génotypes de VHC, avec dans chaque groupe des
virus similaires entre les cas et un patient index connu pour être chroniquement infecté.
La transmission du VHC est survenue le même jour, soit durant la même séance -suggérant une
transmission horizontale via les professionnels de santé-, soit la séance d'après -qui pourrait être en
accord avec une transmission verticale probablement par les appareils de dialyse-, ou les deux.
L'analyse des structures, des équipements, des plannings du personnel et des pratiques
10
professionnelles a montré un sous-effectif, un grand turn-over, un manque de formation et de
nombreuses brèches dans le contrôle infectieux. Leur accumulation conforte l'hypothèse de la
transmission par les mains contaminées des professionnels de santé, leurs gants ou de petites pièces
d'équipements médicaux.
L'étude cas-contrôle (22 cas, 62 contrôles) suggère aussi fortement que le VHC était principalement
transmis via les professionnels de santé durant les connexions successives des patients aux appareils
de dialyse. Une observation directe des pratiques a révélé de fréquents débordements de sang dans
les doubles filtres artériels.
"Durant cette épidémie, la transmission du VHC s'est faite principalement de patient à patient via les
mains des professionnels de santé. Cependant, la transmission via les appareils de dialyse en raison
d'une possible contamination de composants internes n'a pu être exclue", concluent les chercheurs.
Ceux-ci soulignent les limitations de leur étude et notamment son caractère rétrospectif et le fait que
l'audit des pratiques professionnelles ait été réalisé à partir de l'interview du personnel et
d'observations dans une autre unité de la société qui possédait le centre de Béziers. En février 2002,
Bernard Kouchner s'était déclaré déçu par le résultat des études en cours.
6.5 Vaccination
N Engl J Med. 2005 Oct 13;353(15):1555-63.
Efficacy of an acellular pertussis vaccine among adolescents and adults.
Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, Greenberg DP, Keitel W, Barenkamp S,
Bernstein DI, Edelman R, Edwards K; APERT Study Group.
UCLA Center for Vaccine Research, Research and Education Institute, Harbor-UCLA Medical Center,
David Geffen School of Medicine, UCLA, Torrance, Calif 90502, USA.
BACKGROUND: Pertussis immunization of adults may be necessary to improve the control of a rising
burden of disease and infection. This trial of an acellular pertussis vaccine among adolescents and
adults evaluated the incidence of pertussis, vaccine safety, immunogenicity, and protective efficacy.
METHODS: Bordetella pertussis infections and illnesses were prospectively assessed in 2781 healthy
subjects between the ages of 15 and 65 years who were enrolled in a national multicenter,
randomized, double-blind trial of an acellular pertussis vaccine. Subjects received either a dose of a
tricomponent acellular pertussis vaccine or a hepatitis A vaccine (control) and were monitored for 2.5
years for illnesses with cough that lasted for more than 5 days. Each illness was evaluated with use of
a nasopharyngeal aspirate for culture and polymerase-chain-reaction assay, and serum samples from
patients in both acute and convalescent stages of illness were analyzed for changes in antibodies to
nine B. pertussis antigens. RESULTS: Of the 2781 subjects, 1391 received the acellular pertussis
vaccine and 1390 received the control vaccine. The groups had similar ages and demographic
characteristics, and the median duration of follow-up was 22 months. The acellular pertussis vaccine
was safe and immunogenic. There were 2672 prolonged illnesses with cough, but the incidence of this
nonspecific outcome did not vary between the groups, even when stratified according to age, season,
and duration of cough. On the basis of the primary pertussis case definition, vaccine protection was 92
percent (95 percent confidence interval, 32 to 99 percent). Among unimmunized controls with illness,
0.7 percent to 5.7 percent had B. pertussis infection, and the percentage increased with the duration
of cough. On the basis of other case definitions, the incidence of pertussis in the controls ranged from
370 to 450 cases per 100,000 person-years. CONCLUSIONS: The acellular pertussis vaccine was
protective among adolescents and adults, and its routine use might reduce the overall disease burden
and transmission to children. Copyright 2005 Massachusetts Medical Society.
Hong Kong Med J. 2005 Oct;11(5):381-90.
Influenza vaccination: options and issues.
Wong SS, Yuen KY.
Department of Microbiology, Centre of Infection, University of Hong Kong, Queen
Mary Hospital, 102 Pokfulam Road, Hong Kong.
Currently available vaccines have similar efficacy if they are matched to the most prevalent circulating
strains. They also have comparable adverse effect profiles. The choice of a specific preparation of
vaccine therefore requires consideration of cost, purity of the vaccine preparation in terms of the
amount of egg protein and endotoxin, allergy to different constituents of the vaccine, reactogenicity
11
profiles, as well as the preferred route of administration. Intradermal injection of the vaccine appears to
be a viable alternative to the traditional intramuscular administration with the additional benefit of
requiring a smaller volume of vaccine. Despite the documented benefits in various community and
institutional settings, influenza vaccination has been underutilised by most target groups. A major
obstacle to broader coverage of vaccination is the perceived ineffectiveness of the vaccine and the
relatively benign nature of the illness in most patients. Uptake of vaccine among target populations,
especially health care workers, needs to be improved through a concerted effort between frontline
clinicians and health authorities.
South Med J. 2005 Sep;98(9):876-82.
Pre-event willingness to receive smallpox vaccine among physicians and public safety
personnel.
Silk BJ, del Rio C, Ivansco LK, Wetterhall SF, Augustine JJ, Blumberg HM, Berkelman RL.
Center for Public Health Preparedness and Research, Department of Epidemiology, Rollins School of
Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30317, USA.
[email protected]
BACKGROUND: Planning for voluntary smallpox vaccination of health and safety officials began in
December 2002. MATERIALS AND METHODS: Surveys were conducted among physicians and fire
and police department personnel in Atlanta, Georgia. Information on demographics, willingness to
receive smallpox vaccine, self-reported knowledge level, and potential vaccine contraindications was
analyzed. RESULTS: Forty-one percent of physicians (n = 199) were undecided on vaccination (32%
would receive vaccine and 27% would not). Forty-eight percent of firefighters (n = 343) and 41% of
police (n = 466) were undecided; 23% and 41% would receive vaccine, whereas 28% and 18% would
not (fire and police, respectively). Absence of contraindications was associated with physicians'
willingness to be vaccinated (P = 0.006). Many physicians (66%) and most public safety personnel
(88%) considered themselves inadequately informed on smallpox vaccine. In a multivariate analysis,
inadequately informed respondents were more likely to be undecided (OR = 2.23, CI = 1.39 to 3.56).
CONCLUSIONS: Before implementation of the smallpox vaccination program, self-assessed
knowledge about smallpox disease and vaccine were poor.
MeSH Terms: Adult - Attitude to Health* - Bioterrorism - Family Characteristics - Female - Georgia Health Knowledge, Attitudes, Practice - Health Policy - Humans - Male - Middle Aged - Multivariate
Analysis - Physicians/psychology* - Police* - Questionnaires - Research Support, Non-U.S. Gov't Smallpox Vaccine* - Specialties, Medical - Voluntary Programs*
Substances: Smallpox Vaccine
Cochrane Database Syst Rev. 2005 Oct 19;4:CD000100.
Vaccines for preventing hepatitis B in health-care workers.
Chen W, Gluud C, Chen W Md Ph D Candidate.
BACKGROUND: Hepatitis B virus (HBV) causes acute and chronic liver diseases. Hepatitis B
vaccination is recommended for health-care workers. OBJECTIVES: To assess the beneficial and
harmful effects of hepatitis B vaccination in health-care workers. SEARCH STRATEGY: We searched
the trial registers of The Cochrane Hepato-Biliary Group, The Cochrane Library, MEDLINE, and
EMBASE to February 2003. SELECTION CRITERIA: Randomised trials comparing any dose, injection
route, injection site, or schedule of hepatitis B plasma-derived vaccines (PDV) or recombinant
vaccines (RV) versus placebo, no intervention, or another hepatitis B vaccine in health-care workers.
DATA COLLECTION AND ANALYSIS: Two reviewers extracted the data independently. The
reviewers assessed the methodological quality of the trials regarding generation of the allocation
sequence, allocation concealment, double blinding, and follow-up. The results were presented as
relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: We identified 21 randomised
trials, all with one or more methodological weaknesses. Four trials demonstrated that PDV versus
placebo significantly decreased hepatitis B events at maximum follow-up (RR 0.51, 95% CI 0.35 to
0.73). RV did not differ significantly from PDV in eliciting a protective hepatitis B surface antibody (antiHBs) level in two trials. Both vaccines were well tolerated. Low-dose vaccine (1 or 2 microg) by the
intradermal route resulted in significantly more participants without protective anti-HBs level compared
with high-dose (10 or 20 microg) by the intramuscular route (RR 1.41, 95% CI 1.13 to 1.76). The
intradermal route caused significantly more local adverse events, while the intramuscular route caused
significantly more systemic adverse events. The gluteal injection produced significantly more
participants without protective anti-HBs level than the deltoid injection. The prevalence of anti-HBs
seroconversion by rapid vaccination (0, 1, and 2 months) was significantly lower than that by standard
vaccination (0, 1, and 6 months). Booster vaccinations with different RV doses (2.5, 5, 10, 20, or 40
microg) produced similar prevalence of anti-HBs seroconversion in three trials assessing participants
12
who did not respond to previous HBV vaccination. AUTHORS' CONCLUSIONS: PDV significantly
prevents hepatitis B events. RV seems to be able to elicit similar protective anti-HBs levels. The
intramuscular route with 20 microg RV was significantly more effective compared with the intradermal
route with 2 microg RV as was the standard schedule compared with a rapid schedule and deltoid
intramuscular injection compared with the gluteal intramuscular injection. It is unclear if booster
vaccination of non-responders offers higher anti-HBs seroconversion and hepatitis B vaccine prevents
the infection of hepatitis B mutants in health-care workers
7. Risques chimiques
In Archives des maladies professionnelles et de médecine du travail, : vol 66, n 4, p. 326 – 334,
septembre 2005
Développement d'une nouvelle méthode d'évaluation des risques chimiques : application dans
les laboratoires hospitaliers
R. Persoons, L. Dumas, M. Stoklov, A. Maître - Article scientifique - PDF
Objectif : Le contexte réglementaire concernant les risques chimiques et la nécessité de prévention de
leurs effets sur la santé ont conduit le CHU de Grenoble à mettre en place une démarche d'évaluation
des risques toxiques professionnels, en s'intéressant dans un premier temps aux laboratoires de
biologie.
Méthode : Après avoir identifié et caractérisé les dangers à partir des phrases de risques contenues
dans les fiches de données de sécurité des produits commerciaux, un algorithme de hiérarchisation
des dangers est créé. Seuls les produits les plus dangereux bénéficient d'une évaluation de
l'exposition par des observations de terrain. A partir du calcul des indices de risques sont identifiées
les situations inacceptables.
Résultats : Pour chaque produit manipulé sont définis 9 types de danger : effets locaux respiratoires,
cutanés et oculaires, effets systémiques par absorption respiratoire, cutanée ou orale, effets
cancérogènes, mutagènes et reprotoxiques. A chaque classe sont affectés 3 niveaux de danger : peu
dangereux, dangereux, très dangereux, les agents CMR étant toujours classés 2 ou 3. Pour les
produits dangereux et très dangereux sont calculés un indice d'exposition (fréquence d'utilisation et
quantité de produit manipulé) et des indices de protection (respiratoire, cutanée et oculaire), chaque
variable ayant 3 niveaux croissants ; 11 indices de risques sont calculés à partir du danger, de
l'exposition et de la protection
Conclusion : L'intérêt du calcul d'indices de risques réside dans sa possible automatisation. Bien que
cette méthode nécessite un travail important de recueil des données, elle apporte des éléments précis
quant aux programmes d'action.
ntérêt du calcul d'indices de risques réside dans sa possible automatisation. Bien que cette méthode
nécessite un travail important de recueil des données, elle apporte des éléments précis quant aux
programmes d'action.
Toxicité, évaluation du risque, agent chimique, laboratoire hospitalier
In Objectif prévention, vol. 28, no 4, 2005
Exposition au chlore et désinfection de chambres
Sylvie Bédard (asstsas)
Des membres du personnel des services d'hygiène et de salubrité de centres hospitaliers se plaignent
de malaises lors de la désinfection à l'eau de Javel des chambres de bénéficiaires atteints de diarrhée
associée au Clostridium difficile ( CD ).
Accès au texte intégral : http://www.asstsas.qc.ca/documentation/op/op284003.pdf
J Occup Environ Hyg. 2005 Jun;2(6):314-22.
Evaluation of a modified scavenging system to reduce occupational exposure to nitrous oxide
in labor and delivery rooms.
Chessor E, Verhoeven M, Hon CY, Teschke K.
School of Occupational and Environmental Hygiene, University of British
13
Columbia, Vancouver, British Columbia, Canada. [email protected]
We developed a new scavenging mask for the administration of nitrous oxide to mothers-to-be during
labor in order to minimize leakage of the patient's exhaled breath into the room and, therefore,
decreasing staff exposure to nitrous oxide. The scavenging system was designed with an inner mask
for gas delivery, an outer mask to capture exhaled breath, and a continuous exhaust airflow based on
breathing flow rates. In this study we field tested the scavenging system by measuring personal
exposures of nurses (N = 30) and room air concentrations (N = 33), while patients self-administered
nitrous oxide either through the conventional or modified scavenging system. Personal exposures
were measured using passive nitrous oxide monitors, and area measurements were made using a
direct-reading infrared analyzer. Information about volumes of nitrous oxide used, nurses' movements,
and patients' use of the analgesic was recorded in order to examine factors that influenced exposures
and the effectiveness of the scavenging system. The new scavenging system significantly reduced
exposures in the room and to nurses (arithmetic mean nitrous oxide concentrations = 39.7 ppm and
40.2 ppm, respectively, compared with 82.2 ppm and 69.3 ppm, respectively, for the conventional
system). Other factors associated with lower concentrations included larger distances between the
nurse and the patient, and greater times since nitrous oxide was used. Observations during the field
trial indicated that subjects did not hold the scavenging mask close enough to the face to capture
exhaled breath during much of the time when the breath was highly contaminated. Additional
modifications to the scavenging system are required to further reduce nitrous oxide concentrations and
to improve comfort and usability.
MeSH Terms: - Anesthetics, Inhalation/analysis* - British Columbia - Comparative Study - Consumer
Satisfaction - Delivery Rooms* - Equipment Design - Female - Gas Scavengers* - Humans - Labor,
Obstetric - Models, Theoretical - Nitrous Oxide/analysis* - Obstetrical Nursing/instrumentation Occupational Exposure/analysis - Occupational Exposure/prevention & control* - Pregnancy Research Support, Non-U.S. Gov't - Respiratory Protective Devices* - - Substances: - Anesthetics,
Inhalation - Nitrous Oxide
Publication Types: Evaluation Studies
Hosp Pharm Eur 2005 Nov; :52, 54
External contamination of antineoplastic drug vials
Connor-TH
Healthcare workers are increasingly being exposed to antineoplastic and other hazardous drugs.
Studies show that cleaning, in combination with covering the filled vial with a plastic film, can reduce
external contamination on vials. Several factors have contributed to the potential for increase in
exposure of healthcare workers to antineoplastic and other hazardous drugs. These include increasing
numbers of patients with cancer and other chronic illnesses, the use of higher doses of drugs (made
possible by strategies to reduce the toxic side-effects of the drugs), noncancer use of antineoplastic
drugs and the development of other potent drugs, such as antiviral agents. Because it has been well
documented over the past 20 years that healthcare workers, especially pharmacists and nurses, are
exposed to these drugs in the workplace, government institutions and professional organisations
around the world have developed guidelines for the safe handling of antineoplastic and other
hazardous drugs. In the USA, the National Institute for Occupational Safety and Health (NIOSH)l
recently published an alert that lists recommendations for the safe handling of all hazardous drugs, of
which antineoplastic drugs are the major class. Others classes of hazardous drugs include some
hormonal, immunosuppressive and antiviral agents, monoclonal antibodies and several miscellaneous
drugs.
KW: Hazardous-materials; Drug-therapy; Drugs; Antineoplastic-agents; Health-care-facilities; Healthcare-personnel
Surg Endosc. 2005 Oct 12
Injuries sustained by colorectal surgeons performing colonoscopy.
Liberman AS, Shrier I, Gordon PH.
Division of Colorectal Surgery, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis,
Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, Quebec, H3T
1E2, [email protected].
BACKGROUND: Repetitive tasks in the workplace are one cause of injury. This study aimed to identify
injuries specific to physicians routinely performing colonoscopy, and to identify prevention strategies.
METHODS: A survey was sent to all 2,173 worldwide members of the American Society for Colon and
Rectal Surgery to investigate injuries or disabilities that resulted from performing colonoscopy and the
methods used to prevent and alleviate symptoms related to the procedure. RESULTS: The response
rate was 28%. Of the respondents, 96% performed colonoscopy. At least one injury or pain believed to
14
result from performing colonoscopy was reported by 39% of the respondents. The most frequently
reported injuries were to hands and fingers (n = 257), neck (n = 65), and back (n = 52). The methods
adopted to alleviate injury included changing the height of the stretcher or video monitor, changing
from a standing to a sitting position, minimizing torque on the colonoscope, having an assistant
perform the torque maneuver, and resting or taking time off from colonoscopy. Two respondents also
created devices to make the instrument more ergonomic. CONCLUSION: The number of colorectal
surgeons encountering injury from colonoscopy highlights the need for preventive strategies. The
study results suggest that it may be necessary to improve the design of colonoscopes to make them
more ergonomic. Appropriate positioning of the endoscopist, patient, and monitors may diminish some
of the injuries encountered.
8. Risques physiques
8.1 Rayonnements ionisants
In Archives des maladies professionnelles et de médecine du travail, : vol 66, n 4, p. 369 - 374,
septembre 2005
Étude de l'observance des règles de radioprotection en milieu hospitalier à Abidjan
Y. M. Kouassi, S. B. Wognin, R. N'gbesso, Y. B. Yeboue-Kouame, A.F. Tchicaya, D. Alla, J. S. Bonny
But de l'étude : Le risque d'exposition aux rayonnements ionisants découle du non-respect des
mesures de radioprotection par les travailleurs. Nous avons initié la présente étude pour évaluer le
niveau d'application des textes régissant la radioprotection en Côte-d'Ivoire.
Méthode : L'étude transversale descriptive a été menée dans 6 formations sanitaires de la ville
d'Abidjan utilisant des tubes à rayons X.
Résultats : Les règles administratives étaient peu suivies : 50 % des établissements n'étaient pas
enregistrés au Service central de la protection contre les rayonnements ionisants (SCPRI) et 83,3 %
ne disposaient pas de personne compétente en matière de radioprotection. Concernant les
dispositions techniques, 29,6 % des locaux n'avaient pas de signalisation, 46,1 % des salles de radio
avaient en moyenne 10 années de fonctionnement et 79,2 % avaient subi au moins 3 réparations par
année. Les contrôles avant la mise en service et les contrôles de routine ont concerné respectivement
11,1 % et 29,1 % des intallations. La majorité des travailleurs (97,5 %) se protégeaient à l'aide d'un
tablier plombé ; 59,8 % d'entre eux portaient un dosimètre.
Discussion : Les insuffisances dans l'application des principes de la radioprotection s'expliquent par
les imprécisions et lacunes au niveau des textes de lois ivoiriens et par les difficultés matérielles et
logistiques rencontrées par le Service central de protection contre les rayonnements Ionisants
(SCPRI) dans ses missions de contrôle. La quasi-absence de contrôle, n'incite guère les employeurs
à procéder à des corrections techniques qui sont perçues comme des contraintes économiques
supplémentaires.
Conclusion : Nous suggérons une actualisation de la législation ivoirienne, surtout dans certaines de
ses dispositions et son application effective par le SCPRI qui doit accroitre sa capacité d'intervention.
rayons X, radioprotection, risque professionnel
Radioprotection en milieu médical : Conseil et assistance le l'IRSN pour les professionnels de
santé
Institut de Radioprotection et de Sûreté Nucléaire
Clin Physiol Funct Imaging. 2005 Jul;25(4):196-202.
Radiation doses to staff involved in sentinel node operations for breast cancer.
Klausen TL, Chakera AH, Friis E, Rank F, Hesse B, Holm S.
Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark.
15
[email protected]
BACKGROUND: The use of radioactive compounds for sentinel node biopsy is now a generally
accepted part of the surgical treatment of breast cancer and melanoma, with the risk of radiation
exposure to the operating team. The aim of this investigation was to study the levels of this exposure
in relation to the permissible radiation dose limits. METHODS: The radiation exposure to the hands
and bodies of the operating surgeons (the 'risk persons') was measured by thermoluminescent
dosimeters in 79 operations and to the pathologists handling the specimens in 17 cases. Radioactivity
and dose rate measurement from tumours and breast specimens were also performed. RESULTS:
During an operation the mean skin dose (+/-SD) to the thermoluminescent dosimeters placed at the
hand and the abdominal wall were 0.04 +/- 0.04 mSv (79 operations) and 0.01 +/- 0.02 mSv (67
operations) respectively. For the pathologist, the mean hand dose per operation was below the
detection limit (17 operations). Correlation between the measured dose rate and the radioactive
content of the tumours was 0.998. CONCLUSIONS: The radiation exposure to the staff involved in
sentinel node (SN) biopsy for breast cancer using radioactive labelled tracers will be considerably
below the permissible limits, even with high numbers of SN biopsy procedures. Pregnant staff
members should participate in <100 SN operations.
MeSH Terms: Body Burden - Breast Neoplasms/pathology* - Breast Neoplasms/radionuclide imaging*
- Breast Neoplasms/surgery - Humans - Lymph Nodes/pathology* - Lymph Nodes/radionuclide
imaging* - Lymphatic Metastasis - Nuclear Medicine - Occupational Exposure/analysis* - Radiation
Dosage - Radiation Monitoring/methods - Radiation Protection/methods Radiopharmaceuticals/analysis - Radiopharmaceuticals/diagnostic use - Relative Biological
Effectiveness - Risk Assessment/methods - Risk Factors - Sentinel Lymph Node Biopsy/methods* Technetium Tc 99m Aggregated Albumin/analysis* - Technetium Tc 99m Aggregated
Albumin/diagnostic use*
Substances: Radiopharmaceuticals - Technetium Tc 99m Aggregated Albumin - technetium Tc 99m
nanocolloid
8.2 Troubles musculo-squelettiques
Thèse pour le diplôme d'état de docteur en médecine. Médecine du travail, 2004
Les manipulateurs en radiologie face aux risques de troubles musculosquelettiques : analyse
et prévention des risques à l'hôpital Laennec de Nantes.
ROUAUD AMELINEAU (Emmanuelle)
Université de Nantes. Nantes.
Mots-clés BDSP : Radiologie, Prévention, Facteur risque, Maladie professionnelle, Médecine travail,
Ergonomie, Poste travail, Droit travail, Enquête, Hôpital, Loire Atlantique, France, Identité
professionnelle
Appl Ergon. 2005 Sep;36(5):609-18.
Electromyography as a measure of peak and cumulative workload in intermediate care and its
relationship to musculoskeletal injury: an exploratory ergonomic study.
Village J, Frazer M, Cohen M, Leyland A, Park I, Yassi A.
School of Occupational and Environmental Hygiene, University of British Columbia (UBC), Vancouver,
BC, Canada. [email protected]
Injury rates in Intermediate Care (IC) facilities are high and the factors related to these injuries are
unclear. The objectives of this exploratory sub-study, which is part of a large multi-faceted study in 8
IC facilities are to: (1) evaluate EMG measured over a full-shift in the back and shoulders of 32 care
aides (CAs) as an indicator of peak and cumulative workload (n = 4 x 8 facilities); investigate the
relationship between EMG measures and injury indicators; and explore the relationship between EMG
measures and other workload measurements. Lumbar EMG was converted to predicted cumulative
spinal compression and ranged in CAs from 11.7 to 22.8 MNs with a mean of 16.4 MNs. Average
compression was significantly different during different periods of the day (p < 0.001) with highest
16
compression during pre-breakfast when CAs assist most with activities of daily living. Significant
differences were found in average compression between low and high injury facilities for 3 of 5 periods
of the day (p < 0.010). Peak compressions exceeding 3400 N occurred for very little of the workday
(e.g. 11.25s during the 75 min period pre-breakfast). Peak neck/shoulder muscle activity is low (99%
APDF ranged from 8.33% to 28% MVC). Peak and cumulative spinal compression were significantly
correlated with lost-time and musculoskeletal injury rates as well as with total tasks observed in the
CAs (p < 0.01). Perceived exertion was only correlated with peak compressions (p < 0.01). Facilities
with low injury rates provided significantly more CAs (p < 0.01) to meet resident needs, and
subsequently CAs performed fewer tasks, resulting in less peak and cumulative spinal loading over
the day.
MeSH Terms: Back/physiopathology - Back Injuries/diagnosis* - Back Injuries/physiopathology British Columbia - Electromyography/methods - Female - Human Engineering/methods* - Humans Male - Middle Aged - Musculoskeletal Diseases/diagnosis* - Musculoskeletal
Diseases/physiopathology - Nurses' Aides* - Occupational Diseases/diagnosis* - Occupational
Diseases/physiopathology - Research Support, Non-U.S. Gov't - Risk Factors - Shoulder/injuries Shoulder/physiopathology - Sick Leave - Workload*
Publication Types: Clinical Trial - Multicenter Study
J Long Term Eff Med Implants. 2005;15(5):559-66.
Texas passes first law for safe patient handling in america: landmark legislation protects
healthcare workers and patients from injury related to manual patient lifting.
Hudson MA.
Editorial Board, Ergonomics and Injury Prevention, Journal of Long-Term Effects
of Medical Implants; Public Health Nurse, Coos County Public Health Department,
North Bend, Oregon, USA.
On June 17,2005, Texas Governor Rick Perry (R) signed into law Senate Bill 1525, making Texas the
first state in the nation to require hospitals and nursing homes to implement safe patient handling and
movement programs. Governor Perry is to be commended for this heroic first stand for safe patient
handling in America. The landmark legislation will take effect January 1, 2006, requiring the
establishment of policy to identify, assess, and develop methods of controlling the risk of injury to
patients and nurses associated with lifting, transferring, repositioning, and movement of patients;
evaluation of alternative methods from manual lifting to reduce the risk of injury from patient lifting,
including equipment and patient care environment; restricting, to the extent feasible with existing
equipment, manual handling of all or most of a patient's weight to emergency, life-threatening, or
exceptional circumstances; and provision for refusal to perform patient handling tasks believed to
involve unacceptable risks of injury to a patient or nurse.Manually lifting patients has been called
deplorable, inefficient, dangerous to nurses, and painful and brutal to patients; manual lifting can
cause needless suffering and injury to patients, with dangers including pain, bruising, skin tears,
abrasions, tube dislodgement, dislocations, fractures, and being dropped by nursing staff during
attempts to manually lift. Use of safe, secure, mechanical lift equipment and gentle friction-reducing
devices for patient maneuvering tasks could eliminate such needless brutality.Research has proven
that manual patient lifting is extremely hazardous to healthcare workers, creating substantial risk of
low-back injury, whether with one or two patient handlers. Studies on the use of mechanical patient lift
equipment, by either nursing staff or lift teams, have proven repeatedly that most nursing staff back
injury is preventable, leading to substantial savings to employers on medical and compensation
costs.Because the healthcare industry has relied on people to do the work of machines, nursing work
remains the most dangerous occupation for disabling back injury. Back injury from patient lifting may
be the single largest contributor to the nursing shortage, with perhaps 12% of nurses leaving or being
terminated because of back injury. The US healthcare industry has not kept pace with other industries,
which provide mechanical lift equipment for lifting loads equivalent to the weight of patients, or with
other countries, such as Australia and England, which are more advanced in their use of modern
technology for patient lifting and with no-lifting practices in compliance with government regulations
and nursing policies banning manual lifting.With Texas being the first state to succeed in passing
legislation for safe patient handling, other states are working toward legislative protection against
injury with manual patient lifting. California re-introduced safe patient handling legislation on February
17, 2005, with CA SB 363, Hospitals: Lift Teams, following the September 22, 2004, veto of CA AB
2532 by Governor Arnold Schwarzenegger, who said he believes existing statutory protection and
workplace safety standards are sufficient to protect health care workers from injury. Massachusetts HB
2662, Relating to Safe Patient Handling in Certain Health Facilities, was introduced December 1,
2004. Ohio HB 67, signed March 21, 2005 by Governor Bob Taft (R), creates a program for interestfree loans to nursing homes for implementation of a no-manual-lift program. New York companion bills
17
AB 7641 and SB 4029 were introduced in April, 2005, calling for creation of a 2-year study to establish
safe patient handling programs and collect data on nursing staff and patient injury with manual patient
handling versus lift equipment, to determine best practices for improving health and safety of
healthcare workers and patients during patient handling. Washington State is planning re-introduction
of safe patient handling legislation, after WA HB 1672, Relating to reducing injuries among patients
and health care workers, was stalled in committee in February, 2005. Language from these state
initiatives may be used as models to assist other states with drafting safe patient handling legislation.
Rapid enactment of a federal mandate for Safe Patient HandlingNo Manual Lift is essential and
anticipated.
9. Violence
Epidemiology. 2005 Sep;16(5):704-9.
Risk factors for work-related assaults on nurses.
Gerberich SG, Church TR, McGovern PM, Hansen H, Nachreiner NM, Geisser MS, Ryan AD, Mongin
SJ, Watt GD, Jurek A.
Regional Injury Prevention Research Center and Center for Violence Prevention and Control, Division
of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis,
Minnesota, USA. [email protected]
BACKGROUND: Work-related homicides have been the subject of considerable study, but little is
known about nonfatal violence and relevant risk factors. METHODS: We surveyed 6300 Minnesota
nurses who were selected randomly from the 1998 licensing database and determined their
employment and occupational violence experience. In a nested case-control study, we examined
environmental exposures and physical assault. Cases of assault in the previous 12 months and
controls randomly selected from assault-free months were surveyed about prior-month exposures.
RESULTS: After adjustment by multiple logistic regression, incidence of physical assault was 13.2 per
100 persons per year (95% confidence interval = 12.2-14.3). Among 310 cases and 946 control
subjects, odds ratios for assault were increased: in nursing homes or long-term care facilities (2.6; 1.93.6), emergency departments (4.2; 1.3-12.8), and psychiatric departments (2.0; 1.1-3.7); in
environments not "bright as daylight" (2.2; 1.6-2.8); and for each additional hour of shift duration (1.05;
0.99-1.11). Risks were decreased when carrying cellular telephones or personal alarms (0.3; 0.2-0.7).
CONCLUSIONS: These results may guide in-depth investigation of ways protective and risk factors
can control violence against nurses.
MeSH Terms: Adult - Case-Control Studies - Epidemiologic Studies - Female - Humans - Incidence Logistic Models - Male - Middle Aged - Minnesota/epidemiology - Nurses/psychology Nurses/statistics & numerical data* - Occupational Exposure/prevention & control - Occupational
Exposure/statistics & numerical data* - Occupational Health* - Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't - Research Support, U.S. Gov't, P.H.S. - Risk Factors Violence/statistics & numerical data* - Workplace
Accid Emerg Nurs. 2005 Jul;13(3):180-5.
Violence in the accident and emergency department--an international perspective.
Ferns T.
Department of Acute and Continuing Care, University of Greenwich, School of Health and Social Care,
Avery Hill Road, London SE9 2UG, United Kingdom. [email protected]
Violence and aggression experienced by emergency nurses has been the focus of international
concern. This paper examines the phenomena of violence experienced by emergency department
nursing staff from an international perspective by reviewing original, published research studies.
Methodological inconsistencies and concerns, a lack of comprehensive studies and persistent underreporting may mean that the reality of clinical practise has not being captured by researchers. The
literature suggests that clients presenting with weapons in the emergency department may be
characteristic of North American departments but is much less likely to occur in the United Kingdom
were weapons use is much more likely to be opportunistic. Excessive verbal abuse is a global
phenomenon and nursing staff and organisations may be significantly affected by workplace violence.
However, violence against nursing staff remains poorly researched or understood.
MeSH Terms: Aggression* - Emergency Service, Hospital* - Humans - Nursing Staff, Hospital* Occupational Exposure/statistics & numerical data* - Violence/statistics & numerical data*
Publication Types: Review - Review, Tutorial
18
10. Autres
L'eau dans les établissements de santé
Ministère des solidarités de la santé et de la famille, Direction de l'Hospitalisation et de l'Organisation
des Soins, Direction Générale de la Santé.
Dans les établissements de santé, l’eau a de nombreux usages exigeant des qualités spécifiques. Elle
peut constituer une source d’infections graves, en cas de contamination, particulièrement pour les
patients les plus fragiles. Les principaux risques sanitaires liés à l’utilisation de l’eau dans les
établissements de santé doivent donc être identifiés et évalués afin de déterminer les moyens à
mettre en œuvre pour maîtriser ces risques.
La direction de l’hospitalisation et de l’organisation des soins et la direction générale de la santé ont
missionné un groupe de travail pour rédiger un guide afin d’aider les établissements de santé à mettre
en œuvre une démarche globale de gestion de la qualité de l’eau. Les travaux s’inscrivent dans le
cadre du Plan National Santé Environnement (action relative à la prévention des légionelloses) et du
Programme National de Lutte contre les Infections Nosocomiales 2005 - 2008.
A ce titre, le guide technique sur l’eau dans les établissements de santé :
identifie les principaux dangers et risques sanitaires liés aux divers usages de l’eau,
propose des éléments d’organisation pour la gestion de ces risques,
donne des recommandations sur la qualité de l’eau requise selon les différents usages,
définit les règles générales de conception et d’entretien des installations de production et de
distribution d’eau.
Ce document s'adresse aux responsables des établissements de santé ainsi qu’à l’ensemble des
professionnels concernés (cadres de direction, personnels médicaux, paramédicaux, soignants et
personnels des services techniques).
Guide technique
Accès au texte intégral : http://www.sante.gouv.fr/htm/dossiers/eau_etabs/guide_eau_etabs.pdf
Can J Public Health. 2005 Sep-Oct;96(5):333-9.
Trends in injuries, illnesses, and policies in Canadian healthcare workplaces.
Yassi A, Gilbert M, Cvitkovich Y.
Department of Health Care and Epidemiology and Department of Medicine, University of British
Columbia (UBC),Vancouver. [email protected]
BACKGROUND: Analysis of workers' compensation data and occupational health and safety trends in
healthcare across Canada was conducted to provide insight concerning workplace injuries and
prevention measures undertaken in the healthcare sector. METHODS: Timeloss claims data were
collected for 1992-2002 from the Association of Workers' Compensation Boards of Canada. Labour
Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and
Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and
safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention
measures in their regions. RESULTS: The national timeloss injury rate declined from 4.3 to 3.7 injuries
per 100 person-years since 1998. Musculoskeletal injuries consistently comprised the majority of
timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently
resulted in timeloss claims although they are known to cause great concern in the workplace.
Prevention measures taken in the various provinces related to safer equipment (lifts and electric
beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well
as adjudication policies confounded the comparison of injury rates across provinces. DISCUSSION:
Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging
workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is
complex, but there is reason to believe that focus on prevention can further decrease injuries. While
occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on
successful prevention measures and best practices may improve workplace conditions and thereby
further reduce injury rates for higher risk healthcare sector occupations.
- © CHU de Rouen -
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