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Veille documentaire Médecine du travail du personnel hospitalier - Mars 2006 - CHU Rouen
Veille documentaire
Médecine du travail du personnel hospitalier
- Literature Follow-up : occupational health for Healthcare Workers -
Mars 2006
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 CNRACL (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.
La veille juridique est réalisée par l’ISTNF (Institut de santé du nord de la France).
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/).
Sommaire
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.4
6. Risques biologiques ............................................................................................................... p.6
6.1 Accident d'exposition au sang ................................................................................. p.7
6.2 Contamination soignant-soigné
6.3 Transmission aérienne ............................................................................................ p.7
6.4 Transmission de contact
6.5 Vaccination .............................................................................................................. p.8
7. Risques chimiques ................................................................................................................. p.8
8. Risques physiques
8.1 Rayonnements ionisants ......................................................................................... p.9
8.2 Troubles musculo-squelettiques .............................................................................. p.9
9. Violence
10. Autres ................................................................................................................................. p.10
Veille juridique .......................................................................................................................... p.12
1
1. Allergies
- Documents en français :
In La Revue du Praticien, tome 56, n 3, 15 février 2006
Les allergies au latex
Bayrou O
L'hypersensibilité aux protéines du latex, cause possible de choc anaphylactique peropératoire, a
beaucoup augmenté (mais elle tend à se stabiliser) chez les professionnels de santé, les enfants
opérés à de multiples reprises, et toutes les personnes utilisant des gants de latex. Une allergie
alimentaire croisée est souvent associée; par ailleurs, les additifs du caoutchouc entrainent des
eczémas surtout professionnels.
article de périodique
2. Bonnes pratiques
3. Conditions de travail et santé psychologique
Soins. 2005 Dec;(701):55.
4/4 Prévenir l'épuisement professionnel.
La mutuelle de la sante et du social.
MeSH Terms: Burnout, Professional/diagnosis - Burnout, Professional/prevention & control* Burnout, Professional/psychology - Humans - Nursing Staff/organization & administration - Nursing
Staff/psychology* - Occupational Health* - Primary Prevention - Psychiatric Status Rating Scales
Publication Types: Review
- Documents en anglais :
Nurs Forum. 2005 Oct-Dec;40(4):123-8.
A concept analysis: the grieving process for nurses.
Brunelli T.
Winston-Salem State University, Winston-Salem, North Carolina, USA. [email protected]
The concept of the grieving process has been explored extensively in families losing a loved one or in
a patient grieving over a terminal diagnosis. The patients and families live through this experience one
time. What about the nurse who lives it several times a week by caring for these patients and families?
How does a nurse grieve? Little publication and research have been done surrounding the grieving
process for nurses. This is a concept analysis that clarifies the grieving process for nurses. Clarifying
this process will enable further development of nursing research and education, ultimately benefiting
nursing practice and retention.
MeSH Terms: Adaptation, Psychological - Attitude of Health Personnel* - Attitude to Death - Burnout,
Professional/prevention & control - Burnout, Professional/psychology* - Grief* - Humans - Mental
Health - Models, Nursing - Models, Psychological* - Nurse's Role/psychology - Nurse-Patient
Relations - Nurses/psychology* - Occupational Health - Prognosis - Self Care - Self-Help Groups Social Support
BMC Public Health. 2005 Sep 1;5:92.
Pride and confidence at work: potential predictors of occupational health in a hospital setting.
Nilsson K, Hertting A, Petterson IL, Theorell T.
School of Life Sciences, University of Skovde, Skovde, Sweden. [email protected]
BACKGROUND: This study focuses on determinants of a healthy work environment in two
departments in a Swedish university hospital. The study is based on previously conducted longitudinal
studies at the hospital (1994-2001), concerning working conditions and health outcomes among health
care personnel in conjunction with downsizing processes. Overall, there was a general negative trend
in relation to mental health, as well as long-term sick leave during the study period. The two
departments chosen for the current study differed from the general hospital trend in that they showed
2
stable health development. The aim of the study was to identify and analyse experiential determinants
of healthy working conditions. METHODS: Thematic open-ended interviews were carried out with
seventeen managers and key informants, representing different groups of co-workers in the two
departments. The interviews were transcribed verbatim and an inductive content analysis was made.
RESULTS: In the two studied departments the respondents perceived that it was advantageous to
belong to a small department, and to work in cooperation-oriented care. The management approaches
described by both managers and co-workers could be interpreted as transformational, due to a strain
of visionary, delegating, motivating, confirmative, supportive attitudes and a strongly expressed
solution-oriented attitude. The daily work included integrated learning activities. The existing
organisational conditions, approaches and attitudes promoted tendencies towards a work climate
characterised by trust, team spirit and professionalism. In the description of the themes organisational
conditions, approaches and climate, two core determinants, work-pride and confidence, for healthy
working conditions were interpreted. Our core determinants augment the well-established concepts:
manageability, comprehensiveness and meaningfulness. These favourable conditions seem to
function as a buffer against the general negative effects of downsizing observed elsewhere in the
hospital, and in the literature. CONCLUSION: Research illuminating health-promoting aspects is rather
unusual. This study could be seen as explorative. The themes and core dimensions we found could be
used as a basis for further intervention studies in similar health-care settings. The result could also be
used in future health promotion studies in larger populations. One of the first steps in such a strategy
is to formulate relevant questions, and we consider that this study contributes to this.
MeSH Terms: Adult - Attitude of Health Personnel* - Female - Hospital Departments/manpower Hospital Departments/organization & administration* - Humans - Interpersonal Relations* - Interviews Leadership - Male - Middle Aged - Morale - Neurology - Obstetrics and Gynecology Department,
Hospital/organization & administration - Occupational Health* - Personnel, Hospital/psychology* Questionnaires - Research Support, Non-U.S. Gov't - Social Support - Sweden - Trust Workplace/psychology*
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=16137331
http://www.biomedcentral.com/1471-2458/5/92
Nurs Outlook. 2005 Nov-Dec;53(6):291-9.
The consequences of job stress for nurses' health: time for a check-up.
McNeely E.
Department of Environmental Health, Occupational Health Program, Harvard University School of
Public Health, Room 3-098, Landmark Center, 401 Park Drive, PO Box 15697, Boston, MA 02215,
USA. [email protected]
The processes and outcomes of nurses' work are described extensively in studies about patient care,
nursing education and training, job satisfaction, health care quality and management, and
organizational behavior. These studies evaluate the relationship between nurses' behavior and
organizational health (ie, productivity) or between nurses' behavior and patient health (ie, medical
error). Fewer studies probe the association between the nature of nursing work and the status of
nurses' health despite the logical connection between how well nurses feel and how well they perform,
or even, whether they discontinue working altogether for health reasons. Yet, for many nurses working
in today's health care environment, work is a stressful part of their lives. This article explores the
connections between stressful work and nurses' health, especially given the restructuring of their work
in the current health care system. The working conditions that give rise to stress and the potential
health consequences from it are well described in the general stress literature and summarized herein.
Moreover, studies about nurses' work and nurses' health are discussed in light of the limitations for
connecting job stress to job changes or health outcomes over time. Current approaches for dealing
with nurses' stress, such as the attraction to "Magnetism", may inadvertently impede progress in this
area. Recommendations for the future are included.
MeSH Terms: Absenteeism - Adaptation, Psychological - Attitude of Health Personnel - Burnout,
Professional/complications* - Burnout, Professional/etiology - Burnout, Professional/prevention &
control - Burnout, Professional/psychology - Decision Making, Organizational - Efficiency,
Organizational - Forecasting - Health Care Reform/organization & administration - Health Services
Needs and Demand - Health Status* - Humans - Internal-External Control - Job Satisfaction - Medical
Errors/nursing - Nurse's Role*/psychology - Nursing Research/organization & administration - Nursing
Staff*/organization & administration - Nursing Staff*/psychology - Occupational Health* - Outcome and
Process Assessment (Health Care) - Risk Factors - Social Support - Workload
3
4. Hygiène et gestion des risques
Rev Infirm. 2005 Dec;(116):33-4.
Securité du personnel soignant : les equipements d'alerte.
Charles E.
MeSH Terms: Cellular Phone/supply & distribution - Cellular Phone/utilization* - Equipment Design Hospital Communication Systems - Hospitals, Psychiatric - Humans - Nursing Staff, Hospital* Occupational Health* - Security Measures/organization & administration*
OR Manager. 2005 Dec;21(12):1, 7, 9-11.
OSHA is pressing ORs to adopt safety scalpels but surgeons resist.
[No authors listed]
MeSH Terms: Attitude of Health Personnel - Diffusion of Innovation - Humans - Needlestick
Injuries/prevention & control - Operating Rooms - Protective Devices/utilization* - Safety Management
- Surgical Instruments* - United States - United States Occupational Safety and Health Administration*
OR Manager. 2005 Dec;21(12):12-3.
What OSHA says about safety scalpels.
Williams D.
MeSH Terms: Humans - Needlestick Injuries/prevention & control* - Protective Devices* - Safety
Management - Surgery Department, Hospital - Surgical Instruments* - United States - United States
Occupational Safety and Health Administration*
Publication Types: Interview
5. Infections nosocomiales
CCLIN Sud-Ouest
Prévention du risque infectieux en imagerie médicale non interventionnelle (2005)
Pilles D
Centre de Coordination de la Lutte Contre les Infections Nosocomiales Sud-Ouest] concepts
généraux, personnel médical et paramédical, locaux, équipements et dispositifs médicaux, fiches
pratiques, gestion des circuits en radiologie non interventionnelle, gestion des antiseptiques, annexes
; 115 pages
absorptiométrie photonique /méthodes ; aspiration (méthode) ; contaminations par piqûre d'aiguille
/prévention et contrôle ; déchets médicaux ; désinfection ; *diagnostic par imagerie /méthodes
\recommandation professionnelle ; échographie /méthodes ; équipement et appareillage hospitaliers ;
*hygiène ; imagerie par résonance magnétique /méthodes ; lavage mains ; literie et linge ; *lutte contre
infection /méthodes \recommandation professionnelle ; mammographie /méthodes ; oxygénothérapie
/méthodes ; personnel sanitaire ; personnel santé auxiliaire ; radiographie panoramique /méthodes ;
radioprotection /méthodes ; service radiologie hôpital /organisation et administration ;
tomodensitomètre ; tomodensitométrie /méthodes ; transport sanitaire /méthodes
recommandation professionnelle
In Médecine et maladies infectieuses, Volume 36 - Numéro 2 - pp: 99-104
Réservoirs et transmission de Pseudomonas aeruginosa en réanimation médicale
Lashéras, Guisset, Boulestreau, Rogues, Fiore, Szajner et al.
"Objectifs : Décrire les réservoirs et la transmission de Pseudomonas aeruginosa dans un service de
réanimation.
Patients et méthodes : Étude descriptive prospective de six mois réalisée à partir de prélèvements
d'eau et de mains du personnel et à partir de prélèvements cliniques. Les parentés génomiques entre
les souches de P. aeruginosa de même sérotype et obtenues sur une même période ont été
caractérisées par l'électrophorèse en champ pulsé.
Résultats : Parmi les 211 patients hospitalisés pendant la période de l'étude, quatorze (6,6 %) ont
4
présenté une infection à P. aeruginosa. Sur 494 prélèvements d'eau, 80 étaient contaminés par P.
aeruginosa. Les points régulièrement désinfectés étaient plus rarement contaminés que les autres (p
<10-5). Sur 140 prélèvements de mains, un a montré une contamination certaine par P. aeruginosa à
partir d'un patient infecté.
Conclusions : La transmission croisée manuportée de P. aeruginosa a pu être observée au cours de
cette étude. Les précautions strictes d'hygiène des mains doivent être renforcées telles que le port
des gants et l'utilisation des produits hydroalcooliques. La persistance de P. aeruginosa au niveau des
points d'eau devrait nous amener à maintenir la désinfection régulière.
Hygiène / Réanimation / Pseudomonas aeruginosa / Transmission croisée
Article de périodique
Chest. 2006 Jan;129(1):95-101.
Colonization of severe acute respiratory syndrome-associated coronavirus among health-care
workers screened by nasopharyngeal swab.
Ho HT, Chang MS, Wei TY, Hsieh WS, Hung CC, Yang HM, Lu YT.
Department of Laboratory Medicine, Division of Chest Medicine, Mackay Memorial Hospital, 92, Sec 2,
Chung-Shan North Rd, Taipei, 10449, Taiwan.
STUDY OBJECTIVES: To report the efficacy and findings of a large-scale preventive screening
program for severe acute respiratory syndrome-associated coronavirus (SARS-CoV) using
amplification of the virus from a nasopharyngeal swab (NPS) obtained from the health-care workers
(HCWs). DESIGN: A prospective observational study. SETTING: A medical center in Taiwan.
PARTICIPANTS: Two hundred thirty HCWs. INTERVENTION: NPS examination for the presence of
SARS-CoV by two nested reverse transcription-polymerase chain reaction (RT-PCR) assays.
MEASUREMENTS AND RESULTS: During the outbreak of severe acute respiratory syndrome
(SARS), NPS polymerase chain reaction screening of HCWs for SARS-CoV was performed. SARSCoV was examined by two nested RT-PCRs and a quantitative RT-PCR. Serum-specific antibodies
were assessed by enzyme immunoassay and indirect immunofluorescence. We monitored 230 HCWs,
including 217 first-line HCWs and 13 non-first-line HCWs. One hundred ninety first-line HCWs and 13
non-first-line HCWs had negative results in both nested RT-PCR assays. Two first-line HCWs who
were positive on both nested RT-PCR assays had SARS. They had 16,900 +/- 7,920 copies (mean +/SD) of RNA per milliliter in the NPS and had detectable anti-SARS antibodies. The remaining 25 firstline HCWs were negative for the first nested RT-PCR but positive for the second nested RT-PCR.
Their corresponding titers were 338 +/- 227 copies of RNA per milliliter; antibodies developed in none
of these 25 HCWs. The expression and function of angiotensin-converting enzyme-2 were not different
among these HCWs. This study shows that colonization of SARS-CoV occurred in 25 of 217 wellprotected first-line HCWs on a SARS-associated service, but they remained seronegative.
CONCLUSION: With the second RT-PCR assay more sensitive than the first RT-PCR assay, we are
able to show that approximately 11.5% of well-protected HCWs exposed to SARS patients or
specimens may have colonization without seroconversion. Only those with significant clinical
symptoms or disease would have active immunity. Thus, regular NPS screening for nested RT-PCR
assays in conjunction with a daily recording of body temperature in all first-line HCWs may provide an
effective way of early detection.
MeSH Terms: Adult - Antibodies, Viral/immunology - Comparative Study - Cross
Infection/epidemiology* - Cross Infection/transmission - Cross Infection/virology - Disease
Transmission, Patient-to-Professional* - Female - Fluorescent Antibody Technique, Indirect - Health
Personnel - Humans - Immunoenzyme Techniques - Male - Nasopharynx/virology* - RNA,
Viral/analysis - Research Support, Non-U.S. Gov't - Retrospective Studies - Reverse Transcriptase
Polymerase Chain Reaction - SARS Virus/genetics - SARS Virus/immunology - SARS Virus/isolation
& purification* - Severe Acute Respiratory Syndrome/transmission - Severe Acute Respiratory
Syndrome/virology* - Taiwan/epidemiology - Substances: Antibodies, Viral - RNA, Viral
Infection. 2005 Oct;33(5-6):309-13.
Dutch guideline for preventing nosocomial transmission of highly resistant microorganisms
(HRMO).
Kluytmans-Vandenbergh MF, Kluytmans JA, Voss A.
Laboratory for Microbiology and Infection Control, Amphia Hospital, location Molengracht, 90158, 4800
RK Breda, The Netherlands.
Hospitals are faced with the increasingly rapid emergence and dissemination of antimicrobial-resistant
microorganisms. US and European guidelines on the prevention of antimicrobial resistance in
hospitals were, until recently, mainly directed at methicillin-resistant Staphylococcus aureus (MRSA).
In 2004, the Dutch Working Party on Infection Prevention issued a guideline on the prevention of
nosocomial transmission of highly resistant microorganisms (HRMO), in order to fulfill the growing
5
need for additional guidance on the control of other pathogens with acquired resistance and the
potential to spread within hospitals (such as glycopeptide-resistant Enterococcus faecium, penicillinresistant Streptococcus pneumoniae, extendedspectrum beta-lactamase producing
Enterobacteriaceae, and other (multi)drug-resistant gram-negatives). In addition to providing criteria
for defining HRMO, the Dutch guideline provides recommendations on isolation of patients, active
surveillance, and contact tracing. The guideline will enable the comparison of HRMO rates between
hospitals, and may be used to evaluate the efficacy of programs to control antibiotic use and/or
nosocomial transmission of resistant pathogens. The eventual success of nationwide implementation
of this guideline remains to be established in the coming years.
MeSH Terms: Cross Infection/microbiology - Cross Infection/prevention & control* - Cross
Infection/transmission - Drug Resistance, Multiple, Bacterial* - Enterobacteriaceae/drug effects Enterobacteriaceae/isolation & purification - Enterococcus faecium/drug effects - Enterococcus
faecium/isolation & purification - Health Policy* - Netherlands - Practice Guidelines* - Staphylococcus
aureus/drug effects - Staphylococcus aureus/isolation & purification - Streptococcus pneumoniae/drug
effects - Streptococcus pneumoniae/isolation & purification
Clin Infect Dis. 2006 Apr 1;42(7):981-8. Epub 2006 Feb 15.
Nosocomial pertussis: costs of an outbreak and benefits of vaccinating health care workers.
Calugar A, Ortega-Sanchez IR, Tiwari T, Oakes L, Jahre JA, Murphy TV.
Immunization Services Division, National Immunization Program, Centers for Disease Control and
Prevention, Atlanta, GA, 30333, USA. [email protected].
Background. In September 2003, 17 symptomatic cases of pertussis among health care workers
(HCWs) resulted from a 1-day exposure to an infant who was later confirmed to have pertussis. These
HCWs identified 307 close contacts. The hospital implemented extensive infection-control measures.
The objective of this study was to determine direct and indirect costs incurred by the hospital and
symptomatic HCWs as a result of the September 2003 outbreak and to estimate possible benefits of
vaccinating HCWs from the hospital perspective.Methods. We determined costs by interviewing
infection-control and hospital personnel, reviewing billing records, and surveying symptomatic HCWs.
We calculated the benefits and costs of a vaccination program for HCWs, using a probabilistic model
to estimate the number of pertussis exposures that would require control measures annually.
Sensitivity and threshold analyses were performed.Results. The outbreak cost to the hospital was
$74,870. The total measured cost of the outbreak was $81,382, including costs incurred by HCWs
($6512). Our model predicted that vaccinating HCWs against pertussis would prevent >46% of
exposures from HCWs with pertussis per year and would provide net savings. The benefit for the
hospital was estimated to be 2.38 times the dollar amount invested in vaccinating HCWs. The number
of exposures prevented and the benefit-cost ratio were sensitive to the number of exposures identified,
the incidence of pertussis among HCWs, and HCW turnover.Conclusions. A single nosocomial
pertussis outbreak resulted in substantial disruption and costs to the hospital and to HCWs. Our model
suggests that cost savings and benefits could be accrued by vaccinating HCWs against pertussis.
6. Risques biologiques
J Viral Hepat. 2006 Jan;13(1):2-4.
Hepatitis B virus (HBV) DNA levels and the management of HBV-infected health care workers.
van der Eijk AA, de Man RA, Niesters HG, Schalm SW, Zaaijer HL.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the
Netherlands.
Different guidelines exist for the management of hepatitis B virus (HBV)-infected health care workers
(HCWs). Various HBV DNA levels are used as a cutoff level to determine whether an HBV-infected
HCW is allowed to perform exposure-prone procedures (EPPs) or not. In this paper we discuss the
factors that determine HBV DNA levels and the implications of different HBV DNA cutoff levels for EPP
performing HCWs. If the level of HBV DNA in the serum of HCWs is used to determine acceptability
for the conduct of EPPs, it is necessary to take into account the variability in time of HBV DNA levels
in HBV carriers and the reliability and reproducibility of the molecular diagnostic test involved. The
issue of standardization has to be addressed, before a universal, maximum level of viraemia for EPP
performing HCWs can be introduced.
MeSH Terms: DNA, Viral/blood* - Disease Transmission, Professional-to-Patient/prevention & control*
- Health Personnel - Hepatitis B/blood* - Hepatitis B/diagnosis - Hepatitis B/transmission - Hepatitis
6
B/virology - Hepatitis B e Antigens/blood - Hepatitis B virus/genetics* - Humans - Viremia/virology
Substances: DNA, Viral - Hepatitis B e Antigens
6.1 Accident d'exposition au sang
Surg Clin North Am. 2005 Dec;85(6):1299-305, xiii.
Strategies for preventing sharps injuries in the operating room.
Berguer R, Heller PJ.
Contra Costa Regional Medical Center, Department of Surgery, 2500 Alhambra Avenue, Martinez, CA
94553, USA. [email protected]
With the discovery of AIDS and HIV, the medical community began to widely recognize the dangers of
serious illnesses spread-ing through contact with contaminated blood and body fluids. In response, the
Centers for Disease Control and other groups have developed guidelines for the operating room to
prevent the spread of infection from, for example, accidental needle sticks. Unfortunately, those
guidelines are not always strictly followed. This article reviews studies that have examined
precautionary practices, including such practices as double gloving, the use of blunt suture needles,
and the use of neutral zones for passing sharps. The article also provides related sources for further
information.
MeSH Terms: Accidents, Occupational/prevention & control* - Acquired Immunodeficiency
Syndrome/transmission - Blood-Borne Pathogens/isolation & purification - Comparative Study - Cross
Infection/prevention & control* - Cross Infection/virology - Disease Transmission, Patient-toProfessional/prevention & control* - Female - Follow-Up Studies - Guidelines - HIV
Infections/transmission* - Humans - Infection Control/methods - Infection Control/standards* - Male Needlestick Injuries/epidemiology - Needlestick Injuries/prevention & control* - Occupational Health* Operating Rooms/standards* - Risk Assessment
6.2 Contamination soignant-soigné
6.3 Transmission aérienne
J Antimicrob Chemother. 2005 Nov;56(5):919-22. Epub 2005 Sep 23.
Experience of using convalescent plasma for severe acute respiratory syndrome among
healthcare workers in a Taiwan hospital.
Yeh KM, Chiueh TS, Siu LK, Lin JC, Chan PK, Peng MY, Wan HL, Chen JH, Hu BS, Perng CL, Lu JJ,
Chang FY.
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service
General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Neihu,
Taipei, 114, Taiwan.
OBJECTIVES: To describe the immunological responses and clinical outcome of coronavirus (SARS)
infected healthcare workers (HCW) who had been administered with convalescent plasma as a
treatment. METHODS: Convalescent plasma (500 mL) was obtained from each of three SARS
patients and transfused into the three infected HCW. Donors were blood type O and seronegative for
hepatitis B and C, HIV, syphilis and human T-cell lymphotropic virus types I and II (HTLV-I and -II).
Serum antibody (IgG) titre was >640. Apharesis was performed with a CS 3000 plus cell separator
followed by the forming of the convalescent phase plasma. As part of the routine check with donated
plasma, the convalescent plasma was confirmed free of residual SARS-CoV by RT-PCR. Serial serum
samples obtained from the recipients of the convalescent plasma were collected to undertake realtime quantitative RT-PCR for SARS-CoV for direct measurement of viral concentration. Specific
immunoglobulin IgM and IgG concentrations were titrated using an antigen microarray developed inhouse. RESULTS: Viral load dropped from 495 x 10(3), 76 x 10(3) or 650 x 10(3) copies/mL to zero or
1 copy/mL one day after transfusion. Anti-SARS-CoV IgM and IgG also increased in a time-dependent
7
manner following transfusion. All three patients survived. One HCW became pregnant subsequently,
delivering 13 months after discharge. Positive anti-SARS-CoV IgG was detected in the newborn.
Passive transfer of anti-SARS-CoV antibody from the mother was considered as a possibility.
CONCLUSIONS: All infected HCW whose condition had progressed severely and who had failed to
respond to the available treatment, survived after transfusion with convalescent plasma.
MeSH Terms: Adult - Antibodies, Viral/blood - Female - Health Personnel* - Hospitals - Humans Immune Sera/administration & dosage* - Immunization, Passive* - Immunoglobulin G/blood Immunoglobulin M/blood - Male - Occupational Diseases/therapy* - RNA, Viral/analysis - Reverse
Transcriptase Polymerase Chain Reaction - SARS Virus/genetics - SARS Virus/immunology - Severe
Acute Respiratory Syndrome/therapy* - Taiwan - Treatment Outcome - Viral Load
Substances: Antibodies, Viral - Immune Sera - Immunoglobulin G - Immunoglobulin M - RNA, Viral
6.4 Transmission de contact
6.5 Vaccination
MMWR Recomm Rep. 2006 Feb 24;55(RR-2):1-16.
Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection
Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization
Practices (ACIP).
Pearson ML, Bridges CB, Harper SA; Healthcare Infection Control Practices Advisory Committee
(HICPAC); Advisory Committee on Immunization Practices (ACIP).
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Atlanta, GA 30333,
USA. [email protected]
This report summarizes recommendations of the Healthcare Infection Control Practices Advisory
Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning
influenza vaccination of health-care personnel (HCP) in the United States. These recommendations
apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices,
urgent care centers, and outpatient clinics, and to persons who provide home health care and
emergency medical services. The recommendations are targeted at health-care facility administrators,
infection-control professionals, and occupational health professionals responsible for influenza
vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP
recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are
strongly encouraged to provide vaccine to their staff by using evidence-based approaches that
maximize vaccination rates.
MeSH Terms: Cross Infection/prevention & control* - Health Personnel/standards* - Humans Infection Control/standards* - Influenza Vaccines/administration & dosage* - Influenza,
Human/prevention & control* - United States - Vaccination/standards* - Substances: Influenza
Vaccines
Publication Types: Guideline
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm
7. Risques chimiques
NIOSH, february 2006
NIOSH Safety and Health Topic: Occupational Exposure to Antineoplastic Agents
Introduction; Publications, Guidelines, Review Articles and Surveys; Effects of Occupational Exposure;
Occupational Monitoring; Environmental Sampling, Decontamination, and Protective Equipment
http://www.cdc.gov/niosh/topics/antineoplastic/
8
8. Risques physiques
8.1 Rayonnements ionisants
Med J Malaysia. 2005 Jul;60 Suppl C:26-9.
Radiation exposure to the surgeon during femoral interlocking nailing under fluoroscopic
imaging.
Muzaffar TS, Imran Y, Iskandar MA, Zakaria A.
Department of Orthopaedics, School of Medical Scienc es, Universiti Sains Malaysia, Kubang Kerian,
Kota Bharu, Kelantan, Malaysia.
Femoral interlocking nailing requires fluoroscopic assistance for insertion of the nail and distal screws.
In this study, scattered radiation to the eye and hand of the operating surgeon was measured during
the procedure. Thermo-luminescent dosimeter (TLD) was used to quantify the dose received by the
surgeon. The mean radiation exposure time during the procedure was 3.89 minutes. The mean
scattered radiation doses to the hand and eye were 0.27 mSv and 0.09 mSv per procedure
respectively. These very low doses have made a surgeon very unlikely to receive more than the
recommended annual dose limit set by the National Council on Radiological Protection.
MeSH Terms: Eye* - Femoral Fractures/radiography - Femoral Fractures/surgery - Fluoroscopy* Fracture Fixation, Intramedullary* - Hand* - Humans - Occupational Exposure* - Orthopedics* Prospective Studies - Radiation Dosage* - Scattering, Radiation - Thermoluminescent Dosimetry
Bioelectromagnetics. 2006 Feb;27(2):156-8.
Therapeutic staff exposure to magnetic field pulses during TMS/rTMS treatments.
Karlstrom EF, Lundstrom R, Stensson O, Mild KH.
National Institute for Working Life, Umea, Sweden.
Transcranial magnetic stimulation or repetitive transcranial magnetic stimulation (TMS/rTMS) is
currently being used in treatments of the central nervous system diseases, for instance, depressive
states. The principles of localized magnetic stimulation are summarized and the risk and level of
occupational field exposure of the therapeutic staff is analyzed with reference to ICNIRP guidelines for
pulses below 100 kHz. Measurements and analysis of the occupational exposure to magnetic fields of
the staff working with TMS/rTMS are presented.
MeSH Terms: Allied Health Personnel/statistics & numerical data* - Body Burden - Electromagnetic
Fields* - Environmental Monitoring/methods* - Environmental Monitoring/standards - Humans Occupational Exposure/analysis* - Occupational Exposure/statistics & numerical data* - Radiation
Dosage - Research Support, Non-U.S. Gov't - Risk Assessment/methods* - Sweden/epidemiology Transcranial Magnetic Stimulation/statistics & numerical data*
8.2 Troubles musculo-squelettiques
Scand J Caring Sci. 2005 Dec;19(4):419-26.
Factors related to long-duration pain and sick leave among Swedish staff working in the public
health service.
Nilsson A, Sjoden PO, Dahl J, Denison E.
Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University,
Sweden. [email protected]
The aim of the present study was to provide information about factors related to long-duration pain
(LDP) (>3 months), sick leave (SL) and long sick leave (LSL) (>3 months) among staff in the
community health services. The specific research question was: To what extent do data on activity,
physical function, pain severity, psychological/cognitive factors, expectations of LDP, expectations to
be working within 6 months and work satisfaction predict LDP, SL and LSL respectively? Logistic
regression analyses were used to test predicted membership in the groups LDP, SL and LSL. In this
context prediction refers to statistical prediction only, due to the cross-sectional design. Staff (n = 914)
in the public health services in a medium-sized Swedish city completed a questionnaire during the
spring of 2000. The results show that musculoskeletal pain and SL for this occupational group are
9
common. Pain severity, expectations of LDP and fear-avoidance increased the odds of being in the
LDP group, while kinesiophobia decreased the odds. Pain severity and kinesiophobia increased the
odds of being in the SL group, while expectations to be working in 6 months decreased the odds. Only
expectations to be working in 6 months predicted membership in the LSL group, decreasing the odds.
Although some caution is warranted concerning the representativity of the sample, the results indicate
that expectations about pain duration and ability to work are important psychosocial factors in LDP and
LSL.
MeSH Terms:Adult - Aged - Cross-Sectional Studies - Female - Health Personnel*/statistics &
numerical data - Humans - Logistic Models - Male - Middle Aged - Musculoskeletal
Diseases/epidemiology* - Musculoskeletal Diseases/psychology - Occupational
Diseases/epidemiology* - Occupational Diseases/psychology - Pain/epidemiology* - Pain/prevention &
control - Public Health Administration/manpower - Research Support, Non-U.S. Gov't - Risk Factors Sick Leave*/statistics & numerical data - Sweden/epidemiology
NIOSH, january 2006
Safe Patient Handling and Movement Principles
The information contained in this document is still in draft form and as such should not be considered
as a final statement of NIOSH policy.
The presentation Safe Patient Handling and Movement Principles, was developed by NIOSH and its
partners, the American Nurses Association and the Veterans Health Administration's Patient Safety
Center, to improve work practices for patient care workers. This presentation is designed for use in
training by schools of nursing. The presentation will remain available for review until May 30, 2006.
After that date, NIOSH will consider all the comments submitted, and make appropriate revisions to
the presentation before publishing a final version. This presentation will also undergo scientific peer
review. The details of this review will be referenced on the NIOSH Web site in the near future. The
presentation is formatted in Flash and includes both audio and video. The draft presentation is
available in an online version and a downloadable version.
http://www.cdc.gov/niosh/review/public/safe-patient/
9. Violence
10. Autres
BMJ. 2006 Feb 11;332(7537):322.
Doctors with history of drug misuse will face spot checks.
Day M.
Publication Types: News
Occup Environ Med 2006 Mar; 63(3):173-179
Validation of an asthma questionnaire for use in healthcare workers
Delclos-GL; Arif-AA; Aday-L; Carson-A; Lai-D; Lusk-C; Stock-T; Symanski-E; Whitehead-LW;
Benavides-FG; Anto-JM
Previous studies have described increased occurrence of asthma among healthcare workers, but to
our knowledge there are no validated survey questionnaires with which to study this occupational
group. AIMS: To develop, validate, and refine a new survey instrument on asthma for use in
epidemiological studies of healthcare workers. An initial draft questionnaire, designed by a
multidisciplinary team, used previously validated questions where possible; the occupational exposure
section was developed by updating health services specific chemical lists through hospital walkthrough surveys and review of material safety data sheets. A cross-sectional validation study was
conducted in 118 non-smoking subjects, who also underwent bronchial challenge testing, an interview
with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens.
The final version consisted of 43 main questions in four sections. Time to completion of the
questionnaire ranged from 13 to 25 minutes. Test-retest reliability of asthma and allergy items ranged
from 75% to 94%, and internal consistency for these items was excellent (Cronbach's alpha > or =
0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a
sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same
combination showed a sensitivity of 79% and specificity of 98%. Agreement between self-reported
10
exposures and industrial hygienist review was similar to previous studies and only moderate,
indicating the need to incorporate more reliable methods of exposure assessment. Against the
aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of
allergies to dust, dust mite, and animals. Initial evaluation of this new questionnaire indicates good
validity and reliability, and further field testing and cross-validation in a larger healthcare worker
population is in progress. The need for development of more reliable occupational exposure
assessment methods that go beyond self-report is underscored.
Questionnaires; Bronchial-asthma; Health-care-personnel; Epidemiology; Occupational-exposure;
Exposure-assessment; Allergies; Dusts; Dust-particles; Dust-exposure
Scott Med J. 2005 May;50(2):73-4.
Walking at work: a pedometer study assessing the activity levels of doctors.
Jatkinson J, Goody RB, Walker CA.
BACKGROUND: The World Health Organisation cites a sedentary lifestyle as one of the top ten
causes of morbidity and mortality worldwide.4 A recent, large-scale clinical study showed that brisk
walking and vigorous exercise are associated with substantial (and similar) re ductions in the
incidence of coronary heart disease. Current guidelines suggest 10,000 steps per day as an
appropriate activity target for healthy adults. AIMS: This study aims to assess whether doctors are
meeting this daily walking target during working-hours, and whether additional out-of-hours exercise is
required. METHODS: 16 doctors from St. John's Hospital in Livingston (comprising 4 Medical
Consultants, 4 Surgical Consultants, 4 Medical PRHOs and 4 Surgical PRHOs) each used a belt-worn
pedometer to record all steps made during 5 consecutive day shifts. Stride length and total daily steps
were recorded. Steps made out-with working hours were not counted. Total steps and hours worked
were recorded at the end of each day. RESULTS: Average daily steps recorded were 7907 (Medical
PRHOs), 5068 (Surgical PRHOs), 4822 (Surgical Consultants) and 4647 (Medical Consultants). P
values of < 0.1 were obtained for the variation in steps between the Medical PRHOs and both the
Consultant Surgeons and Consultant Physicians. Distance walked per shift varied from 3.84
(Consultant Physicians) to 6.85 kilometres (Medical PRHOs). CONCLUSION: Walking at work does
provide a substantial proportion of a doctor's recommended daily activity quota. However, it is still
necessary to engage in additional, out-of-hours exercise in order to consistently meet the current
recommendations for physical exercise.
MeSH Terms: Adult - Consultants/classification - Consultants/statistics & numerical data* Exercise/physiology* - Humans - Internship and Residency/classification - Internship and
Residency/statistics & numerical data* - Life Style - Medical Staff, Hospital/classification - Medical
Staff, Hospital/statistics & numerical data* - Middle Aged - Monitoring, Ambulatory/instrumentation* Monitoring, Ambulatory/methods - Reference Standards - Scotland - Time Factors Walking/physiology* - Walking/statistics & numerical data - Workplace
BMC Public Health. 2005 Dec 27;5:142.
Work factors and smoking cessation in nurses' aides: a prospective cohort study.
Eriksen W .
Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
[email protected]
BACKGROUND: The prevalence of smoking in nursing personnel remains high. The aim of this study
was to identify work factors that predict smoking cessation among nurses' aides. METHODS: Of 2720
randomly selected, Norwegian nurses' aides, who were smoking at least one cigarette per day when
they completed a questionnaire in 1999, 2275 (83.6 %) completed a second questionnaire 15 months
later. A wide spectrum of work factors were assessed at baseline. Respondents who reported smoking
0 cigarettes per day at follow-up were considered having stopped smoking. The odds ratios and 95 %
confidence intervals of stopping smoking were derived from logistic regression models. RESULTS:
Compared with working 1-9 hours per week, working 19-36 hours per week (odds ratio (OR) = 0.35;
95 % confidence interval (CI) = 0.13 - 0.91), and working more than 36 hours per week (i.e. more than
full-time job) (OR = 0.27; CI = 0.09 - 0.78) were associated with reduced odds of smoking cessation,
after adjustments for daily consumption of cigarettes at baseline, age, gender, marital status, and
having preschool children. Adjusting also for chronic health problems gave similar results.
CONCLUSION: There seems to be a negative association between hours of work per week and the
odds of smoking cessation in nurses' aides. It is important that health institutions offer workplacebased services with documented effects on nicotine dependence, such as smoking cessation courses,
so that healthcare workers who want to stop smoking, especially those with long working hours, do not
have to travel to the programme or to dedicate their leisure time to it.
MeSH Terms: Adult - Comparative Study - Confidence Intervals - Female - Humans - Life Style Logistic Models - Male - Middle Aged - Multivariate Analysis - Norway/epidemiology - Nurses'
Aides/psychology* - Nurses' Aides/statistics & numerical data - Occupational Health/statistics &
numerical data* - Organizational Culture - Prospective Studies - Questionnaires - Research Support,
11
Non-U.S. Gov't - Smoking/epidemiology - Smoking/prevention & control - Smoking/psychology Smoking Cessation/statistics & numerical data* - Work Schedule Tolerance - Workplace/psychology*
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=16379672
http://www.biomedcentral.com/1471-2458/5/142
Veille juridique
- Arrêté du 6 janvier 2006 modifiant l'arrêté du 24 novembre 2003 relatif aux emballages des déchets
d'activités de soins à risques infectieux et assimilés et des pièces anatomiques d'origine humaine
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SANP0620127A
- © CHU de Rouen -
12

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