NosoBase ID notice : 382587

Suite aux contrôles réalisés sur des dispositifs utilisés plus spécifiquement dans le champ de la nutrition, l’Agence a estimé nécessaire de rappeler aux fabricants les exigences normatives relatives à la stérilisation par oxyde d’éthylène.

Methods: Environmental screening for a variety of clinically relevant viruses was carried out over 3 months in a UK pediatric hospital using air sampling and surface swabbing. Swabs were tested for the presence of virus nucleic acid by quantitative polymerase chain reactions.

Results: Viral nucleic acid was found on surfaces and in the air throughout the screening period, with adenovirus DNA being the most frequent. Door handles were frequently contaminated. Torque-teno virus was also found at numerous sites.

Conclusion: Evidence of environmental contamination with viral pathogens is present in health care environments and may be indicative of an infectious virus being present. Screening for viruses should be included in infection control strategies. Torque-teno virus may provide a better marker of contamination and reduce time and cost of screening for individual viruses.

Methods: Newborns with birth weight<1,500 g or gestational age (GA)<33 weeks were included prospectively over 2 years in a single-center tertiary neonatal intensive care unit. The computerized physician order entry system (CPOE) generated alerts when antibiotics were prescribed for at least 5 consecutive days and these cases were reviewed by an expert group following international recommendations.

Results: Four hundred sixty-one neonates were included, with a mean GA of 30 weeks (range, 26-32 weeks) and mean birth weight 1,270 g (range, 950-1600 g). The CPOE flagged 158 cases of potential NI, 85.1% of which were classified as true NI and 14.9% of which were false positive. Incidence and device-associated nosocomial bloodstream infection rates were 21.9% and 10.8 per 1,000 central venous catheter days, respectively. GA ≤28 weeks (odds ratio, 2.18; 95% confidence interval, 1.2-4) and >7 central venous catheter days (odds ratio, 1.47; 95% confidence interval, 1.3-1.7) were independently associated with the risk of nosocomial bloodstream infection.

Conclusion: Combining CPOE and interdisciplinary review may improve the accuracy of NI recording in a neonatal intensive care unit.

Aim: To describe the successful control of an outbreak caused by a new strain of CA-MRSA in a newborn nursery.

Methods: The investigation of the outbreak in July 2012 is reported with the control measures taken. Molecular typing of the MRSA isolates was performed.

Findings: An outbreak of SSTI caused by CA-MRSA occurred in a newborn nursery. Six neonates were infected in a one-month period [infection rate: 8.5% (6/71)]. A new variant of CA-MRSA was responsible, which was characterized as USA300-related, Panton-Valentine Leucocidin (PVL) positive, arginine catabolic mobile element (ACME) negative, sequence type 8 (ST8), staphylococcal cassette chromosome mec (SCCmec) type IVa, agr type I and spa type t008. The outbreak among term neonates followed a rapid transmission pattern and was successfully controlled by implementing various outbreak control measures, including universal chlorhexidine bathing.

Conclusion: This is the first report of a hospital outbreak caused by a USA300-related CA-MRSA clone in Korea. Early recognition and reinforcement of infection control measures are important in decreasing transmission of CA-MRSA in a hospital setting.


NosoBase ID notice : 384439

Observance des pratiques de prévention et leur association aux bactériémies associées aux voies centrales dans des unités de réanimation néonatale
Zachariah P; Furuya EY; Edwards J; Dick A; Liu H; Herzig C; et al. Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units. American journal of infection control 2014/08; 42(8): 847-851.
Mots-clés : SOIN INTENSIF; PREVENTION; OBSERVANCE; BACTERIEMIE; CATHETER VEINEUX CENTRAL; NEONATOLOGIE; PROTOCOLE; SURVEILLANCE
Background: Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates.

Methods: An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates.

Results: Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P<.05).

Conclusions: Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.

Methods: We employed an online survey of Israeli health care professionals and the general public in Israel (N=240).

Results: When risk perception is relatively low, health care professionals tend to base their attitudes toward vaccines on analytical knowledge (Rc=0.315; P<.05), whereas in situations with high risk perception, the results did not indicate any significant difference between Israeli health professionals and the Israeli general public, hence both groups base their attitudes more on emotions and personal experience than on analytical knowledge.

Conclusions: Public health organizations must consider the fact that health professionals are a group that cannot be automatically treated as an extension of the organization. When the risk is tangible and relevant, health care workers behave and act like everybody else. Our study contributes to understanding health care professionals' perceptions about vaccines and the thinking processes underlying such perceptions.

Methods: We investigated varicella-zoster virus immunity of all HCWs in high-risk departments. To determine the history of varicella, all applicants completed a standardized questionnaire at the time of blood sampling for serologic testing.

Results: Of the 550 HCWs, 526 (96%) were varicella seropositive. Although self-reported history was highly predictive of seropositivity (≥96%) among all age groups, the negative predictive value was extremely low (4%-5%) among all age groups. The prevaccination screening strategy was cheaper than vaccination without antibody screening if the varicella seroprevalence was >28%.

Conclusion: Seroprevalence was high (≥95%) among HCWs born in Korea before 1988. The self-reported varicella history did not accurately predict immunity, especially for individuals who have negative or uncertain varicella history. Given the high seroprevalence of varicella in Korean HCWs, serologic screening before vaccination was more cost-effective than universal vaccination.

Objective: Summarize strategies to enhance adoption of VAP prevention interventions.

Methods: We conducted a systematic literature review of articles in the MEDLINE database published between 2002 and 2012. We selected articles on the basis of specific inclusion criteria. We used structured forms to abstract implementation strategies and inserted them into the "engage, educate, execute, and evaluate" framework.

Results: Twenty-seven articles met our inclusion criteria. Engagement strategies included multidisciplinary teamwork, involvement of local champions, and networking among peers. Educational strategies included training sessions and developing succinct summaries of the evidence. Execution strategies included standardization of care processes and building redundancies into routine care. Evaluation strategies included measuring performance and providing feedback to staff.

Conclusion: We summarized and organized practical implementation strategies in a framework to enhance adoption of recommended evidence-based practices. We believe this work fills an important void in most clinical practice guidelines, and broad use of these strategies may expedite VAP reduction efforts.


NosoBase ID notice : 384267

Stratégies pour prévenir les pneumonies sous ventilation assistée dans des établissements de court séjour : actualisation 2014
Klompas M; Branson R; Eichenwald EC; Greene LR; Howell MD; Lee G; et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infection control and hospital epidemiology 2014/08; 35(8): 915-936.
Mots-clés : PNEUMONIE; VENTILATION ASSISTEE; NEONATALOGIE; PEDIATRIE; SOIN INTENSIF


NosoBase ID notice : 376656

Vaccination contre les pneumonies à Staphylococcus aureus
Spaulding AR; Salgado-Pabon W; Merriman JA; Stach CS; Ji Y; Gillman AN; et al. Vaccination against Staphylococcus aureus pneumonia. The Journal of infectious diseases 2014/06/15; 209(12): 1955-1962.
Mots-clés : STAPHYLOCOCCUS AUREUS; VACCINATION; PREVENTION; PNEUMONIE; ENDOCARDE
Background: Staphylococcus aureus causes serious infections in both hospital and community settings_ENREF_1. Attempts have been made to prevent human infection through vaccination against bacterial cell-surface antigens; thus far all have failed. Here we show that superantigens and cytolysins, when used in vaccine cocktails, provide protection from S. aureus USA100-USA400 intra-pulmonary challenge.

Methods: Rabbits were actively vaccinated (wild-type toxins or toxoids) or passively immunized (hyperimmune serum) against combinations of superantigens (toxic shock syndrome toxin-1, enterotoxins B and C, and enterotoxin-like X) and cytolysins (α, β, and γ-toxins) and challenged intra-pulmonary with multiple strains of S. aureus, both methicillin-sensitive and methicillin-resistant.

Results: Active vaccination against a cocktail containing bacterial cell-surface antigens enhanced disease severity as tested by infective endocarditis. Active vaccination against secreted superantigens and cytolysins resulted in protection of 86/88 rabbits when challenged intra-pulmonary with 9 different S. aureus strains, compared to only 1/88 non-vaccinated animals. Passive immunization studies demonstrated production of neutralizing antibodies was an important mechanism of protection.

Conclusions: The data suggest that vaccination against bacterial cell-surface antigens increases disease severity, but vaccination against secreted virulence factors provides protection against S. aureus. These results advance our understanding of S. aureus pathogenesis and have important implications in disease prevention.

Aim: To determine whether early mobility aided by physiotherapy reduces the incidence of HAP and length of stay in patients on medical wards.

Methods: One respiratory and one elderly care medicine ward in one hospital association in Birmingham, UK, received the ‘Early Mobility Bundle’. The bundle consisted of extra targeted physiotherapy and collaboration with ward staff to encourage and promote activity. The incidence of HAP, falls, pressure sores, length of stay (LOS) and activity level were then compared to two matched wards within the same hospital association.

Results: HAP incidence was significantly lower in the intervention group (P<0.0001) and remained so after adjusting for confounders (P=0.001). Activity levels were higher (P=0.04) and patients’ LOS was more likely to fall in the shortest quartile (OR: 1.44; P=0.009) in the intervention group. There was no significant difference in other outcomes.

Conclusion: The Early Mobility Bundle demonstrates a promising method to reduce the incidence of HAP and to increase activity in medical inpatients.