The importance of implementing safe sharps practices in the laboratory setting in Europe

Healthcare workers are at risk of sharps injuries and subsequent infection from more than 40 bloodborne pathogens or species. Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) together account for the vast majority of cases. The Directive 2010/32/EU “Prevention from sharp injuries in the hospital and healthcare sector”, issued to protect workers from these risks, requires an integrated approach to prevention including awareness-raising, education, training, elimination of unnecessary needles, safe procedures for sharps use and disposal, banning of recapping, vaccination, use of personal protective equipment, provision of safety-engineered devices, and appropriate surveillance, monitoring, response and follow-up. As laboratories represent a high-risk setting both in the preanalytical and analytical phase, we reviewed accidents and prevention in this setting in the light of the new legislation. Phlebotomy is the procedure carrying the highest risk of exposure and infection, involved in 30-50% of HIV and HCV cases detected in nationwide systems following accidental blood exposures implemented since the 1990s in Italy and France. In laboratories, problems in the management of sharps containers, recapping, needle disassembly by hand and blood transfer from syringes into tubes were observed and accounted for two-thirds of injuries. These accidents could be reduced through education and monitoring of behaviours, and introduction of medical devices incorporating safety-engineered protection mechanisms with appropriate training. Laboratory staff should be immunized against HBV, and know policies and procedures for the post-exposure management and prophylaxis. The management commitment to safety is crucial to ensure the necessary support to these changes

Electronic Sensors for Assessing Interactions between Healthcare Workers and Patients under Airborne Precautions

International audienceBackground: Direct observation has been widely used to assess interactions between healthcare workers (HCWs) and patients but is time-consuming and feasible only over short periods. We used a Radio Frequency Identification Device (RFID) system to automatically measure HCW-patient interactions. Methods: We equipped 50 patient rooms with fixed sensors and 111 HCW volunteers with mobile sensors in two clinical wards of two hospitals. For 3 months, we recorded all interactions between HCWs and 54 patients under airborne precautions for suspected (n=40) or confirmed (n=14) tuberculosis. Number and duration of HCW entries into patient rooms were collected daily. Concomitantly, we directly observed room entries and interviewed HCWs to evaluate their self- perception of the number and duration of contacts with tuberculosis patients. Results: After signal reconstruction, 5490 interactions were recorded between 82 HCWs and 54 tuberculosis patients during 404 days of airborne isolation. Median (interquartile range) interaction duration was 2.1 (0.8-4.4) min overall, 2.3 (0.8-5.0) in the mornings, 1.8 (0.8-3.7) in the afternoons, and 2.0 (0.7-4.3) at night (P,1024). Number of interactions/day/HCW was 3.0 (1.0-6.0) and total daily duration was 7.6 (2.4-22.5) min. Durations estimated from 28 direct observations and 26 interviews were not significantly different from those recorded by the network. Conclusions: The RFID was well accepted by HCWs. This original technique holds promise for accurately and continuously measuring interactions between HCWs and patients, as a less resource-consuming substitute for direct observation. The results could be used to model the transmission of significant pathogens. HCW perceptions of interactions with patients accurately reflected reality

Utilisation d' un test de détection d' interféron gamma pour le dépistage de l' infection tuberculeuse chez le personnel de soins (expérience d' un service de santé au travail)

Malgré les progrès du traitement et de la prévention, la tuberculose reste une maladie en progression et représente une des trois premières causes de décès par pathologie infectieuse dans le monde (1,7 millions de décès par an) . Dans le milieu de soin, une transmission de la tuberculose peut intervenir entre patients et soignants. Le seul test utilisé en routine pour le dépistage précoce de l ITL chez les professionnels de santé était, jusqu à récemment, l'intradermoréaction à la tuberculine (lDR). Il présente plusieurs limites, d une part liées à sa réalisation et surtout à son manque de spécificité. Deux tests sanguins basés sur la détection d interféron g, maintenant disponibles (T-SPOT.TB ou QuantiFERON) sont nettement plus spécifiques, surtout en cas de vaccination antérieure par le BCG, et au moins aussi sensibles que l IDR .Ce travail a permis de faire le bilan de l utilisation, chez 268 personnes, d un de ces tests : QuantiFERON®-TB Gold In Tube, par un service de Santé au Travail hospitalier. Trois situations distinctes d utilisation du test ont été analysées : une enquête autour d un cas, la surveillance du personnel d un laboratoire de bactériologie et la surveillance du personnel soignant présentant une IDR >= 15 mm ou ayant varié de plus de 10 mm évoquant une infection tuberculeuse. Le test QuantiFERON® présente un intérêt diagnostique indéniable pour le personnel de soin. Il nous a permis d optimiser la surveillance et nous a orientés dans la décision thérapeutique dans cette population.Des recommandations nationales, en cours d élaboration devront permettre de confirmer une stratégie d utilisation de ces tests chez les personnels de santé.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Étude transversale des intentions de vaccination contre la grippe saisonnière et la COVID-19 des professionnels de santé : quels leviers pour la promotion vaccinale ?

International audienceIn France, a high vaccine coverage among healthcare workers against seasonal flu is an important public health objective, particularly in the context of the COVID-19 epidemic. We published an online questionnaire targeting all French healthcare workers investigating previous flu vaccination and intention for vaccination against the 2020-21 flu and COVID-19. The study invitation was disseminated through the GERES network during summer 2020. Among 3,556 participants, the majority worked in a hospital or nursing home setting.The results illustrate, for both vaccinations, the gradient of vaccine uptake across professional categories, higher among physicians than among nurses and weaker among nurse assistants. The results suggest that uptake could be improved by targeting promotion on healthcare workers who were occasionally vaccinated during past years and by improving access. Hypothetical acceptance of COVID-19 vaccination correlated with flu vaccination during recent years, even if performed sporadically.Une bonne couverture vaccinale des soignants contre la grippe saisonnière est un objectif de santé publique, en particulier dans le contexte de l’épidémie de Covid-19. Un questionnaire destiné aux soignants exerçant en France a été mis en ligne et diffusé par le réseau Geres durant l’été 2020. Les questions portaient sur leur statut vaccinal antigrippal antérieur et les raisons de vaccination ou non ainsi que sur leurs intentions vaccinales contre la grippe pour la période hivernale 2020-2021 et contre la Covid-19. 3 556 professionnels de santé exerçant en majorité en établissement de santé, social ou médico-social ont répondu.Les résultats reflètent, pour les deux vaccinations, le gradient professionnel d’adhésion à la vaccination, plus fort chez les médecins que chez les infirmiers et moins fort chez les aides-soignants. L’analyse révèle qu’il serait possible d’améliorer la couverture vaccinale antigrippale en ciblant les personnels vaccinés occasionnellement au cours des dernières années et en améliorant l’accès à la vaccination. L’acceptation théorique de la vaccination contre la Covid-19 apparaît corrélée à la vaccination antigrippale même pratiquée sporadiquement

Quantifying preferences around vaccination against frequent, mild disease with risk for vulnerable persons: A discrete choice experiment among French hospital health care workers

International audienceThe individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance

Social conformism and confidence in the system as antecedents of vaccine hesitancy: A questionnaire to explain intention for COVID-19 vaccination among healthcare workers in France

BackgroundHealthcare workers (HCW) are a priority group for COVID-19 vaccination. The start of the COVID-19 campaign among French HCW offered an opportunity to explore the psychological antecedents of vaccine hesitancy (VH), in particular their extension from the 5C model (complacency, confidence, convenience, calculation, collective benefit) to a 7C model including social conformism and confidence in the system.MethodsWe developed a knowledge and attitude (KA) questionnaire with 30 items relating to the 7 components of psychological antecedents. The questionnaire was administered online among a snowballing sample of French HCW, recruited December 2020 through January 2021 via professional organizations. We used multivariate logistic regression to explore the association of 7C components and individual KA items with COVID-19 vaccine intention.ResultsAmong the 5234 participants, the vaccine intention model fits (pseudo R-squared values (R2)) of individual components ranged from R2=0.48 for Calculation to R2=0.07 for Convenience, with R2=0.29 for Confidence in System and R2=0.26 for Social Conformism. In nested models including the initial 5C components, adding Confidence in System or Social Conformism increased the model fit significantly. In a multivariate model including a shortlist of items, the strongest associations with vaccine intention were observed for a positive attitude on the vaccine’s benefit-risk balance (strongly agree vs. strongly disagree: odds ratio 16.81, 95%-confidence interval 9.66-29.25). DiscussionThe results suggest that social conformism and confidence in the system are essential independent antecedents of VH. This questionnaire can be used to explore COVID-19 VH accompanying the transition into a long-term vaccination strategy

Interferon-γ Release Assay vs. Tuberculin Skin Test for Tuberculosis Screening in Exposed Healthcare Workers: A Longitudinal Multicenter Comparative Study

International audienceOBJECTIVE:Healthcare workers (HCWs), especially those caring for patients with tuberculosis (TB), are at high risk of acquiring that disease. The poor specificity of tuberculin skin testing (TST) prompted us to evaluate the effectiveness of the interferon-γ release assay (IGRA) in comparison with TST in a large prospective, multicenter, 1-year study of HCWs with occupational exposure to TB.METHODS:HCWs from high-risk units at 14 university hospitals were invited to participate and underwent both TST and IGRA (first Quantiferon TB Gold-IT®, QFT-G, then T-SPOT.TB® if QFT-G was indeterminate) at baseline and after 1 year. We collected demographic characteristics, country of birth, history of TB, immunosuppression, past exposure to TB, history of BCG vaccination, results of most recent TST, job category, and duration of current function.RESULTS:Among 807 HCWs enrolled, current or past TST at baseline was positive (≥15 mm) in 282 (34.9%); the IGRA was positive in 113 (14.0%) and indeterminate in 3 (0.4%). After 1 year, 594 HCWs had both an IGRA and TST (or prior TST≥15 mm) at baseline and an IGRA and TST (if indicated). The conversion rate was 2.5% (9 of 367) with TST and 7.6% (45 of 594) with IGRA, with poor agreement between the 2 tests. Using only QFT-G, conversion (9.9%) and reversion (17.8%) rates were higher for baseline QFT-G positive quantitative values <1 IU/mL.CONCLUSION:TST and the IGRA yielded discordant results. The value of IGRA in addition to TST remains undetermined; the two should be jointly interpreted in decision-making (clinical trial registration NCT00797836)

Social conformism and confidence in systems as additional psychological antecedents of vaccination: a survey to explain intention for COVID-19 vaccination among healthcare and welfare sector workers, France, December 2020 to February 2021

International audienceBackground - The start of the COVID-19 vaccination campaign among French healthcare and welfare sector workers in January 2021 offered an opportunity to study psychological antecedents of vaccination in this group.Aim We explored whether knowledge and attitude items related to social conformism and confidence in systems contributed to explaining intention for COVID-19 vaccination.Methods We developed a knowledge and attitude questionnaire with 30 items related to five established and two hypothetical psychological antecedents of vaccination (KA-7C). The online questionnaire was distributed from 18 December 2020 to 1 February 2021 through chain-referral via professional networks, yielding a convenience sample. We used multivariable logistic regression to explore the associations of individual and grouped KA-7C items with COVID-19 vaccine intention.Results Among 5,234 participants, the vaccine intention model fit (pseudo R-squared values) increased slightly but significantly from 0.62 to 0.65 when adding social conformism and confidence in systems items. Intention to vaccinate was associated with the majority opinion among family and friends (OR: 11.57; 95% confidence interval (CI): 4.51–29.67) and a positive perception of employer’s encouragement to get vaccinated (vs negative; OR: 6.41; 95% CI: 3.36–12.22). The strongest association of a knowledge item was identifying the statement ‘ Some stages of vaccine development (testing) have been skipped because of the epidemic emergency.’ as false (OR: 2.36; 95% CI: 1.73–3.22).Conclusion The results suggest that social conformism and confidence in systems are distinct antecedents of vaccination among healthcare and welfare workers, which should be taken into account in vaccine promotion