Évaluation des pratiques professionnelles en matière de gestion du risque infectieux au cabinet d’ophtalmologie en région Bourgogne

Doi : JFO-09-2007-30-7-0181-5512-101019-200700138National audienceObjectives: To evaluate the hygiene practices during ophthalmologists’consultations in Burgundy, France, so as to identify the difficulties they encounter in implementing new professional guidelines. Method: The survey was based on an anonymous transversal descriptive survey conducted via a questionnaire sent in May 2006 to 102 ophthalmologists. Results: Data from 51 questionnaires were included in the survey, showing a good response rate (50%). The survey revealed that the perception of the risk of transmitting an infection was “important” to “most important” (59.2%). A steam autoclave was used by 38.8% of the ophthalmologists. Those who did not sterilize instruments disinfected them (30%). Finally, ophthalmologists preferred more information to training (90% versus 50%, p=0.015). Conclusion: This survey highlights the need for improvements in education for practitioners and their assistants, especially in the sterilization of instruments and equipment.Objectif : Évaluer les pratiques des ophtalmologistes bourguignons en consultation, afin d’identifier les difficultés rencontrées notamment dans la mise en place des nouvelles recommandations professionnelles en matière de gestion du risque infectieux. Méthode : L’évaluation des pratiques a reposé sur une enquête descriptive transversale anonyme ; 102 ophtalmologistes ont reçu un auto-questionnaire par voie postale, entre avril et mai 2006. Résultats : Cinquante et un questionnaires ont été exploités, soit un taux de participation des ophtalmologistes de 50 %. Le risque de transmission d’une infection en général a été perçu comme important à très important dans 59,2 % des cas. Un autoclave à vapeur d’eau est présent chez 38,8 % des ophtalmologistes. Pour ceux qui ne possèdent pas d’autoclave à vapeur d’eau, 30 % font stériliser leurs instruments par un établissement de santé et 70 % réalisent une désinfection. Enfin, une demande d’information plus que de formation a été souhaitée par les praticiens (90 % versus 50 % ; p = 0,015). Conclusion : Les différents constats faits lors de cette enquête ont permis d’envisager des actions d’amélioration possibles en matière de formation initiale et continue des praticiens et de leurs assistants, notamment concernant la décontamination du matériel

Antiplatelet and anticoagulant agents in vitreoretinal surgery: a prospective multicenter study involving 804 patients

Publication for the CFSR Research NetInternational audiencePURPOSE: To assess the rate of hemorrhagic complications after vitreoretinal surgery and the influence of antithrombotic agents. METHODS: Hemorrhagic complications of vitreoretinal procedures performed in seven ophthalmologic centers on patients treated or not treated with antiplatelet (AP) or anticoagulant (AC) agents were prospectively collected. Patients' characteristics, surgical techniques, and complications were recorded during surgery and for 1 month after. RESULTS: Eight hundred four procedures were performed between January 2015 and April 2015. Among them, 18.4% were treated with AP agents (n = 148) and 7.8% with AC agents (n = 63), with 18 of them treated with NOACS (new oral anticoagulants). AP or AC agents were continued in 96.5% and 80.7% of cases, respectively. Fifty-three patients (6.6%) developed one or more hemorrhagic complications in one eye during this period. In univariate analysis, AC agents were not associated with hemorrhagic complications (P = 0.329) in contrast to AP (P = 0.005). However, in multivariate analysis, AP agents were no longer associated with hemorrhagic complications and the intraoperative use of endodiathermy was the only factor associated with hemorrhagic complications (P = 0.001). CONCLUSIONS: This study showed that AP and AC agents were not a factor associated with hemorrhagic complications during vitreoretinal surgery. The continuation of these treatments should be considered without risk of severe hemorrhagic complications

Endophthalmitis after intravitreal injections: Incidence, presentation, management, and visual outcome REPLY

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Detection of temporal clusters of health care-associated infections or colonizations with Pseudomonas aeruginosa.

International audienceWe investigated temporal clusters of Pseudomonas aeruginosa cases between 2005 and 2014 in 1 French university hospital, overall and by ward, using the Kulldorff method. Clusters of positive water samples were also investigated at the whole hospital level. Our results suggest that water outlets are not closely involved in the occurrence of clusters of P aeruginosa cases

Impact of new water systems on healthcare-associated colonization or infection with Pseudomonas aeruginosa

International audienceAim: We aimed to study the impact of new water systems, which were less contaminated with P. aeruginosa, on the incidence of healthcare-associated P. aeruginosa cases (colonizations or infections) in care units that moved to a different building between 2005 and 2014.Methods: Generalized Estimated Equations were used to compare the incidence of P. aeruginosa healthcare-associated cases according to the building.Results: Twenty-nine units moved during the study period and 2,759 cases occurred in these units. No difference was observed when the new building was compared with older buildings overall.Conclusion: Our results did not support our hypothesis of a positive association between water system contamination and the incidence of healthcare-associated P. aeruginosa cases. These results must be confirmed by linking results of water samples and patients' data

Burden of gastroenteritis outbreaks: specific epidemiology in a cohort of institutions caring for dependent people

International audienceBackground: In institutions caring for dependent people, viral gastroenteritis occurs frequently and is highly contagious. In elderly persons, these episodes can lead to hospitalization and occasionally death.Aim: To study the impact of gastroenteritis outbreaks (GOs) in institutions caring for dependent people.Methods: This study was conducted on 18 sites consisting of 35 units from four different disciplines (geriatric medicine and rehabilitation, psychogeriatrics, geriatric nursing homes, and specialized care homes for adults with physical and mental disabilities). Spatio-temporal analysis of GOs was performed during six winter seasons, and clinical and viral data were analysed with regard to structural parameters (size of the sites and dining-room organization), virus epidemiology and chronology of the outbreaks and type of activities.Results: A total of 98 outbreaks were recorded in the 35 units. The risk of GO was high even outside national epidemic periods. Viruses were searched for in 86 outbreaks and were identified in 96.5% (83/86) of these outbreaks: norovirus genotype GII. 4 (59.0%, 49/83), other viruses (41.0%, 34/83). There were variations between surveillance periods in terms of GO frequencies and attack rates and types of viruses. Dining-room organization could be a factor in cross-infection at a site.Conclusion: Specific surveillance that takes into account the precise epidemiology needs to be developed in institutions caring for dependent people in order to improve infectious disease control and information for healthcare workers. (C) 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved

Endovascular stenting for chronic femoro-iliac venous obstructive disease: Clinical efficacy and short-term outcomes

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