Prévention des risques de transmission des infections : connaître les pratiques formelles et informelles du personnel hospitalier

La prévention des infections dans les établissements de santé est un sujet d’actualité. Malgré la promotion de mesures de prévention, on constate qu’elles ne sont pas complètement appliquées. Toutefois, s’attarder uniquement à ces manques offre une prise limitée pour améliorer la prévention, en ignorant d’autres mesures que le personnel pourrait avoir développées. L’objectif de la recherche est de décrire les pratiques, formelles et informelles, de prévention de la transmission des infections, utilisées par diverses catégories de personnel hospitalier, ainsi que d’explorer les représentations reliées à ces pratiques. L’approche qualitative utilisée permet une vision systémique des activités de prévention. Nous avons effectué, à Montréal, 27 entrevues et 186 heures d’observation de personnel infirmier, de préposées aux bénéficiaires et de préposées à l’entretien sanitaire, tous expérimentés, dans quatre unités de soins dont deux de courte et deux de longue durée. Les résultats montrent que les mesures de prévention ne sont pas des actes isolés mais qu’elles font partie d’un processus débutant par l’identification des risques à partir de trois familles d’informations: la contamination du patient, celle de l’environnement et les difficultés d’interaction avec le patient. Nous avons identifié certaines pratiques permettant de pallier des situations où les mesures de prévention prescrites sont jugées insuffisantes et révèlent des compétences méconnues du personnel. Ces pratiques peuvent notamment faire appel au travail d'équipe, faisant ressortir l’importance de la dimension collective du travail pour la prévention des infections. L’analyse des représentations du risque relié au Clostridium difficile montre de plus que les participantes à la recherche craignent de le transmettre aux patients et à leur propre famille et adoptent en conséquence des pratiques spécifiques de prévention, au travail et hors travail. À cause de situations mettant en échec la prévention, certaines participantes pensent de plus être des porteuses saines de ce microorganisme et craignent son activation si elles sont affaiblies. Certains aspects de l’organisation du travail peuvent aussi entraver leurs efforts : l’absence de moments de concertation, la présence de personnel non régulier et le manque de formation. Nous concluons sur l’importance d’appuyer les efforts de prévention basés sur des stratégies qui font appel au travail d’équipe, qui semblent avoir un potentiel intéressant pour la prévention des infections, et sur la nécessité de prendre en compte les préoccupations du personnel dans les interventions éducatives le concernant.Preventing infections in health care facilities is a subject of current interest. Despite the promotion of prevention measures, it is well known that they are not completely applied. However, confining interest just to these lacunae does not provide a good handle on improving prevention, if we do not pay attention to other measures that hospital personnel may have developed spontaneously. The objective of the current research project is to describe formal and informal practices for preventing infection used by various categories of hospital personnel, as well as to explore the representations of risk related to their informal practices. The qualitative research approach used gives a systemic vision of prevention activities. We carried out 27 interviews and 186 hours of observation of experienced nursing staff, health care aides and hospital cleaning staff, in two short-term and two long-term hospital units in Montreal. The results show that prevention measures are not isolated acts, but part of a process that starts with risk identification based on three sets of information: patient contamination, environmental contamination and difficulties in interacting with patients. We have identified some measures developed by staff members that allow them to cope with situations where the prescribed procedures are felt to be insufficient; these measures reveal their hitherto-unrecognized skills and can be collective, showing the importance of joint work for infection prevention. The analysis of representations of risks related to Clostridium difficile shows that study participants feared transmitting it to patients and to their own families, and adopted specific prevention measures both at work and outside the workplace. Because of situations where prevention failed, some participants think they may be healthy carriers of that microorganism and fear infection may be activated if they become weak for any reason. Some aspects of work organization may also get in the way of their efforts: the absence of time for exchanging information, the presence of casual staff and the lack of training. We conclude that it is important to support prevention efforts based on collective strategies, that seem to have an interesting potential to prevent infections, and that it is necessary to take into account the preoccupations of staff during educational interventions targeting them

Écouter et voir dans un monde technique : Effets de la discontinuité des horaires sur l’activité de travail des infirmières

La structure des horaires et ses effets sur le travail des infirmières et infirmières auxiliaires d’un hôpital de soins de courte durée ont été analysés dans un contexte de modifications du réseau québécois de la santé. L’analyse montre de courts séjours chez les patients et une très grande discontinuité des périodes de travail chez le personnel infirmier : 60 % de celles qui travaillaient dans un département cumulent moins de cinq quarts par mois dans ce département. Ainsi, elles ont souvent peu d’information sur les patients et la constante recomposition des équipes peut affecter leurs stratégies pour pallier cette situation. Les aspects « techniques » du travail ne pouvant être escamotés, les aspects « humains » deviennent compressibles. Cette organisation du travail peut-elle diminuer le caring, privant d’une part les patients de contacts importants et entraînant d’autre part, chez les soignantes, une perte du sens de leur travail ? Est-ce que cette perte de sens aurait un effet sur le taux d’absence, très élevé dans cette population ?The structure of work schedules and its effects on the work activity of health care workers in a short-term care facility were analyzed in a context of changes to the Québec health care system. The analysis revealed short patient stays and a great discontinuity in work periods for nursing personnel : 60 % of health care workers in one department worked for fewer than five shifts per month in this department. Thus, the workers often have little information on patients, and the constant changes in the work teams can affect the strategies that they use to remedy the situation. Since the “technical” aspects of the work cannot be reduced, the more “human” aspects can be compressed. Could this type of work organization diminish caring, thus depriving patients of important human contact and health care workers of their sense of the meaning of their work. Could this loss of meaning affect the absenteeism rate, which is known to be high among nurses ?La estructura de los horarios y sus efectos sobre el trabajo de las enfermeras y enfermeras auxiliares en un hospital de atención a corto plazo fueron analyzados en un contexto de modificaciones de la red quebequense de la salud. El análisis enseña estancias cortas de los pacientes y una discontinuidad muy grande de los periodos de trabajo del personal enfermero : 60 % de las que trabajaban en un departamento cumulaban menos de cinco turnos por més en este departamento. Así, a menudo tenían poca información sobre los pacientes y la constante recomposición de los equipos puede afectar las estrategias para paliar la situación. Como no se puede minimizar los aspectos « técnicos » del trabajo, se comprime los aspectos « humanos ». ¿ Puede esta organización de trabajo disminuir la atención, privando por una parte los pacientes de contactos importantes, y llevando por otra parte, una pérdida del sentido del trabajo para el personal sanitario ? ¿ Tendría esta pérdida un efecto sobre la tasa de ausencia, muy elevada en esta población 

Looking and listening in a technical world : Effects of discontinuity in work schedules on nurses’ work activity

The structure of work schedules and its effects on the work activity of health care workers in a short-term care facility were analyzed in a context of changes to the Québec health care system. The analysis revealed short patient stays and a great discontinuity in work periods for nursing personnel : 60 % of health care workers in one department worked for fewer than five shifts per month in this department. Thus, the workers often have little information on patients, and the constant changes in the work teams can affect the strategies that they use to remedy the situation. Since the “technical” aspects of the work cannot be reduced, the more “human” aspects can be compressed. Could this type of work organization diminish caring, thus depriving patients of important human contact and health care workers of their sense of the meaning of their work. Could this loss of meaning affect the absenteeism rate, which is known to be high among nurses ?La structure des horaires et ses effets sur le travail des infirmières et infirmières auxiliaires d’un hôpital de soins de courte durée ont été analysés dans un contexte de modifications du réseau québécois de la santé. L’analyse montre de courts séjours chez les patients et une très grande discontinuité des périodes de travail chez le personnel infirmier : 60 % de celles qui travaillaient dans un département cumulent moins de cinq quarts par mois dans ce département. Ainsi, elles ont souvent peu d’information sur les patients et la constante recomposition des équipes peut affecter leurs stratégies pour pallier cette situation. Les aspects « techniques » du travail ne pouvant être escamotés, les aspects « humains » deviennent compressibles. Cette organisation du travail peut-elle diminuer le caring, privant d’une part les patients de contacts importants et entraînant d’autre part, chez les soignantes, une perte du sens de leur travail ? Est-ce que cette perte de sens aurait un effet sur le taux d’absence, très élevé dans cette population ?La estructura de los horarios y sus efectos sobre el trabajo de las enfermeras y enfermeras auxiliares en un hospital de atención a corto plazo fueron analyzados en un contexto de modificaciones de la red quebequense de la salud. El análisis enseña estancias cortas de los pacientes y una discontinuidad muy grande de los periodos de trabajo del personal enfermero : 60 % de las que trabajaban en un departamento cumulaban menos de cinco turnos por més en este departamento. Así, a menudo tenían poca información sobre los pacientes y la constante recomposición de los equipos puede afectar las estrategias para paliar la situación. Como no se puede minimizar los aspectos « técnicos » del trabajo, se comprime los aspectos « humanos ». ¿ Puede esta organización de trabajo disminuir la atención, privando por una parte los pacientes de contactos importantes, y llevando por otra parte, una pérdida del sentido del trabajo para el personal sanitario ? ¿ Tendría esta pérdida un efecto sobre la tasa de ausencia, muy elevada en esta población 

Desenvolvimento participativo da cadeia produtiva sustentável de leite no Assentamento rual Eli Vive

Anais do 35º Seminário de Extensão Universitária da Região Sul - Área temática: Tecnologia e Produção.A atividade leiteira é uma ótima estratégia para melhoria da renda de pequenos produtores, que por meio de sua inserção no mercado, tem impacto econômico no País. Objetiva-se com o projeto o desenvolvimento participativo da cadeia produtiva sustentável de leite no Assentamento rural Eli Vive, articulando a integração entre a Instituição de Ensino e a comunidade externa. O projeto é coordenado pelo Departamento de Zootecnia em parceria com a Empresa Júnior da Zootecnia (CATECz) e envolve docentes e discentes de Ciências Agrárias da Universidade Estadual de Londrina. O Assentamento Rural Eli Vive localiza-se no município de Londrina (PR), com 540 famílias assentadas, sendo que 24 possuem vacas leiteiras em suas propriedades. O projeto atende mensalmente os assentados com atividades dinâmicas (dia de campo, palestras, oficinas) sobre temas que envolvem a cadeia produtiva de leite. Os assentados recebem visitas técnicas quinzenais em suas propriedades, nas quais são relatados e/ou identificados problemas e dúvidas relacionadas à produção. Com os recursos obtidos por meio da aprovação de um projeto da Secretaria de Estado da Ciência, Tecnologia e Ensino Superior (SETI) foi implementado uma unidade demonstrativa de pastejo rotativo para vacas leiteiras. A partir disso, foram e estão sendo desenvolvidas atividades visando à produção de alimentos para o rebanho. Foi confeccionado um manual técnico intitulado ‘’Produção Agroecológica de Leite’’, abordando aspectos de instalações, nutrição, manejo do gado leiteiro e sanidade. O projeto visa capacitar e profissionalizar os assentados a fim de promover uma produção sustentável de leite com alta qualidade sanitária para consumo e comercialização, melhorando a renda familiar e a qualidade de vida dos assentados, evitando o êxodo rural. Também é importante na construção do Projeto Político Pedagógico dos cursos de graduação de Ciências Agrárias, contextualizando os acadêmicos nessa realidade de produção sustentável em pequenas propriedades e de organização socia

Cloning and endogenous expression of a Eucalyptus grandis UDP-glucose dehydrogenase cDNA

UDP-glucose dehydrogenase (UGDH) catalyzes the oxidation of UDP-glucose (UDP-Glc) to UDP-glucuronate (UDP-GlcA), a key sugar nucleotide involved in the biosynthesis of plant cell wall polysaccharides. A full-length cDNA fragment coding for UGDH was cloned from the cambial region of 6-month-old E. grandis saplings by RT-PCR. The 1443-bp-ORF encodes a protein of 480 amino acids with a predicted molecular weight of 53 kDa. The recombinant protein expressed in Escherichia coli catalyzed the conversion of UDP-Glc to UDP-GlcA, confirming that the cloned cDNA encodes UGDH. The deduced amino acid sequence of the cDNA showed a high degree of identity with UGDH from several plant species. The Southern blot assay indicated that more than one copy of UGDH is present in Eucalyptus. These results were also confirmed by the proteomic analysis of the cambial region of 3- and 22-year-old E. grandis trees by 2-DE and LC-MS/MS, showing that at least two isoforms are present. The cloned gene is mainly expressed in roots, stem and bark of 6-month-old saplings, with a lower expression in leaves. High expression levels were also observed in the cambial region of 3- and 22-year-old trees. The results described in this paper provide a further view of the hemicellulose biosynthesis during wood formation in E. grandis

Tropospheric and stratospheric smoke over Europe as observed within EARLINET/ACTRIS in summer 2017

For several weeks in summer 2017, strong smoke layers were observed over Europe at numerous EARLINET stations. EARLINET is the European research lidar network and part of ACTRIS and comprises more than 30 ground-based lidars. The smoke layers were observed in the troposphere as well as in the stratosphere up to 25 km from Northern Scandinavia over whole western and central Europe to the Mediterranean regions. Backward trajectory analysis among other tools revealed that these smoke layers originated from strong wild fires in western Canada in combination with pyrocumulus convection. An extraordinary fire event in the mid of August caused intense smoke layers that were observed across Europe for several weeks starting on 18 August 2017. Maximum aerosol optical depths up to 1.0 at 532 nm were observed at Leipzig, Germany, on 22 August 2017 during the peak of this event. The stratospheric smoke layers reached extinction coefficient values of more than 600 Mm−1 at 532 nm, a factor of 10 higher than observed for volcanic ash after the Pinatubo eruption in the 1990s. First analyses of the intensive optical properties revealed low particle depolarization values at 532 nm for the tropospheric smoke (spherical particles) and rather high values (up to 20%) in the stratosphere. However, a strong wavelength dependence of the depolarization ratio was measured for the stratospheric smoke. This indicates irregularly shaped stratospheric smoke particles in the size range of the accumulation mode. This unique depolarization feature makes it possible to distinguish clearly smoke aerosol from cirrus clouds or other aerosol types by polarization lidar measurements. Particle extinction-to-backscatter ratios were rather low in the order of 40 to 50 sr at 355 nm, while values between 70-90 sr were measured at higher wavelengths. In the western and central Mediterranean, stratospheric smoke layers were most prominent in the end of August at heights between 16 and 20 km. In contrast, stratospheric smoke started to occur in the eastern Mediterranean (Cyprus and Israel) in the beginning of September between 18 and 23 km. Stratospheric smoke was still visible in the beginning of October at certain locations (e.g. Evora, Portugal), while tropospheric smoke was mainly observed until the end of August within Europe. An overview of the smoke layers measured at several EARLINET sites will be given. The temporal development of these layers as well as their geometrical and optical properties will be presented