Ampleur et impact des évènements indésirables graves liés aux soins: Étude d'incidence dans un hôpital du Centre-Est tunisien

Introduction: La prévention des événements indésirables représente une priorité de santé du fait de leur fréquence et de leur gravité potentielle.Ce travail a été mené afin d'avoir un diagnostic de la situation épidémiologique relative aux événements indésirables survenant dans notre hôpital.Méthodes: Une étude prospective a été menée auprès de tous les patients qui ont été hospitalisés au CHU Farhat Hached - Sousse (Tunisie) sur une période d'un mois dans quatorze services de l'hôpital. La détection d'évènement indésirable grave (EIG) était basée sur les critères adoptésdans différentes études. Les tests T et Chi 2 ont été utilisés pour identifier les facteurs contribuant à l'apparition d'évènements indésirables.Résultats: Au total, 162 EIG ont été identifiés pendant la période. 45% de ces évènements étaient des infections nosocomiales. Ces EIG ont eu comme conséquences un décès chez 9,2% des patients, la mise en jeu du pronostic vital de 26% des patients et la prolongation de la durée de séjour chez 61,7% d'entre eux. L'admission dans des circonstances particulières et l'exposition à des soins invasifs étaient identifiés comme des facteurs de risque potentiels EIG. Conclusion: Le renforcement de la stratégie de gestion des risques sanitaires en ciblant préférentiellement le risque infectieux constitue une étape fondamentale dans l'amélioration de la sécurité des patients au sein de notre établissement de santé

Etude clinique et épidémiologique du paludisme en zone urbaine d'Afrique soudano-sahélienne (Pikine-Sénégal)

Pour des raisons de coût et de tolérance, la chimiothérapie présomptive repose toujours essentiellement sur la chloroquine, malgré l'apparition, il y a dix ans en Afrique de l'Est, de souches de #Plasmodium falciparum$ résistantes à la chloroquine et leur extension à l'ensemble de l'Afrique intertropicale. Dans le cas des zones urbaines, plusieurs particularités épidémiologiques du paludisme suggèrent qu'à partir de certains niveaux de chimiorésistance d'autres stratégies de lutte anti paludique pourraient être développées avec un meilleur rapport coût/efficacité. Dans une première approche de cette question, une recherche a été faite à Pikine, à savoir s'il existait des paramètres cliniques ou épidémiologiques, faciles à obtenir chez un enfant consultant pour fièvre, qui permettraient de choisir entre trois attitudes possibles : abstention thérapeutique, traitement présomptif, confection d'une goutte épaiss

Evidence update on prevention of surgical site infection

Purpose of review: surgical site infection (SSI) is a common health care associated infection and complicates up to 10-20% of operations with considerable health care resources. Apart from the widely adopted use of appropriate hair removal, antibiotic prophylaxis, avoidance of hypothermia and peri-operative glycaemic control to reduce SSIs this review has considered new research and systematic reviews, and whether their findings should be included in guidelines. Recent findings: The efficacy of preoperative bathing/showering, antibiotic prophylaxis for clean surgery and perioperative oxygen supplementation to reduce the risk of SSI is still in doubt. By contrast, the use of 2% chlorhexidine in alcohol skin preparation, postoperative negative pressure wound therapy and antiseptic surgical dressings do show promise. Antimicrobial sutures in independent meta-analyses were found to reduce the risk of SSI after all classes of surgery (except dirty) whereas the use of wound guards, or diathermy skin incision (compared with scalpel incision), did not. Summary: The incidence of SSI after surgery is not falling. Based on this review of published trials and evidence-based systematic reviews some advances might be included into these care bundles. More research is needed together with improved compliance with care bundles

Evaluation of Epidemic Intelligence Systems Integrated in the Early Alerting and Reporting Project for the Detection of A/H5N1 Influenza Events

Web-based expert systems dedicated to epidemic intelligence were developed to detect health threats. The Early Alerting and Reporting (EAR) project, launched under the Global Health Initiative, aimed at assessing the feasibility and opportunity of pooling seven of those expert systems. A qualitative survey was carried out with EAR participants to document epidemic intelligence strategies and to assess perceptions regarding the performance of participating systems. Timeliness and sensitivity were rated with high scores illustrating the overall perceived value of all systems while weaknesses were underlined especially in terms of representativeness, completeness and flexibility. These findings were corroborated by the quantitative analysis performed on signals potentially related to influenza A/H5N1 events which occurred in March 2010. For the six systems for which this information was available; the detection rate ranged from 31% to 38%, and increased to 72% when considering the virtual combined system. The positive predictive values (PPV) ranged from 3% to 24% and the F1-score ranged from 6% to 27%. These low scores point out false positive signals related to varying abilities of the systems to efficiently sort-out information and reduce background noise. For the seven systems sensitivity ranged from 38% to 72%. An average difference of 23% was observed between the sensitivities calculated for human cases and epizootics, underlining the difficulties to develop an efficient algorithm or a single pathology. The sensitivity increased to 93% when the virtual combined system was considered, clearly illustrating the systems’ complementarities. The average delay between the detection of the A/H5N1 events by the systems and their official reporting by WHO or OIE was 10.2 days (CI95%, 6.7; 13.8). This work illustrates the diversity in implemented epidemic intelligence activities, differences in systems designs and the potential added values and opportunities for synergy: between systems, between users and between systems and users.JRC.G.2-Global security and crisis managemen

Factors Influencing Performance of Internet-Based Biosurveillance Systems Used in Epidemic Intelligence for Early Detection of Infectious Diseases Outbreaks

Background: Internet-based biosurveillance systems have been developed to detect health threats using information available on the Internet, but system performance has not been assessed relative to end-user needs and perspectives. Method and Findings: Infectious disease events from the French Institute for Public Health Surveillance (InVS) weekly international epidemiological bulletin published in 2010 were used to construct the gold-standard official dataset. Data from six biosurveillance systems were used to detect raw signals (infectious disease events from informal Internet sources): Argus, BioCaster, GPHIN, HealthMap, MedISys and ProMED-mail. Crude detection rates (C-DR), crude sensitivity rates (C-Se) and intrinsic sensitivity rates (I-Se) were calculated from multivariable regressions to evaluate the systems’ performance (events detected compared to the gold-standard) 472 raw signals (Internet disease reports) related to the 86 events included in the gold-standard data set were retrieved from the six systems. 84 events were detected before their publication in the gold-standard. The type of sources utilised by the systems varied significantly (p,0001). I-Se varied significantly from 43% to 71% (p = 0001) whereas other indicators were similar (C-DR: p = 020; C-Se, p = 013). I-Se was significantly associated with individual systems, types of system, languages, regions of occurrence, and types of infectious disease. Conversely, no statistical difference of C-DR was observed after adjustment for other variables. Conclusion: Although differences could result from a biosurveillance system’s conceptual design, findings suggest that the combined expertise amongst systems enhances early detection performance for detection of infectious diseases. While all systems showed similar early detection performance, systems including human moderation were found to have a 53% higher I-Se (p = 00001) after adjustment for other variables. Overall, the use of moderation, sources, languages, regions of occurrence, and types of cases were found to influence system performance.JRC.G.2-Global security and crisis managemen

VEB-1 Extended-Spectrum β-lactamase–producing Acinetobacter baumannii, France1

VEB-1 extended-spectrum β-lactamase–producing Acinetobacter baumannii was responsible for an outbreak in hospitals in France. A national alert was triggered in September 2003 when 4 hospitals reported clusters of A. baumannii infection with similar susceptibility profiles. Case definitions and laboratory guidelines were disseminated, and prospective surveillance was implemented; strains were sent to a single laboratory for characterization and typing. From April 2003 through June 2004, 53 hospitals reported 290 cases of A. baumannii infection or colonization; 275 isolates were blaVEB-1-positive and clonally related. Cases were first reported in 5 districts of northern France, then in 10 other districts in 4 regions. Within a region, interhospital spread was associated with patient transfer. In northern France, investigation and control measures led to a reduction of reported cases after January 2004. The national alert enabled early control of new clusters, demonstrating the usefulness of early warning about antimicrobial drug resistance

Hydrology modelling R packages: a unified analysis of models and practicalities from a user perspective

Following the rise of R as a scientific programming language, the increasing requirement for more transferable research, and the growth of data availability in hydrology, R packages containing hydrological models are becoming more and more available to hydrologists. Corresponding to the core of the hydrological studies workflow, their value is increasingly meaningful regarding the reliability of methods and results. Despite package and model distinctiveness, no study has ever 5 provided a comparison of R packages for conceptual rainfall-runoff modelling from a user perspective, contrasting their philosophy, model characteristics and ease of use. We have selected eight packages based on our ability to consistently run their models on simple hydrology modelling examples. We have uniformly analysed the exact structure of seven of the hydrological models integrated in these R packages in terms of conceptual storages and fluxes, spatial discretisation, data requirements and output provided. The analysis showed that very different modelling choices are associated with these packages, which emphasises various hydrological concepts. These specificities are not always sufficiently well explained by the package documentation. Therefore a synthesis of the package functionalities was performed from a user perspective. This synthesis helps inform selection of what packages could/should be used depending on the problem at hand. In this regard, technical features, documentation, R implementations and computational times were investigated. Moreover, by providing a framework for package comparison, this study is a step forward towards supporting more transferable and reusable methods and results for hydrological modelling in R