Factors affecting compliance with glove removal after contact with a patient or environment in four intensive care units

International audienc

Assessment of the usefulness of performing bacterial identification and antimicrobial susceptibility testing 24 h a day in a clinical microbiology laboratory

The impact of inoculating agar media with positive blood cultures and of performing bacterial identification and antimicrobial susceptibility testing (AST) for positive urine cultures, blood cultures and certain fluid cultures after day hours (night service (NS)) was evaluated in a clinical microbiology laboratory. The impact of the NS was assessed in terms of decreases in the delays from the time of sampling to the time at which results became available and of the consequences for patient management and antimicrobial treatment. Two major benefits were obtained: initiation of earlier appropriate treatment, and change to a reduced-spectrum but still efficient regimen. The hours of laboratory testing and the availability and transmission of results to the clinical staff were recorded. Concurrently, these hours were estimated as though laboratory tests had been performed in the absence of NS. Reductions in delay were defined as the differences between the hours actually spent and the estimated hours. Economic concerns were also considered. Overall, 430 samples for which an identification and/or AST were performed during the NS were included in the study. The NS led to the implementation of earlier appropriate therapy in 97 cases (22.6%), and to the change to reduced-spectrum but still efficient regimens in 23 additional cases (5.3%). In conclusion, there appeared to be benefits from a system providing bacterial identification and AST overnight, but a study of the cost-effectiveness of the NS would be useful to back up this observation

Impact of screening and identifying methicillin-resistant Staphylococcus aureus carriers on hand hygiene compliance in 4 intensive care units

BackgroundOur objective was to assess the impact of screening and identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers as a single measure in 4 intensive care units (ICUs). Methods An evaluative study including two 6-month periods was conducted prospectively. The evaluation concerned the hand hygiene compliance (HHC) for contacts with MRSA carriers versus contacts with noncarriers (comparison C1, main objective) and for a period of absence of identification (P1) versus a period of identification (P2) (comparison C2) and MRSA cross transmission (P1 vs P2) (comparison C3) measured with 2 indicators. Results Overall, 1326 opportunities of hand hygiene were observed. Concerning C1, the HHC for contacts with MRSA carriers was 42.5% versus 43.1% for contacts with noncarriers (not significant). This absence of difference was recorded whatever the ICU specialty, the category of personnel, and the nature of contacts. Concerning C2, the HHC in P1 was 44.8% versus 48.5% in P2 (not significant). Concerning C3, no significant difference was identified between the 2 periods. Conclusion We did not identify any advantage by using screening and identifying MRSA carriers in those 4 ICUs in which no specific strategy of additional contact measures was implemented for MRSA carriers

Évaluation des services rendus par le système de fonctionnement en continu d’un laboratoire de bactériologie

RésuméDepuis 2005, le laboratoire de bactériologie du CHU d’Angers a mis en place un système de fonctionnement continu nécessitant la présence d’un technicien de laboratoire la nuit, qui poursuit l’analyse de certains prélèvements. Objectifs Évaluer les services rendus par le laboratoire, en termes de réduction des délais de transmission des résultats, mais aussi en termes de journées de traitement efficace (TE) gagnées et/ou réduction du spectre de l’antibiothérapie (gains majeurs). Méthode Étude prospective sur quatre mois durant lesquels tous les prélèvements « continués » la nuit ont été inclus. Les délais de prise en charge observés ont été comparés aux délais attendus en cas d’absence du dispositif actuel. Résultats Sur les 430 prélèvements inclus, la réduction du délai de rendu des résultats était au moins égale à 24 heures dans 97 % des cas. Au total, plus d’un prélèvement « continué » la nuit sur quatre ont permis d’obtenir un gain majeur pour la prise en charge thérapeutique du patient, soit 111 journées gagnées sur un TE et 27 journées gagnées sur une réduction du spectre de l’antibiothérapie. Discussion Ce système, unique en France, est un outil d’aide au bon usage des antibiotiques au même titre que les référentiels ou la consultation d’un référent en infectiologie. Il s’agit d’un système performant et potentiellement économique, ayant un impact à la fois sur l’efficacité du traitement des patients et sur l’écologie microbienne de l’établissement

Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes

SummaryOur objective was to assess the importance of monitoring hand hygiene compliance (HHC) during series of successive contacts with patients or surroundings for measurement and interpretation of the compliance rates. A direct observational study of HHC was performed in four intensive care units (ICUs) and four healthcare settings with non-intensive care wards (NICWs). Hand hygiene (HH) opportunities were differentiated into two categories: extra-series opportunities (ESOs) (before or after a single contact, and before the first contact or after the last contact of a series of successive contacts) or as intra-series opportunities (ISOs) (from the opportunity following the first contact to the opportunity preceding the last in the same series). In all, 903 opportunities of HH were performed in ICUs and 760 in NICWs. The proportion of ISOs was 46.0% in ICUs and 22.9% in NICWs. The overall HHC was significantly higher in NICWs than in ICUs (61.2% vs 47.5%, P < 0.00001). The HHC was significantly higher for ESOs than for ISOs (67.7% vs 28.5%, P < 0.00001). The HHC for ISOs was significantly higher in ICUs (32.2% vs 19.0%, P < 0.005). If the distribution of categories of HH opportunities observed in NICWs had been the same as in ICUs, the overall HHC would have been similar in NICWs (46.4%) and in ICUs (47.5%). Monitoring HHC during entire care episodes in series of successive contacts is necessary to avoid a strong overestimation of the overall compliance rates. Concurrently, comparison of compliance data should take into account the proportion of ISOs included in the evaluation study

Acremonium strictum Fungaemia in a Paediatric Immunocompromised Patient: Diagnosis and Treatment Difficulties

During the past two decades, an increasing number of unusual moulds has been reported as responsible for septicaemia and systemic or disseminated infections in immunocompromised patients. Investigation of fever in a 10-year-old boy with acute myeloblastic leukaemia, including blood cultures on selective media, allowed the diagnosis of a fungaemia due to the slow-growing fungus Acremonium strictum. The patient recovered with liposomal amphotericin B (AmB) and voriconazole, followed by voriconazole alone due to AmB resistance. Facing a neutropenic patient with fever, clinicians usually suspect bacterial or viral aetiologies. This case, however, illustrates the need for mycological analysis of blood samples in febrile neutropenic patients and for antifungal susceptibility testing

Dépistage des troubles visuels et auditifs chez l'enfant. Application des recommandations chez les médecins généralistes du Maine-et-Loire

Dépister précocement les troubles visuels et auditifs chez le nourrisson permet une meilleure prise en charge thérapeutique. Ce rôle est en grande partie dévolu aux médecins généralistes et obligatoires lors des examens de santé du 9e et du 24e mois. Nous avons réalisé une enquête prospective auprès de l’ensemble des médecins généralistes d’un département français, afin de connaître leurs habitudes pratiques cliniques en matière de dépistage des troubles sensoriels. Le taux de réponses de 49 % a permis d’exploiter 321 questionnaires. Nous constatons que l’examen clinique n’est pas systématique et qu’il est principalement effectué lors des examens des 4e, 9e et 24e mois ou en cas de doute parental. Si les signes d’alerte sont, dans leur ensemble, bien connus des médecins généralistes, les facteurs de risque sont recherchés de façon incomplète. L’examen clinique reste sommaire avec la réalisation des principaux réflexes pour l’appareil visuel, mais une recherche superficielle du strabisme ou de l’amblyopie. Le dépistage auditif est réalisé principalement avec la voix ou le claquement des mains, bien que deux tiers d’entre eux possèdent des jouets calibrés. L’âge minimum de prise en charge est mal connu des praticiens et cela peut être préjudiciable à la bonne prise en charge des déficits sensoriels. Le nouveau carnet de santé devrait permettre un dépistage plus pertinent des troubles sensoriels chez le nourrisson : une plus large diffusion des informations et des conduites à tenir est nécessaire