Le personnel soignant et l'hygiène des mains en réanimation : une analyse sociologique

Introduction/objectif du travail : Depuis quelques années, l’intérêt de l’analyse du comportement du personnel hospitalier vis-à-vis de règles d’hygiène des mains (HM) a été beaucoup étudié, ce qui a permis de mieux comprendre l’échec ou le caractère transitoire du succès de nombreux programmes d’amélioration de son observance. Cependant, peu d’études de ce type ont été réalisées en France. Notre objectif était d’étudier les aspects sociologiques des pratiques d’HM en réanimation. Matériel et Méthodes : L’étude a été réalisée par l\u27Institut de Psychologie et de Sociologie Appliquées de l\u27Université Catholique de l\u27Ouest (UCO, Angers), en collaboration avec l\u27équipe opérationnelle d\u27hygiène et deux services de réanimation du CHU d\u27Angers. Elle a comporté une phase d\u27observation participante menée par une étudiante en sociologie (Master-1), infirmière (IDE) de formation initiale, et une phase d\u27entretiens semi directifs réalisés par deux enseignants chercheurs de l\u27UCO. Résultats : Une constatation importante a été l\u27existence d\u27un conflit pour les soignants entre la règle ontextualisée telle qu\u27elle est pratiquée avec l\u27influence des antériorités du service, de la socialisation par les pairs (périodes de doublage) ou des situations d\u27urgence d\u27une part, et la règle institutionnalisée (recommandations) telle qu\u27elle est définie par les experts et transmise par les IDE hygiénistes. Les professionnels de l\u27hygiène et les soignants ont souvent une conception différente des soins : les premiers les décomposent en séquences de plusieurs tâches avec un acte d\u27HM à pratiquer entre chacune d\u27elles, alors que les seconds perçoivent un soin comme un tout, et effacent mentalement certaines interruptions pour assurer l\u27enchaînement des tâches. Il est apparu que d\u27après les entretiens, l\u27"asepsie" était la règle absolue pour les IDE, constituant un "plus" par rapport à l\u27"hygiène". Ainsi, une pratique comme l\u27HM ne serait "que" de l\u27hygiène par rapport à d\u27autres pratiques considérées comme garantes de l\u27"asepsie", ce qui pourrait constituer un facteur de mauvaise observance de l\u27HM. Enfin, il a été observé le fréquent ressenti d\u27un risque plus important de contamination du patient vers le soignant que du soignant vers un autre patient, ce qui génère des comportements auto protecteurs. Conclusion : Il paraît important que dans leurs relations avec les soignants, les professionnels de l\u27hygiène hospitalière aient conscience que le non suivi des règles d\u27hygiène ne doit pas être interprété comme un dysfonctionnement ou un acte non rationnel, mais qu\u27il correspond à l\u27application d\u27autres logiques d\u27action à caractère prioritaire pour les soignants

Effect on comfort of administering bubble-humidified or dry oxygen: the Oxyrea non-inferiority randomized study.

The clinical interest of using bubble humidification of oxygen remains controversial. This study was designed to further explore whether delivering dry oxygen instead of bubble-moistened oxygen had an impact on discomfort of ICU patients. This randomized multicenter non-inferiority open trial included patients admitted in intensive care unit and receiving oxygen. Any patient receiving non-humidified oxygen (between 0 and 15 L/min) for less than 2 h could participate in the study. Randomization was stratified based on the flow rate at inclusion (less or more than 4 L/min). Discomfort was assessed 6-8 and 24 h after inclusion using a dedicated 15-item scale (quoted from 0 to 150). Three hundred and fifty-four ICU patients receiving non-humidified oxygen were randomized either in the humidified (HO) (n = 172), using bubble humidifiers, or in the non-humidified (NHO) (n = 182) arms. In modified intention-to-treat analysis at H6-H8, the 15-item score was 26.6 ± 19.4 and 29.8 ± 23.4 in the HO and NHO groups, respectively. The absolute difference between scores in both groups was 3.2 [90% CI 0.0; + 6.5] for a non-inferiority margin of 5.3, meaning that the non-inferiority analysis was not conclusive. This was also true for the subgroups of patients receiving either less or more than 4 L/min of oxygen. At H24, using NHO was not inferior compared to HO in the general population and in the subgroup of patients receiving 4 L/min or less of oxygen. However, for patients receiving more than 4 L/min, a post hoc superiority analysis suggested that patients receiving dry oxygen were less comfortable. Oxygen therapy-related discomfort was low. Dry oxygen could not be demonstrated as non-inferior compared to bubble-moistened oxygen after 6-8 h of oxygen administration. At 24 h, dry oxygen was non-inferior compared to bubble-humidified oxygen for flows below 4 L/min

Targeting of T/Tn Antigens with a Plant Lectin to Kill Human Leukemia Cells by Photochemotherapy

Photochemotherapy is used both for solid tumors and in extracorporeal treatment of various hematologic disorders. Nevertheless, its development in oncology remains limited, because of the low selectivity of photosensitizers (PS) towards human tumor cells. To enhance PS efficiency, we recently covalently linked a porphyrin (TrMPyP) to a plant lectin (Morniga G), known to recognize with high affinity tumor-associated T and Tn antigens. The conjugation allowed a quick uptake of PS by Tn-positive Jurkat leukemia cells and efficient PS-induced phototoxicity. The present study was performed: (i) to evaluate the targeting potential of the conjugate towards tumor and normal cells and its phototoxicity on various leukemia cells, (ii) to investigate the mechanism of conjugate-mediated cell death. The conjugate: (i) strongly increased (×1000) the PS phototoxicity towards leukemic Jurkat T cells through an O-glycan-dependent process; (ii) specifically purged tumor cells from a 1∶1 mixture of Jurkat leukemia (Tn-positive) and healthy (Tn-negative) lymphocytes, preserving the activation potential of healthy lymphocytes; (iii) was effective against various leukemic cell lines with distinct phenotypes, as well as fresh human primary acute and chronic lymphoid leukemia cells; (iv) induced mostly a caspase-independent cell death, which might be an advantage as tumor cells often resist caspase-dependent cell death. Altogether, the present observations suggest that conjugation with plant lectins can allow targeting of photosensitizers towards aberrant glycosylation of tumor cells, e.g. to purge leukemia cells from blood and to preserve the normal leukocytes in extracorporeal photochemotherapy

Advances, Challenges and Opportunities in 3D CMOS Sequential Integration

3D sequential integration enables the full use of the third dimension thanks to its high alignment performance. In this paper, we address the major challenges of 3D sequential integration: in particular, the control of molecular bonding allows us to obtain pristine quality top active layer. With the help of Solid Phase Epitaxy, we can match the performance of top FET, processed at low temperature (600°C), with the bottom FET devices. Finally, the development of a stable salicide enables to retain bottom performance after top FET processing. Overcoming these major technological issues offers a wide range of applications

Integration of a Graphene FET on SiC Substrates

International audienc

Integration of a Graphene FET on SiC Substrates

International audienc

Projet infirmier de prévention des accidents domestiques à travers le « Jeu des 7 erreurs du Centre Antipoison »

National audienc

International Humanitarian Law against the background of Custom and Humanity

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Study of n- and p-type dopants activation and dopants behavior with respect to annealing conditions in silicon germanium-on-insulator (SGOI)

We have investigated the p- and n-type dopants in thin SGOI (20 nm) material obtained by Ge enrichment. The samples are doped with either BF2 or arsenic or phosphorus and then annealed with either a spike or a 15 s rapid thermal annealing in a temperature range of 850-1050 °C. We have observed that sheet resistance (Rsh) obtained in SGOI for p-type is approximately independent of annealing conditions. In addition, these values are lower than the SOI (20 nm) reference. Result reveals that almost all BF2 atoms remain in SGOI substrate giving rise to low Rsh, whereas dopant out diffuses and segregates in SOI. In contrast, Rsh measured with arsenic and phosphorus implanted SGOI samples is higher than SOI