Information concerning multidrug-resistant bacterial colonization or infection in the medical transfer letter

OBJECTIVES

The aim of this study was to evaluate the proportion of transfer letters that contained information relative to infection or colonization by multidrug-resistant (MDR) bacteria and factors associated with the presence of that information.

PATIENTS AND METHODS

Patients for whom at least one of these selected MDR bacteria (methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, or MDR Pseudomonas aeruginosa) was isolated during their hospitalization and who were transferred to another health care facility between 2009 and 2012 were included. Information of the MDR bacterium and the mention of isolation precautions were evaluated in the electronic medical record.

RESULTS

Information (mention of MDR bacterium or isolation precaution) was present in 57% [52; 65] of records. Full information (genus and species, concept of MDR bacterium and mention of isolation precaution) was found in 20% [16; 25]. The presence of a dedicated item in the standard medical discharge letter was associated with more frequent information. Less information was retrieved with P. aeruginosa cases than with the other 2 MDR bacteria.

CONCLUSION

The presence of the information has improved, but it is still insufficiently reported. Measures to improve information are needed. Indeed, information on MDR bacterial colonization or infection is the first step for isolation precautions. An item could be added to all standard medical discharge letters. An item could also be added to the indicators used to assess quality and safety in healthcare facilities.

Quality of care of patients with type 1 diabetes: population-based results in a French region

AIM

Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients.

METHODS

Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The 'optimized results' included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data.

RESULTS

A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA(1c) tests more often and were more frequently on optimal treatment; however, there was no difference in HbA(1c) values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period.

CONCLUSION

This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.

Variability of radiofrequency exposure across days of the week: a population-based study

Although measurement of the radiofrequency (RF) exposure can today be performed with personal exposure meters, this approach would be very expensive and time-consuming for large studies, and long term measurements would require considerable commitment of the study participants. Thus, there is a need for validated exposure assessment methods that do not require individual measurements for each study participant. Among the potential predictors, one of the most amenable to being recorded adequately is the day of the week. Drawing upon an existing population-based study, our goal was therefore to assess variability of individual RF exposure across days of the week. The random sample consisted of 34 people who were supplied with a personal exposure meter for seven consecutive days, and kept a time-location-activity diary. A total of 225,414 electric field strength measurements were recorded in 12 different RF bands. Summary statistics were calculated with the robust regression on order statistics method. We found evidence for statistically significant variability of individual RF exposure across days of the week, though the relative magnitude of the differences observed was small. Larger studies are needed to validate these results and determine whether day of the week is an important determinant for inclusion in individual RF exposure prediction models that remain urgently needed to conduct epidemiological studies on potential health effects.

Meta-analysis of intraoperative povidone–iodine application to prevent surgical-site infection

Background

The effectiveness of intraoperative povidone–iodine (PVI) application in the reduction of surgical-site infection (SSI) remains controversial. This meta-analysis was performed to assess the effect of intraoperative PVI application compared with no antiseptic solution (saline or nothing) on the SSI rate.

Methods

The meta-analysis included randomized controlled trials that compared intraoperative PVI lavage with no PVI in patients undergoing surgery with SSI as the primary outcome. A fixed-effects or random-effects model was used as appropriate, and heterogeneity was assessed by the Cochran Q and the I2 value.

Results

Twenty-four randomized controlled trials totalling 5004 patients (2465 patients with PVI and 2539 patients without) were included: 15 in the main analysis and nine in the sensitivity analysis. The rate of SSI was 8·0 per cent in the PVI group and 13·4 per cent in the control group. Intraoperative PVI application significantly decreased the SSI rate (relative risk 0·58, 95 per cent confidence interval 0·40 to 0·83; P = 0·003) and consistent results were observed in subgroup analyses according to the method of PVI administration, its timing and the type of surgery.

Conclusion

The meta-analysis results suggested that the use of intraoperative PVI reduced rates of SSI.