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Verjat-Trannoy D, Merle V, Daniel C, Sambourg J, Astagneau P. Incorporation of skin preparation guidelines in local surgical facility protocols: what kind of barriers does it face? A multi-centre study in France. J Hosp Infect 2024; 145:203-209. [PMID: 38286240 DOI: 10.1016/j.jhin.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Surgical site infection (SSI) is the most frequent and severe adverse event after surgery. Among preventive measures, the preoperative skin preparation (PSP) is known to be heterogeneously implemented in routine practice. A prerequisite would be the actual incorporation of guidelines in French surgical local protocols. AIM To assess whether PSP recommendations have been incorporated in local protocols and to identify the reasons for the non-incorporation. METHODS An online survey was proposed to all infection control teams (ICTs) in facilities participating in the French national surveillance and prevention of SSI network Spicmi. The reference recommendations were based on the French Society for Hospital Hygiene guidelines. FINDINGS In all, 485 healthcare facilities completed the questionnaire. The incorporation of recommendations in the facility protocol varied between 30% and 98% according to the recommendation. The measures most frequently incorporated were antisepsis with an alcoholic product and cessation of systematic hair removal. The least frequently incorporated were the use of plain soap for preoperative shower and the non-compulsory skin cleaning in the operating room. Barriers reported were either specific to PSP (e.g. 'Concern about an increase of SSI', 'Scepticism about recommendations', 'Force of habit') or non-specific (e.g. 'The protocol not yet due to be updated'). CONCLUSION We suggest that although some major prevention measures have been incorporated in the local protocol of most facilities, local protocols still frequently include some non-evidence based former recommendations. Communication about evolution of SSI rates, diffusion of guidelines by learned societies, and exchange with judiciary experts could make clear the conditions for applying recommendations.
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Affiliation(s)
- D Verjat-Trannoy
- Mission nationale Spicmi, Centre régional de prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France.
| | - V Merle
- Direction de la qualité et de la gestion des risques, Groupe Hospitalier du Havre, Le Havre, France; Inserm U1086 Anticipe, Centre François Baclesse, Caen, France
| | - C Daniel
- Mission nationale Spicmi, Centre régional de prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
| | - J Sambourg
- Centre régional de prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
| | - P Astagneau
- Mission nationale Spicmi, Centre régional de prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France; Sorbonne université, INSERM, Institut Pierre Louis d'Epidémiologie et de santé Publique, Paris, France
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2
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Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, Zahar JR, Sales-Wuillemin E, Tubach F, Lucet JC. Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey. Antimicrob Resist Infect Control 2019; 8:173. [PMID: 31749961 PMCID: PMC6852912 DOI: 10.1186/s13756-019-0625-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs. Methods A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception. Results Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation. Conclusions We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions. Trial registration Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.
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Affiliation(s)
- L Vaillant
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France
| | - G Birgand
- 2Department of Medicine, NIHR, Imperial College London, Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - M Esposito-Farese
- AP-HP, Bichat-Claude Bernard Hospital, Unité de Recherche Clinique Paris Nord Val de Seine and CIC-EC 1425, 48 rue Henri Huchard, F-75018 Paris, France
| | - P Astagneau
- 4Medecine Sorbonne University, AP-HP, Regional centre for Prevention of Healthcare-associated infections, 8 rue Maria Helena Vieira da Silva, 75014 Paris, France
| | - C Pulcini
- 5EA 4360 APEMAC, CHRU de Nancy, University of Lorraine, Infectious and Tropical Diseases Unit, 34 Cours Léopold, 54000 Nancy, France
| | - J Robert
- Sorbonne University, U1135, Team E13, CR7 INSERM, AP-HP, Pitié-Salpêtrière Hospital, Bactériologie-Hygiène, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - J R Zahar
- 7AP-HP, Avicenne Hospital, Infection Control Unit, 125 Rue de Stalingrad, 93000 Bobigny, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
| | | | - F Tubach
- INSERM, UMR 1123, AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmacoépidémiologie (Cephepi), 75013 Paris, France
| | - J C Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
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Roux J, Nekkab N, Astagneau P, Crépey P. Modeling Carbapenemase-producing Enterobacteriaceae episodes’ evolution in France over 2010-2020. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Incidence of Carbapenemase-Producing Enterobacteriaceae (CPE) episodes within hospitals is rising at an alarming rate and threaten health systems and patient safety worldwide. Their number is growing in France since 2009 associated with inter-regional dissemination and importation of international cases. This study aimed at describing the dynamics of CPE episodes in France over 2010-2016 and forecasting their evolution for 2017-2020.
Methods
Surveillance data of CPE episodes (imported and non-imported) from August 2010 to November 2016 were issued from the French national Healthcare-Associated Infections Early Warning and Response System. Impact of seasonality on the number of CPE episodes was analyzed using seasonal-to-irregular ratios. Seven models issued from time series analysis and three ensemble stacking models (average, convex and linear stacking) were used to describe and forecast CPE episodes. The model with the best forecasting’s quality was then trained on all available data (2010-2016) and used to predict CPE episodes over 2017-2020.
Results
Over 2010-2016, 3,559 CPE episodes were observed in France. Compared to the average yearly trend, we observed a 30% increase in the number of CPE episodes in September and October. On the opposite, a decrease of 20% was noticed in February compared to other months. We also noticed a 1-month lagged seasonality of non-imported episodes compared to imported ones. The number of non-imported episodes appeared to grow faster than imported ones starting from 2014. Average stacking gave the best forecasts and predicted an increase over 2017-2020 with a peak up to 345 CPE episodes (95% PI [124-1,158], 80% PI [171-742]) in September 2020.
Conclusions
The number of CPE episodes is predicted to rise in the next years in France because of non-imported episodes. These results could help public health authorities in the definition and evaluation of new containment strategies.
Key messages
Time series modeling predicts an increase in the number of CPE episodes in France in the next few years with a quicker rise of non-imported episodes. An increase of 30% in the number of CPE episodes was observed in September and October with a 1-month lagged seasonality impact of non-imported episodes compared to imported one.
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Affiliation(s)
- J Roux
- REPERES - EA 7449, University of Rennes, EHESP, Rennes, France
| | - N Nekkab
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers (CNAM), Paris, France
- Unité PACRI, Institut Pasteur, CNAM, Paris, France
| | - P Astagneau
- CPias Ile-de-France, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre & Marie Curie, Sorbonne Université, Paris, France
| | - P Crépey
- REPERES - EA 7449, University of Rennes, EHESP, Rennes, France
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L’hériteau F, Nkoumazok B, Gaudichon A, Astagneau P. Évolution des consommations d’antibiotiques dans 115 établissements de santé, Ile-de-France, 2013–2017. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lecoq L, L’hériteau F, Blanchard H, Nkoumazok B, Astagneau P, Aujard Y, Boileau P, Letouzey M. Le petit poids pour l’âge gestationnel augmente le risque d’infection néonatale tardive chez les grands prématurés. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Banaei-Bouchareb L, Solomiac A, Astagneau P, Guillon L, Miliani K, May-Michelangeli L. Infections du site opératoire trois mois après pose de prothèse totale de hanche ou de genou : résultats nationaux 2017. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abbas M, de Kraker MEA, Aghayev E, Astagneau P, Aupee M, Behnke M, Bull A, Choi HJ, de Greeff SC, Elgohari S, Gastmeier P, Harrison W, Koek MBG, Lamagni T, Limon E, Løwer HL, Lyytikäinen O, Marimuthu K, Marquess J, McCann R, Prantner I, Presterl E, Pujol M, Reilly J, Roberts C, Segagni Lusignani L, Si D, Szilágyi E, Tanguy J, Tempone S, Troillet N, Worth LJ, Pittet D, Harbarth S. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect 2018; 102:267-276. [PMID: 30529703 DOI: 10.1016/j.jhin.2018.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. AIM To determine the time-trend of SSI rates in surveillance networks. METHODS SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. FINDINGS Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. CONCLUSION In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.
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Affiliation(s)
- M Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - E Aghayev
- Swiss RDL, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Schulthess Klinik, Zürich, Switzerland
| | - P Astagneau
- Reference Centre for Prevention and Control of Healthcare-associated Infections, APHP University Hospital, Paris, France
| | - M Aupee
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - M Behnke
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Bull
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - H J Choi
- Division of Infectious Diseases, Office of Infection Control, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - S C de Greeff
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - S Elgohari
- National Infection Service, Public Health England, London, UK
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Harrison
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | - M B G Koek
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - E Limon
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain
| | - H L Løwer
- Norwegian Institute of Public Health, Department of Infectious Disease Epidemiology, Oslo, Norway
| | - O Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Marquess
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - R McCann
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - I Prantner
- National Center for Epidemiology, Budapest, Hungary
| | - E Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria
| | - M Pujol
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - J Reilly
- Healthcare Associated Infection, Antimicrobial Resistance, Decontamination and Infection Control Group, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK; Safeguarding Health Through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - C Roberts
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | | | - D Si
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - E Szilágyi
- National Public Health and Medical Officer Service, Budapest, Hungary
| | - J Tanguy
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - S Tempone
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - N Troillet
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospital, Sion, Switzerland
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia
| | - D Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Le Meur N, Grammatico-Guillon L, Wang S, Astagneau P. Health insurance database for post-discharge surveillance of surgical site infection following arthroplasty. J Hosp Infect 2016; 92:140-6. [DOI: 10.1016/j.jhin.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/11/2015] [Indexed: 12/23/2022]
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Haudebourg L, Seringe E, Aggoune M, Bertrand M, Boulot F, Astagneau P. A nosocomial hepatitis viral c transmission in an auto-dialysis center: risk factors using a root-causes analysis. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475066 DOI: 10.1186/2047-2994-4-s1-p229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Arnaud I, Jarlier V, Astagneau P. Regional trends in extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBLE), E. coli SBLE and K. pneumonia SBLE between 2009 and 2013. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474622 DOI: 10.1186/2047-2994-4-s1-o44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Verjat-Trannoy D, Abdelaziz A, Chauvin V, Hovasse C, Hubas L, Astagneau P. Peripheral venous catheter in cardiology: root cause analysis of an adverse event during patient transport in radiology. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475160 DOI: 10.1186/2047-2994-4-s1-p210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cossin S, Malavaud S, Jarno P, Giard M, L'Hériteau F, Simon L, Bieler L, Molinier L, Marcheix B, Venier AG, Simon L, Ali-Brandmeyer O, Neels C, Jarno P, Aupée M, Perennec M, Astagneau P, L'Hériteau F, Daniel F, Campion C, Giard M, Bernet C, Caillat-Vallet E, Venier AG, Bervas C, Reyreaud E, Baillet P, Costa Y, Jost JL, Merle V, Merlo L, Seguier JC, Malavaud S, Bruyere F, Thiolet JM, Barquin-Guichard S. Surgical site infection after valvular or coronary artery bypass surgery: 2008–2011 French SSI national ISO-RAISIN surveillance. J Hosp Infect 2015; 91:225-30. [DOI: 10.1016/j.jhin.2015.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/16/2015] [Indexed: 11/17/2022]
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Delory T, Seringe E, Antoniotti G, Novakova I, Goulenok C, Paysant I, Boyer S, Carbonne A, Naas T, Astagneau P. Prolonged delay for controlling KPC-2-producing Klebsiella pneumoniae outbreak: the role of clinical management. Am J Infect Control 2015; 43:1070-5. [PMID: 26174583 DOI: 10.1016/j.ajic.2015.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) are becoming of immediate concern for infection control policies. Prompt detection of CPE on health care setting admission is crucial to halt the spread of an outbreak. We report a cluster of 13 Klebsiella pneumoniae carbapenemase (KPC)-2-producing K pneumoniae cases in a tertiary care hospital.The objective of this study was to identify contributing factors originating the outbreak. METHODS An outbreak investigation was conducted using descriptive epidemiology, observation of health care practices, and interviews of management staff. A root cause analysis was performed to identify patent and latent failures of infection control measures using the association of litigation and risk management method. RESULTS The main patent failure was the delay in identifying KPC-2-producing K pneumoniae carriers. Contributing factors were work and environmental factors: understaffing, lack of predefined protocols, staff members' characteristics, and underlying patients' characteristics. Latent failures were as follows: no promotion of the national guidelines for prevention of CPE transmission, no clear procedure for the management of patients hospitalized abroad, no clear initiative for promoting a culture of quality in the hospital, biologic activity recently outsourced to a private laboratory, and poor communication among hospital members. CONCLUSION Clinical management should be better promoted to control hospital outbreaks and should include team work and safety culture.
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Affiliation(s)
- T Delory
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France
| | - E Seringe
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France.
| | | | - I Novakova
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France
| | | | - I Paysant
- Groupe Générale de Santé, Paris, France
| | - S Boyer
- Groupe Générale de Santé, Paris, France; Laboratoire Bactériologie Novescia, Paris, France
| | - A Carbonne
- Office of Quality and Safety in Care, Direction Générale de l'Offre de Soins-Bureau PF2-Ministère de la Santé, des affaires sociales et du droit des femmes, Paris, France
| | - T Naas
- Department of Bacteriology, APHP, Laboratoire de Bactériologie-Virologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Centre National de Référence de la résistance aux antibiotiques, Le Kremlin Bicêtre, France; EA7361, Faculté de Médecine, Université Paris Sud, France
| | - P Astagneau
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France; Department of Epidemiology, Ecole des Hautes Etudes en Santé Publique/Universités Sorbonne Paris Cité, Paris, France
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Miliani K, Migueres B, Verjat-Trannoy D, Thiolet JM, Vaux S, Astagneau P, the French Prevalence Survey Study Group C. National point prevalence survey of healthcare-associated infections and antimicrobial use in French home care settings, May to June 2012. Euro Surveill 2015. [DOI: 10.2807/1560-7917.es2015.20.27.21182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- K Miliani
- Regional Coordinating Centre for Nosocomial Infection Control (CClin Paris – Nord), Paris, France
| | - B Migueres
- Regional Coordinating Centre for Nosocomial Infection Control (CClin Paris – Nord), Paris, France
- Home Health Care of the Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - D Verjat-Trannoy
- Regional Coordinating Centre for Nosocomial Infection Control (CClin Paris – Nord), Paris, France
| | - J M Thiolet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint Maurice, France
| | - S Vaux
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint Maurice, France
| | - P Astagneau
- Department of epidemiology and biostatistics, EHESP French School of Public Health, Rennes, France
- Regional Coordinating Centre for Nosocomial Infection Control (CClin Paris – Nord), Paris, France
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Verjat-Trannoy D, Ertzscheid MA, Monier S, Jouzeau N, Zaro-Goni D, Astagneau P. Message to the caregivers: communicating to patients on hand hygiene improves your practices! Antimicrob Resist Infect Control 2015. [PMCID: PMC4475180 DOI: 10.1186/2047-2994-4-s1-p292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Chyderiotis S, Seringe E, Blanckaert K, Guet L, Kadi Z, Astagneau P. Influenza vaccination coverage in healthcare workers during the 2014-2015 season. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474715 DOI: 10.1186/2047-2994-4-s1-p18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Chyderiotis S, Legeay C, Verjat-Trannoy D, Le Gallou F, Astagneau P, Lepelletier D. Efficacy of copper surfaces in the healthcare environment: a systematic review. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474853 DOI: 10.1186/2047-2994-4-s1-p45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Grammatico-Guillon L, Rusch E, Astagneau P. Surveillance of prosthetic joint infections: international overview and new insights for hospital databases. J Hosp Infect 2015; 89:90-8. [DOI: 10.1016/j.jhin.2013.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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Couderc C, Lacavé L, L'Hériteau F, Astagneau P. Surveillance of Overall Hospital Antibiotic Consumption: Is Stratification according to Hospital Size the Best Method? Infect Control Hosp Epidemiol 2015; 32:1223-5. [DOI: 10.1086/662622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Grammatico-Guillon L, Baron S, Gaborit C, Denier P, Rosset P, Bernard L, Rusch E, Astagneau P. Intérêt et limites du Programme de médicalisation des systèmes d’information dans la surveillance des infections de prothèses orthopédiques. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Grammatico-Guillon L, Baron S, Gaborit C, Bernard L, Rosset P, Rusch E, Astagneau P. G-07: Infection du site opératoire après arthroplastie de hanche ou du genou : une cohorte PMSI, 2008–2012. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Grammatico-Guillon L, Rusch E, Denier P, Bernard L, Rosset P, Astagneau P. Nouvel outil de mesure des infections du site opératoire : le PMSI, dans les infections de prothèses orthopédiques. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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23
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Ndir A, Diop A, Faye M, Astagneau P, Ndoye B. P243: Evaluation of the management of infectious risk in a neonatal unit in Dakar. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687818 DOI: 10.1186/2047-2994-2-s1-p243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Verjat-Trannoy D, Gauthier A, Ertzscheid MA, Jouzeau N, Monier S, Zaro-Goni D, Astagneau P. P148: Hand hygiene communication from healthcare workers to patients: results of a pilot survey in several healthcare facilities. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688156 DOI: 10.1186/2047-2994-2-s1-p148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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25
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Arnaud I, Bajolet O, Bertrand X, Blanchard H, Caillat-Vallet E, Dumartin C, Eveillard M, Fosse T, Garreau N, Hoff O, Marty N, Maugat S, Reyreaud E, Savey A, Sénéchal H, Simon L, Sousa E, Trystram D, Coignard B, Jarlier V, Astagneau P. O034: Regional trends in enterobacteriaceae extended-spectrum beta-lactamase-producing (ESBLE) and methicillin-resistant staphylococcus aureus (MRSA) between 2007 and 2011. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687780 DOI: 10.1186/2047-2994-2-s1-o34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Izoard S, Brenet A, Astagneau P, Kadi Z. P090: Importance of the information system in the fight against multi-drug resistant bacteria. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688434 DOI: 10.1186/2047-2994-2-s1-p90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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27
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L’Hériteau F, Lacavé L, Leboucher B, Decousser JW, De Chillaz C, Astagneau P, Aujard Y. Surveillance en réseau des bactériémies sur cathéter en néonatologie : résultats 2010 du réseau NEOCAT. Arch Pediatr 2012; 19:984-9. [DOI: 10.1016/j.arcped.2012.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
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28
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Barboza P, Vaillant L, Gastellu-Etchegorry M, Gauthier V, Giese C, Astagneau P. Mondialisation des risques sanitaires et intelligence épidémiologique en France. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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29
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Verjat-Trannoy D, Thillard D, Daniel F, Aupée M, Laland C, Simon L, Giard M, Rabaud C, Astagneau P. Assessment practices of peripheral venous catheters use: results of a multicentre observational study in France in 2010. BMC Proc 2011. [PMCID: PMC3239787 DOI: 10.1186/1753-6561-5-s6-p53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Verjat-Trannoy D, Tanguy J, Thillard D, Astagneau P. Assessment of corrective actions implemented by healthcare facilities following a multicentre observational study on peripheral intravenous catheters. BMC Proc 2011. [PMCID: PMC3239788 DOI: 10.1186/1753-6561-5-s6-p54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Hansen S, Sohr D, Geffers C, Astagneau P, Blacky A, Koller W, Morales I, Moro ML, Palomar M, Szilagyi E, Suetens C, Gastmeier P. The concordance of European and US definitions for healthcare-associated infections (HAI). BMC Proc 2011. [PMCID: PMC3239430 DOI: 10.1186/1753-6561-5-s6-o2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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32
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Miliani K, L’Hériteau F, Lacavé L, Carbonne A, Astagneau P. Imipenem and ciprofloxacin consumption as factors associated with high incidence rates of resistant Pseudomonas aeruginosa in hospitals in northern France. J Hosp Infect 2011; 77:343-7. [DOI: 10.1016/j.jhin.2010.11.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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33
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Dettenkofer M, Ammon A, Astagneau P, Dancer SJ, Gastmeier P, Harbarth S, Humphreys H, Kern WV, Lyytikäinen O, Sax H, Voss A, Widmer AF. Infection control--a European research perspective for the next decade. J Hosp Infect 2010; 77:7-10. [PMID: 21145620 DOI: 10.1016/j.jhin.2010.07.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 07/16/2010] [Indexed: 11/25/2022]
Abstract
A symposium was held in June 2009 near Freiburg in Germany. Twenty-nine attendees from several European countries participated, most of whom are actively involved in research and hospital infection prevention and control. The following topics were presented and discussed: isolation and screening for control of multidrug-resistant organisms; impact of the environment on healthcare-associated infection (HAI); new technologies to control infection--state of evidence; surveillance of HAI; methodological challenges and research priorities for infection control and control of HAI: learning from each other in a united Europe. This Leader summarises the main issues for debate and the number of consensus points agreed amongst delegates.
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Affiliation(s)
- M Dettenkofer
- Institute of Environmental Medicine and Hospital Epidemiology, University Medical Center Freiburg, Freiburg, Germany.
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Carbonne A, Thiolet JM, Fournier S, Fortineau N, Kassis-Chikhani N, Boytchev I, Aggoune M, Seguier JC, Senechal H, Tavolacci MP, Coignard B, Astagneau P, Jarlier V. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill 2010; 15. [PMID: 21144448 DOI: 10.2807/ese.15.48.19734-en] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae type 2 was detected in September 2009 in two hospitals in a suburb south of Paris, France. In total, 13 KPC-producing K. pneumoniae type 2 cases (four with infections and nine with digestive-tract colonisations) were identified, including a source case transferred from a Greek hospital. Of the 13 cases, seven were secondary cases associated with use of a contaminated duodenoscope used to examine the source case (attack rate: 41%) and five were secondary cases associated with patient-to-patient transmission in hospital. All isolated strains from the 13 patients: (i) exhibited resistance to all antibiotics except gentamicin and colistin, (ii) were more resistant to ertapenem (minimum inhibitory concentration (MIC) always greater than 4 mg/L) than to imipenem (MIC: 1–8 mg/L, depending on the isolate), (iii) carried the blaKPC-2 and blaSHV12 genes and (iv) had an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern. These cases occurred in three hospitals: some were transferred to four other hospitals. Extended infection control measures implemented in the seven hospitals included: (i) limiting transfer of cases and contact patients to other wards, (ii) cohorting separately cases and contact patients, (iii) reinforcing hand hygiene and contact precautions and (iv) systematic screening of contact patients. Overall, 341 contact patients were screened. A year after the outbreak, no additional case has been identified in these seven hospitals. This outbreak emphasises the importance of rapid identification and notification of emerging highly resistant K. pneumoniae strains in order to implement reinforced control measures.
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Affiliation(s)
- A Carbonne
- Centre de coordination de la lutte contre les infections nosocomiales (CCLIN, Regional Coordinating Centre for Nosocomial Infection Control), Paris-Nord, France.
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35
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Birgand G, Blanckaert K, Carbonne A, Coignard B, Barbut F, Eckert C, Grandbastien B, Kadi Z, Astagneau P. Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006-2007 and associated clusters in 2008-2009. ACTA ACUST UNITED AC 2010; 15. [PMID: 20587362 DOI: 10.2807/ese.15.25.19597-en] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2006 and 2007, a large outbreak of Clostridium difficile infections (CDIs) with PCR-ribotype 027 was identified in northern France. Overall, 38 healthcare facilities notified 529 CDIs over a 22-month period, including 281 laboratory-confirmed CDI 027 and 248 non-confirmed CDI 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). The cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between France and Belgium. An active surveillance and prevention campaign was launched at the first epidemic peak including hygiene precautions for healthcare professionals, which supported healthcare facilities to improve care organisation. The outbreak was controlled at the end of 2007, but sporadic cases were identified until the end of 2009. A bundle of appropriate control measures may halt the spread of such outbreaks, provided that substantial human resources and financial support are available.
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Affiliation(s)
- G Birgand
- Regional coordinating centre for nosocomial infection control, Paris, France.
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36
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Astagneau P, Daniel F, L'heriteau F, Olivier M, Jarno P, Thiolet JM. 215 Surgical site infection surveillance in France: a bench-marking experience through a network during the last decade. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041608.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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37
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Daniel F, L’Hériteau F, Grandbastien B, Coignard B, Astagneau P. La surveillance des infections du site opératoire en France : analyse des tendances entre 1999 et 2006. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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38
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Alseny-Gouly C, Botherel AH, Lebascle K, Daniel F, Astagneau P. Les facteurs de risque des infections du site opératoire après césarienne « étude cas-témoins ». Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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39
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Caillère N, Leroy C, Josseran L, Brun-Ney D, Beaujouan L, Gailhard I, Ilef D, Astagneau P. Évaluation d’une méthode statistique pour l’alerte sanitaire fondée sur le ressenti d’un service d’urgence. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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40
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Birgand G, Carbonne A, Blanckaert K, Kadi Z, Grandbastien B, Coignard B, Barbut F, Astagneau P. Investigation sur deux années d’épidémie de Clostridium difficile ribotype 027 dans le Nord de la France. Rev Epidemiol Sante Publique 2008. [DOI: 10.1016/j.respe.2008.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Miliani K, L'Heriteau F, Alfandari S, Arnaud I, Costa Y, Deliere E, Carbonne A, Astagneau P. Specific control measures for antibiotic prescription are related to lower consumption in hospitals: results from a French multicentre pilot study. J Antimicrob Chemother 2008; 62:823-9. [DOI: 10.1093/jac/dkn277] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Astagneau P. [Les infections nosocomiales par le virus de l'hépatite C : l'arbre qui cache la forêt ?]. Virologie (Montrouge) 2007; 11:405-407. [PMID: 36131463 DOI: 10.1684/vir.2011.7244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- P Astagneau
- Département de santé publique, Faculté de médecine Pierre et Marie Curie, Université Paris VI, Responsable du Centre interrégional de la lutte contre l'infection nosocomiale, Paris Centre biomédical des Cordeliers, 15, rue de l'École-de-Médecine, 75006 Paris
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Blanckaert K, Barbut F, Carbonne A, Poujol I, Thiolet J, Astagneau P, Coignard B. Infections à Clostridium difficile PCR-ribotype 027 (ICD) : épidémiologie et gestion des risques. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1294-5501(07)73926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Blanckaert K, Coignard B, Grandbastien B, Astagneau P, Barbut F. [Update on Clostridium difficile infections]. Rev Med Interne 2007; 29:209-14. [PMID: 18023937 DOI: 10.1016/j.revmed.2007.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 09/08/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE Clostridium difficile is an anaerobic gram positive, spore-forming bacterium which is responsible for 15-25% of antibiotic-associated diarrhea and for more than 95% of pseudomembranous colitis (PMC). This paper will review the main knowledge on C. difficile-associated infections and their recent evolution. CURRENT KNOWLEDGE AND KEY POINTS Since 2003, outbreaks of severe C. difficile-associated diarrhea (CDAD) have been increasingly reported in Canada and the United States. This trend is assumed to be associated with the rapid emergence and spread of a specific clone of C. difficile belonging to PCR-ribotype 027 or North American Pulsotype 1, pulsotype (NAP1). This clone is characterized by the overproduction of toxins A and B and is positive for a third toxin named binary toxin. This clone has spread in UK, in Belgium, in the Netherlands, and, more recently, in France where it has been responsible for large outbreaks mainly in northern France. FUTURE PROSPECTS AND PROJECTS A systematic reporting of C. difficile incidence by health facilities should enable a better assessment of this pathology in France.
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Affiliation(s)
- K Blanckaert
- Centre de coordination de la lutte contre les infections nosocomicales Paris-Nord, 15, rue de L'école-de-médecine, 75006 Paris, France.
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Ngo Y, Maugat S, Duong QT, Nguyen TNH, Astagneau P. [Risk of hepatitis C related to traditional medicine: a case control study in Ho Chi Minh City, Vietnam]. Rev Epidemiol Sante Publique 2007; 55:107-12. [PMID: 17442516 DOI: 10.1016/j.respe.2006.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 11/30/2006] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The transmission of hepatitis C virus (HCV) is strongly associated with blood transfusion and drug abuse. However, in about a third of HCV-infected subjects, the risk factors are not clearly identified though some cases are likely to be healthcare associated. In an Asian country such as Vietnam, invasive procedures used for traditional and beauty care could be potential risk factors. The aim of the present study was to identify the risk factors of HCV infection in a population sample in Ho Chi Minh City. METHOD A case-control study matched by gender and age was performed among blood adults donors at the Centre of hematological diseases and blood transfusion. Cases were defined as blood donors with HCV-positive Elisa. Controls were selected at random among ELISA HCV-negative donors. A standardized questionnaire was used to collect data focusing on invasive medical procedures, beauty care and on invasive procedures related to traditional medicine. RESULT Among the 80 cases and 240 controls, the independent predictors of anti-HCV positivity using a stepwise logistic regression were: blood transfusion, intravenous drug abuse, acupuncture, ventoused scarification and practice of scarification (adjusted odds ratio and IC95%: 3.8 [1.1-13.1], 3.5 [1.7-7.3], 5.4 [2.3-12.7], 5.4 [2.5-11.7], 6.6 [1.6-26.4] respectively). The other risk factors such as past hospitalization surgery, tattooing, being a healthcare worker, or practising tattooing or piercing were not associated with HCV infection. CONCLUSION To be exposed to ventoused scarifications or acupuncture are risk factors for the transmission of HCV in Vietnam. A wide information campaign on hygiene practices for general population as well as the practitioners is needed to ensure safer health cares in traditional medicine.
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Affiliation(s)
- Y Ngo
- Département de santé publique, université Pierre-et-Marie-Curie (Paris-VI), Paris, France
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Rioux C, Grandbastien B, Astagneau P. Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. J Hosp Infect 2007; 66:217-23. [PMID: 17540477 DOI: 10.1016/j.jhin.2007.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 04/06/2007] [Indexed: 10/23/2022]
Abstract
Surgical site infections (SSI) are a key target of nosocomial infection control policy. We evaluated the impact of a six-year surveillance system based on data from INCISO, a network of volunteer surgical wards from hospitals in Northern France. Each year surgical patients were enrolled consecutively and surveyed during their in- and out-hospital stay until 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria and several risk factors such as wound class, American Society of Anesthesiologists score, operation duration, elective/emergency, videoscopy and type of surgery. A dashboard was displayed at the end of each annual survey, so that participants could compare with other surgery adjusted for National Nosocomial Infections Surveillance system (NNIS) risk index and standardised incidence ratio (SIR). Over the six years, 3661 SSI were identified in 150 440 surgical patients (crude incidence: 2.4%) from 548 surgery wards. The crude SSI incidence decreased from 3.8 to 1.7% (P for trend <0.0001, relative reduction: -55%) and the NNIS-0 adjusted SSI incidence from 2.0 to 1% (P for trend <0.0001; relative reduction: -50%). An active surveillance system striving for benchmark through a network is an effective strategy to reduce SSI incidence. Sustaining control efforts have to be made to maintain low SSI level beyond the three primer years.
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Affiliation(s)
- C Rioux
- Regional Co-ordinating Centre for Nosocomial Infection Control, Paris, France.
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47
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Blanckaert K, Barbut F, Coignard B, Grandbastien B, Astagneau P. Clostridium difficile and hand hygiène. Med Mal Infect 2007. [DOI: 10.1016/s0399-077x(07)80024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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L'Hériteau F, Olivier M, Maugat S, Joly C, Merrer J, Thaler F, Grandbastien B, Beaucaire G, Astagneau P. Impact of a five-year surveillance of central venous catheter infections in the REACAT intensive care unit network in France. J Hosp Infect 2007; 66:123-9. [PMID: 17517447 DOI: 10.1016/j.jhin.2007.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 03/22/2007] [Indexed: 11/30/2022]
Abstract
Central venous catheter (CVC)-related infections (CRIs) are a key target for infection control in intensive care units (ICUs). The aim of this study was to describe temporal trends of CRI incidence in a network of volunteer ICUs in Northern France. During a 4 month surveillance period each year, all CVCs in place for more than 48h were prospectively followed until removal or patient discharge. Standard clinical and microbiological criteria were used to define colonization and CRI. The standardized incidence ratio (SIR) was estimated by dividing the number of observed CRIs by the number of expected CRIs, which was computed using a logistic regression model including risk factors for CRI. CRI incidence and SIR were fed back to ICUs as a benchmark at the end of each period. From 2001 to 2005, 135 ICUs participated for at least one surveillance period. Overall, 11 703 CVC in 9182 patients (122 495 CVC-days) were included. CRI incidence was 2.8 per 1000 CVC-days. Among 35 ICUs that participated for three or more consecutive periods, CRI incidence decreased significantly by 58.6%. SIR also decreased significantly from the first to the third surveillance period in these ICUs. These results suggest that surveillance programmes have a significant impact on CRI risk in ICUs and remain an important strategy for combating nosocomial infections in these settings.
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Affiliation(s)
- F L'Hériteau
- Regional Coordinating Centre for Nosocomial Infection Control, Institut Biomédical des Cordeliers, 15-21 rue de l'Ecole de Médecine, 75006 Paris, France.
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Carbonne A, Arnaud I, Coignard B, Trystram D, Marty N, Maugat S, Fosse T, Savey A, Dumartin C, Senechal H, Bertrand X, Bajolet O, Astagneau P, Jarlier V. O364 Multidrug-resistant bacteria surveillance, France, 2002–2005. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miliani K, L'Heriteau F, Arnaud I, Carbonne A, Astagneau P. P2096 Are recommendations for antibiotic use related to antibiotic consumption in hospital? Results from a French surveillance network. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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