Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene

In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.

Radiative relaxation in isolated large carbon clusters: Vibrational emission versus recurrent fluorescence

Recurrent fluorescence (RF) from isolated carbon clusters containing between 24 and 60 atoms is theoretically investigated as a function of internal energy, cluster size, and structural features. The vibrational relaxation kinetics and the associated IR emission spectra are determined by means of a Monte Carlo approach with vibrational density of states computed in the harmonic approximation. RF is generally found to be highly competitive with vibrational emission. The behaviors predicted for clusters of various sizes and archetypal structures indicate that the IR emission spectra are strongly influenced by RF, an energy gap law being obtained for the evolution of the RF rate constant depending on the electronic excitation state. The present results are relevant to the photophysics of the interstellar medium and could contribute to elucidating the carriers of the extended red emission bands and the continuum emission lying below the aromatic infrared bands believed to originate from mixed aromatic–aliphatic compounds.

Atomistic modeling of the infrared response of fullerenes under hydrostatic pressure

The anharmonic infrared spectrum of individual C₆₀ and C₇₀ fullerenes under hydrostatic pressure was theoretically computed by means of atomistic simulations. Using a tight-binding model for the fullerenes and a simple particle-based pressure-transmitting fluid, the structural and vibrational properties were determined at room temperature and up to 20 GPa. All properties generally exhibit relative variations that are linear with increasing pressure, but whose magnitude can be comparable to pure thermal effects. The bond length contraction usually agrees with existing results, and for C₇₀ our approach manages to reproduce the occasionally negative pressure coefficient found for some low-frequency modes in experiments.

Size Effect in the Ionization Energy of PAH Clusters

We report the first experimental measurement of the near-threshold photoionization spectra of polycyclic aromatic hydrocarbon clusters made of pyrene C16H10 and coronene C24H12, obtained using imaging photoelectron-photoion coincidence spectrometry with a VUV synchrotron beamline. The experimental results of the ionization energy are compared to calculated ones obtained from simulations using dedicated electronic structure treatment for large ionized molecular clusters. Experiment and theory consistently find a decrease of the ionization energy with cluster size. The inclusion of temperature effects in the simulations leads to a lowering of this energy and to quantitative agreement with the experiment. In the case of pyrene, both theory and experiment show a discontinuity in the IE trend for the hexamer. This work demonstrates the ability of the models to describe the electronic structure of PAH clusters and suggests that these species are ionized in astronomical environments where they are thought to be present.

Surveillance of Occupational Blood and Body Fluid Exposures Among French Healthcare Workers in 2004

Objective.

To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs).

Design.

Prospective national follow-up of HCWs from January 1 to December 31, 2004.

Setting.

University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis.

Participants.

At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire.

Results.

A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time—equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time—equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures.

Conclusion.

National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.

Intramolecular Processes Revealed Using UV-Laser-Induced IR-Fluorescence: A New Perspective on the "Channel Three" of Benzene

Radiative relaxation in the infrared (IR) is common following nonradiative electronic relaxation processes, but it is rarely measured. We present ultraviolet laser-induced infrared fluorescence (UV-LIIRF) excitation spectroscopy and dispersed UV-LIIRF spectroscopy of gas phase benzene vibronically excited around the onset of channel 3, using a homemade spectrometer. We found that the vibrational IR fluorescence yield is clearly higher when benzene is excited above the onset than when it is excited below. Significant changes in dispersed IR emission profiles resulting from excitations below and above the onset of channel 3 were also observed. These results suggest that isomerization of benzene toward fulvene occurs efficiently below the opening of channel 3 and confirm that channel 3 involves a photophysical relaxation pathway that efficiently competes with isomerization.

Low-energy vibrational spectra of flexible diphenyl molecules: biphenyl, diphenylmethane, bibenzyl and 2-, 3- and 4-phenyltoluene

Gas phase spectra of six bi-phenyl molecules are reported allowing an accurate determination of their active low-frequency vibrational modes.

Validation of the French version of the Hospital Survey on Patient Safety Culture questionnaire

OBJECTIVE

To assess the psychometric properties of the French version of the Hospital Survey on Patient Safety Culture questionnaire (HSOPSC) and study the hierarchical structure of the measured dimensions.

DESIGN

Cross-sectional survey of the safety culture.

SETTING

18 acute care units of seven hospitals in South-western France.

PARTICIPANTS

Full- and part-time healthcare providers who worked in the units.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Item responses measured with 5-point agreement or frequency scales. Data analyses A principal component analysis was used to identify the emerging components. Two structural equation modeling methods [LInear Structural RELations (LISREL) and Partial Least Square (PLS)] were used to verify the model and to study the relative importance of the dimensions. Internal consistency of the retained dimensions was studied. A test-retest was performed to assess reproducibility of the items.

RESULTS

Overall response rate was 77% (n = 401). A structure in 40 items grouped in 10 dimensions was proposed. The LISREL approach showed acceptable data fit of the proposed structure. The PLS approach indicated that three dimensions had the most impact on the safety culture: 'Supervisor/manager expectations & actions promoting safety' 'Organizational learning-continuous improvement' and 'Overall perceptions of safety'. Internal consistency was above 0.70 for six dimensions. Reproducibility was considered good for four items.

CONCLUSIONS

The French HSOPSC questionnaire showed acceptable psychometric properties. Classification of the dimensions should guide future development of safety culture improving action plans.

Temperature effects on the rovibrational spectra of pyrene-based PAHs

Absorption infrared spectra have been computed for a variety of polycyclic aromatic hydrocarbon molecules of the pyrene family, taking into account anharmonicity and temperature effects, rovibrational quantization, and couplings. The energy levels are described by a second-order perturbative expansion of the rovibrational Hamiltonian in the vibrational and rotational quantum numbers, as relevant for a symmetric-top molecule, with ingredients obtained from quantum chemistry calculations. Multicanonical Monte Carlo simulations are carried out to compute bidimensional IR intensity histograms as a function of total energy and vibrational frequency, which then provide the absorption spectrum at arbitrary temperatures via a Laplace transformation. The main spectral features analyzed for neutral, anionic, and cationic pyrene indicate a strong dependence on temperature, in agreement with existing laboratory experiments, and a significant contribution of rotational degrees of freedom to the overall broadenings. The spectral shifts and broadenings reveal some sensitivity of anharmonicities to the charge and protonation states and, in the case of protonated pyrene and pyrenyl cation, on possible isomers and between aromatic and aliphatic C-H bands. Implications of the present work to the general issue of interstellar emission features are discussed.

Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005-2008

French hospitals are required to implement antibiotic stewardship programmes (ABS) to improve antibiotic use. We analysed the legal framework on ABS and assessed its impact on hospitals' ABS development in Southwestern France. For each official text, required measures, date of issue, means of control and incentives were analysed. Annual retrospective surveys were conducted in 84 hospitals from 2005 to 2008 to monitor implementation of ABS components: organisation, resources and actions. Evolution of individual measures and of a structure and process indicator (SPI) reflecting ABS was described for each hospital. From 2002, official texts issued by health authorities set out requirements on ABS, based on previous professional guidelines. Incentives and means of control were reinforced in 2006 and in 2007 with mandatory reporting of SPI for public disclosure. ABS implementation improved during the course of the study period. In 2008, at least 98% of hospitals had implemented formularies, antibiotic committees, surgical prophylaxis guidelines, and monitored antibiotic use; antibiotic advisors were appointed in 85% of hospitals. Little progress was made regarding time dedicated by pharmacists to antibiotic management and restrictive dispensation using stop-orders. Computerised tools, continuing education and audits remained under-used. SPI values were higher in private hospitals and rehabilitation centres than in others. Official texts and the SPI public disclosure increased professionals' and hospital managers' commitment to develop ABS, resulting in improvements. However, some actions still need to be reinforced. It appears crucial to monitor practical implementation to better approach ABS effectiveness and to adapt requirements.

Phase space theory of evaporation in neon clusters: the role of quantum effects

Unimolecular evaporation of neon clusters containing between 14 and 148 atoms is theoretically investigated in the framework of phase space theory. Quantum effects are incorporated in the vibrational densities of states, which include both zero-point and anharmonic contributions, and in the possible tunneling through the centrifugal barrier. The evaporation rates, kinetic energy released, and product angular momentum are calculated as a function of excess energy or temperature in the parent cluster and compared to the classical results. Quantum fluctuations are found to generally increase both the kinetic energy released and the angular momentum of the product, but the effects on the rate constants depend nontrivially on the excess energy. These results are interpreted as due to the very few vibrational states available in the product cluster when described quantum mechanically. Because delocalization also leads to much narrower thermal energy distributions, the variations of evaporation observables as a function of canonical temperature appear much less marked than in the microcanonical ensemble. While quantum effects tend to smooth the caloric curve in the product cluster, the melting phase change clearly keeps a signature on these observables. The microcanonical temperature extracted from fitting the kinetic energy released distribution using an improved Arrhenius form further suggests a backbending in the quantum Ne(13) cluster that is absent in the classical system. Finally, in contrast to delocalization effects, quantum tunneling through the centrifugal barrier does not play any appreciable role on the evaporation kinetics of these rather heavy clusters.

Temperature and anharmonic effects on the infrared absorption spectrum from a quantum statistical approach: application to naphthalene

A method is developed to calculate the finite-temperature infrared absorption spectrum of polyatomic molecules with energy levels described by a second-order Dunham expansion. The anharmonic couplings are fully incorporated in the calculation of the quantum density of states, achieved using a Wang-Landau Monte Carlo procedure, as well as in the determination of transition energies. Additional multicanonical simulations provide the microcanonical absorption intensity as a function of both the absorption wavelength and the internal energy of the molecule. The finite-temperature spectrum is finally obtained by Laplace transformation of this microcanonical histogram. The present scheme is applied to the infrared spectrum of naphthalene, for which we quantify the shifting, broadening, and third-order effects as a continuous function of temperature. The influence of anharmonicity and couplings is manifested on the nontrivial variations of these features with increasing temperature.

Evidence for cluster shape effects on the kinetic energy spectrum in thermionic emission

Experimental kinetic energy release distributions obtained for the thermionic emission from C(n) (-) clusters, 10< or =n< or =20, exhibit significant non-Boltzmann variations. Using phase space theory, these different features are analyzed and interpreted as the consequence of contrasting shapes in the daughter clusters; linear and nonlinear isomers have clearly distinct signatures. These results provide a novel indirect structural probe for atomic clusters associated with their thermionic emission spectra.

Relationship between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from 47 French hospitals

OBJECTIVE

To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals.

METHODS

We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days.

SETTING

Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested.

RESULTS

In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR(2)], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR(2), 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care ( aR(2), 0.28).

CONCLUSIONS

A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.

Outbreak of staphylococcal bullous impetigo in a maternity ward linked to an asymptomatic healthcare worker

An outbreak of staphylococcal bullous impetigo occurred over a period of five months in a maternity ward involving seven infected and two colonised neonates. The skin lesions were due to epidermolytic toxin A-producing Staphylococcus aureus. Infection control measures were implemented and a retrospective case-control study performed. Contact with an auxiliary nurse was the only risk factor for cases of bullous impetigo (P<0.01). The nurse cared for all seven cases and was an asymptomatic nasal carrier of the epidemic strain. Repeated courses of decontamination treatment failed to eradicate carriage. Nine months after the last case, another neonate developed a more severe form of bullous impetigo and the auxiliary nurse was reassigned to an adult ward.

Relation entre politique de bon usage et consommation des antibiotiques dans les établissements de santé

OBJECTIVE

The authors had for aim to study the relationship between antibiotic policies and antibiotic consumption in hospitals.

DESIGN

A component analysis was used to summarize the various measures of the antibiotic policies developed by hospitals. Antibiotics consumption was expressed as a number of Daily Defined Doses per 1,000 patient-days. The relation was studied by a multiple linear regression model with adjustment on hospital activity.

RESULTS

The first component illustrated an active program of antibiotic policies associating: a local antibiotic committee, an infectious diseases consultant, written local guidelines for prescriptions and restrictive measures before dispensing. The highest antibiotic consumption was associated with active policies, especially for carbapenems, glycopeptides, and aminoglycosides. However the relationship differed according to the type of hospital, with lower antibiotic consumption, especially for penicillins, in private hospitals that had more active policies.

CONCLUSION

The difference between public and private hospitals could be explained by the type of institution but also by the unit used to measure antibiotic consumption.

Multiscale dynamics of cluster fragmentation

The fragmentation of rare-gas clusters is theoretically investigated over time scales ranging from ionization and electronic excitation ( approximately fs) up to experimentally relevant times ( approximately ms). For this purpose a combination of methods are used, including nonadiabatic molecular dynamics, classical dynamics on the ground electronic state surface, and a kinetic description for the final evaporative cascade. The present multiscale protocol shows that, although the clusters are strongly out of equilibrium upon excitation, the long-time properties appear as statistical already after 1 ps.

Theoretical Rates for the Emission of Atomic Hydrogen from a Naphthalene Cation

The statistical phase space theory (PST) in its orbital transition state version has been used to calculate the dissociation rate associated with the loss of atomic hydrogen from a polycyclic aromatic hydrocarbon molecule. The PST model has been applied to the naphthalene cation with input data obtained exclusively from first-principle calculations using density functional theory. Without any fitting parameters, the calculated dissociation rates are found to agree well with available measurements. The effects of vibrational anharmonicities are investigated and are shown to lower the dissociation rates by a factor of about five.

Accurate modeling of sequential decay in clusters over long time scales: Insights from phase space theory

A general theoretical framework for describing the thermally induced sequential decay in atomic clusters is presented. The scheme relies on a full treatment of individual dissociation steps based on phase space theory (PST), built into a kinetic Monte Carlo (kMC) procedure. This combined PST/kMC approach allows one to follow the evolution of several statistical properties such as the size, the angular momentum, or the temperature of the cluster over arbitrarily long time scales. Quantitative accuracy is achieved by incorporating anharmonicities of the vibrational densities of states, the rigorous conservation of angular momentum via the effective dissociation potential, and a proper calibration of the rate constants. The approach is tested and validated on selected Lennard-Jones clusters in various situations. Several approximations, including a mean-field rate equation treatment, are critically discussed; possible extensions are presented.

Les accidents d’exposition au sang chez les sages-femmes dans les maternités françaises

OBJECTIVE

Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession.

MATERIAL AND METHOD

During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database.

RESULTS

169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments.

CONCLUSION

Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

Politique d'utilisation des antibiotiques : état des lieux dans 99 établissements de santé de l'interrégion Sud-Ouest

OBJECTIVE

Increasing antimicrobial resistance in bacteria is a major health problem and requires the implementation of stringent policies to optimize the use of antibiotics.

DESIGN

In 2003 the authors conducted a study in southwestern French hospitals, using a questionnaire to assess the implementation of antibiotic policies according to national guidelines issued by the French government in 2002.

RESULTS

The most frequent actions quoted by the 99 respondents were: issuing of a list of available antibiotics, issuing of information regarding antibiotic consumption and bacterial resistance, and control of antibiotics dispensation. Local guidelines were available in 45% of hospitals for curative treatment and in 87% for antibioprophylaxis in surgery. The evaluation of antibiotic use and computer links between clinical settings, pharmacy and microbiology lab were the less widespread measures. The number and type of actions were related to hospital size and activity.

CONCLUSIONS

These findings support that policies for an appropriate use of antimicrobials should be reinforced by issuing treatment guidelines and specific tools for dispensation and evaluation. This survey also emphasizes the need for appropriate policies relating to the size and medical activities of healthcare institutions.

Temperature Measurement from the Translational Kinetic Energy Release Distribution in Cluster Dissociation: A Theoretical Investigation

Unimolecular dissociation of neutral and charged argon clusters is theoretically investigated in the context of calorimetric measurements. The temperature of the product cluster is estimated from the distribution of the translational kinetic energy released (KER), assumed to have the form f(epsilon) approximately epsilon(alpha) exp(-epsilon/k(B)T). Phase space theory (PST) in its orbiting transition state (OTS) version is validated by comparing its predictions to the results of large-scale molecular dynamics simulations. The temperatures estimated from the KER distributions are seen to be generally lower than the actual microcanonical temperature computed from independent Monte Carlo simulations of the product cluster at thermal equilibrium. On the basis of these deviations, the various approximations leading from the rigorous PST/OTS treatment to the assumed exponential form are critically discussed. In the case of Ar(n)(+) clusters, the use of a quantum diatomic-in-molecules Hamiltonian constructed from recent ab initio calculations reveals some possible inadequacies of the 1/r(4) ion/dipole interaction at intermediate distances due to some residual charge transfer.