Characteristics and costs of carbapenemase-producing enterobacteria carriers (2012/2013)

OBJECTIVES

We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours.

PATIENTS AND METHODS

We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs.

RESULTS

Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution.

CONCLUSIONS

Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units.

Bacteriological validation of a new apparatus for disinfection of hospital waste at the point of disposal

OBJECTIVES

To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste.

METHODS

Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate.

RESULTS

In all treated carriers, a bacterial population decrease of at least 5 log10 was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10 was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10 and 10 log10 for vegetative anaerobes of normal fecal flora.

CONCLUSION

Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.

[Seroprevalence of hepatitis B and C viruses in a psychiatric institution]

Many patients admitted to psychiatric institutions have a history of risk factors for contamination with the hepatitis B and C viruses (HBV and HCV). Immunization policies for psychiatric institution patients are not widely know. A study conducted in a 600-bed psychiatric institution in Paris, France, to evaluate the proportion of potentially contaminating patients at admission, as well as immunization use in HBV-negative patients. Serologic markers for the HBV and HCV were looked for prospectively in all patients admitted over a two-month period. Immunization use was evaluated in the patients who had a first serologic test in 1995 or 1996 and follow-up tests until the end of 1997. The prospective part of the study demonstrated preadmission exposure to the HBV in 23.0 +/- 6.0% of patients. This proportion was larger in men (26.0%) than in women (14.8%), although the difference was not statistically significant (P = 0.10). Four patients (2.0%) tested positive for the HbS Ag. Among the HBV-negative patients, 13.0% received the vaccine; all had protective antibody levels. These patients were younger and more likely to be first-time admissions (18.4% vs 3.6%, P < 0.01). HCV seroprevalence was 6.0%. Serologic tests for the HBV were requested for 327 patients between January 1995 and december 1996. Among the patients who were seronegative at admission and received follow-up at the study hospital, only 13.8% were immunized at this hospital. Of the HCV-positive subjects, 63.3% were also HBV-positive. None of the HCV-positive HBV-negative subjects received immunization subsequently. Six to eight per cent of patients admitted to the study hospital are potentially contaminating for the HBV or HCV. The level of hepatitis B vaccine use is too low, particularly in high-risk patients. These data indicate a need for policies aimed at effectively preventing HBV and HCV transmission (information, education, immunization campaigns), both during the psychiatric institution stay and after discharge.