[Economic and organizational impact of the use of a disposable sheath with a flexible cystoscope]. / Cystoscope flexible à gaine stérile à usage unique: impact organisationnel et économique et sécurité bactériologique.

PURPOSE: To assess both economical and organizational impact as well as bacteriologic safety of a flexible cystoscope with sterile disposable sheath (FCSDS) compared to standard flexible cystoscopy (SFC) in two French urologic academic units. PATIENTS: Two-center prospective study, comparing the use of the FCSDS to the SFC on two consecutive periods of time. Two hundred and five patients were included and divided into each group. Duration procedures and costs were analysed in the two techniques. The urinary tract infection rate was also described. A dedicated sheaths leaks test after use was performed systematically. RESULTS: The preparation time of the fibroscope was longer for the sheathed cystoscopy group: 16.2 minutes versus 10.9 minutes for the standard group. The mean duration of disinfection was significantly shorter for the sheathed cystoscopy group: 53.8 minutes saved compared to the standard group; 99.01% of the tested sheaths, after their use, had no breaches. Urinary tract infections rate were similar in the two groups. The average cost of a sheathed cystoscopy compared to the standard was significantly cheaper in Lyon and almost equivalent in Marseille. CONCLUSION: The FCSDS allows significant saving over the disinfection duration, consumable costs and staff costs, while ensuring patient bacteriologic safety similar to SFC.

Species-driven interpretation guidelines in case of a single-sampling strategy for blood culture.

The purpose of this paper is to define guidelines to interpret positive blood cultures (BCs) to distinguish bloodstream infection (BSI) from contamination in BCs drawn with a single venipuncture. During a 2-year period, each positive BC set (comprising six bottles from a single venipuncture) was prospectively categorised by clinicians, bacteriologists and hospital epidemiologists as BSI or contamination. For each case, the number of positive bottles per set, results from Gram staining and microorganism identification were analysed in order to define interpretation guidelines. We analysed 940 positive BC sets. The BSI rate in monomicrobial BC sets was positively correlated with the number of positive bottles. The positive predictive value was 88% with one and 100% with ≥2 positive bottles for Escherichia coli; 100% for Staphylococcus aureus, Pseudomonas and Candida spp., regardless of the number of positive bottles; 3.5%, 61.1%, 78.9% and 100% for coagulase-negative staphylococci (CoNS) with one, two, three and ≥4 positive bottles, respectively. Using a single-sampling strategy, interpretation guidelines for monomicrobial positive BCs are based on the number of positive bottles per set, results from Gram staining and microorganism identification: ≥4 positive bottles (≥2 with Gram-negative bacilli) always led to a diagnosis of BSI. The CoNS BSI rate positively correlates with the number of positive bottles.

[Management of infectious risk associated with therapeutic pools]. / Gestion des risques infectieux liés aux piscines et bains collectifs à usage médical.

UNLABELLED: There is no specific legislation concerning pools and others medical hydrotherapy equipments relating hygiene and security rules. For this reason, the hydrotherapy pools use the public swimming pools legislation. METHOD: This article is based on literature review (database Medline and Embase--manual research). RESULTS: This article offers a review of pool associated infections along with the description of the measures designed to minimise the possible transmission of infection during hydrotherapy activities such as: Technical measures: pool and premises conception, water treatments, feed tanks, air quality. Hygiene rules for patients and hospital staff and pathologies which are contra-indications to hydrotherapy activities. Microbiological and physico-chemical monitoring. DISCUSSION: The infectious risk remains low with therapeutic pools. However, the development of specific legislation and surveillance should be enhanced. CONCLUSION: All these measures are part of the quality assurance program that must be implemented to control the safety of these installations.

Detecting related cases of bloodstream infections using time-interval distribution modelling.

An algorithm was designed to highlight related bloodstream infections using data from a nosocomial infection surveillance system to help local public health authorities direct specific measures towards clusters of cases. The approach was based on a two-step procedure. The first was a test to identify pathogens with an abnormal number of close cases. The second modelled, for the identified pathogens, the distribution of time intervals between successive cases as a mixture of two theoretical distributions in order to determine a threshold below which a specific investigation is required. The algorithm was applied to bloodstream infection surveillance data collected during a 10-year period (1996-2005) in an 878-bed teaching hospital (24 wards) in Lyon, France. The first step identified seven pathogens among the 18 being studied. The modelling succeeded in setting time thresholds to spot clusters of cases requiring further investigation with defined sensitivity and specificity. Setting the sensitivity level at 95%, the threshold values ranged from 24 days (Acinetobacter baumannii) to 294 days (Enterobacter cloacae); the specificity was higher than 70% (up to 97.5% for A. baumannii) except for E. cloacae (52.1%). Setting the specificity level at 95% resulted in a decrease in sensitivity except for A. baumannii (it reached nearly 100%); it fell below 50% for three pathogens: around 40% for Streptococcus pneumoniae and Enterococcus faecalis and 25% for Enterobacter cloacae. The threshold values then ranged from 8 days (S. pneumoniae) to 67 days (Streptococcus pyogenes). The approach proved promising though further refinements are needed before routine use.

[Monoarthritis caused by Streptococcus pyogenes after nasal septoplasty: interest of the nasal decontamination in preoperative care]. / Monoarthrite àStreptococcus pyogenes dans les suites d'une septoplastie: intérêt de la décontamination nasale en préopératoire.

The nasal septoplasty is a very current intervention in otorhinolaryngology surgery. The infectious complications of this intervention are rare and mostly mild. We report here the case of a patient hospitalized in ambulatory surgery within a fracture of the nose with luxation of the septum in the nasal fossa. This patient was operated for a reduction of this fracture with septoplasty. Twelve hours after the intervention the patient presented septic arthritis due to Streptococcus pyogenes. The tracks of prevention are presented.