[Tuberculosis and healthcare workers: Risk reduction and disease prevention in health care settings]. / Tuberculose et personnel soignant : prévention du risque en milieu de soins.

Tuberculosis is a human disease caused by Mycobacteriumtuberculosis, and transmitted by airborne pathway. Documented cases of tuberculosis infection in healthcare workers have been reported in both developed and developing countries. Early recognition of potentially infectious cases, immediate implementation of airborne precautions and prompt medical treatment of cases, are required to lower the risk of disease transmission. Molecular biology techniques allow earlier diagnosis. In the event of non-compliance with airborne precautions, the investigation will further have to establish exhaustive lists of potentially exposed healthcare workers and patients, looking for cases of latent tuberculosis infections whose treatment should help avoid active tuberculosis disease.

Maternity staff immunization coverage against pertussis and maternal vaccination practices: Results of a 2017 cross-sectional survey in five public maternity hospitals.

OBJECTIVES: To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. MATERIALS AND METHODS: 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. RESULTS: Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine "often" or "very often". CONCLUSIONS: Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

[Nasopharyngeal carriage of SARS-CoV-2 among health personnel with symptoms suggestive of COVID-19 in a University Hospital in the Paris suburbs]. / Évaluation par RT-PCR du portage nasopharyngé du SARS-Cov-2 chez les personnels de santé symptomatiques suspects de COVID-19 dans un CHU de la banlieue parisienne.

INTRODUCTION: A consultation dedicated to symptomatic health professionals was opened at the beginning of the COVID-19 epidemic in order to meet the specific needs of this population. The objective of this work was to estimate the frequency of SARS-Cov-2 nasopharyngeal carriage in symptomatic healthcare workers suspected of having COVID-19 and to determine the factors associated with this carriage. METHODS: Of the 522 consultants, 308 worked in the Hospital and 214 outside. They had mild forms of COVID-19 and non-specific clinical signs with the exception of agueusia/anosmia, which was significantly more common in those with positive RT-PCR. The rate of RT-PCR positivity was 38% overall, without significant difference according to profession. It was higher among external consultants (47% versus 31%). In the hospital, this rate was significantly lower for symptomatic staff in the care sectors, compared to staff in the technical platforms and laboratories (24%, versus 45%, p = 0.006 and 54%, respectively, p < 0.001), but did not differ between staff in COVID units and other care sectors (30% versus 28%). Among the external consultants, the positivity rates of nursing home and private practices staff (53% and 55% respectively) were more than double that of acute care hospital staff (24%, p < 0.001). CONCLUSIONS: These data confirm the strong impact of COVID-19 on health professionals. The higher positivity rates among symptomatic professionals working outside the hospital compared to those working in hospital may be explained in part by a shortage of protective equipment and by difficulties in accessing virological diagnosis, which were greater outside the hospital when the epidemic began.

Role of safety-engineered devices in preventing needlestick injuries in 32 French hospitals.

OBJECTIVES: To evaluate safety-engineered devices (SEDs) with respect to their effectiveness in preventing needlestick injuries (NSIs) in healthcare settings and their importance among other preventive measures. DESIGN: Multicenter prospective survey with a 1-year follow-up period during which all incident NSIs and their circumstances were reported. Data were prospectively collected during a 12-month period from April 1999 through March 2000. The procedures for which the risk of NSI was high were also reported 1 week per quarter to estimate procedure-specific NSI rates. Device types were documented. Because SEDs were not in use when a similar survey was conducted in 1990, their impact was also evaluated by comparing findings from the recent and previous surveys. SETTING: A total of 102 medical units from 32 hospitals in France. PARTICIPANTS: A total of 1,506 nurses in medical or intensive care units. RESULTS: A total of 110 NSIs occurring during at-risk procedures performed by nurses were documented. According to data from the 2000 survey, use of SEDs during phlebotomy procedures was associated with a 74% lower risk (P<.01). The mean NSI rate for all relevant nursing procedures was estimated to be 4.72 cases per 100,000 procedures, for a 75% decrease since 1990 (P<.01); however, the decrease in NSI rates varied considerably according to procedure type. Between 1990 and 2000, decreases in the NSI rates for each procedure were strongly correlated with increases in the frequency of SED use (r=0.88; P<.02). CONCLUSION: In this French hospital network, the use of SEDs was associated with a significantly lower NSI rate and was probably the most important preventive factor.

Risk of needlestick injuries by injection pens.

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.

Cardiovascular effects in the rat of intrathecal injections of apomorphine at the thoracic spinal cord level.

Intrathecal (i.t.) administration of apomorphine at the upper thoracic level lowered blood pressure and heart rate in awake rats. This decrease was dose-dependent and competitively antagonized by haloperidol (i.v. and i.t.) or domperidone (i.t.) but not by domperidone (i.v.). Furthermore, these effects of apomorphine were not affected by alpha- and beta-blocking drugs (i.t.). The results suggest a spinal site, at least in part, for the cardiovascular effect of apomorphine.

Management of accidental exposure to HIV: the COREVIH 2011 activity report.

BACKGROUND: Post-exposure prophylaxis (PEP) relies on procedures allowing quick access to treatment in case of accidental exposure to viral risk (AEV). Occupational blood exposure (OBE) affects mainly caregivers; these accidents are monitored and assessed by the inter-regional center for nosocomial infections (C-CLIN), occupational physicians, and infection control units. They are classified apart from sexual exposure for which there is currently no monitoring. METHODS: Data was extracted from the COREVIH (steering committee for the prevention of HIV infection) 2011 activity reports (AR), available online. Data collection was performed using a standardized grid. RESULTS: Twenty-four out of 28 AR were available online. Nine thousand nine hundred and twenty AEV were reported, 44% of OBE, and 56% of sexual and other exposures. PEP was prescribed in 8% of OBE and in 77% of sexual exposures. The type of PEP was documented in 52% of the cases. Follow-up was poorly documented. CONCLUSION: AR provide an incomplete and heterogeneous review of exposure management without any standardized data collection. The difficulties encountered in data collection and monitoring are due to differences in care centers (complex patient circuits, multiple actors) and lack of common dedicated software. Sexual exposures account for 50% of AEV and most are treated; but they are incompletely reported and consequently not analyzed at the regional or national level. A typical AR collection grid is being studied in 2 COREVIH, with the objective to improve collection and obtain useful national data.

Effectiveness of respirator masks for healthcare workers, in France.

OBJECTIVE: The authors had for objective to evaluate the air-tightness of FFP2 respirator masks used by healthcare workers, with a quantitative fit-test protocol. MATERIALS AND METHODS: This test measures the number of ambient particles inside and outside the respirator mask. The ratio between both is called fit-factor. The fit-test is successful for an FFP2 respirator mask when the fit-factor is equal or superior to 100. The tests were performed in three hospitals. Nine types of FFP2 respirator masks were fit-tested, classified in three groups: hard shell, duckbill, and flat-fold respirator masks. RESULTS: One hundred and eighty fit-tests were performed. Less than a third of the fit-tests were successful (35/130). The rate of successful tests was higher with flat-fold (57.5%, 23/40) than with duckbill (18.3%, 11/60), or hard shell respirator masks (3.3%, 1/30), (P<0.05). Zero to 60% of healthcare workers had a successful fit-test with the respirator masks used in each hospital. This percentage increased with the number of tested respirator masks. No 100% success rate was ever reached in any hospital with the three tested respirator masks. CONCLUSION: Duckbill, and flat-fold respirator masks seem to be better adapted for healthcare workers than hard shell respirator masks. It seems necessary to implement new recommendations for respiratory protection in France. At least two types of respirator masks with various sizes and shape should be available and fitting controls should be performed with respirator masks that are worn by healthcare workers exposed to infectious risks.

Hypotensive and bradycardic effects elicited by spinal dopamine receptor stimulation: effects of D1 and D2 receptor agonists and antagonists.

In anesthetized rats, intrathecal (i.t.) administration, at the upper thoracic level of the spinal cord of fenoldopam (a selective dopamine D1-receptor agonist) or quinpirole (a selective D2-receptor agonist) decreased blood pressure (BP) and heart rate (HR) in a dose-dependent manner. Apomorphine, a nonselective DA receptor agonist, produced similar effects. Apomorphine-induced hypotension was competitively antagonized by either SCH 23390 or remoxipride, selective D1- and D2-receptor antagonists, respectively, but only remoxipride antagonized the bradycardia. Furthermore, SCH 23390 antagonized the hypotensive effect of fenoldopam but did not change that induced by quinpirole. Remoxipride antagonized the hypotensive effect of quinpirole but did not alter the hypotensive effect of fenoldopam. Quinpirole-induced bradycardia was antagonized only by remoxipride. Bradycardia elicited by fenoldopam did not appear to be generated by dopamine receptor stimulation, as suggested by the lack of blocking effects of SCH 23390 and remoxipride. Data obtained with fenoldopam were corroborated with use of SK&F 38393, another dopamine D1-receptor agonist. We conclude that hypotensive effects of i.t.-administered DA receptor agonists appear to result from activation of spinal D1- and D2-receptors whereas bradycardia is related only to activation of spinal D2-receptors.

Rostrocaudal localization of cardiovascular responses induced by intrathecal administration of apomorphine in conscious, freely moving rats.

In conscious freely moving rats, administration of apomorphine (179 nmol), a dopamine receptor agonist, into the intrathecal (i.t.) space decreased mean aortic blood pressure (MBP) and heart rate (HR). Both the magnitude and the time of appearance of the response varied according to the spinal level of administration. The largest and immediately appearing effect was observed after the injection at the upper thoracic site, whereas the magnitude of the responses was smaller with an immediate or slightly delayed (0.5-1.5 min) onset at lower thoracic and midcervical levels. More caudal responses appeared to be due to spreading of the drug along the spinal axis (onset in 1-2 min after administration). Behavioral responses (stereotyped movements) were observed within 2-3 min after administration and were nearly the same whatever the site of administration. These results corroborate, as do those provided by i.t. injections of tritiated apomorphine, the spinal origin of cardiovascular effects of i.t. apomorphine. Furthermore, spinal transection at the T5-T7 level did not change the magnitude and duration of decreases in MBP and HR elicited by i.t. apomorphine injected at the T2-T4 level. Moreover, this procedure enhanced responses to i.t. administration at the T9-T10 level. In conclusion, these results favor the existence of a spinal site of action for the cardiovascular effects of apomorphine. Furthermore, they indicate that spinal transection is accompanied by development of a hypersensitive phenomenon (of a mechanism to be determined).

[The spinal dopaminergic system]. / Le système dopaminergique spinal.

A new dopaminergic innervation has been described quite recently: the dopaminergic spinal cord system. In this review are presented the different steps which lead to the individualization of this dopaminergic system and the reported results actually available concerning its probable anatomical organization. Finally, most of the data which illustrate the possible functions of this system are discussed. Interestingly, its participation in the transmission of nociceptive signals and the control of cardiovascular patterns appear now well established. Such functional implications give new information on the possible targets of central dopaminergic agonists and antagonists, particularly at the cardiovascular level.