Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococcus faecium: The value of a computerized monitoring system to limit their spread.

OBJECTIVE: To quickly implement Infection Prevention and Control measures ("search and isolate" strategy), a computerized monitoring system for carbapenemase-producing Enterobacteriaceae (CPE) and Vancomycin-resistant Enterococcus faecium (VRE) carrier and contact patients has been developed in our hospital since 2014. The objectives were to assess the value of a computerized monitoring system in CPE and VRE management and to evaluate the relevance of extended monitoring of all contact patients. METHODS: Using the data extracted from the computerized system, we conducted a descriptive analysis of CPE and VRE carriers detected from 2004 to 2019 and CPE and VRE extensive contact patients (when hospital stay overlapped with the stay of a carrier in the same unit) from 2014 to 2019. RESULTS: Between 2015 and 2019 (microbiological data only available during this period), 113 CPE and 558 VRE carriers were registered in the database (DB). Among them, 33.9% CPE and 12.8% VRE carriers were infected (p = 0.02). The most frequent infections were urinary tract infections (52.0%), bloodstream infections (20.0%) and pneumonia (16.0%). Close to 8000 (7679) extended contact patients were exposed. Only 26.2% of them were removed from the DB because of appropriate negative post-exposure rectal screenings. No rectal screening was performed in 33.5% of contact patients. Between 2014 and 2019, 16 outbreaks occurred. The proportion of infected carriers differed significantly between outbreaks (index cases) and non-epidemic episodes (50.0% and 20.5% respectively, p = 0.03). The detection system was able to control diffusion in 99.7% of readmissions of known carriers. Among the 360 readmissions detected by the system, only one was involved in an outbreak due to non-compliance with infection control measures. CONCLUSION: Given the low screening completion rate (26.2%) and the low detection rate (1.3%), extended monitoring of contact patients does not seem relevant. After five years of use, the computerized monitoring system has demonstrated its effectiveness in terms of responsiveness and limitation of the spread of multidrug-resistant organisms.

An unprecedented and large-scale support mission to assist residential care facilities during the COVID-19 pandemic.

Background: In March 2020, COVID-19 cases occurred in residential care facilities. To assist these facilities, the regional health agency of the Meurthe-et-Moselle administrative district ordered a support mission. Methods: Infection prevention and control mobile teams were formed under the coordination of the infection prevention and control department (IPCD) of a university hospital. Teams went to residential care facilities for the elderly, to facilities for people with disabilities (FPD) and independent living communities (ILC). They visited the facilities and met with the management and the ward staff to assess the situation and to identify any potential support needs. Results: Over two non-consecutive weeks, 104 residential care facilities were visited (9025 residents). If urgent needs were identified, the IPCD was directly informed by the teams to initiate an extensive assistance operation. Thereby, additional staff and equipment were provided for every facility in need. Although most of them had implemented good management to face the pandemic, four emergency field support operations took place in facilities with uncontrolled outbreaks. Conclusions: This is the first reported support action for residential care facilities during the pandemic in France. As no major outbreaks were noticed later, this mission was deemed a success and met the residential care facilities' needs for support. Many facilities have expressed the need to cooperate with infection prevention and control specialists in the future, both during outbreaks, also in routine daily practice. This report highlights the need to maintain support for residential care facilities and to implement a permanent collaboration between hospitals and residential care facilities.

Quantitative Health Risk Assessment of the Chronic Inhalation of Chemical Compounds in Healthcare and Elderly Care Facilities.

Previous studies have described the chemical pollution in indoor air of healthcare and care facilities. From these studies, the main objective of this work was to conduct a quantitative health risk assessment of the chronic inhalation of chemical compounds by workers in healthcare and elderly care facilities (hospitals, dental and general practitioner offices, pharmacies and nursing homes). The molecules of interest were 36 volatile and 13 semi-volatile organic compounds. Several professional exposure scenarios were developed in these facilities. The likelihood and severity of side effects that could occur were assessed by calculating the hazard quotient for deterministic effects, and the excess lifetime cancer risk for stochastic effects. No hazard quotient was greater than 1. Three compounds had a hazard quotient above 0.1: 2-ethyl-1-hexanol in dental and general practitioner offices, ethylbenzene and acetone in dental offices. Only formaldehyde presented an excess lifetime cancer risk greater than 1 × 10-5 in dental and general practitioner offices (maximum value of 3.8 × 10-5 for general practitioners). The health risk for chronic inhalation of most compounds investigated did not appear to be of concern. Some values tend to approach the acceptability thresholds justifying a reflection on the implementation of corrective actions such as the installation of ventilation systems.