Bacteria which are highly resistant to antibiotics are not resistant hydro-alcoholic products.

BACKGROUND: Preventing the emergence of antibiotic-resistant bacteria requires strict adherence to standard precautions, including hand hygiene by hydro-alcoholic friction, a technique now recommended. Our study evaluates the in vitro efficacy of an hydro-alcoholic product on four emerging resistant bacteria. METHODS AND MATERIALS: The product was tested using the dilution-neutralization method using the NF/EN 13727+A2 standard on Staphylococcus epidermidis which is resistant to methicillin and has a reduced reaction to glycopeptide antibiotics, on Enterococcus faecium which is resistant to glycopeptides, as well as on Klebsiella pneumoniae and Pseudomonas aeruginosa which produce carbapenemases. Each of the steps was performed as a blind test on the test product as on the comparator. The surviving bacteria count was measured after 24 and 48 hours' incubation and the rate of reduction was calculated. RESULTS: A reduction which was higher than 5 decimal logarithms was observed 30seconds after contact. The test product had an 80% bactericidal concentration on Pseudomonas aeruginosa and 40% on the three other germs. The bactericidal concentration of the comparator was 80% on the four micro-organisms. DISCUSSION: The present study confirms the effect of hydro-alcoholic products on emerging resistant bacteria. The results make it possible to answer questions from healthcare professionals who often confuse antibiotics and antiseptics and question whether using hydro-alcoholic hand sanitizer is worth it. Proof of efficacy at 30seconds is reassuring since this time is close to that observed when evaluating practices. The data could be completed by performing in vitro tests using the NF/EN 1500 standard.

Asymptomatic carriage of extensively drug-resistant bacteria (eXDR), a simple way to assess spontaneous clearance.

The duration of eXDR carriage depends on several factors that might be difficult to recover. We aim to assess the duration of eXDR carriage by using a simple to recover parameter: the number of consecutive negative screening. 131 eXDR carriers (51 VRE and 80 CPE) were included. The number of consecutive negative screenings was strongly associated with eXDR clearance. All patients displaying at least three negative screenings over a seven-month period were never screened positive thereafter. Taking into account the number of negative screenings as a part of a case-by-case risk assessment would be helpful for the decision to maintain or lift eXDR-focused precautions.

Evaluation of excreta management in a large French multi-hospital institution.

BACKGROUND: Excreta are a major source of multidrug-resistant Enterobacteriaceae including strains that produce extended-spectrum beta-lactamase (ESBL). The increase of ESBL incidence in Assistance Publique - Hôpitaux de Paris (AP-HP) hospitals prompted an evaluation of the equipment and practices used to dispose of excreta. AIM: To evaluate the use of equipment for the management of excreta and to review practices of healthcare workers in their disposal. METHODS: A cross-sectional survey was conducted in 2012. FINDINGS: A total of 28 AP-HP hospitals including 536 units (342 acute care units and 194 rehabilitation and long-term care units) were evaluated. Among the patients on the day of the survey, 5697 (43%) wore diapers and 1767 (13%) were using a bedpan. Sixty-one percent of the beds were equipped with shared toilets and 43% of the toilets were equipped with hand sprayers, a device favouring the spread of faecal material in the environment. Sixty eight percent of the units were equipped with bedpan washer-disinfectors. Only 52% of the bedpan washer-disinfectors were located in rooms where alcohol-based hand rubs (ABHRs) were available. In 71% of the units the bedpan was rinsed before disinfection, mostly in the patient's bathroom (62%). Finally, only 9% of questioned healthcare workers said they followed an educational programme about excreta disposal. CONCLUSION: This survey shows that, in the field of multidrug-resistant Enterobacteriaceae control and the promotion of hand hygiene with ABHRs, excreta management is a concerning but neglected subject.