Host contact dynamics shapes richness and dominance of pathogen strains.

The interaction among multiple microbial strains affects the spread of infectious diseases and the efficacy of interventions. Genomic tools have made it increasingly easy to observe pathogenic strains diversity, but the best interpretation of such diversity has remained difficult because of relationships with host and environmental factors. Here, we focus on host-to-host contact behavior and study how it changes populations of pathogens in a minimal model of multi-strain interaction. We simulated a population of identical strains competing by mutual exclusion and spreading on a dynamical network of hosts according to a stochastic susceptible-infectious-susceptible model. We computed ecological indicators of diversity and dominance in strain populations for a collection of networks illustrating various properties found in real-world examples. Heterogeneities in the number of contacts among hosts were found to reduce diversity and increase dominance by making the repartition of strains among infected hosts more uneven, while strong community structure among hosts increased strain diversity. We found that the introduction of strains associated with hosts entering and leaving the system led to the highest pathogenic richness at intermediate turnover levels. These results were finally illustrated using the spread of Staphylococcus aureus in a long-term health-care facility where close proximity interactions and strain carriage were collected simultaneously. We found that network structural and temporal properties could account for a large part of the variability observed in strain diversity. These results show how stochasticity and network structure affect the population ecology of pathogens and warn against interpreting observations as unambiguous evidence of epidemiological differences between strains.

Close proximity interactions support transmission of ESBL-K. pneumoniae but not ESBL-E. coli in healthcare settings.

Antibiotic-resistance of hospital-acquired infections is a major public health issue. The worldwide emergence and diffusion of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae, including Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is of particular concern. Preventing their nosocomial spread requires understanding their transmission. Using Close Proximity Interactions (CPIs), measured by wearable sensors, and weekly ESBL-EC-and ESBL-KP-carriage data, we traced their possible transmission paths among 329 patients in a 200-bed long-term care facility over 4 months. Based on phenotypically defined resistance profiles to 12 antibiotics only, new bacterial acquisitions were tracked. Extending a previously proposed statistical method, the CPI network's ability to support observed incident-colonization episodes of ESBL-EC and ESBL-KP was tested. Finally, mathematical modeling based on our findings assessed the effect of several infection-control measures. A potential infector was identified in the CPI network for 80% (16/20) of ESBL-KP acquisition episodes. The lengths of CPI paths between ESBL-KP incident cases and their potential infectors were shorter than predicted by chance (P = 0.02), indicating that CPI-network relationships were consistent with dissemination. Potential ESBL-EC infectors were identified for 54% (19/35) of the acquisitions, with longer-than-expected lengths of CPI paths. These contrasting results yielded differing impacts of infection control scenarios, with contact reduction interventions proving less effective for ESBL-EC than for ESBL-KP. These results highlight the widely variable transmission patterns among ESBL-producing Enterobacteriaceae species. CPI networks supported ESBL-KP, but not ESBL-EC spread. These outcomes could help design more specific surveillance and control strategies to prevent in-hospital Enterobacteriaceae dissemination.

Tracking Clinical Staff Behaviors in an Operating Room.

Inadequate staff behaviors in an operating room (OR) may lead to environmental contamination and increase the risk of surgical site infection. In order to assess this statement objectively, we have developed an approach to analyze OR staff behaviors using a motion tracking system. The present article introduces a solution for the assessment of individual displacements in the OR by: (1) detecting human presence and quantifying movements using a motion capture (MOCAP) system and (2) observing doors' movements by means of a wireless network of inertial sensors fixed on the doors and synchronized with the MOCAP system. The system was used in eight health care facilities sites during 30 cardiac and orthopedic surgery interventions. A total of 119 h of data were recorded and analyzed. Three hundred thirty four individual displacements were reconstructed. On average, only 10.6% individual positions could not be reconstructed and were considered undetermined, i.e., the presence in the room of the corresponding staff member could not be determined. The article presents the hardware and software developed together with the obtained reconstruction performances.

Detailed contact data and the dissemination of Staphylococcus aureus in hospitals.

Close proximity interactions (CPIs) measured by wireless electronic devices are increasingly used in epidemiological models. However, no evidence supports that electronically collected CPIs inform on the contacts leading to transmission. Here, we analyzed Staphylococcus aureus carriage and CPIs recorded simultaneously in a long-term care facility for 4 months in 329 patients and 261 healthcare workers to test this hypothesis. In the broad diversity of isolated S. aureus strains, 173 transmission events were observed between participants. The joint analysis of carriage and CPIs showed that CPI paths linking incident cases to other individuals carrying the same strain (i.e. possible infectors) had fewer intermediaries than predicted by chance (P < 0.001), a feature that simulations showed to be the signature of transmission along CPIs. Additional analyses revealed a higher dissemination risk between patients via healthcare workers than via other patients. In conclusion, S. aureus transmission was consistent with contacts defined by electronically collected CPIs, illustrating their potential as a tool to control hospital-acquired infections and help direct surveillance.

In situ heating transmission electron microscopy observation of nanoeutectic lamellar structure in Sn-Ag-Cu alloy on Au under-bump metallization.

We investigated the microstructural evolution of Sn(96.4)Ag(2.8)Cu(0.8) solder through in situ heating transmission electron microscopy observations. As-soldered bump consisted of seven layers, containing the nanoeutectic lamella structure of AuSn and Au5Sn phases, and the polygonal grains of AuSn2 and AuSn4, on Au-plated Cu bond pads. Here, we found that there are two nanoeutectic lamellar layers with lamella spacing of 40 and 250 nm. By in situ heating above 140°C, the nanoeutectic lamella of AuSn and Au5Sn was decomposed with structural degradation by sphering and coarsening processes of the lamellar interface. At the third layer neighboring to the lamella layer, on the other hand, Au5Sn particles with a zig-zag shape in AuSn matrix became spherical and were finally dissipated in order to minimize the interface energy between two phases. In the other layers except both lamella layers, polycrystal grains of AuSn2 and AuSn4 grew by normal grain growth during in situ heating. The high interface energy of nanoeutectic lamella and polygonal nanograins, which are formed by rapid solidification, acted as a principal driving force on the microstructural change during the in situ heating.

QRS pattern and improvement in right and left ventricular function after cardiac resynchronization therapy: a radionuclide study.

BACKGROUND: Predicting response to cardiac resynchronization therapy (CRT) remains a challenge. We evaluated the role of baseline QRS pattern to predict response in terms of improvement in biventricular ejection fraction (EF). METHODS: Consecutive patients (pts) undergoing CRT implantation underwent radionuclide angiography at baseline and at mid-term follow-up. The relationship between baseline QRS pattern and mechanical dyssynchrony using phase analysis was evaluated. Changes in left and right ventricular EF (LVEF and RVEF) were analyzed with regard to baseline QRS pattern. RESULTS: We enrolled 56 pts, 32 with left bundle branch block (LBBB), 4 with right bundle branch block (RBBB) and 20 with non-specific intraventricular conduction disturbance (IVCD). A total of 48 pts completed follow-up. LBBB pts had significantly greater improvement in LVEF compared to RBBB or non-specific IVCD pts (+9.6 ± 10.9% vs. +2.6 ± 7.6%, p = 0.003). Response (defined as ≥ 5% increase in LVEF) was observed in 68% of LBBB vs. 24% of non-specific IVCD pts (p = 0.006). None of the RBBB pts were responders. RVEF was significantly improved in LBBB (+5.0 ± 9.0%, p = 0.007), but not in non-specific IVCD and RBBB pts (+0.4 ± 5.8%, p = 0.76). At multivariate analysis, LBBB was the only predictor of LVEF response (OR, 7.45; 95% CI 1.80-30.94; p = 0.006), but not QRS duration or extent of mechanical dyssynchrony. CONCLUSIONS: Presence of a LBBB is a marker of a positive response to CRT in terms of biventricular improvement. Pts with non-LBBB pattern show significantly less benefit from CRT than those with LBBB.

Sub-micrometer particles produced by a low-powered AC electric arc in liquids.

The article presents the report of the production of composites of sub-micrometer metal particles in matrix consisted of the metal compounds by means of an AC electric arc in water and paraffin solutions using electrodes carbon-metal and metal-metal (metal: Ni, Fe, Co, Cu). The advantage of this method is the low electric power (from 5 to 10 W) needed in comparison to standard DC arc-discharge methods (0.8 to 3 kW). This method enables the production of particles from conductive material also in wide range of temperature and in solvent which could be either transparent to light or opaque. Moreover the solvent can be electrolyte or insulating liquid. The microstructure of the composite layer was investigated by scanning electron microscopy (SEM), Electron Probe Microanalysis (EPMA) and X-ray. During particles production in water metal oxides were created. Additionally using cobalt-copper, nickel-copper as couple electrodes, insoluble in water copper (II) hydroxide crystal grains were created additionally which crystals shape was depended on transition metal. For iron-copper couple electrodes system the copper (II) hydroxide was not formed. Experiments with sequence production of Ni and Fe particles with C electrode assisting in molten paraffin let to obtain both Ni and Fe particles surrounded by paraffin. After solidification the material was insulator but if locally magnetic field influenced on the liquid solution in that place after solidification a new composite was created which was electric current conductor with resistivity around 0.1 omega x m, was attracted by magnetic field and presented magneto resistance around 0.4% in changing magnetic field in a range 150 mT. After mixing the concentrated paraffin with normal paraffin resistivity of the mixture increased and it became photosensitive and created small voltage under light influence.

Longitudinal data collection to follow social network and language development dynamics at preschool.

DyLNet is a large-scale longitudinal social experiment designed to observe the relations between child socialisation and oral language learning at preschool. During three years, a complete preschool in France was followed to record proximity interactions of about 200 children and adults every 5 seconds using autonomous Radio Frequency Identification Wireless Proximity Sensors. Data was collected monthly with one week-long deployments. In parallel, survey campaigns were carried out to record the socio-demographic and language background of children and their families, and to monitor the linguistic skills of the pupils at regular intervals. From data we inferred real social interactions and distinguished inter- and intra-class interactions in different settings. We share ten weeks of cleaned, pre-processed and reconstructed interaction data recorded over a complete school year, together with two sets of survey data providing details about the pupils' socio-demographic profile and language development level at the beginning and end of this period. Our dataset may stimulate researchers from several fields to study the simultaneous development of language and social interactions of children.

Right ventricular systolic function and cardiac resynchronization therapy.

AIMS: The effect of cardiac resynchronization therapy (CRT) on right ventricular ejection fraction (RVEF) has not been well studied. Furthermore, it is unclear whether baseline RVEF influences response to CRT. To evaluate the acute and chronic effects of CRT on right ventricular systolic function, and to investigate whether baseline RVEF impacts response to CRT. METHODS AND RESULTS: Forty-four patients with a standard indication for CRT underwent radionuclide angiography at baseline and after at least 6 months' follow-up for measuring RVEF, right ventricular synchrony (using phase analysis), and left ventricular ejection fraction (LVEF). In addition, NYHA functional class and 6-min walking distance (6MWD) were evaluated. There were no significant acute changes in RVEF with CRT. After a mean follow-up of 9 +/- 5 months, RVEF was slightly improved (by 1.9 +/- 5.0% in absolute terms, P = 0.016), and to a lesser extent than LVEF (5.1 +/- 9.0%, P = 0.009 compared with RVEF). Right ventricular dyssynchrony was significantly improved at follow-up (P = 0.016). Patients with a baseline RVEF < or = 0.35 (n = 19) were less likely to improve in NYHA class (P = 0.016), and also tended to improve less in 6MWD and LVEF (P < 0.06). CONCLUSION: Cardiac resynchronization therapy has no acute effect on RVEF, and only slightly improves RVEF at follow-up. Patients with reduced RVEF at baseline were less likely to respond to CRT, indicating that right ventricular systolic dysfunction may play a role in patient selection.

Measurement of left ventricular ejection fraction by real time 3D echocardiography in patients with severe systolic dysfunction: comparison with radionuclide angiography.

AIM: Measurement of left ventricular ejection fraction (LVEF) using real time 3D echocardiography (3DE) has been performed in subjects with preserved or modestly reduced systolic function. Our aim was to evaluate this technique in the subset of patients with severe systolic dysfunction. METHODS AND RESULTS: Consecutive patients with LVEF less than 0.35 at two-dimensional echocardiography were included. LVEF obtained by 3DE was compared to the value measured by radionuclide angiography (RNA). Real time full-volume 3DE was performed, with offline semiautomated measurement of LVEF using dedicated software (Cardioview RT, Tomtec) by a single observer blinded to the results of RNA. A total of 50 patients were evaluated, of whom 38 (76%, 27 males, age 69 +/- 13 years) had a 3DE of sufficient quality for analysis. LVEF for this group was 0.21 +/- 0.07 using 3DE and 0.27 +/- 0.08 using RNA. The agreement between the two techniques was rather poor (r = 0.49; P < 0.001; 95% limits of agreements of -0.20 to 0.09). Truncation of the apex was observed in 6 of 38 (16%) patients. CONCLUSION: In patients with severe systolic dysfunction, 3DE shows poor agreement for measurement of LVEF as compared to RNA. There may be underestimation of up to 20% in absolute terms by 3DE. Accordingly, the two methods are not interchangeable for the follow-up of LV function. A limitation of 3DE may, at least in part, be related to the incomplete incorporation of the apical region into the pyramidal image sector in patients with dilated hearts.

Author Correction: Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy.

AIMS: To assess changes in cardiac adrenergic activity with cardiac resynchronization therapy (CRT), and to investigate whether these changes are related to improvement in left ventricular ejection fraction (LVEF). METHODS AND RESULTS: Sixteen patients (13 males, age 66 +/- 7 years) were studied at baseline and after > or =6 months of CRT (mean follow-up 9.2 +/- 3.2 months). LVEF was assessed by nuclear angiography. Responders were defined as patients showing > or =5% absolute increase in LVEF + improvement in > or =1 NYHA class + absence of heart failure hospitalization. Cardiac sympathetic nerve activity was studied by (123)I-metaiodobenzyl-guanidine ((123)I-MIBG) scintigraphy. Responders (n = 8) showed lower (123)I-MIBG washout at follow-up when compared with non-responders (P = 0.002), indicating lower cardiac sympathetic nerve activity. The decrease in (123)I-MIBG washout at follow-up when compared with baseline was only seen in the responder group (P = 0.036). There was a moderate correlation between increase in LVEF and decrease in (123)I-MIBG washout (r = 0.52, P = 0.04). CONCLUSION: CRT induces a reduction in cardiac sympathetic nerve activity in responders, that parallels an improvement in LVEF, whereas non-responders do not show any significant changes.

Variations of the Elastic Properties of the CoCrFeMnNi High Entropy Alloy Deformed by Groove Cold Rolling.

The variations of the mechanical properties of the CoCrFeMnNi high entropy alloy (HEA) during groove cold rolling process were investigated with the aim of understanding their correlation relationships with the crystallographic texture. Our study revealed divergences in the variations of the microhardness and yield strength measured from samples deformed by groove cold rolling and conventional cold rolling processes. The crystallographic texture analyzed by electron back scattered diffraction (EBSD) revealed a hybrid texture between those obtained by conventional rolling and drawing processes. Though the groove cold rolling process induced a marked strengthening effect in the CoCrFeMnNi HEA, the mechanical properties were also characterized by an unusual decrease of the Young's modulus as the applied groove cold rolled deformation increased up to about 0.5 before reaching a stabilized value. This decrease of the Young's modulus was attributed to the increased density of mobile dislocations induced by work hardening during groove cold rolling processing.

Structural homogeneity and mass density of bulk metallic glasses revealed by their rough surfaces and ultra-small angle neutron scattering (USANS).

The ultra-small angle neutron scattering (USANS) measures the microscale structure of heterogeneity and the scattering from rough surfaces with small scattering volumes can be neglected. But this is not true in amorphous alloys. The small angle scattering from such surfaces is not negligible, regardless of scattering volume. However, we demonstrate that the unwanted rough surfaces can be utilized to determine the homogeneity and mass density of amorphous metallic glasses using the USANS and surface neutron contrast matching technique. The power law scattering of the homogeneous Cu50Zr50 amorphous alloy disappeared under the surface contrast-matched environment, a mixture of hydrogenated/deuterated ethanol having low surface tension against the metallic alloys, indicating that the scattering originated not from its internal structure but from the rough surface. This confirms the structural homogeneity not only at the atomic level but also on a larger scale of micrometer. On the other hand, the crystallized Cu50Zr50 alloy showed strong power-law scattering under the matching environment due to the structural heterogeneity inside the alloy. This technique can apply to the bulk samples when the transmission is high enough not causing multiple scattering that is easily detected with USANS and when the surface roughness is dominant source of scattering.

Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.

The use of perfusion scintigraphy to differentiate proximal right coronary artery stenosis from distal right coronary artery stenosis in patients with inferior left ventricular ischaemia.

OBJECTIVE: The identification of patients with a significant proximal right coronary artery (RCA) is of clinical relevance since it may direct diagnostic and therapeutic strategies. This study was performed to determine parameters of (201)Tl RV perfusion SPECT which can be used to discriminate between proximal and distal RCA stenosis in patients with inferior left ventricular (LV) ischaemia. In addition, feasibility and reproducibility of a new semi-quantitative method for the assessment of RV perfusion were evaluated. METHODS: Inferior LV ischaemia was due to a single distal RCA stenosis in 10 (group I) and proximal RCA stenosis in 27 patients (group II). Twenty patients with normal (201)Tl myocardial perfusion scintigraphy and low likelihood of cardiovascular disease were used as a reference (group III). RESULTS: RV (201)Tl stress uptake did not differ between the three groups. However, group II showed a significantly higher (201)Tl rest uptake indicating RV redistribution whereas in group I and III tracer washout was shown. Extent and severity of LV inferior ischaemia was not different between groups I and II. RV redistribution has a sensitivity of 0.74, a specificity of 0.80, and an overall agreement of 0.76 for detecting proximal RCA stenosis. The feasibility of the assessment of RV (201)Tl perfusion was 94%. Inter-observer and intra-observer coefficients of variation for RV (201)Tl perfusion assessment were 1.5 and 2.4%, respectively. CONCLUSION: RV (201)Tl perfusion scintigraphy is feasible and reproducible. RV (201)Tl redistribution can be used to discriminate between proximal and distal RCA stenosis in patients with inferior LV ischaemia.

Socioeconomic correlations and stratification in social-communication networks.

The uneven distribution of wealth and individual economic capacities are among the main forces, which shape modern societies and arguably bias the emerging social structures. However, the study of correlations between the social network and economic status of individuals is difficult due to the lack of large-scale multimodal data disclosing both the social ties and economic indicators of the same population. Here, we close this gap through the analysis of coupled datasets recording the mobile phone communications and bank transaction history of one million anonymized individuals living in a Latin American country. We show that wealth and debt are unevenly distributed among people in agreement with the Pareto principle; the observed social structure is strongly stratified, with people being better connected to others of their own socioeconomic class rather than to others of different classes; the social network appears to have assortative socioeconomic correlations and tightly connected 'rich clubs'; and that individuals from the same class live closer to each other but commute further if they are wealthier. These results are based on a representative, society-large population, and empirically demonstrate some long-lasting hypotheses on socioeconomic correlations, which potentially lay behind social segregation, and induce differences in human mobility.

Optimizing sequential biventricular pacing using radionuclide ventriculography.

BACKGROUND: Biventricular pacemakers are usually programmed with the default setting of synchronous biventricular pacing, although the ventricles may be paced sequentially. Whether this parameter is important for optimizing resynchronization therapy is not clear. OBJECTIVES: The purpose of this study was to investigate whether sequential pacing acutely improves left ventricular ejection fraction (LVEF) and dyssynchrony and to assess the feasibility of nuclear ventriculography for device optimization. METHODS: Twenty-seven patients implanted with a biventricular pacemaker or implantable cardioverter-defibrillator for heart failure were studied. LVEF was measured using planar radionuclide ventriculography during simultaneous biventricular pacing and during sequential pacing at four different interventricular intervals ranging from LV-40 (preexciting the left ventricle by 40 ms) to LV+40 (preexciting the right ventricle). Interventricular and intraventricular dyssynchrony were analyzed by phase analysis at each setting. RESULTS: There was great heterogeneity in individual response to VV interval programming. Twenty-four of 27 patients (89%) had significant changes (both favorable and unfavorable) in LVEF at different interventricular delays, with variations of up to 10% in absolute terms. Simultaneous biventricular pacing yielded maximal LVEF in 9 of 27 patients (33%), with a relative increase in LVEF of 18 +/- 14% by optimized sequential pacing in the remaining patients. Interventricular dyssynchrony varied significantly, with least dyssynchrony at the LV-20 setting (P = .024). There were no significant differences in intraventricular dyssynchrony at the different settings. CONCLUSION: Programming VV intervals has considerable impact on LVEF. However, there is a great degree of variation between patients in response to these settings, requiring individual assessment for device optimization.

Interindividual Contacts and Carriage of Methicillin-Resistant Staphylococcus aureus: A Nested Case-Control Study.

BACKGROUND: Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination. OBJECTIVE: To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study. SETTING: French long-term care facility in 2009. PARTICIPANTS: Patients (n=329) and HCWs (n=261). METHODS: We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables. RESULTS: The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage. CONCLUSIONS: Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.

Attitudes, risk of infection and behaviours in the operating room (the ARIBO Project): a prospective, cross-sectional study.

INTRODUCTION: Inappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). This study will focus on the continued assessment of OR staff behaviours using a motion tracking system and their impact on the SSI risk during surgical procedures. METHODS AND ANALYSIS: This multicentre prospective cross-sectional study will include 10 ORs of cardiac and orthopaedic surgery in 12 healthcare facilities (HCFs). The staff behaviour will be assessed by an objective, continued and prolonged quantification of movements within the OR. A motion tracking system including eight optical cameras (VICON-Bonita) will record the movements of reflective markers placed on the surgical caps/hoods of each person entering the room. Different configurations of markers positioning will be used to distinguish between the staff category. Doors opening will be observed by means of wireless inertial sensors fixed on the doors and synchronised with the motion tracking system. We will collect information on the OR staff, surgical procedures and surgical environment characteristics. The behavioural data obtained will be compared (1) to the 'best behaviour rules' in the OR, pre-established using a Delphi method and (2) to surrogates of the infectious risk represented by microbiological air counts, particle counts, and a bacteriological sample of the wound at closing. Statistics will be performed using univariate and multivariate analysis to adjust on the aerolic and architectural characteristics of the OR. A multilevel model will allow including surgical specialty and HCFs effects. Through this study, we will develop an original approach using high technology tools associated to data processing techniques to evaluate 'automatically' the behavioural dynamics of the OR staff and their impact on the SSI risk. ETHICS AND DISSEMINATION: Approbation of the Institutional Review Board of Paris North Hospitals, Paris 7 University, AP-HP (no 11-113, 6 April 2012). The findings will be disseminated through peer-reviewed journals, and national and international conference presentations.