Hospital-wide prospective mandatory surveillance of invasive aspergillosis in a French teaching hospital (2000-2002).

A multidisciplinary working group devoted to epidemiological surveillance of invasive aspergillosis (IA) was created in January 2000 in Grenoble University Hospital. This article presents the results of a three-year IA surveillance. The multidisciplinary working group surveyed all hospitalized patients, and the mycology laboratory detected most suspected IA cases. Cases were reviewed monthly by the Aspergillosis Committee, and were classified according to international consensus criteria. Possible nosocomial acquisition was determined. Among the 490 alerts, 74 IA cases were observed: six proven cases (8%), 36 (49%) probable cases and 32 (43%) possible cases. The incidence was 4.4 (95% CI 3.4-5.4) IA/100 000 patient-days. Among the proven and probable IA cases, we observed 10 nosocomial cases and six cases of undetermined origin. No cases were noted in the protected rooms in the haematology unit. Only one cluster of cases (three nosocomial cases) was detected in the haematology unit. Forty-three percent of cases (N=32) were hospitalized in the haematology unit, and all other cases were hospitalized elsewhere. This three-year survey found a high rate of non-nosocomial IA cases and a high frequency of IA cases hospitalized in units other than haematology. Thus, this study shows the importance of IA surveillance in haematology units and all high-risk units.

[Single-use laryngoscope blade assessment]. / Evaluation des lames de laryngoscopes à usage unique.

OBJECTIVES: To assess the feasibility of switching disposable laryngoscope blades and to compare the disposable blades available on the market to reusable blades within the context of a new variant of Creutzfeldt-Jakob disease. STUDY DESIGN: Comparative prospective study. MATERIAL AND METHODS: Study conducted on patients intubated for surgical procedures in all operating theatres of a university hospital. The anaesthetic practitioner filled in an assessment form giving a score on nine criteria for each blade used. Data were recorded on Epi Info software. Satisfaction scores of each criterion were compared for both disposable blades and reusable blades. RESULTS: Six brands of blades were tested with 225 blades. Disposable blades were evaluated as inferior to the reusable blades in 62% of cases. Two blades were reported as more satisfactory: the 670166 Rusch-Pilling and Vital View blades. CONCLUSION: The disposable blades were not easily accepted by the anaesthetists particularly for difficult intubations, which is why reusable blades should not be totally removed from practice. Single-use blades proposed by different manufacturers are not identical. We chose 670166 Rusch-Pilling blades, the best adapted to our institution. The switch to disposable blades would require that blade manufacturers improve the quality of the blades.

[Resources and organization of 124 health-care institutions in South-East France for standard precautions and isolation]. / Ressources et organisation de 124 etablissements de l'interrégion Sud-Est pour la mise en oeuvre des précautions standard et d'isolement septique.

OBJECTIVES: The authors had aimed to evaluate resources and organization necessary for applying guidelines issued 5 years earlier in various institutions: standard precautions, septic isolation, prevention against spread of multidrug-resistant bacteria. MATERIAL AND METHODS: Volunteer institutions were surveyed for hygiene product consumption, architectural requirements, inventory of protocols, description septic patients'management, and available personnel. RESULTS: One hundred and twenty-four institutions (40,784 beds) were included in the study. Eleven percent had no hygiene physician or nurse; the rates of personnel specialized in hygiene practice were 0.4 physicians per 800 beds and 0.8 registered nurses per 400 beds. Eighty-eight percent of the studied institutions had a protocol for standard precautionary measures, 77% had a septic isolation protocol. A multidrug-resistant bacteria identification sheet was attached to examination reports in 87% of cases. Multidrug-resistant bacteria screening was practiced by 18.1% of the institutions. Hygiene product consumption for 1000 days of hospitalization was 7861 disposable gloves, 2.3 1 of hydroalcoholic solution, and 63 disposable gowns. 28.9% of the wards lacked water hand washing points, 32.2% had no sinks, and 48.5% had no local equipment maintenance. In addition, 40.7% of the beds were in single rooms, 4.8% of the institutions had no single rooms. Differences were observed depending on specialties and institutions. CONCLUSION: Analysis of consumption shows insufficient application of standard precautions, notably for hydroalcoholic solutions. The number of single rooms is acceptable, architectural requirements were not adequate in too many wards. These results can explain some problems encountered in applying the guidelines.