Gastroenteritis outbreaks in elderly homes in the east of France during winter 2009/10: aetiology research for a series of 37 outbreaks.

Although acute gastroenteritis is a common cause of morbi-mortality in care homes, there is no national surveillance system in France except for food-borne gastroenteritis. Since 2008, a specific surveillance system has been operating in nursing homes in Alsace, a region in eastern French. In the winter season 2009/10 we had the opportunity to study 37 outbreaks, collecting data on attack rate, duration and aetiology as well as epidemic management in nursing homes. We noticed the responsiveness of the institutions, with a mean period of 1.6 days between the onset of first symptoms and the implementation of management measures (95% confidence interval (CI): 1.0­2.2). One or several stool samples were taken in 27 of the 37 described outbreaks. The only pathogen detected was norovirus, and the positive samples were from outbreaks with a very typical pattern: vomiting in 36 of the outbreaks, a high average attack rate of 36.8% (95% CI: 31.5­42.2) and a short average duration of 8.9 days (95% CI: 5.8­7.0). No severe cases, hospitalisations or deaths were reported. The high frequency of norovirus isolation indicated that systematic bacteriological analysis in local laboratories is not cost-effective. Consequently, Cire Est recommends to test for bacteria and viruses only in cases presenting with fever or atypical symptoms. Nevertheless, Cire Est also recommends to continue sending stool samples to the French National Centre for enteric viruses, more for the benefit of the virological surveillance programme than for diagnostic purposes.

Pre-operative skin preparation practices: results of the 2007 French national assessment.

BACKGROUND: Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. AIM: To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. METHODS: A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. FINDINGS: Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P < 0.001). Compliance with hair removal procedures was observed in 91.5% of cases (95% CI 91.2-91.8), and compliance with surgical site disinfection recommendations was observed in 25,529 cases (62.0%, 95% CI 61.5-62.5). The following documentary evidence was found: information given to patient, 35.6% of cases; pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. CONCLUSION: The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties.

A(H1N1) pandemic influenza and its prevention by vaccination: paediatricians' opinions before and after the beginning of the vaccination campaign.

BACKGROUND: In June 2009, the World Health Organization declared an A(H1N1) influenza pandemic. In October 2009, the largest vaccination campaign in Canadian history began. The aim of this study was to document paediatricians' knowledge, attitudes and practices (KAP) regarding A(H1N1) pandemic influenza and its prevention by vaccination just after the beginning of the A(H1N1) vaccination campaign and to compare the results with those obtained before campaign initiation. METHODS: A self-administered mail-based questionnaire was sent to all Canadian paediatricians. Questionnaires were analyzed in two subsets: those received before and after the beginning of the vaccination campaign. RESULTS: Overall the response rate was 50%. Respondents' characteristics were comparable between the two subsets. Before the beginning of the campaign, 63% of paediatricians perceived A(H1N1) pandemic infection as a serious disease, that would occur frequently without vaccination compared to more than 75% after. Before the vaccination campaign, half of respondents or less thought that the A(H1N1) vaccine was safe (50%) and effective (35%) compared to 77% and 72% after. The proportion of paediatricians who reported they had received sufficient information on A(H1N1) vaccine increased from 31% before to 73% after the beginning of the vaccination campaign. The majority of respondents intended to get vaccinated against A(H1N1) influenza themselves (84% before and 92% after). Respondents' intention to recommend the A(H1N1) vaccine to their patients increased from 80% before the beginning of the campaign to 92% after. In multivariate analysis, the main determinants of paediatricians' intention to recommend the A(H1N1) vaccine were their intention to get vaccinated against A(H1N1) influenza themselves and a belief that A(H1N1) vaccine would be well accepted by health professionals who administer vaccines to the public. CONCLUSION: Results of this study show important increases in physicians' level of confidence about A(H1N1) vaccine's safety and immunogenicity and their willingness to recommend this vaccine to their patients. These changes could be explained, at least partially, by the important effort done by public health authorities to disseminate information regarding A(H1N1) vaccination.