Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units.

BACKGROUND: French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. METHODS: A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. RESULTS: In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. CONCLUSIONS: Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.

Influence of infection control report cards on patients' choice of hospital: pilot survey.

The impact on patients' attitudes of quality report cards on infection control in hospitals has never previously been studied. In 2006, the French government implemented a mandatory report card on infection control activity (ICALIN) in all hospitals. This approach was aimed at encouraging professionals to change their routine practices in case they should lose patients due to a low ICALIN score. Our objective was to assess what impact ICALIN could have on patients' attitude as regards hospital choice. We performed a survey of patients and visitors in 14 randomly selected hospitals of various ICALIN scores. A convenience sample of 381 patients and visitors completed an anonymous questionnaire on ICALIN, their reasons for choosing a hospital and attitude in the event of a low ICALIN score. Factors associated with interest in ICALIN and impact of ICALIN on hospital choice were assessed by logistic regression. Our results showed that 77% of participants were interested in ICALIN. ICALIN was ranked sixth as a reason for choosing a hospital. In the case of a low ICALIN, 24.1% of participants would refuse admission and 54.9% would seek advice from their general practitioner. Sociodemographic factors had no influence on patients' attitude. In conclusion, our survey suggests that patients take note of poor performance on infection control report cards. As most patients rely on their general practitioner to interpret these report cards, there is a definite need for further communication with general practitioners on this issue.

Association between institutionalization and carriage of multiresistant bacteria in the elderly at the time of admission to a general hospital.

The impact of institutionalization on the carriage of multiresistant bacteria among the elderly was assessed prospectively by comparing the carriage rate in institutionalized patients over 70 years of age to the carriage rate in patients over 70 living at home (58 patients/group). Nares, skin, and rectal swabs were obtained within 24 h of admission to the hospital. Among the 20 carriers identified, 75% came from institutions. Significantly, institutionalized patients were incontinent (P < 0.001), less autonomous than those living at home (P < 10(-6)), and had taken antibiotics recently (P < 0.02). The primary characteristics associated with bacterial colonization were institutional living (P < 0.02), having at least one underlying disease (P < 0.001), dependence (Karnofsky index < or = 50; P < 0.02), recent treatment with antibiotics (P < 0.02), and the presence of skin lesions (P < 0.02). Among the risk factors identified, institutionalization can be readily determined upon admission; systematic communication of carrier status of transfer patients would improve overall patient care.

[Specific features of nosocomial infections in the elderly at a general hospital center. 5 surveys of annual prevalence]. / Particularités des infections nosocomiales chez les personnes âgées dans un centre Hospitalier Général. D'après cinq enquêtes de prévalence annuelles.

Specific features of nosocomial infections in patients aged 70 years or older admitted to a short-term care medical department in a 400-bed general hospital were studied to assist in designing nosocomial infection control programs for this population. Data from five annual prevalence surveys were evaluated retrospectively. The 517 patients aged 70 years or older were compared to the 1093 patients younger than 70 years. The older patients were more likely to have risk factors for nosocomial infections including severe disease (36.2% vs 19.1%; P < 10(-6)), referral from another department (24.6% vs 17.5%; P < 0.01), a long hospital stay duration (8.5 days vs 3.5 days), mechanical ventilation (4.3% vs 1.6%; P < 0.01), an indwelling urinary catheter (12.0% vs 4.0%; P < 10(-7)), and a long median duration of urinary catheterization (6 days vs 2 days). The prevalence of nosocomial infections was increased nearly two-fold in the older patients (10.3% vs 5.6%; P < 0.01), although the difference was statistically significant only for urinary tract infections (5.4% vs 1.4%; P < 10(-5)), particularly in patients without urinary catheters. After exclusion of all patients with urinary tract infections, the prevalence of nosocomial infections was similar in the older and younger patients (4.3% vs 3.7%) despite a persistently higher frequency of risk factors for nosocomial infection in the older group. These results indicate that urinary tract infection should be the main target of programs aimed at minimizing nosocomial infection in elderly patients admitted to short-term care facilities. Faultless technique is essential during urinary catheter insertion. High-quality nursing care contributes substantially to the prevention of urinary tract infection in noncatheterized patients with urinary incontinence or neurologic disorders.

[Molecular epidemiology of pneumococci with decreased susceptibility to penicillin isolated in a Parisian pediatric hospital]. / Epidémiologie moléculaire des pneumocoques de sensibilité diminuée a la pénicilline isolés dans un hôpital pédiatrique parisien.

Pneumococci with decreased susceptibility or resistant to penicillin (PRP) have been isolated with an increasing frequency in France. Among PRP, isolates of serotypes 23F and 9V were the most frequently recovered in our children's hospital. Penicillin-resistance is due to the appearance of altered penicillin binding proteins (PBPs) with reduced affinity for beta-lactam antibiotics. 3 PBPs have been well studied, 2b, 2x and 1a, and the sequences of their genes have been determined. Our molecular epidemiological study of 14 PRP 9V and 26 PRP 23F isolated mainly from otitis in 1993-94, consisted of determining chromosomic restriction patterns (Apa I) by pulsed-field gel electrophoresis, and restriction patterns (Hinf I) of PBP genes pbp 2b, pbp 2x and pbp 1a after PCR. All the PRP 9V exhibited the same pulsotype and identical patterns for each of the genes pbp 2b, pbp 2x and pbp 1a, suggesting a clonal origin. The origins of PRP 23F were more heterogenous: 5 clones could be defined, with one predominant clone composed of 20 isolates. Most of the PRP 23F shared identical profiles for the genes pbp 2b, pbp 2x and pbp 1a with the PRP 9V, suggesting a horizontal transfer of DNA. Molecular markers, which provide more informations than serotyping, were useful to clarify the complex epidemiology of PRP.