Dermal and pulmonary absorption of ethanol from alcohol-based hand rub.

BACKGROUND: Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among HCWs after hygienic hand disinfection. METHODS: Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift. Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in expired air. RESULTS: Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of 28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h shift, and urine tests were negative in all participants. CONCLUSION: Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was detected but was below toxic levels.

Pontiac fever among retirement home nurses associated with airborne legionella.

The aim of this study was to ascertain incidence of symptoms compatible with Pontiac fever (PF) and to assess their association with exposure to legionella bacteria among retirement home nurses who help residents take their shower. Within a non-epidemic framework, 104 nurses of 19 retirement homes were followed up during an average period of four months. Data on symptoms, number and location of showers they attended were recorded daily by each participant. Water and aerosol bacterial quality was characterised at the end of follow-up using the culturable and the in-situ hybridisation techniques. Among 11 Pontiac-like episodes, eight cases complied with the study definition of PF. Water concentrations >10(3) cfu legionella per litre were associated with an increased risk of PF, with dose-response patterns. No association was established between the aerosol legionella concentrations and PF events. A threshold value of 103 cfu legionella per litre of water might be used with a view to protection from legionella-associated occupational conditions.

Legionellosis prevention in France.

Since 1997, both the prevention of legionellosis and the control of Legionella in water networks and cooling towers have greatly improved in France. The epidemiological surveillance of Legionnaires' disease showed an increase, which was followed by a decrease in the incidence after a maximum was reached in 2005 (incidence rate of 2.5 per 10(5)). A steady decrease in the incidence rate has been observed since 2006, mainly due to the efficacy of control measures both for cooling towers and hospital water networks. In hospitals, a proactive approach was proposed in 1998 and quantitative limit values with systematic survey were put into force in 2002. The percentage of nosocomial cases has decreased dramatically and is now around 6-7% of all cases recorded in France. No nosocomial outbreak has been reported in recent years. However, this is not the case for community cases linked to diverse exposure sources, including cooling towers.

[Control measures for a VRE outbreak in a haemodialysis unit]. / Mise en oeuvre de mesures visant à contrôler une épidémie de portage d'Entérocoques Résistants aux Glycopeptides dans un centre d'hémodialyse.

We report an outbreak of colonization with Vancomycin Resistant Enterococci (VRE) in the Haemodialysis unit of our hospital. From October 2004 to September 2008, 19 patients were found positive. The risk of acquiring this multi-resistant bacterium is extremely important in patients undergoing haemodialysis, heightened measures have gradually been set to control cross transmissions: first isolation, then geographic clustering of carriers and finally creating cohorting sectors with different staff for carriers, contacts and VRE free patients. This re-organization was supplemented by strengthening procedures for hand hygiene, active screening of patients and enhanced cleaning. Monitoring of the epidemic curve has allowed us to demonstrate the effectiveness of measures introduced. However, deleterious effects were observed in patients whose habits were changed; we could also highlight significant impact on the activity of the unit.

[Survey on the activity of hospital departments of dermatology in France]. / Enquête sur l'activité des services de Dermatologie hospitaliers français.

INTRODUCTION: The Collège des Enseignants de Dermatologie de France initiated a study to assess the activity of the departments of dermatology in French hospitals. We report the results of this survey. MATERIAL AND METHODS: The study was conducted during a randomly selected week in the year 2000. An anonymous questionnaire was sent to all the departments of dermatology in the hospitals in France and was completed for each patient leaving the hospital during that week. The data collected were: the type of establishment, admission method, hospitalization method, type of pathology, motive for hospitalization, length of hospitalization and type of treatment used. RESULTS: The response rate was of 96 p. 100 for the University hospital centers and 80 p. 100 for the non-university hospitals. The number of patients treated per year was of 65 628 for the University hospitals and of 16,000 for the others. Ninety percent of the hospitalizations corresponded to direct admissions. The pathologies at the origin of the majority of yearly hospitalizations were, for the University hospitals: melanoma, leg ulcers, highly specialized dermatoses and systemic diseases and for the other hospitals: leg ulcers, HIV infection, highly specialized dermatoses and erysipela. The pathologies requiring the greatest number of hospitalization days were melanoma, leg ulcers, erysipela and highly specialized dermatoses. DISCUSSION: This study shows that the activity in the departments of dermatology is centered on pathologies that are clearly severe in terms of Public Health (oncology, infectious diseases and angiology). It also shows the efforts made for the management of patients in out-patient settings.

Short-term effects of air pollution on mortality in the cities of Rouen and Le Havre, France, 1990-1995.

In this study, the authors examined the short-term effects of ambient air pollution on mortality across 2 French cities: Rouen and Le Havre. In Poisson regression models, which controlled for day-of-week effects, the authors used nonparametric smoothing to control for temporal trend, weather, and influenza epidemics. In Rouen, an interquartile range increase of 60.5-94.1 microg/m3 of ozone was associated with an increase of 4.1% (95% confidence interval = 0.6, 7.8) of total mortality. Daily variations in sulfur dioxide (interquartile range increase = 17.6-36.4 microg/m3) were also associated with an 8.2% increase (95% confidence interval = 0.4, 16.6) in respiratory mortality. An increase of 6.1% (95% confidence interval = 1.5, 10.9) of cardiovascular mortality was also observed with an interquartile range increase of nitrogen dioxide (i.e., 25.3-42.2 microg/m3). With respect to Le Havre, an interquartile range increase in daily levels of sulfur dioxide (11.3-35.6 microg/m3) was associated with an increase of approximately 3% (95% confidence interval = 0.8, 5) of cardiovascular mortality. For particulate matter less than or equal to 13 microm in diameter (interquartile increase = 21.5, 45.4 microg/m3), an increase of 6.2% (95% confidence interval = 0.1, 12.8) was observed. The estimates of pollutant effects and their standard deviations were slightly affected by the degree of smoothing temporal variations in this study. When low collinearity was present, the 2-pollutant models provided acceptable estimates of pollutant effects. They suggested that the ozone effect was independent of the Black Smoke effect, and that the effects of sulfur dioxide and nitrogen dioxide were unlikely to be confounded by ozone concentrations. However, high collinearity leads to large estimates of the pollutant coefficient variances and, therefore, leads to inaccurate estimates of pollutant effects. The analysis of the contributory effects of different pollutant mixtures requires further investigation in those instances in which high collinearity between pollutants is present.

[Impact of the daily variations of the air pollution on the ambulatory emergency health services activity. Study in the urban area of Rouen (France)]. / Impact des variations quotidiennes de la pollution atmosphérique sur l'activité du dispositif d'urgences pré-hospitalières. Etude dans l'agglomération de Rouen.

BACKGROUND: The aim of this study was to evaluate feasibility of using both the emergency phone calls (SAMU) and medical interventions (SMUR) related to ambulatory emergency services for local epidemiological surveillance of health impact of air pollution. METHODS: A temporal ecological study was performed at Rouen area (France) (380,000 inhabitants) for 1990-1997 (SAMU) and 1990-1996 (SMUR). The pollutants tested were: Sulphur dioxide (SO(2)), Particles (PM13), and Nitrogen dioxide (NO(2)), as collected routinely by a local automated network. For each phone call (SAMU) or emergency interventions (SMUR), the date, medical reason for calling (SAMU) or diagnosis after interventions (SMUR) (classified as respiratory, cardiovascular or other diseases) have been extracted from a specific information system. A statistical analysis based on time series analysis associated to a Poisson regression was conducted, taking into account temporal trend, seasonal variations, influenza, days of the week, holiday and meteorological data. RESULTS: An association was observed between ambulatory emergency services activity for cardiovascular diseases, and the daily variations of both SO(2) (relative risk=1.008 [1.001-1.016] for SAMU with an increase of 10 microg/m(3)) and NO(2) (relative risk=1.018 [1.008-1. 030] for SAMU, relative risk=1.016 [1.001-1.032] for SMUR with an increase of 10 microg/m(3)). No association could be observed with the respiratory diseases for these pollutants. CONCLUSION: The ambulatory emergency services activity data could contribute to an epidemiological surveillance of the health impact of the air pollution, but a better quality of data collected (concerning both procedures and codification) is requested. The interest of an epidemiological surveillance, rather than usual pollutant monitoring, remains to evaluate.