Awareness of standard precautions for 4439 healthcare professionals in 34 institutions in France.

OBJECTIVE: The study objective was to assess the awareness of standard precautions (SP) among healthcare professionals, 1 year after the latest national guidelines were issued. METHODS: A multicenter cross-sectional survey was conducted in 34 volunteer institutions in 2010. Data was collected using an anonymous and self-administered questionnaire. The data was analyzed with a program developed from Epi-Info software. RESULTS: Four thousand four hundred and thirty-nine questionnaires were analyzed. Most respondents were nurses (44.1%) or nurses' aides (26.7%) followed by physicians (3.5%). 25% of respondents had participated in specific PS training in the previous 5 years. The percentage of correct answers for each question ranged from 37.1 to 91%. There was 72.6% of correct answers on hand hygiene but only 7.3% of correct answers on use of appropriate barriers and disposal of needles. 39.3% of respondents gave correct answers to eight or more of the 10 SP questions. The level of knowledge of nurses was higher compared to other professionals. The lowest level of knowledge was observed in long-term care and psychiatric institutions. CONCLUSIONS: The knowledge of healthcare professionals on use of appropriate protective barriers and disposal of needles is still too limited. The survey results should be used to develop adequate and targeted educational interventions.

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.

Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006-2007 and associated clusters in 2008-2009.

In 2006 and 2007, a large outbreak of Clostridium difficile infections (CDIs) with PCR-ribotype 027 was identified in northern France. Overall, 38 healthcare facilities notified 529 CDIs over a 22-month period, including 281 laboratory-confirmed CDI 027 and 248 non-confirmed CDI 027 cases (incidence rate per 10,000 elective bed days: 1.63, range: 0.07 to 7.94). The cases occurred mainly in long-term care hospital facilities and nursing homes, near the border between France and Belgium. An active surveillance and prevention campaign was launched at the first epidemic peak including hygiene precautions for healthcare professionals, which supported healthcare facilities to improve care organisation. The outbreak was controlled at the end of 2007, but sporadic cases were identified until the end of 2009. A bundle of appropriate control measures may halt the spread of such outbreaks, provided that substantial human resources and financial support are available.

Retrospective investigation of patients exposed to possible transmission of hepatitis C virus by a capillary blood glucose meter.

A 75-year-old female with no known risk factors for hepatitis C virus (HCV) infection was hospitalized and a diagnosis of HCV seroconversion was established (HCV immunoblot and a positive quantitative viral load). An epidemiological investigation revealed that, during a previous hospitalization resulting in a diagnosis of diabetes, she had shared a Glucotrend capillary blood glucose meter (CBGM; Roche Diagnostics, France) with a known HCV-positive diabetic patient. Poor hygiene practices were observed when using this device. Since the Glucotrend CBGM had been purchased, the suspected source patient had been hospitalized eight times and another 19 diabetic patients with known anti-HCV antibodies also regularly attended the same hospital. Consequently, 35 diabetic patients who had been hospitalized at the same time as the suspected source patient and 1305 patients who had used the Glucotrend CBGM were invited to undergo serum anti-hepatitis B virus, anti-HCV and anti-human immunodeficiency virus testing. Among the 35 diabetic patients, none of the 24 subjects tested were positive. Among the 1305 other patients, 995 were tested and 19 (2%) were anti-HCV positive. Although this prevalence is higher than that reported in the general French population, this excess risk cannot be attributed to use of the CBGM. Furthermore, molecular analysis showed that the two HCV strains isolated did not belong to the same phylogenetic cluster. However, as a result of this incident, measures were taken to minimize the transmission of bloodborne viruses in the hospital concerned. Other French hospitals were informed by a national alert message from the French Agency for the Safety of Health Products.

Chlamydial genital infection in Algiers: a sero-epidemiological survey.

Using a microimmunofluorescence test, the prevalence of antichlamydial immunoglobulin (Ig) G in 720 people in Algiers was studied. 34 (36%) of women with low genital infection, 28 (30%) of 91 patients attending a cancer screening clinic, and 44 (100%) of prostitutes had antichlamydial IgG at a titre greater than or equal to 1:16. Among 180 women seeking a rubeola test, 48 (26.6%) had IgG titres greater than or equal to 1:16. 144 infants less than 3 months old were also tested and 16.6% of them had IgG titres greater than or equal to 1:160; 20 (20.7%) of 97 men with chronic urethritis had IgG titres greater than or equal to 1:16. Antibody titres suggesting active disease in prostitutes, patients attending the cancer screening clinic and women with low genital infection were found in 95%, 11% and 17% respectively.

[Epidemiologic aspects of acute respiratory infections in children less than 6 months of age through a retrospective study in Algiers--Algeria]. / Aspects épidémiologiques des infections respiratoires aiguës chez des enfants de moins de 6 ans à travers une étude rétrospective à Alger--Algerie.

Personal medical files of 874 children from 0 to 4 years old monitored in a Maternal and Child Health Center were reviewed. Acute respiratory infections (ARI) represent about 37% of the total of these outpatients. Annual frequent occurrence of ARI has been estimated at 2.13 per child/per annum among babies less than 1 year old, and diminishes regularly with age to reach 0.74 per child/per annum in the age group 3-4 years. ARI were a motive for medical advice more frequent among boys than girls (p less than 0.01). Distribution of ARI according to their level shows that ARI above glottis represent 46% of total ARI, this percentage increasing with age. Approximately 63% of these ARI were treated by antibiotics.

[Acute respiratory infections of viral origin in the children of Algiers, Algeria based on a seroepidemiological study]. / Les infections respiratoires aiguës d'origine virale chez les enfants à Alger--Algérie, à travers une étude séro-épidémiologique.

401 double serum samples from 0 to 14 year old children with acute respiratory diseases (ARD) were analysed in view to establish the viral etiology. 198 (49.4%) out of the 401 were positive. The syncytial respiratory virus (SRV) was the most frequent (29.8%) among the positives, followed by the parainfluenzae virus type 3 (24.7), the influenza A virus (23.7%), the parainfluenzae type 1 (8.5%), the influenza B (7%) and the parainfluenza type 2 (2%). Seven samples out of 109 were positive for adenovirus. The SRV infections were very frequent before one year of age and after six. The parainfluenza virus type 3 was found mostly during the second year of life and was different in this from the types 1 and 2 prevalent after the age of six. The SRV is responsible for subglottic ARD (73%), as well as the parainfluenza virus type 3 (68.5%), the influenza virus types A (69%) and B (61.5%). On the contrary, the parainfluenza viruses types 1 (70%) and 2 (67%) attacked especially the upper respiratory tract. Studies were also worked out on the effects of season, sex, antibiotherapy, as well as on the viruses most incriminated in hospitalization.

[Genital Chlamydia infections. A seroepidemiologic study in Algiers]. / Les infections génitales a Chlamydia. Etude séroépidémiologique a Alger.

The prevalence of anti-Chlamydia antibodies was studied among 329 patients divided into 5 groups, 34 (36%) of the women with a low genital infection have antibodies at a titre greater than 16 versus 12 (17%) of the patients attending the women's clinic for routine pelvic examination. 44 (100%) of 44 prostitutes had antibodies greater than 16 meanwhile only 2 (7%) of 30 women attending an obstetric clinic had antibodies greater than 16. Titres suggesting active chlamydial infection were found in prostitutes (95%), women with low genital infection (17%) and patients attending a cancer screening clinic (11%). In other hand, using immunofluorescence test with monoclonal anti Chlamydia trachomatis antibodies, 20 (45.5%) of the prostitutes were found antigen positive.

Polio outbreak in Algeria: epidemiological, virological and vaccinational aspects.

During a poliomyelitis outbreak (October 1983) in El Oued territory (Algeria) 28 cases were diagnosed. All the patients were under 4 years old. The ratio of females to males was 0.33. No deaths occurred during this epidemic. 25 of the 28 polio cases were diagnosed by cell culture and 81% were polio type 1. The epidemiological survey established that the epidemic was due to the insufficiency of vaccination coverage, since the consumption of antipolio vaccine in the epidemic area had dropped by 25% from 1982 to 1983. 7 of the 28 polio cases had been given at least 3 injections of vaccine at the correct intervals. 5 of 8 vaccine samples from the epidemic area had an insufficient titre of polio type 1. These observations showed that the nature of the vaccine, whether killed or live virus, was less important for controlling poliomyelitis than providing medical and sanitary facilities to ensure good vaccination coverage.

Herpetic and chlamydial genital infections in Algiers, Algeria: value of the Papanicolaou staining.

The prevalence of herpetic and chlamydial genital infections was studied in 309 women attending an outpatient gynecology clinic (Algiers, Algeria). Cell culture, IF on smears and Papanicolaou staining were the methods used for HSV diagnosis, serology by the MIF method and Papanicolaou staining were used for Chlamydia trachomatis diagnosis. The prevalence of herpetic genital infection was estimated at 7.2% by cell culture, 89% by IF method, and 3.9% using the Papanicolaou staining. Specific anti-Chlamydia trachomatis IgG with a titer greater than or equal to 16 were found in 35.7% out of 95 sera, and 18% out of the 95 women had an IgG titer greater than or equal to 64. If we consider IgG titer greater than or equal to 64 as significant for an active chlamydial genital infection, the concordance rate between the Papanicolaou staining and the MIF method is of 48%. However, the Papanicolaou method appears as insensitive for both the HSV and Chlamydia trachomatis diagnosis. The relative specificity of this method for HSV diagnosis accounts for its use as a screening test.

Rapid diagnosis of respiratory syncytial virus infection by antigen immunofluorescence detection with monoclonal antibodies and immunoglobulin M immunofluorescence test.

During a respiratory syncytial virus (RSV) infection outbreak in a pediatric hospital, diagnosis was made by immunofluorescence on smears by using an anti-RSV monoclonal antibody (IFm). Immunoglobulins M and G were titrated by indirect immunofluorescence on HEp-2 cells infected with an RSV strain. The IFm was sensitive (89%) and specific (75%) when compared with the cell culture method. We showed that the specimens which were found positive by IFm and negative by cell culture were truly positive. Under these conditions, the IFm test appears more sensitive and more specific than cell culture, particularly when no care is taken to maintain the specimens in the cold during transport. In this study the immunoglobulin M immunofluorescence test had a low sensitivity (34%), especially on serum samples taken on days 0 to 4 after the onset of illness.