Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene.

In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.

Update of the SFMV (French society of vascular medicine) guidelines on the conditions and safety measures necessary for thermal ablation of the saphenous veins and proposals for unresolved issues.

Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document).

Preoperative hair removal and surgical site infections: network meta-analysis of randomized controlled trials.

Preoperative hair removal has been used to prevent surgical site infections (SSIs) or to prevent hair from interfering with the incision site. We aimed to update the meta-analysis of published randomized controlled trials about hair removal for the prevention of SSIs, and conduct network meta-analyses to combine direct and indirect evidence and to compare chemical depilation with clipping. The PubMed, ScienceDirect and Cochrane databases were searched for randomized controlled trials analysing different hair removal techniques and no hair removal in similar groups. Paired and network meta-analyses were conducted. Two readers independently assessed the study limitations for each selected article according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Nineteen studies met the inclusion criteria. No study compared clipping with chemical depilation. Network meta-analyses with shaving as the reference showed significantly fewer SSIs with clipping, chemical depilation, or no depilation [relative risk 0.55, 95% confidence interval 0.38-0.79; 0.60, 0.36-0.97; and 0.56, 0.34-0.96, respectively]. No significant difference was observed between the absence of depilation and chemical depilation or clipping (1.05, 0.55-2.00; 0.97, 0.51-1.82, respectively] or between chemical depilation and clipping (1.09, 0.59-2.01). This meta-analysis of 19 randomized controlled trials confirmed the absence of any benefit of depilation to prevent surgical site infection, and the higher risk of surgical site infection when shaving is used for depilation. Chemical depilation and clipping were compared for the first time. The risk of SSI seems to be similar with both methods.

Outbreak of typhoid fever on the French Riviera.

A case-control study was conducted to establish the source of a community outbreak of typhoid fever in Utelle, France, a village located in the Alpes-Maritimes district of the French Riviera. Thirteen confirmed cases of typhoid fever and 41 confirmed community controls were included in the study. Cases and controls did not differ regarding ingestion of water. Multivariate logistic regression analysis identified consumption of pork meats during a village festival as the only statistically significant risk factor for typhoid fever after adjusting for age and sex (odds ratio, 76.0; 95% confidence interval, 3.5-1660). Assessment of food-handling procedures at the inn where the food had been prepared showed that the refrigeration and cooking facilities were inadequate to maintain a proper sanitary environment during the preparation of a meal for 350 people. Although the exact cause of the epidemic could not be confirmed, food contaminated by a chronic typhi carrier is the most plausible hypothesis.

Efficacy and safety of an intravenous induction therapy for treatment of disseminated Mycobacterium avium complex infection in AIDS patients: a pilot study.

Monotherapy with macrolides for the treatment of disseminated Mycobacterium avium complex (MAC) bacteraemia leads to drug resistance and relapse of bacteraemia. Gastrointestinal intolerance is a common reason for treatment withdrawal of multidrug regimens. We have assessed the efficacy and safety of initial parenteral therapy together with a macrolide, for disseminated MAC infection, defined as two positive blood cultures, in AIDS patients. Patients received a daily infusion of amikacin 15 mg/kg + ethambutol 20 mg/kg + ciprofloxacin 400 mg/day, for 1 month, together with a macrolide by oral route. Fifteen patients were included and 13 (86%) achieved negative culture before the end of parenteral therapy.

[Hospital medical students: a population at risk for accidental exposure to blood]. / Les étudiants hospitaliers: une population à risque d'accidents d'exposition au sang (AES).

OBJECTIVE: Infections transmitted by blood such as viral hepatitis B and C or human immunodeficiency virus (HIV) are a true threat to health care workers. As medical students are exposed to accidental contamination during their hospital activities, we conducted a survey among medical students in Nice France to determine the frequency and circumstances of needle prick accidents and how the risk of blood exposure is managed. METHODS: A survey was conducted between December 1 and December 15, 1996 among second cycle medical students. An anonymous questionnaire was proposed to all students attending mandatory faculty classes. A blood-exposure accident was defined as a needle prick or a cut caused by another sharp object which occurred in the hospital. RESULTS: Among the 237 students enrolled in the classes, 200 (84%) responded to the survey. Among these, one-quarter had experienced a blood-exposure accident by needle prick. For students terminating their second cycle, this rate was 37%. In 58% of the cases, the accidents had occurred when the students were on duty (excepting hospital training courses). Blood drawing for gas measurements was the most frequent circumstance (44%). Only 39% of the students had declared the accident and 51% had had a serology control within 2 months. The serological status of the source patient was unknown to the students in nearly half the cases. Only one out of two students applied elementary safety measures systematically (gloves, not recapping the needle). Only 13% of the students stated they had received information about blood-exposure accidents and their prevention and less than 50% had a correct notion of the risk of hepatitis B and C and HIV transmission by needle pricks. CONCLUSION: The incidence of blood-exposure accidents in hospital medical students is high and probably underestimated by official statistics due to the low declaration rate. Measures should rapidly implemented to inform and train students on prevention. Our units are currently working with students, the medical faculty and the occupational medicine unit to reach these objectives.

Do viral load and CD8 cell count at initiation of tritherapy influence the increase of CD4 T-cell count?

BACKGROUND: Tritherapies including protease inhibitors improve clinical status and usually increase CD4 T cell count. However, the dissociation between the marked decreases in viral load and the incomplete restoration of CD4 cell counts with a three-drug combination has been reported. We assessed this potential difference among our patients. METHODS: Patients were enrolled when a protease inhibitor was prescribed to them for the first time. Using a computerized medical record (ADDIS), we retrospectively assessed a potential relationship between the increase in CD4 T cells (deltaCD4) at M3, M6 and variables including sex, age, CDC staging, protease inhibitor, prior antiviral therapy, CD8 and viral load at baseline. We used Epi-Info 6.4 and BMDP software. RESULTS: Data were analyzed on 154 patients. The median CD4 T cell count was 157 at baseline, 215 at month 3 and 202 at month 6. The median viral load was 52000 copies at baseline, 530 at month 3 and 500 at month 6. In a univariate analysis, a significant relationship was found between deltaCD4 and CD8 at baseline. A statistically significant negative correlation appeared between the CD8 cell count at baseline and deltaCD4 at M6 (r=-0.28, Pearson). Moreover, we found that there also was a relationship between deltaCD4 and viral load at baseline. There was a correlation between deltaCD4 at M6 and the viral load at M0 (r=0.37, Pearson). In a multiple regression model, after CD8 count at baseline had been accounted for, we found a significant correlation between deltaCD4 and viral load at baseline (multiple r=0.33 at M3, and 0.40 at M6). CONCLUSIONS: Patients with a low viral load do not benefit from as great an increase in CD4 T cell count as others when they receive a tritherapy including protease inhibitors. These results suggest that another mechanism rather than direct viral pathogenicity leads to CD4 T cell destruction. This mechanism may not be efficiently stopped by antiviral therapy, especially protease inhibitors.

Comparing nosocomial infection rates among surgical intensive-care units: the importance of separating cardiothoracic and general surgery intensive-care units.

Among surgical intensive-care units (ICUs), we assessed differences in risk-adjusted nosocomial infection rates between cardiothoracic (CT) and general surgery ICUs, using National Nosocomial Infection Surveillance data from 1987 to 1995. Device-associated rates and average length of stay were significantly lower in CT ICUs. Comparisons of risk-adjusted nosocomial infection rates among CT ICUs should be made separately from rates from general surgery ICUs.

Severity of illness scoring systems to adjust nosocomial infection rates: a review and commentary.

BACKGROUND: Nosocomial infections (NI) are often used by hospitals for external comparisons. In the National Nosocomial Infection Surveillance system, NI rates from intensive care units (ICUs) are adjusted for extrinsic risk factors such as device use but would be enhanced if they were better adjusted with a direct measurement of patients' severity of illness. METHOD: We performed a Medline search on the literature during 1991 to 1996 to identify a severity of illness scoring system (SISS) that would be useful for further adjusting ICU NI rates. We assessed the scoring system for objectivity, simplicity, discriminating power, and availability. RESULTS: Eleven studies reported the use of SISS. Seven used scoring systems developed to predict mortality rates. Four correlated SISS with all sites of NI and, in general, did not meet with success. Six showed some predictive value between SISS and nosocomial pneumonia. The Acute Physiology and Chronic Health Evaluation score (version II or III), used in five studies, was the most commonly used SISS but performed inconsistently and may not be available in many ICUs. CONCLUSION: New approaches for measures of severity of illness need to be developed to adjust NI rates. Until such measures are available, comparative NI rates will be limited in their use as definitive indicators of quality of care.