Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI).

BACKGROUND: Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS: The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS: Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION: VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.

Factors associated with Vancomycin-resistant Enterococcus acquisition during a large outbreak.

Between 2013 and 2014 a Vancomycin-resistant Enterococci (VRE) outbreak occurred in a teaching hospital in France. The outbreak was significant possibly due to the lack of implementation of recommended control measures. The aim of this study was to identify the effect of the lack of adherence to control measures for prevention of VRE acquisition in contact patients taking into account individual risk factors. Contact patients (first two months of the outbreak) with VRE acquisition were compared to patients without VRE acquisition (univariate and logistic regression), in terms of institutional characteristics (unit of hospitalization and isolation measures) and risk factors. Between December 2013 and February 2014, 282 contact patients were included in the study. The prevalence of VRE acquisition was 6.4% (18/282). Significant risk factors for VRE acquisition according to logistic regression analysis were; lack of isolation, hospitalization in the same hospital unit as a VRE carrier patient and lack of isolation (RR=856.8, p=0.001), hospitalization in a specific unit (RR=927.4, p=0.002), McCabe score equal to 2 (RR=5233.6, p=0.008), age (RR=1.2 by year, p=0.011), hemodialysis (RR=36.1, p=0.011), central venous catheter (RR=25.4, p=0.021) and surgery (RR=0.012, p=0.007). Antibiotic use was a significant risk factor for VRE acquisition using univariate analysis (p<10-3). The findings confirm that the factors focused on by the study (lack of isolation and dedicated unit) had a significant effect on VRE acquisition as patient associated factors. It highlights the importance of observance of the guidelines.