[Prompt control of an imported carbapenem-resistant Acinetobacter baumanii outbreak in a French intensive care unit]. / Contrôle rapide d'une épidémie par une souche d'Acinetobacter baumanii résistant à l'imipénème importée de pays émergent dans un service de réanimation en France.

OBJECTIVE: to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. METHODS: Careful review of the contact's and carrier's files and outbreak management procedures. RESULTS: An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. CONCLUSIONS: restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.

[A role for hypnosis in cataract surgery: Report of 171 procedures]. / Apport de l'hypnose dans la chirurgie de cataracte, à propos de 171 chirurgies.

OBJECTIVES: To study the effectiveness of relaxation hypnosis in outpatient cataract surgery. STUDY DESIGN: Prospective study of 171 patients undergoing cataract surgery under hypnosis, performed by the same nurse anesthetist. The procedures were performed by 2 senior surgeons, A and B (A=78 surgeries, and B=93 surgeries) under topical anesthesia and with a 2.2-mm mini-incision. The hypnosis group (n=102) was compared to a control group (n=69) according to quantitative, objective criteria: hemodynamic changes and the need for intravenous medication in operating room, as well as subjective, qualitative criteria: surgical comfort, effectiveness of hypnosis, and patient satisfaction. Subgroup analyses by surgeon, 1st and 2nd eye surgery, were performed. RESULTS: Hemodynamic parameters were not significantly different between the 2 groups: systolic blood pressure (P=0.06) and maximum heart rate (P=0.25). However, the use of intraoperative intravenous medication was significantly higher in the control group (49.3% versus 21.6%, P<0.001). The effectiveness of relaxation was scored at a mean of 5.25/6 by the nurse anesthetist. The patients in the hypnosis group reported a mean comfort rating of 8.4/10, and 100% were satisfied with this hypnosis experience. CONCLUSIONS: Preliminary results of this study are very positive for all three parties: patient/anesthetist/surgeon. They are leading to an expanded university training program for operating room personnel in order to improve quality of care and reduce premedication in elderly patients so as to facilitate their return to home.