Resume L'infection urinaire constitue l'infection nosocomiale la plus frequente et peut s... more Resume L'infection urinaire constitue l'infection nosocomiale la plus frequente et peut se compliquer, de facon non exceptionnelle, de septicemies, generatrices parfois de chocs toxi-infectieux. Le sondage vesical a demeure constitute le premier facteur de risque de l'infection urinaire nosocomiale. Frequemment necessaire en anesthesie et en reanimation ou la surveillance de la diurese constitute l'un des elements du monitoring, l'indication du sondage vesical a demeure doit s'assortir des mesures de prevention du risque infectieux. Il s'agit : de limiter indication et duree du sondage a demeure, d'effectuer le sondage vesical selon les regles strictes de l'asepsie, de gerer le sondage a demeure en systeme clos et d'assurer la qualite et la frequence des toilettes et des changes. C'est au prix du respect de ces regles simples mais essentielles que la frequence de cette complication infectieuse pourra etre reduite.
In France, infection control (IC) practitioners appeared in the late 1970s. In 1995, French healt... more In France, infection control (IC) practitioners appeared in the late 1970s. In 1995, French health authorities formally introduced the concept of IC teams, which became mandatory in November 1999. Confidential IC annual reports for each hospital became mandatory in 2000. Under pressure from consumer associations, the Ministry of Health introduced IC performance indicators for public reporting in 2004, the first being known as ICALIN. Although the annual IC report was intended to be a hospital report, in practice it was often considered to be the IC team's report, so IC teams began to be held accountable for the performance of their hospitals against IC indicators. Several IC teams thought that the report failed to reflect the volume and range of their activities, especially in terms of counselling. However, most of them recognized the benefit of public reporting, as their work was at least under scrutiny and recognized as useful. Using indicators to evaluate IC performance thus ...
contre les cercosporioses du bananier aux Antilles françaises Banatrace, un système d'information... more contre les cercosporioses du bananier aux Antilles françaises Banatrace, un système d'information géographique multi-acteurs pour la gestion et la traçabilité des épandages aériens. Sciences Eaux & Territoires, INRAE, 2011, p.
International Journal of Antimicrobial Agents, 2007
Background: Surgical site infection (SSI) is one of the most frequent nosocomial infections. Sinc... more Background: Surgical site infection (SSI) is one of the most frequent nosocomial infections. Since 1999, a national coordination of regional networks has been implemented to gather SSI incidence data according to standardised method. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse a 6-year temporal trend. Methods: Surgery patients were enrolled by voluntary participating wards in a yearly 3-month incidence survey. In each ward, 200 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard CDC criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Results: During 6 years, the study included 620,176 operations (17,430,253 operated patient-days follow-up; median post-operative follow-up: 28 days). The overall SSI incidence rate was 1.68%. Organ space and deep incisional SSI accounted for 41.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.91% [0.88-0.94%] for NNIS-0 patients to 13.8% [12.5−15.2%] for NNIS-2, 3 patients. The SSI incidence varied from 1.15% for herniorraphy to 9.2% for colon surgery. In NNIS-0 patients, emergency surgery increased the SSI risk for C-section whereas videoscopy surgery was at lower risk for cholecystectomy. From 1999 to 2004, NNIS-0 SSI incidence decreased from 1.1 to 0.9 for 100 operated patients (relative difference: −18%). According to procedure, the trend remained significant only for herniorraphy. Conclusion: This database provided thorough standardised estimate of SSI incidence according to various surgery procedures. Impact of the national policy on SSI incidence remains to be further evaluated, although encouraging results were evidenced for specific surgery. O15 Changes in healthcare-associated infection rates in French maternity units from 1997 to 2003
Infection Control & Hospital Epidemiology, 2007
Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures ... more Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs).Design.Prospective national follow-up of HCWs from January 1 to December 31, 2004.Setting.University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis.Participants.At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire.Results.A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 per...
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that t... more Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs among hospitals. The aim of the current study was to identify relevant and easily available adjustment criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43 private hospitals located in southwestern France and overseas departments using retrospective data from 2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000 patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs (range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422 DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the comparison among hospitals are easily available. It is important that each country establish its own model considering the intrinsic peculiarities of the hospital system and taking into account both indicators (DDD/1000 PDs or DDD/100 admissions) to design the best model.
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that t... more Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs among hospitals. The aim of the current study was to identify relevant and easily available adjustment criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43 private hospitals located in southwestern France and overseas departments using retrospective data from 2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000 patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs (range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422 DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the comparison among hospitals are easily available. It is important that each country establish its own model considering the intrinsic peculiarities of the hospital system and taking into account both indicators (DDD/1000 PDs or DDD/100 admissions) to design the best model.
Introduction Since ten years, quality indicators (QI) are mandatorily measured in all French hosp... more Introduction Since ten years, quality indicators (QI) are mandatorily measured in all French hospitals. They are used for hospital quality improvement, public disclosure and regulation goals. After a decade of use, the Ministry of Health and the French National Authority for Health set up a task force to evaluate these QI. The goal was to provide a decision aid to the Ministry and HAS in terms of suppressing or maintaining their use, or modifying their content. As there was no available integrated tool, the task force started with the development and test of a tool during the year 2015. This tool aimed at evaluating all components of their performance (measurement feasibility, metrological performance and relevance for users) of QIs according to each of the three goals. The objective was to define an operational and structured method allowing the overall appraisal of ongoing national QI in healthcare, to apply it on ten indicators and to study its impact. Methods The national expert workgroup was constituted by clinicians, epidemiologists, healthcare facility managers, quality managers, sociologists and a patients’ representative: step 1: a search for similar experiences in other countries; step 2: a literature review to identify relevant assessment criteria and methods; step 3: a consensus method between the members of the group to select the criteria: Using a modified Rand/UCLA Appropriateness Method, the appropriateness of these criteria was checked for evaluating the indicators according to each of the three goals. The group extracted a list of criteria for each goal. Each criterion was assessed using a quantitative approach or a qualitative approach; step 4: test and implementation of the method on 10 national QI to identify operational issues in the implementation of the method: The indicator's results collected the previous years were analyzed; the scientific soundness of the indicator development was reviewed; field hospital workers (doctors, nurses, managers), health authorities employees and patients were interviewed. All these data results were discussed by the task force, summarized and displayed on spider charts presenting standardized scores. This integrated tool was tested on ten national process QIs; step 5: assessment criteria of impact of the work: implementation of the recommendations by the Ministry and HAS. Results Twelve were selected as appropriate for the evaluation of QIs for regulation use: relevance (importance of the quality characteristic captured for the healthcare system; benefit/ability to take decision based on the results; potential risks/side effects), feasibility (understandability and Interpretability of the indicator and its results; barriers to implementation due to data collection effort; delays related to data production), scientific soundness of the indicator development (indicator evidence; validity; risk adjustment) and current metrological performance (indicator expression can be influenced by providers; discriminatory power; dynamics of change). Among these, 11 were selected for hospital improvement and 7 for public disclosure. The tool was applied on 10 process QIs. We proposed to suppress four of them and to modify or suspend the six others. The four QIs were suppressed, and the others have been or are currently in a process of modification. Conclusion By combining qualitative and quantitative evaluations, the QUID instrument offers a solid method for thoroughly appraising each indicator. The value of the QUID method was supported by the clear-cut conclusions on 10 QIs and subsequently by the decisions of the Ministry and the HAS to follow the recommendations. More research is needed to finalize the tool on other types of indicators.
Resume Un systeme de surveillance hospitaliere de l'infection par le VIH a ete mis en place e... more Resume Un systeme de surveillance hospitaliere de l'infection par le VIH a ete mis en place en 1985 au CHRU de Bordeaux par le Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA). Un de ses objectifs est l'etude de l'histoire naturelle de la maladie. Lors du suivi pour chaque patient, les donnees epidemiologiques, cliniques et biologiques sont recueillies sur un questionnaire standardise anonyme. La classification des stades de l'infection des Centers for Disease Control est utilisee. La probabilite cumulee d'atteindre le stade IV ou le stade SIDA est calculee par la methode de Kaplan-Meier. Le modele de Cox est utilise pour la comparaison des courbes d'evolution. Au 30 septembre 1990, parmi 1651 sujets adultes inclus dans la cohorte du GECSA, 818 etaient classes stades II et III a l'inclusion et ont ete revus au moins une fois. La repartition par groupe a risque etait (N = 818) : toxicomanes, 37,8 % ; homo-bisexuels, 31,2 % ; transfuses, 8,2 % ; hemophiles, 3,8 % et heterosexuels partenaires de sujets seropositifs ou faisant partie d'un autre groupe a risque de l'infection, 12,3 %. Pour 6,7 %, le groupe a risque etait indetermine. L'analyse de l'evolution clinique a porte sur les 763 patients dont le groupe a risque a pu eter determine de facon certaine. Pour l'ensemble de ces patients, la probabilite cumulee d'atteindre le stade SIDA %etait de 7,6 % a 12 mois (Intervalle de Confiance (IC) a 95 % = 5,5 % − 9,7 %), 13,9 % a 24 mois (10,6 % – 17,2 %), de 18,4 % a 36 mois (14,1 % – 22,7 %) et de 23,0 % a 48 mois (16,7 % – 29,3 %). La comparaison des cinq groupes a risque ne permet pas de mettre en evidence de difference significative d'evolution vers le stade IV, ni vers le stade SIDA. Cette conclusion reste inchangee apres ajustement sur l'âge et le taux de lymphocytes T4 a l'inclusion. Par ailleurs, les probabilites d'atteindre le stade SIDA, dans cette cohorte francaise, sont voisines de celles calculees au sein des cohortes nord-americaines.
RESUME L'ann6e 1996 a vu la lutte contre les infections nosocomiales se doter, en France, de plus... more RESUME L'ann6e 1996 a vu la lutte contre les infections nosocomiales se doter, en France, de plusieurs rdf6rentiels officiels importants. De la cfl'culaire ministdrielle sur le traitement des endoscopes au guide sur le bon usage des antibiotiques h l'h6pital publi6 par I'ANDEM en passant par les techniques de l'isolement septique, ce sont autant de documents qui sont venus poser les bases d'une harmonisation des actions de prevention en matiere d'infections nosocomiales. Beaucoup d'interrogations persistent autour du risque de transmission nosocomiale de certains agents, comme le virus de l'h6patite C et les prions, rendant d61icate l'61aboration de r~gles de pr6vention adaptdes ~t ces situations. Le risque professionnel lid aux accidents d'exposition au sang est rest6 une prdoccupation majeure et la prophylaxie de l'infection h VIH dans ce contexte s'est alignde sur les avancees th6rapeutiques du traitement de cette pathologie. Enfin dans le domaine des infections du site opdratoire certains facteurs de risques comme l'hypothermie ont 6t6 soulign6s et la place de 1' antibioprophylaxie a continual d'etre pr6cis6e. Mots-cl~s : Infections nosocomiales-Contr61e de l'infection-France.
Resume L'infection urinaire constitue l'infection nosocomiale la plus frequente et peut s... more Resume L'infection urinaire constitue l'infection nosocomiale la plus frequente et peut se compliquer, de facon non exceptionnelle, de septicemies, generatrices parfois de chocs toxi-infectieux. Le sondage vesical a demeure constitute le premier facteur de risque de l'infection urinaire nosocomiale. Frequemment necessaire en anesthesie et en reanimation ou la surveillance de la diurese constitute l'un des elements du monitoring, l'indication du sondage vesical a demeure doit s'assortir des mesures de prevention du risque infectieux. Il s'agit : de limiter indication et duree du sondage a demeure, d'effectuer le sondage vesical selon les regles strictes de l'asepsie, de gerer le sondage a demeure en systeme clos et d'assurer la qualite et la frequence des toilettes et des changes. C'est au prix du respect de ces regles simples mais essentielles que la frequence de cette complication infectieuse pourra etre reduite.
In France, infection control (IC) practitioners appeared in the late 1970s. In 1995, French healt... more In France, infection control (IC) practitioners appeared in the late 1970s. In 1995, French health authorities formally introduced the concept of IC teams, which became mandatory in November 1999. Confidential IC annual reports for each hospital became mandatory in 2000. Under pressure from consumer associations, the Ministry of Health introduced IC performance indicators for public reporting in 2004, the first being known as ICALIN. Although the annual IC report was intended to be a hospital report, in practice it was often considered to be the IC team's report, so IC teams began to be held accountable for the performance of their hospitals against IC indicators. Several IC teams thought that the report failed to reflect the volume and range of their activities, especially in terms of counselling. However, most of them recognized the benefit of public reporting, as their work was at least under scrutiny and recognized as useful. Using indicators to evaluate IC performance thus ...
contre les cercosporioses du bananier aux Antilles françaises Banatrace, un système d'information... more contre les cercosporioses du bananier aux Antilles françaises Banatrace, un système d'information géographique multi-acteurs pour la gestion et la traçabilité des épandages aériens. Sciences Eaux & Territoires, INRAE, 2011, p.
International Journal of Antimicrobial Agents, 2007
Background: Surgical site infection (SSI) is one of the most frequent nosocomial infections. Sinc... more Background: Surgical site infection (SSI) is one of the most frequent nosocomial infections. Since 1999, a national coordination of regional networks has been implemented to gather SSI incidence data according to standardised method. The aim of the current study was to describe the largest database ever collected in France on SSI and to analyse a 6-year temporal trend. Methods: Surgery patients were enrolled by voluntary participating wards in a yearly 3-month incidence survey. In each ward, 200 consecutive surgery procedures should be included and patients followed up to 30 days after surgery. SSI was defined based on standard CDC criteria. For each patient, risk factors were collected on the day of surgery including age, ASA score, Altemeier wound class, type and duration of procedure, emergency/elective, and when videoscopy surgery was performed. Results: During 6 years, the study included 620,176 operations (17,430,253 operated patient-days follow-up; median post-operative follow-up: 28 days). The overall SSI incidence rate was 1.68%. Organ space and deep incisional SSI accounted for 41.7% although their proportion varied according to the type of surgery. SSI incidence rate increased from 0.91% [0.88-0.94%] for NNIS-0 patients to 13.8% [12.5−15.2%] for NNIS-2, 3 patients. The SSI incidence varied from 1.15% for herniorraphy to 9.2% for colon surgery. In NNIS-0 patients, emergency surgery increased the SSI risk for C-section whereas videoscopy surgery was at lower risk for cholecystectomy. From 1999 to 2004, NNIS-0 SSI incidence decreased from 1.1 to 0.9 for 100 operated patients (relative difference: −18%). According to procedure, the trend remained significant only for herniorraphy. Conclusion: This database provided thorough standardised estimate of SSI incidence according to various surgery procedures. Impact of the national policy on SSI incidence remains to be further evaluated, although encouraging results were evidenced for specific surgery. O15 Changes in healthcare-associated infection rates in French maternity units from 1997 to 2003
Infection Control & Hospital Epidemiology, 2007
Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures ... more Objective.To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs).Design.Prospective national follow-up of HCWs from January 1 to December 31, 2004.Setting.University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis.Participants.At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire.Results.A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 per...
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that t... more Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs among hospitals. The aim of the current study was to identify relevant and easily available adjustment criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43 private hospitals located in southwestern France and overseas departments using retrospective data from 2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000 patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs (range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422 DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the comparison among hospitals are easily available. It is important that each country establish its own model considering the intrinsic peculiarities of the hospital system and taking into account both indicators (DDD/1000 PDs or DDD/100 admissions) to design the best model.
Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that t... more Hospitals in France are encouraged to monitor antibiotic consumption (AbC) and it is known that this differs among hospitals. The aim of the current study was to identify relevant and easily available adjustment criteria for the purpose of benchmarking. We analysed data from 34 public non-teaching hospitals and 43 private hospitals located in southwestern France and overseas departments using retrospective data from 2005. This study investigated the relationship between AbC expressed as defined daily doses per 1000 patient-days (DDD/1000 PDs) or per 100 admissions (DDD/100 admissions) and the number of venous central lines, the number of episodes of bacteraemia and various hospital characteristics. The relationship was tested using multiple linear analyses. The median total AbC in public hospitals was 395 DDD/1000 PDs (range, 196-737) and 341 DDD/100 admissions (range, 180-792). In private hospitals this was 422 DDD/1000 PDs (range, 113-717) and 212 DDD/100 admissions (range, 38-510). The best model for public hospitals included the proportion of PDs in surgery, intensive care and medical wards and explained 84% of the variability in AbC expressed as DDD/1000 PDs. For private hospitals, the mean length of stay and the proportion of PDs in surgery and medical wards explained 68% of the variability in AbC expressed as DDD/100 admissions. Overall, this French experience shows that relevant adjustment criteria for the comparison among hospitals are easily available. It is important that each country establish its own model considering the intrinsic peculiarities of the hospital system and taking into account both indicators (DDD/1000 PDs or DDD/100 admissions) to design the best model.
Introduction Since ten years, quality indicators (QI) are mandatorily measured in all French hosp... more Introduction Since ten years, quality indicators (QI) are mandatorily measured in all French hospitals. They are used for hospital quality improvement, public disclosure and regulation goals. After a decade of use, the Ministry of Health and the French National Authority for Health set up a task force to evaluate these QI. The goal was to provide a decision aid to the Ministry and HAS in terms of suppressing or maintaining their use, or modifying their content. As there was no available integrated tool, the task force started with the development and test of a tool during the year 2015. This tool aimed at evaluating all components of their performance (measurement feasibility, metrological performance and relevance for users) of QIs according to each of the three goals. The objective was to define an operational and structured method allowing the overall appraisal of ongoing national QI in healthcare, to apply it on ten indicators and to study its impact. Methods The national expert workgroup was constituted by clinicians, epidemiologists, healthcare facility managers, quality managers, sociologists and a patients’ representative: step 1: a search for similar experiences in other countries; step 2: a literature review to identify relevant assessment criteria and methods; step 3: a consensus method between the members of the group to select the criteria: Using a modified Rand/UCLA Appropriateness Method, the appropriateness of these criteria was checked for evaluating the indicators according to each of the three goals. The group extracted a list of criteria for each goal. Each criterion was assessed using a quantitative approach or a qualitative approach; step 4: test and implementation of the method on 10 national QI to identify operational issues in the implementation of the method: The indicator's results collected the previous years were analyzed; the scientific soundness of the indicator development was reviewed; field hospital workers (doctors, nurses, managers), health authorities employees and patients were interviewed. All these data results were discussed by the task force, summarized and displayed on spider charts presenting standardized scores. This integrated tool was tested on ten national process QIs; step 5: assessment criteria of impact of the work: implementation of the recommendations by the Ministry and HAS. Results Twelve were selected as appropriate for the evaluation of QIs for regulation use: relevance (importance of the quality characteristic captured for the healthcare system; benefit/ability to take decision based on the results; potential risks/side effects), feasibility (understandability and Interpretability of the indicator and its results; barriers to implementation due to data collection effort; delays related to data production), scientific soundness of the indicator development (indicator evidence; validity; risk adjustment) and current metrological performance (indicator expression can be influenced by providers; discriminatory power; dynamics of change). Among these, 11 were selected for hospital improvement and 7 for public disclosure. The tool was applied on 10 process QIs. We proposed to suppress four of them and to modify or suspend the six others. The four QIs were suppressed, and the others have been or are currently in a process of modification. Conclusion By combining qualitative and quantitative evaluations, the QUID instrument offers a solid method for thoroughly appraising each indicator. The value of the QUID method was supported by the clear-cut conclusions on 10 QIs and subsequently by the decisions of the Ministry and the HAS to follow the recommendations. More research is needed to finalize the tool on other types of indicators.
Resume Un systeme de surveillance hospitaliere de l'infection par le VIH a ete mis en place e... more Resume Un systeme de surveillance hospitaliere de l'infection par le VIH a ete mis en place en 1985 au CHRU de Bordeaux par le Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA). Un de ses objectifs est l'etude de l'histoire naturelle de la maladie. Lors du suivi pour chaque patient, les donnees epidemiologiques, cliniques et biologiques sont recueillies sur un questionnaire standardise anonyme. La classification des stades de l'infection des Centers for Disease Control est utilisee. La probabilite cumulee d'atteindre le stade IV ou le stade SIDA est calculee par la methode de Kaplan-Meier. Le modele de Cox est utilise pour la comparaison des courbes d'evolution. Au 30 septembre 1990, parmi 1651 sujets adultes inclus dans la cohorte du GECSA, 818 etaient classes stades II et III a l'inclusion et ont ete revus au moins une fois. La repartition par groupe a risque etait (N = 818) : toxicomanes, 37,8 % ; homo-bisexuels, 31,2 % ; transfuses, 8,2 % ; hemophiles, 3,8 % et heterosexuels partenaires de sujets seropositifs ou faisant partie d'un autre groupe a risque de l'infection, 12,3 %. Pour 6,7 %, le groupe a risque etait indetermine. L'analyse de l'evolution clinique a porte sur les 763 patients dont le groupe a risque a pu eter determine de facon certaine. Pour l'ensemble de ces patients, la probabilite cumulee d'atteindre le stade SIDA %etait de 7,6 % a 12 mois (Intervalle de Confiance (IC) a 95 % = 5,5 % − 9,7 %), 13,9 % a 24 mois (10,6 % – 17,2 %), de 18,4 % a 36 mois (14,1 % – 22,7 %) et de 23,0 % a 48 mois (16,7 % – 29,3 %). La comparaison des cinq groupes a risque ne permet pas de mettre en evidence de difference significative d'evolution vers le stade IV, ni vers le stade SIDA. Cette conclusion reste inchangee apres ajustement sur l'âge et le taux de lymphocytes T4 a l'inclusion. Par ailleurs, les probabilites d'atteindre le stade SIDA, dans cette cohorte francaise, sont voisines de celles calculees au sein des cohortes nord-americaines.
RESUME L'ann6e 1996 a vu la lutte contre les infections nosocomiales se doter, en France, de plus... more RESUME L'ann6e 1996 a vu la lutte contre les infections nosocomiales se doter, en France, de plusieurs rdf6rentiels officiels importants. De la cfl'culaire ministdrielle sur le traitement des endoscopes au guide sur le bon usage des antibiotiques h l'h6pital publi6 par I'ANDEM en passant par les techniques de l'isolement septique, ce sont autant de documents qui sont venus poser les bases d'une harmonisation des actions de prevention en matiere d'infections nosocomiales. Beaucoup d'interrogations persistent autour du risque de transmission nosocomiale de certains agents, comme le virus de l'h6patite C et les prions, rendant d61icate l'61aboration de r~gles de pr6vention adaptdes ~t ces situations. Le risque professionnel lid aux accidents d'exposition au sang est rest6 une prdoccupation majeure et la prophylaxie de l'infection h VIH dans ce contexte s'est alignde sur les avancees th6rapeutiques du traitement de cette pathologie. Enfin dans le domaine des infections du site opdratoire certains facteurs de risques comme l'hypothermie ont 6t6 soulign6s et la place de 1' antibioprophylaxie a continual d'etre pr6cis6e. Mots-cl~s : Infections nosocomiales-Contr61e de l'infection-France.
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