Screening for surgical nosocomial infections by crossing databases

Surgical site infection [SSI] is a major cause of morbidity and mortality, and they are the third cause of nosocomial infections. It has been shown that surveillance can reduce the rate of these infections because the publication of the results that introduce a interrogation on her surgical practices. However, surveillance requires considerable medical resources. Our objective is to validate a computer algorithm that uses microbiological results and the results of a C-reactive protein [CRP] assay and granulocyte count to detect SSIs. All patients who underwent colorectal surgery between the 1st of January and the 30th of June 2009 were included. Administrative, surgical and microbiological data and the appearance of neutrophilia and CRP after surgery and during hospitalization were collected. The algorithm uses four biological variables: CRP, neutrophils, and the bacterium found on the positive sample. The CRP and neutrophil variables were coded in 0 or 1. CRP was coded as 1 if the sample was below 5 mg/l at the time of the operation and increased to more than 60 mg/l in the 30 days immediately after post-operation. Neutrophils were coded as 1 if the sample was normal at the time of the operation and increased to more than 12,000 cells/mm[3] in the 30 days immediately after post-operation. The "type of sample" and "bacterium" variables were coded in categories. For the type of sample, we coded 3 if the sampling site was related to the surgical site, 2 if the sampling site was potentially linked to the surgical site, 1 if the sampling site was not directly or indirectly related to the surgical site and 0 if there was no sample. Regarding the bacteria, we coded 3 for bacteria found in over 5% of SSIs, 2 for bacteria found in 2-5% of SSIs, 1 for bacteria found in less than 2% of SSIs and 0 if there were no bacteria. The algorithm calculates a score from 1 to 5. Our study included 195 operations, out of which it was possible to study 168. Following the operations, we found neutrophilia above 12,000 cells/mm[3] in 41.5% of cases and CRP above 60 mg/l in 64.6% of cases. Thirty-seven operations [22%] were complicated by an SSI. The positive predictive values and the negative predictive values in our algorithm were 74.07% and 87.94%, respectively, and the number of records that remain to be investigated is 27 out of 168. Linking databases from bacteriology and biology with those containing the hospital records of surgical procedures is a simple method for identifying surgical nosocomial infections

Assessment of exposure to ethanol vapors released during use of alcohol-based hand rubs by healthcare workers

Despite the increasing use of Alcohol-Based Hand Rub solutions, few studies have quantified the concentrations of inhaled ethanol. The aim of this study was to assess ethanol exposure during hygienic and surgical hand disinfection practices. Ethanol concentrations were measured at the nose level of a wooden dummy and human volunteers. Two systems were used in parallel to determine short-term ethanol vapor exposures: activated charcoal tubes followed by gas chromatography analysis and direct reading on a photoionization detector [PID]. Exposure was assessed for 4 different sequences [N = 10] reproducing hand rubs for simple surgery, nursing care, intensive care and surgical scrub. The ethanol concentrations measured were of a similar order between the dummy and volunteers. The concentrations obtained by PID were higher than the gas chromatography values for the simple care [45%] and nursing care [27%] sequences and reflected specific exposure peaks of ethanol, whereas ethanol concentrations were continuously high for intensive care [440 mg m[-3]] or surgical scrub [650 mg m[-3]]. Ethanol concentrations were similar for these two exposure assessment methods and demonstrated a relationship between handled doses and inhaled doses. However, the ethanol vapors released during hand disinfection were safe for the healthcare workers

Factors determining poor practice in alcoholic gel hand rub technique in hospital workers

Hand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted. Evaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program. A direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training. 3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy [France]. Time after program start [OR 0.97, 95%CI 0.96-0.97] and being female [OR 0.37, 0.24-0.58] were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring [OR 1.8, 1.2-2.7], a bracelet [OR 2.0, 1.1-3.6], a watch [OR 1.9, 1.3-2.9] and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use