[Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000]. / Surveillance des infections nosocomiales dans les maternités du sud-est de la France entre 1997 et 2000.

OBJECTIVES: In this study we describe the changes in medical practices and nosocomial infection rates in obstetrics observed through a surveillance network in the South East of France. MATERIAL AND METHOD: The maternity units which belong to this network participated in voluntary surveillance using the network's methodology. The criteria for the diagnosis of nosocomial infections were in accordance with the methods described by the Centers for Disease Control and Prevention. RESULTS: 101240 pregnancies including 18503 caesareans (18.3%) were included in the network from 1997 to 2000. During the study period, nosocomial infection rates following caesarean section and vaginal delivery decreased respectively from 7.8% to 4.3% (p < 0.001) and from 2.2% to 0.9% (p < 0.001). This evolution was compared with the evolution of collected risk factors. CONCLUSION: In spite of the methodology limits, general value of surveillance and infection control programs in maternity units has been confirmed by the results of this surveillance network. During the study period, both obstetrics-related risk factors for nosocomial infection and observed hospital-acquired infection rates were dramatically reduced, what prove an improvement of quality of care in maternity units.

TT virus. A review of the literature.

In 1997, a new DNA virus was cloned by a Japanese team and designated TT virus (TTV). This virus seemed to be associated with non-A, non-G post-transfusion hepatitis. It was isolated by polymerase chain reaction (PCR) and was presumed to be human Circoviridae. The virus is heterogenous; 16 different genotypes are currently registered, and it can be classified as a "swarm" of at least 5 different viruses. Depending on the PCR technique used, the prevalence of infection ranges from 1.9 to 36% among blood donors, from 11.5 to 71% in hemodialysis patients, from 47 to 82% among patients with non-A, non-B or non-C fulminant hepatic failure, and the most elevated percentage is found in hemophiliacs. Epidemiological studies have established that the routes of TTV infection might be parenteral, oral-fecal, and possibly salivary. Mother-to-infant transmission is controversial. TTV may play a role in the pathogenesis of non-A, non-B or non-C fulminant hepatic failure. Patients co-infected with hepatitis C virus (HCV) and TTV have a significantly higher histological grade score than patients with isolated HCV infection. Treatment with interferon seems to decrease TT viremia, according to results obtained outside the context of clinical trials. TTV seems to be a light pathogenic virus. Its widespread presence in the blood of infected subjects contrasts with the apparent absence of pathological symptoms. PCR standardization is needed to clearly establish its real prevalence worldwide.

[The TT virus: review of the literature]. / Le virus TT: revue de la littérature.

OBJECTIVE: To review the literature on the TT virus. METHODS: The literature review was based on articles identified through MEDLINE between Jan. 1, 1997, and August 15, 1999. RESULTS: In 1997, a new DNA virus, designated TTV, was isolated and seemed to be associated with non A-G post-transfusion hepatitis. The virus was identified using a polymerase chain reaction (PCR) because serology was not routinely available. At least 16 genotypes were identified. Depending on the PCR technique used, the prevalence of infection ranged from 17% to 71% in a group of sera tested. The prevalence rate ranged from 1.2% to 62% among blood donors, from 0.5% to 83% among hemophiliacs and from 1% to 71% in cases of chronic hepatitis. The current hypothesis is that routes of infection were parenteral and orofecal. The pathogenesis of this virus, if it really exists, is not yet clearly established. It has been postulated that some interaction may exist between the TT virus and the hepatitis C virus. The use of interferon seems to decrease the TT viremia, according to results obtained outside the context of clinical trials. CONCLUSION: The pathogenesis of the TT virus needs to be rapidly established for transmission prevention and therapeutic intervention.

Comparison of effectiveness and required time of two surveillance methods in intensive care patients.

The intensive care unit (ICU) standardized protocol of the NNIS (National Nosocomial Infections Surveillance) system is a surveillance method of hospital acquired infections (HAI), which provides device-associated infection rates. The aim of this study was to assess the effectiveness and the required time for data collection and analysis of a selective surveillance method (SSM) derived from the NNIS ICU surveillance protocol, and to compare its data with that of a reference surveillance method (RSM). The sensitivity, specificity and the positive predictive value (PPV) of the RSM were 87.5, 100 and 100%, respectively. The sensitivity, specificity and the PPV of the SSM were 59.4 97.6 and 79.2%, respectively. Considering device-related infections only (ventilator-related pneumonia, catheter-related urinary tract infections, central line-related sepsis), the sensitivities of the RSM and the SSM were 80.9 and 90.5%, respectively. The SSM required only one third of the time of the RSM (1.1 h and 3.4 h per 10 beds per week with the SSM and the RSM, respectively). We conclude that the SSM has a very high sensitivity for detecting device associated infections, but is not sensitive enough for surveying all types of HAI.

Infection control and changes in management of hospitals: the European experience.

The general setting for the management of many European hospitals has undergone enormous changes during the last five to 10 years, especially with respect to economic, personnel and technical resources. This change has had a serious influence on the practice of infection control. To get an insight of the problems infection control practitioners in Europe today have to face, hospital epidemiologists representing nine European countries were asked to answer a questionnaire. In most countries, new laws on communicable disease prevention and infection control in hospitals have been implemented during the last few years. In conjunction with the widespread introduction of quality assurance and the accreditation of hospitals, organizational aspects of infection control have gained importance. However, budget restrictions and the growing competition between institutions are major challenges. In general, there has been a remarkable influence of the documented changes on the practice of infection control in European hospitals. Facing this situation, infection control practitioners should abandon unproven measures and implement those that are evidence-based, to prevent hospital acquired infection (HAI). Cost reducing initiatives, like the use of well designed multi-use devices and the reuse of disposables should be considered and scientifically assessed.