Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene.

In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.

Contributory conditions for unexpected COVID-19 cases and nosocomial COVID-19 infection cases identified from systematic investigation in a French University Hospital.

INTRODUCTION: Nosocomial case (NC) of COVID-19 infections is a challenge for hospitals. We report the results of a seven-month prospective cohort study investigating COVID-19 patients to assess unexpected cases (UC) (no COVID-19 precautionary measure application since admission) and NC. PATIENTS AND METHODS: Investigation by an infection control team of 844 patients with COVID-19 infection hospitalized for more than 24 hours (cases). RESULTS: A total of 301 UC were identified (31% after contact tracing) with a total of 129 contact patients, and 27 secondary cases for 59 of them. In geriatric wards, 50% of cases were UC. NC represented 18% of cases (37% in geriatric wards), mainly identified after contact tracing of wandering cases. CONCLUSION: A rapid infection control response is essential to contain nosocomial transmission, along with detailed contact tracing and screening policy. Dealing with wandering elderly patients remain challenging for HCWs.

Development of consensus-based international antimicrobial stewardship competencies for undergraduate nurse education.

BACKGROUND: There is growing recognition by national and international policymakers of the contribution nurses make towards antimicrobial stewardship. Although undergraduate education provides an ideal opportunity to prepare nurses for antimicrobial stewardship roles and activities, only two-thirds of undergraduate nursing programmes incorporate any antimicrobial stewardship teaching and only 12% cover all the recommended antimicrobial stewardship principles. Nurses also report that they do not have a good knowledge of antibiotics, and many have not heard of the term antimicrobial stewardship. AIM: To provide international consensus on the antimicrobial stewardship competency descriptors appropriate for undergraduate nurse education. METHODS: A modified Delphi approach comprising two online surveys delivered to an international panel of 15 individuals reflecting expertise in prescribing and medicines management in the education and practice of nurses; and antimicrobial stewardship. Data collection took place between February and March 2019. FINDINGS: A total of 15 participants agreed to become members of the expert panel, of whom 13 (86%) completed round 1 questionnaire, and 13 (100%) completed round 2. Consensus was achieved, with consistently high levels of agreement across panel members, on six overarching competency domains and 63 descriptors, essential for antimicrobial stewardship practice. CONCLUSION: The competency descriptors should be used to direct undergraduate nurse education and the antimicrobial stewardship practices of qualified nurses (including those working in new roles such as Nursing Associates) due to the high levels of agreement reached on competency descriptors.

Efficacy of feed additives against Campylobacter in live broilers during the entire rearing period: Part B.

A total of 636 day-of-hatch Ross 308 broilers chicks were used in 4 independent trials carried out to screen the effect of 12 feed additives on reducing cecal colonization of Campylobacterin broilers. The tested additives were probiotics based on B. subtilis and S. cerevisae, a garlic extract, a blend of herbal substances and essential oils, two different combinations of essential oils and organic acids (OA), two mixtures of flavoring compounds, medium chain fatty acids (MCFA), monoglycerides (MG) of MCFA and MG-MCFA+OA. At 14 days of age, all the birds were orally infected with 0.1 mL of a bacterial suspension of C. jejuni ST-45 diluted at 10(5) cfu/mL in tryptone salt broth. In each trial, there was a positive control group and 2 (Trials 1 and 2) or 4 (Trials 3 and 4) additional treatment groups supplemented with additives, which were added to feed or water only to the finisher (21 to 42 d) diet (Trials 1 and 2) or to the starter (0 to 21 d) and finisher diets (Trials 3 and 4). Feed and water were available ad libitum. On days 35 and 42 of age in Trials 1 and 2, and on days 21, 35 and 42 of age in Trials 3 and 4, 10 (Trials 1 and 2) or 12 birds (Trials 3 and 4) per group were euthanized for cecal sampling. In Trial 1, birds fed with MCFA and MG-MCFA had a significant (P<0.05) reduction in cecal Campylobacter colonization compared to control at 35 d, but only the group treated with MG-MCFA maintained the reduction at 42 d. In Trials 2 to 4, no significant differences (P>0.05) in cecal Campylobacter counts were found between the treated and control animals. In conclusion, although none of the treatments were able to completely prevent the colonization of chickens with C. jejuni, MCFA and MG-MCFAs could reduce the pathogen counts when supplemented from 21 days onwards.

[Bronchopulmonary cancer, antiphospholipid syndrome and coagulation disorders]. / Cancer bronchique, syndrome des antiphospholipides et pathologie de la coagulation.

INTRODUCTION: The antiphospholipid syndrome includes recurrent thrombotic manifestations related to antiphospholipid antibodies. Adrenal insufficiency is a rare complication of the antiphospholipid syndrome. EXEGESIS: We report a case of acute adrenal insufficiency secondary to bilateral adrenal hemorrhage in a 45-year-old man. The finding of antiphospholipid antibodies and 6 months later of a polymetastatic bronchopulmonary cancer led us to diagnose a paraneoplasic antiphospholipid syndrome. CONCLUSION: We discuss the role of coagulation disorders in the pathogenesis of tumor growth and rapid metastatic spread. Assessment of the high risk for thrombosis may be of prognostic and therapeutic value in patients with evolutive bronchopulmonary cancer. Early anticoagulation treatment in association with classical treatment of cancer may contribute to prevent malignant process from extending and avoid metastatic spread.

[Late recurrence of subacute De Quervain-Crile thyroiditis]. / Récidive tardive d'une thyroïdite subaiguë de De Quervain-Crile.

Subacute thyroiditis usually recovers completely, and recurrences are unfrequent. We report hereafter the case of a 70-year-old man with a typical diagnosis of subacute thyroiditis. He reported a similar episode 20 years earlier, followed by a mild but persistant hypothyroidism. This case reminds that recurrence of subacute thyroiditis can occur even after many years.