Awareness of standard precautions for 4439 healthcare professionals in 34 institutions in France.

OBJECTIVE: The study objective was to assess the awareness of standard precautions (SP) among healthcare professionals, 1 year after the latest national guidelines were issued. METHODS: A multicenter cross-sectional survey was conducted in 34 volunteer institutions in 2010. Data was collected using an anonymous and self-administered questionnaire. The data was analyzed with a program developed from Epi-Info software. RESULTS: Four thousand four hundred and thirty-nine questionnaires were analyzed. Most respondents were nurses (44.1%) or nurses' aides (26.7%) followed by physicians (3.5%). 25% of respondents had participated in specific PS training in the previous 5 years. The percentage of correct answers for each question ranged from 37.1 to 91%. There was 72.6% of correct answers on hand hygiene but only 7.3% of correct answers on use of appropriate barriers and disposal of needles. 39.3% of respondents gave correct answers to eight or more of the 10 SP questions. The level of knowledge of nurses was higher compared to other professionals. The lowest level of knowledge was observed in long-term care and psychiatric institutions. CONCLUSIONS: The knowledge of healthcare professionals on use of appropriate protective barriers and disposal of needles is still too limited. The survey results should be used to develop adequate and targeted educational interventions.

[Risk of deep infection in first-intention total hip replacement. Evaluation concerning a continuous series of 790 cases]. / Le risque d'infection profonde des prothèses totales de hanche réalisées en première intention. Evaluation sur une série continue de 790 cas.

OBJECTIVE: Deep infections of the operative site is a rare but serious complication of first intention total hip arthroplasties. French data on infections are sparse. We studied the incidence, characteristics and potential risk factors for these infections in a consecutive series of 790 total hip arthroplasties performed as first intention implantations in a University Hospital in France. PATIENTS AND METHODS: All patients undergoing first intention total hip arthroplasty surgery between November 1995 and May 1999 were included in this study. Demographic, clinical, therapeutic and surgical data were collected. Deep infection was defined as proven presence of microorganisms in at least two preoperative samples during revision surgery. Patients were followed for 1 month to 4 years. Potential risk factors were identified with univariate analysis. Chi square and exact Fisher test were used. RESULTS: The overall incidence of deep infections was 1.11 per 100 implantations (95% CI 0.84-2.70). Delay to development ranged from 14 days to 32 months. Eleven infections were proven within the first year and 3 after one year. Two risk factors were identified: absence of systemic antibiotic prophylaxis (RR = 4.74, p = 0.03) and drainage discharge after 48 hours (RR = 3.62, p = 0.02). Other variables associated with infection with a relative risk greater than 2 were obesity, corticosteroid therapy, development of a hematoma, or difficult postoperative wound healing. CONCLUSION: The incidence observed in this series is slightly higher than generally reported in the world literature. It would be important to write an antibiotic prophylaxis protocol with prescription of systemic antibiotics for all operated patients in order to reduce this incidence. Other measures that could improve the quality of care should also be taken: re-evaluation of preoperative skin preparation protocols, systematic screening of patients carrying Staphylococcus aureus before implantation and proper care for these patients.