Burden of COVID-19 on workers in hospital settings: The French situation during the first wave of the pandemic.

We launched a survey in April 2020 to assess the number and proportion of hospital workers infected during the first wave of the COVID-19 pandemic in France, and to assess the attributable mortality. All French hospital settings (HS) were invited to declare new cases and attributable deaths by occupation category each week. Between March 1 and June 28, 2020, participating HS accounted for 69.5% of the total number of HS workers in France, and declared 31,088 infected workers; 16 died from the infection. We estimated that 3.43% (95% CI: 3.42-3.45) of French workers in HS, and 3.97% (95% CI: 3.95-3.99) of healthcare workers were infected during the first wave. Workers in regions with a cumulative rate of hospitalized COVID-19 patients equal or above the national rate, HS other than tertiary hospitals, or occupations with frequent patient contacts were particularly impacted. Targeted prevention campaigns should be elaborated.

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN.

OBJECTIVE: To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities. METHOD: Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12). FINDINGS: Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012. CONCLUSION: Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.

Leptospirosis in Franche-Comté (FRANCE): clinical, biological, and therapeutic data.

OBJECTIVES AND METHOD: We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions. RESULTS: The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days. CONCLUSIONS: We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis.

Antibiotic prescription in nursing homes for dependent elderly people: a cross-sectional study in Franche-Comté.

OBJECTIVES: We had for objective to determine the rate of patients treated with antibiotics and the determinants of antibiotic stewardship in nursing homes for dependent elderly people (French acronym EHPAD), of a French region (Franche-Comté). PATIENTS AND METHODS: A representative sample of EHPAD, in Franche-Comté, was included in a cross-sectional study made between April and June 2012. An external auditor and the EHPAD head physician collected data on the facility and on residents receiving antibiotics on the study day. An infectious diseases specialist and an infection control practitioner analyzed each prescription, a posteriori, to assess criteria of antimicrobial stewardship including re-assessment of the prescription between 48 and 72h after initiation of antibiotic treatment. RESULTS: Sixty-one (2.76%) of the 2210 residents in 18 nursing homes were under antibiotic treatment. This rate ranged from 0% to 7.5% among nursing homes. Sixty-two percent of prescriptions complied with recommendations regarding the choice of the drug, and 41.5% could not be improved by choosing an agent with a weaker ecological impact. Globally, 17.8% of prescriptions met all stewardship criteria including re-assessment of the prescription between 48 and 72h after initiation of antibiotic treatment. CONCLUSIONS: The study results differed. The rate of antibiotic prescription was low in Franche-Comté EHPAD compared to available European data, but antibiotic therapy could be greatly improved. This stresses the need to better train EHPAD physicians for antibiotic stewardship.

Immunosuppression-mediated hepatitis B reactivation diagnosed following an investigation into suspected transfusion-transmitted hepatitis B.

In August 2006, the regional unit for nosocomial infection control (ARLIN) was notified of a case of symptomatic acute hepatitis B (HBV) infection in an immunosuppressed 87-year-old patient who had received a blood transfusion five months previously. Immunosuppression for the treatment of a variety of conditions is increasing. Immunosuppressed patients should be investigated for previous HBV infection and given pre-emptive therapy where indicated. We report our experience investigating a case of HBV reactivation in an immunosuppressed patient. We describe the investigation and highlight the continued need for vigilance for HBV reactivation in immunosuppressed patients who may present to a range of clinicians.

Emergence of extensive-drug-resistant Pseudomonas aeruginosa in a French university hospital.

The aim of this study was to describe the molecular epidemiology and the mechanisms of resistance to beta-lactams of emerging extensive-drug-resistant Pseudomonas aeruginosa (XDRPA) in a tertiary-care university hospital over a three-year period. Analysis included antimicrobial susceptibility profiling and pulsed-field gel electrophoresis (PFGE). Resistance mechanisms to beta-lactams were identified: production of naturally occurring and acquired beta-lactamases, overproduction of MexAB-OprM and MexXY efflux systems and loss of porin OprD were assessed. Eighteen patients were colonised or infected with XDRPA which remained susceptible to colistin and, to a lesser extent, to rifampicin. beta-lactam resistance was, in most cases, due to the overproduction of AmpC, overproduction of the MexXY efflux system and loss of porin OprD. One isolate produced the class D extended-spectrum oxacillinase (OXA-ESBL) Oxa-28, but none produced metallo-beta-lactamase (MBL) or class A extended-spectrum beta-lactamase (ESBL). The XDRPA clustered in eight PFGE patterns and both the acquisition and loss of resistance determinants was observed within a single clone during its spread. The emergence of XDRPA isolates in our university hospital has been characterised by genotypic heterogeneity, variation of mechanisms of resistance to beta-lactams in a single clone and the predominance of chromosomally encoded resistance mechanisms.

[Nosocomial infections caused by Pseudomonas aeruginosa: Exogenous or endogenous origin of this bacterium?]. / Infections nosocomiales à Pseudomonas aeruginosa : origine exogène ou endogène de la bactérie responsable?

Through numerous reports of Pseudomonas aeruginosa outbreaks linked to transmission from environmental reservoirs, infection control practitionners have a univocal picture of its epidemiology: it is an opportunistic pathogen responsible of major outbreaks in intensive care units (ICU) with a major role played by the water network. The objective of this review was to answer to three questions: what is the part of hospital acquisition of P. aeruginosa? What is the part of outbreaks on incidence of hospital-acquired infections? What is the part of environment as a reservoir for transmission? Genotyping of hospital-acquired P. aeruginosa isolates allows us to define the endogenous or exogenous source of the infection and replace the concept of imported/acquired infection. If 80% of infections could be considered as acquired in ICU, the proportion of infections from exogenous source could be estimated at 50%. Even in a context of major outbreak, the epidemic clone represents 20% of the patients colonized and among these patients, only 50% are recognized with clinical samples. Some studies show that water fittings are a major source of P. aeruginosa in ICU. Other reports demonstrate a weak epidemiological link between environmental and clinical strains. Finally, despite the fact that the relative contributions of endogenous and exogenous sources to P. aeruginosa acquisition are not well established, we can assume that the epidemiological pattern of P. aeruginosa infection and colonization is not univocal and may vary both between ICU and within ICU depending on the period considered.

Trends of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae-producing extended-spectrum beta-lactamase (ESBLE) in eastern France: a three-year multi-centre incidence study.

The objective of this study was to describe trends for the years 2004 to 2006 in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae-producing extended-spectrum beta-lactamase (ESBLE) in a large hospital network (70 hospitals in eastern France). The incidence of MRSA per 1,000 patient-days decreased significantly from 0.55 in 2004 to 0.45 in 2006. This trend was observed in medicine and surgery units, whereas MRSA incidence was stable in intensive care, paediatric and obstetric units. The incidence of blood cultures positive for MRSA remained stable at 0.04 per 1,000 patient-days. Conversely, the incidence of ESBLE increased significantly from 0.04 in 2004 to 0.08 in 2006. This increase was caused by the spread of ESBLE-producing Escherichia coli. The mean consumption of alcohol-based gel and solution (ABS), expressed in litres per 1,000 patient-days, was 3.3 in 2002, 4.5 in 2003, 5.4 in 2004 and 6.4 in 2005. There was no association between the consumption of ABS and MRSA incidence. These findings suggest that the French recommendations for the control of multi-drug-resistant bacteria (MDRB) have been effective in reducing, or at least stabilising, the incidence of MRSA in an international context of general increase. However, the diffusion of ESBLE-producing E. coli is a matter of concern and should be carefully monitored.

Surveillance of occupational blood and body fluid exposures among French healthcare workers in 2004.

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 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time-equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time-equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures. CONCLUSION: National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.

Results from a four-year study on the prevalence of nosocomial infections in Franche-Comté: attempt to rank the risk of nosocomial infection.

The aim of this study was to rank the risk of nosocomial infection (NI) according to patient type by analysing the results of annual prevalence studies carried out in Franche-Comté from 2001 to 2004. Patients (N=14,905) were divided into four categories according to the number of endogenous risk factors (age, immunodepression, MacCabe score). The overall prevalence of infection was 6.1% and varied according to the category of patient from 1.93% (no risk factors) to 15.2% (three risk factors). The frequencies of NI related to an invasive procedure and to cross-contamination with multi-drug-resistant (MDR) bacteria were 30.9% and 12.3%, respectively; these percentages did not depend on the type of patient. The prevalence of NI decreased over time for patients with two or three risk factors, but was stable for patients with no risk factors. More than 40% of NIs were potentially avoidable (related to invasive procedures or involving cross-transmission of an MDR bacterium) regardless of the category of patient. This study suggests that at least 30% of NIs could be avoided.

[Influenza vaccination among health-care workers. Vaccination rates in universitary hospital of Besançon, winter 2003-2004]. / La vaccination antigrippale du personnel hospitalier. Enquête de prévalence au CHU de Besançon, hiver 2003-2004.

BACKGROUND: Influenza vaccination reduces the mortality of the patients when the vaccination rates of healthcare workers is important. PURPOSE AND METHOD OF THE STUDY: To investigate the vaccination rates at the Universitary Hospital of Besançon by anonymous questionnaire. RESULTS: Three thousand hundred seventy-seven answers were analyzed (228 men and 1145 women). Two hundred seventy-seven persons declared receiving the vaccine (20.1%) corresponding to sixty-three men (27.6%) and two hundred thirteen women (18.6%) (P = 0.001). The average age of the healthcare workers vaccined was of 38.9+/-11 years. Among most than 50 years, 34% was vaccined. Among the doctors, 40.5% were vaccined against 20.6% of the nurses. In the services of geriatrics, 78.5% of the staff was vaccined. CONCLUSIONS: Our results indicate a weak rate of influenza vaccination in our establishment and a misunderstanding of the character nosocomial of the influenza among the nurse.

Increasing trend of childhood type 1 diabetes in Franche-Comté (France): analysis of age and period effects from 1980 to 1998.

AIMS/HYPOTHESIS: A study was conducted by the Franche-Comté Regional Association of Private Practitioners (Union Régionale des Médecins Libéraux de Franche-Comté) to assess trends in childhood-onset Type 1 diabetes in this administrative region of France, between 1980 and 1998. METHODS: Cases of childhood-onset Type 1 diabetes (aged 0-14 years) were retrospectively recorded with the help of general practitioners, private specialists and hospitals in the Franche-Comté and surrounding administrative regions. Incidence rates and trends during the period were analysed using Poisson regression. RESULTS: During the 19-year study period, 308 cases of childhood-onset Type 1 diabetes were identified. The level of case ascertainment was estimated to be 80.6% (95% CI: 74.7, 87.4). The male-to-female sex ratio was 1.03. The World standardised incidence rate was 6.90/100,000. The incidence rate was 6.03 (95% CI: 4.76, 7.53) for children aged 0 to 4 years, 6.45 (95% CI: 5.23, 7.88) for children aged 5-9 years and 8.56 (95% CI: 7.18, 10.13) for those aged 10-14 years. The annual increase rate was 4.9%, continuous and regular, without any deviation. This trend did not differ according to gender or age group. CONCLUSION/INTERPRETATION: These results confirm that the incidence and the increase rate in childhood Type 1 diabetes in France are average compared to in other European countries over an extended period of time. Furthermore, the regular and linear increase in incidence supports the hypothesis of causal environmental factors diffusing over time. The complementary data provided also illustrate the role that private practitioners may play by their implication in epidemiology and public health.

[Thierry's spatula instrumental extraction: a study of foetal-maternal morbidity]. / L'extraction instrumentale par spatules de Thierry: étude de la morbidité maternofoetale.

OBJECTIVE: Assisted delivery is necessary in many obstetrical conditions but is involved in maternal and foetal complications. The legal pressure and the commendable aim consisting in less neonatal morbidity and mortality have called forth a reflection about the type and the way of instrumental foetal extraction. In 1950, Thierry had already felt this problem and he invented spatula to replace obstetrical forceps. Although this instrument appears empirically little deleterious, literature about its evaluation is very poor. We studied this instrument in a retrospective 190 cases series. PATIENTS AND METHOD: Retrospective study of 190 Thierry's spatula extractions, over a seven-year period (January 1996 to December 2002), at the Centre Hospitalier General of Montbeliard. RESULTS: Out of a total of 8126 deliveries for the study period, the instrumental extraction rate was 5.3%, with 40.6% spatula extractions (190 cases). No failure of Thierry's spatula extraction was noted. DISCUSSION ET CONCLUSION: Our study concludes that spatula is efficient but does not usually permit anterior rotation of occipito-posterior presentation. Maternal and foetal morbidity is not frequent.

[Methicillin-resistant Staphylococcus aureus (MRSA) in rehabilitation and chronic-care-facilities: what is the best strategy?]. / Le staphylocoque doré résistant à la méticilline dans les services et établissements de moyen séjour: quelle stratégie proposer?

BACKGROUND: The risk associated with methicillin-resistant Staphylococcus aureus (MRSA) has been decreasing for several years in intensive care departments, but is now increasing in rehabilitation and chronic-care-facilities (R-CCF). The aim of this study was to use published data and our own experience to discuss the roles of screening for MRSA carriers, the type of isolation to be implemented and the efficiency of chemical decontamination. DISCUSSION: Screening identifies over 90% of patients colonized with MRSA upon admission to R-CCF versus only 50% for intensive care units. Only totally dependent patients acquire MRSA. Thus, strict geographical isolation, as opposed to "social reinsertion", is clearly of no value. However, this should not lead to the abandoning of isolation, which remains essential during the administration of care. The use of chemicals to decolonize the nose and healthy skin appeared to be of some value and the application of this procedure could make technical isolation unnecessary in a non-negligible proportion of cases. SUMMARY: Given the increase in morbidity associated with MRSA observed in numerous hospitals, the emergence of a community-acquired disease associated with these strains and the evolution of glycopeptide-resistant strains, the voluntary application of a strategy combining screening, technical isolation and chemical decolonization in R-CCF appears to be an urgent matter of priority.

[Dioxin emissions and soft-tissue sarcoma: results of a population-based case-control study]. / Emission de dioxines et sarcomes des tissus mous: étude cas-témoins en population.

BACKGROUND: In 1998, the French Ministry of Environment revealed that of 71 French municipal solid waste incinerators processing more than 6 metric tons of material per hour, dioxin emission from 15 of them was above the 10 ng international toxic equivalency factor/m3 (including Besançon, emitting 16.3 ng international toxic equivalency factor/m3) which is substantially higher than the 0.1 international toxic equivalency factor/m3 prescribed by a European directive of 1994. In 2000, a macrospatial epidemiological study undertaken in the administrative district of Doubs, identified two significant clusters of soft-tissue sarcoma and non Hodgkin lymphoma in the vicinity of the municipal solid waste incinerator of Besançon. This microspatial study (at the Besançon city scale), was designed to test the association between the exposure to dioxins emitted by the municipal solid waste incinerator of Besançon and the risk of soft-tissue sarcoma. METHODS: Ground-level concentrations of dioxin were modeled with a dispersion model (Air Pollution Control 3 software). Four increasing zones of exposure were defined. For each case of soft tissue sarcoma, ten controls were randomly selected from the 1990 census database and matched for gender and age. A geographic information system allowed the attribution of a dioxin concentration category to cases and controls, according to their place of residence. RESULTS: Thirty-seven cases of soft tissue sarcoma were identified by the Doubs cancer registry between 1980 and 1995, corresponding to a standardized incidence (French population) of 2.44 per 100,000 inhabitants. Compared with the least exposed zone, the risk of developing a soft tissue sarcoma was not significantly increased for people living in the more exposed zones. CONCLUSION: Before definitely concluding that there is no relationship between the exposure to dioxin released by a solid waste incinerator and soft tissue sarcoma, a nationwide investigation based on other registries should be conducted.

[Correct and incorrect usage of antibiotics. Prevalence study in Franche-Comté]. / Bon et mauvais usage des antibiotiques. Enquête de prévalence en Franche-Comté.

OBJECTIVE: To report the results observed regarding the prescription of antibiotics according to various indications in the Franche-Comté area: curative for a community infection, curative for a nosocomial infection and prophylactic. METHOD: A total of 6,038 patients hospitalized in 32 hospital centers of the Franche-comté area were surveyed. RESULTS: Among the 1,016 (16.8% of the total) patients receiving anti-infection products, 47.7% received anti-infection agents for the treatment of a community infection, 25.9% for a nosocomial infection and 26.4% for prophylaxis. Multiple antibiotherapy was more frequent for the treatment of community infections than for nosocomial infections [p = 0.067, Relative Risk = 1.11, (confidence interval: 95%: 1.00-1.24)]. Sixty percent of the prescriptions of 3rd generation cephalosporines were within the community framework. This class of antibiotics was widely prescribed for the treatment of E. coli infections, multi-sensitive to antibiotics, not only before but after bacteriological documentation. Among the 83 patients treated with fluoroquinolone for a nosocomial infection, 47 (56.6%) were treated with monotherapy. Regarding prophylaxis, 3rd generation cephalosporine and fluoroquinolone, which are not indicated for this, were widely used, in contradiction with the recommendations of the Société Française d'Anesthésie et de Réanimation (French Society of Anesthesia and Reanimation). CONCLUSION: This survey, despite the limits related to the prevalence method, shows the high frequency of antibiotic prescriptions that do not conform to the recommendations of the ANDEM (French agency for the assessment of medical practice) and the scientific societies.

Evaluation of vancomycin use in a large university-affiliated hospital in eastern France in 1999.

OBJECTIVE: In 1999, we conducted a retrospective drug utilization review to determine the volume and pattern of vancomycin use in a university-affiliated hospital in eastern France. METHODS: Total vancomycin use was determined and expressed as vancomycin courses per 100 admitted patients and defined daily doses (DDD) of vancomycin per 100 patient-days. The indication for vancomycin use was classified as appropriate or inappropriate according to the guidelines issues by the HICPAC. RESULTS: A total of 311 vancomycin courses were given, as 2098 DDD, giving crude incidences of 1.17 courses per 100 admitted patients and of 1.19 defined daily doses per 100 patient-days. The frequency of appropriate courses was 66.7%. Of the 63 inappropriate courses of vancomycin, 39.7% and 28.6% were empiric therapy for nosocomial and community-acquired infections, respectively, 20.6% and 6.3% were specific therapy for nosocomial and community-acquired infections, respectively, and 4.7% were prophylactic. CONCLUSIONS: This study shows that vancomycin use in our hospital resulted in a lower selection pressure than has been reported for US university-affiliated hospitals and that comprehensive programs to improve use of vancomycin are needed in our institution.