[Accidents exposing to blood in France]. / Accidents exposant au sang en France.

Occupational blood and body fluids exposure. Occupational blood and body fluids exposure (BBFE) is a serious daily risk to healthcare workers (HCW) wherever they work (i.e. hospital, nursing home or private care). The knowledge of BBFE epidemiology over these 3 sectors of care allows HCF to be aware of BBFE circumstances and can enhance prevention in order to improve overall BBFE prevention. The improvement for compliance with standard precautions and protocols to prevent exposure to BBFE and the increase of safety device disposal use are the main keys of HCW safety.

Accidents exposant au sang en france Les professionnels de santé, quel que soit leur lieu d'activité (hôpital, établissement médico-social et ville), sont, au quotidien, susceptibles d'être victimes d'accidents exposant au sang. La connaissance des données épidémiologiques de ces accidents dans les trois secteurs de l'offre de soins permet aux professionnels de santé d'être conscients des circonstances de ces accidents pour mettre en place les mesures de prévention ad hoc. L'amélioration du respecter des précautions standard et des protocoles pour prévenir l'exposition au sang et aux liquides biologiques ainsi que la mise à disposition croissante des dispositifs médicaux de sécurité sont les principales clefs de la sécurité d'exercice des professionnels.

Prone position and recruitment manoeuvre: the combined effect improves oxygenation.

INTRODUCTION: Among the various methods for improving oxygenation while decreasing the risk of ventilation-induced lung injury in patients with acute respiratory distress syndrome (ARDS), a ventilation strategy combining prone position (PP) and recruitment manoeuvres (RMs) can be practiced. We studied the effects on oxygenation of both RM and PP applied in early ARDS patients. METHODS: We conducted a prospective study. Sixteen consecutive patients with early ARDS fulfilling our criteria (ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2) 98.3 ± 28 mmHg; positive end expiratory pressure, 10.7 ± 2.8 cmH2O) were analysed. Each patient was ventilated in both the supine position (SP) and the PP (six hours in each position). A 45 cmH2O extended sigh in pressure control mode was performed at the beginning of SP (RM1), one hour after turning to the PP (RM2) and at the end of the six-hour PP period (RM3). RESULTS: The mean arterial oxygen partial pressure (PaO2) changes after RM1, RM2 and RM3 were 9.6%, 15% and 19%, respectively. The PaO2 improvement after a single RM was significant after RM3 only (P < 0.05). Improvements in PaO2 level and PaO2/FiO2 ratio were transient in SP but durable during PP. PaO2/FiO2 ratio peaked at 218 mmHg after RM3. PaO2/FiO2 changes were significant only after RM3 and in the pulmonary ARDS group (P = 0.008). This global strategy had a benefit with regard to oxygenation: PaO2/FiO2 ratio increased from 98.3 mmHg to 165.6 mmHg 13 hours later at the end of the study (P < 0.05). Plateau airway pressures decreased after each RM and over the entire PP period and significantly after RM3 (P = 0.02). Some reversible side effects such as significant blood arterial pressure variations were found when extended sighs were performed. CONCLUSIONS: In our study, interventions such as a 45 cmH2O extended sigh during PP resulted in marked oxygenation improvement. Combined RM and PP led to the highest increase in PaO2/FiO2 ratio without major clinical side effects.

Increased risk of non-Hodgkin lymphoma and serum organochlorine concentrations among neighbors of a municipal solid waste incinerator.

Organochlorine chemicals may contribute to an increased risk of non-Hodgkin lymphoma (NHL) within non-occupationally exposed populations. Among these chemicals, dioxins and furans were mainly released by municipal solid waste incinerators (MSWIs) until a recent past in France, a source of exposure that is of public concern. We investigated organochlorines and the risk of NHL among neighbors of a French MSWI with high levels of dioxin emissions (Besançon, France), using serum concentrations to assess exposure. The study area consisted of three electoral wards, containing or surrounding the MSWI. Pesticides, dioxins, furans, and polychlorinated biphenyls (PCBs) were measured in the serum of 34 newly diagnosed NHL cases (2003-2005) and 34 controls. Risks of NHL associated with each lipid-corrected serum concentration were estimated using exact logistic regression. The pesticides ß-hexachlorocyclohexane (odds ratio [OR]=1.05, 95% confidence interval [CI]=1.00-1.12, per 10 ng/g lipid) and p,p' dichloro-diphenyl-trichloroethane (DDT) (OR=1.20, 95% CI=1.01-1.45, per 10 ng/g lipid) were associated with NHL risk. Evidence indicated an increased NHL risk associated with cumulative WHO(1998)-toxic equivalency factor (TEQ) concentrations (dioxins, OR=1.12, 95% CI=1.03-1.26; furans, OR=1.16, 95% CI=1.03-1.35; dioxin-like PCBs, OR=1.04, 95% CI=1.00-1.07; and total TEQ, OR=1.04, 95% CI=1.01-1.05), as well as with non dioxin-like PCBs (OR=1.02, 95% CI=1.01-1.05, per 10 ng/g lipid). Most congener-specific associations were statistically significant. This study provides strong and consistent support for an association between serum cumulative WHO(1998)-TEQ concentrations, at levels experienced by people residing in the vicinity of a polluting MSWI, and risk of NHL.

The role of water fittings in intensive care rooms as reservoirs for the colonization of patients with Pseudomonas aeruginosa.

OBJECTIVE: To assess the role of the water environment in the Pseudomonas aeruginosa colonization of patients in intensive care units in the absence of a recognized outbreak. DESIGN AND SETTING: Prospective, single-centre study over an 8-week period in two adult ICUs at a university hospital. Environmental samples were taken from the water fittings of rooms once per week, during a 8-week period. Patients were screened weekly for P. aeruginosa carriage. Environmental and humans isolates were genotyped by using pulsed-field gel electrophoresis. RESULTS: P. aeruginosa was detected in 193 (86.2%) of the 224 U-bend samples and 10 of the 224 samples taken from the tap (4.5%). Seventeen of the 123 patients admitted were colonized with P. aeruginosa. Only one of the 14 patients we were able to evaluate was colonized by a clone present in the water environment of his room before the patient's first positive sample was obtained. CONCLUSION: The role of the water environment in the acquisition of P. aeruginosa by intensive care patients remains unclear, but water fittings seem to play a smaller role in non-epidemic situations than expected by many operational hospital hygiene teams.

A municipal solid waste incinerator as the single dominant point source of PCDD/Fs in an area of increased non-Hodgkin's lymphoma incidence.

Since 1971, a municipal solid waste incinerator (MSWI) with high dioxin emission levels has been in operation in Besançon, France. We recently found a 2.3-fold risk of non-Hodgkin's lymphoma in the highest exposure zone using a Gaussian-type dispersion model as a proxy for dioxin exposure. However, the sources of PCDD/Fs in this area are a matter of controversy. The aim of this survey was therefore to examine the nature of the PCDD/F soil contamination in the surroundings of the MSWI to characterize whether more than one potential emission source could explain the presence of the PCDD/Fs. PCDD/F congener profiles were determined in 75 soil samples collected in the vicinity of the MSWI. They were compared according to the most environmentally impacted zones and to various spatial contrasts. PCDD/F concentrations ranged from 0.25 to 28.06 pg WHO-TEQ g(-1). Two different clustering algorithms identified the same main cluster (consisting of 73 samples). The remaining two soil samples composed either one, or two clusters. All clusters showed similar congener profiles. Moreover, no contrast was observed for congener distributions between complex and simple topographies, inside and outside the city boundary, the two most and the two least exposed areas, reflecting a common fingerprint. Congener profiles indicate that the area under influence of the MSWI is not subject to other point sources of PCDD/Fs. Since, the most polluting combustion chambers were recently shut down and replaced by a new one with up-to-date pollution control, slowly decreasing dioxin concentrations in the soils are to be expected.

Negligible risk for epidemics after geophysical disasters.

After geophysical disasters (i.e., earthquakes, volcanic eruptions, tsunamis), media reports almost always stress the risk for epidemics; whether this risk is genuine has been debated. We analyzed the medical literature and data from humanitarian agencies and the World Health Organization from 1985 to 2004. Of >600 geophysical disasters recorded, we found only 3 reported outbreaks related to these disasters: 1 of measles after the eruption of Pinatubo in Philippines, 1 of coccidioidomycosis after an earthquake in California, and 1 of Plasmodium vivax malaria in Costa Rica related to an earthquake and heavy rainfall. Even though the humanitarian response may play a role in preventing epidemics, our results lend support to the epidemiologic evidence that short-term risk for epidemics after a geophysical disaster is very low.

Dispersion modeling as a dioxin exposure indicator in the vicinity of a municipal solid waste incinerator: a validation study.

Whether low environmental doses of dioxin affect the general population is the matter of intense debate and controversy. In a previous study, we found a 2.3-fold risk for non-Hodgkin lymphoma associated with residence in areas classified as highly exposed to dioxin emitted from a municipal solid waste incinerator (MSWI) (Besançon, France). The main limitation lay within the use of a first-generation Gaussian-type dispersion model as a proxy for dioxin exposure, since its accuracy had not been assessed before. The aim of this study was to validate this geographic-based exposure through PCDD/F measurements from soil samples. PCDD/F concentration, pH, organic carbon concentration, cation exchange capacity, and geomorphology and ecology features were assessed for 75 sampling points. In simple terrain (i.e. northeast of the MSWI), a significant association was highlighted between modeled dioxin ground-level air concentrations and log-transformed measured dioxin soil concentrations with a strong gradient across exposure categories. Conversely, in a complex topography situation (i.e. southwest of the MSWI), the model overpredicted ground-level air concentrations, particularly in the high exposure zone. First-generation modeling provided a reliable proxy for dioxin exposure in simple terrain, reinforcing the results of our case-control study. However, a more advanced atmospheric diffusion model should have been used for refined assessment in complex terrain.

Dioxin emissions from a solid waste incinerator and risk of non-Hodgkin lymphoma.

BACKGROUND: It is not clear whether low environmental doses of dioxin affect the general population. We previously detected a cluster of patients with non-Hodgkin lymphoma around a French municipal solid waste incinerator with high dioxin emissions. To explore the environmental route suggested by these findings, we carried out a population-based case-control study in the same area. METHODS: We compared 222 incident cases of non-Hodgkin lymphoma diagnosed between 1980 and 1995 and controls randomly selected from the 1990 population census, using a 10-to-1 match. Dioxin ground-level concentrations were modeled with a second-generation Gaussian-type dispersion model, yielding four dioxin exposure categories. The latter were linked to individual places of residence, using Geographic Information System technology. RESULTS: The risk of developing non-Hodgkin lymphoma was 2.3 times higher (95% confidence interval = 1.4-3.8) among individuals living in the area with the highest dioxin concentration than among those living in the area with the lowest dioxin concentration. No increased risk was found for the intermediate dioxin exposure categories. Adjustment for a wide range of socioeconomic characteristics at the block group level did not alter the results. CONCLUSION: Although emissions from incinerators are usually not regarded as an important source of exposure to dioxins compared with other background sources, our findings support the hypothesis that environmental dioxins increase the risk of non-Hodgkin lymphoma among the population living in the vicinity of a municipal solid waste incinerator.