[How to promote the respect of good infusion practices by meeting health care professionals?]. / Comment promouvoir le respect des bonnes pratiques de perfusion en allant à la rencontre des soignants ?

INTRODUCTION: Health care professionals often forget that there are risks associated with infusion therapy even if it is a common care. In order to assess this practice and to draw potential improvement actions, an audit of local gravity-flow intravenous infusion practices was conducted. MATERIAL AND METHOD: The audit, based on a grid including 66 items from the medical prescription to the end of the infusion therapy administration, was conducted in the 6 units which use the most gravity-flow intravenous infusion devices. A multidisciplinary working group was created to decide and organize priority corrective measures in order to improve infusion practices and quality of healthcare. RESULTS: The audit enabled to observe 90hours of nurse's practices (96 infusions) and highlighted heterogeneity in infusion, in some cases inappropriate infusion practices and misuse of infusion devices. We found 4 main issues: labelling infusion therapy, training of health care professionals on good practices, support the purchase of infusion pumps and standardize perfusion line. An interactive educational program for nurses (workshops) was organized to enhance the respect of good practices: infusion identification at any time, respect of hygiene rules, flow rate regulation by counting drops, appropriate use of pumps and flow rate regulators. DISCUSSION: The audit drew up work priorities. The workshops made easier exchanges between professionals and had a warm welcome that's why it is essential to carry on such training. CONCLUSION: This collaborative approach between pharmacists, nurses, hygienists and biomedical technicians contribute to drug management improvement and promote optimal patient care.

Investigation and management of an imipenem-resistant oxa-23 Acinetobacter baumannii outbreak in an intensive care unit.

OBJECTIVES: The study objectives were to describe the investigation and management of an imipenem-resistant Acinetobacter baumannii outbreak that occurred in the 15-bed ICU of a tertiary care teaching hospital (Brest, France), during the summer 2008. PATIENTS AND METHODS: Patients harboring an imipenem-resistant A. baumannii strain were defined as case patients. We described case occurrence and steps taken to control the outbreak: contact isolation, reinforcement of hygiene procedures, unit shutdown decision, unit disinfection, and reopening. We also made a case control study and a cost analysis of the outbreak management. RESULTS: During a 10-day period, five patients were positive for a single clone of imipenem-resistant oxa-23 A. baumannii. Four patients presented with ventilation-acquired pneumonia and one was asymptomatic. The first two patients died one day after the first swab which led to the identification of A. baumannii. No additional case was noted in the ICU or in other hospital units after deciding to close the ICU. The cost of outbreak management was estimated at 264,553 euros. The case control study identified several factors associated with infection or colonization: length of stay in the ICU, chronic respiratory disease, number of previous antibiotic classes used, duration of ventilation, prone position, echocardiography, and presence of a nasogastric tube. CONCLUSION: This outbreak occurred during the summer period requiring the shutdown of the ICU and inducing a considerable cost. Rapid reactions of the ICU staff during the outbreak enabled to limit the epidemic.

[Pressure exerted on tracheal cuffs in intubation in the presence of nitrous oxide]. / Pressions exercées sur la trachée par les ballonnets des sondes d'intubation en présence de protoxyde d'azote.

OBJECTIVE: To compare the time course of endotracheal tube cuff pressures in presence of nitrous oxide (N2O), obtained in a tracheal model with those measured during clinical anaesthesia. STUDY DESIGN: Experimental and clinical prospective study. MATERIAL: Twelve brands of low-pressure tracheal tubes. METHODS: The pressure changes in the cuffs were measured over a three-hour-period in presence of a N2O (50 vol%)/O2 (50 vol%) mixture and mechanical ventilation, the tube being inserted either in a tracheal model or in the trachea of patients during general anaesthesia. RESULTS: The results obtained in vitro were correlated with those measured in the patients. Therefore the tracheal model is a helpful guide for the choice of endotracheal tubes.