[Occupational and non occupational exposure to viral risk]. / Exposition à risque de transmission virale (AES).

The transmission of an infectious disease can occur through exposure to blood or other potentially infectious body fluids, particularly in the event of skin-puncture injuries for healthcare workers, and during sexual intercourse. These situations are known as accidental blood exposures and sexual exposures respectively. Combined actions carried out have allowed to significantly reduce risks, either to healthcare professionals (by standard precautions, provision of safety devices, Hepatitis B vaccination made compulsory in the 1990s, antiretroviral post-exposure prophylaxis that should be initiated as soon as possible after exposure), or to people engaging in unprotected sex (by prevention messages, condom promotion, and antiretroviral post-exposure prophylaxis). In any case, treatment of people infected by chronic diseases such as HBV or HIV, as well as possible drug eradication of HCV, are key for decreasing post-exposure risk of disease transmission. Post-exposure prophylaxis should be initiated as early as possible and intended for use only in patients with high-risk exposures. Knowledge of source person serostatus, information of exposed person on prevention, benefits and risks of treatment, and follow-up procedure are key points. Procedures to be followed in the event of an exposure must be known by all. Arrangements set up to allow risk assessment and management of exposed people rely on hospital services operating on a permanent basis.

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.

[Ultrasound-guided puncture. Modern treatment of liver abscess]. / La ponction échoguidée. Traitement moderne des abcès du foie.

The treatment of liver abscesses has benefitted from progress in imaging, particularly ultrasonography which allows simple and reliable aspiration and drainage. A series of 32 cases is reported, consisting of 29 pyogenic abscesses and 3 amoebic abscesses. Eighty-one per cent of patients were cured by aspiration and/or drainage, while 19% of patients had to be operated. The mean hospital stay was 11 days. Failures of ultrasound-guided aspiration are essentially due to multifocal abscesses caused by multiple organisms.

[Ultrasound-guided puncture. A modern treatment of liver abscess]. / La ponction échoguidée. Traitement moderne des abcès du foie.

The treatment of liver abscesses has benefitted from progress in imaging, particularly ultrasonography which allows simple and reliable aspiration and drainage. A series of 32 cases is reported, consisting of 29 pyogenic abscesses and 3 amoebic abscesses. Eighty-one per cent of patients were cured by aspiration and/or drainage, while 19% of patients had to be operated. The mean hospital stay was 11 days. Failures of ultrasound-guided aspiration are essentially due to multifocal abscesses caused by multiple organisms.

[Prognostic nutritional index in digestive surgery]. / Indice nutritionnel pronostique en chirurgie digestive.

It is difficult to select and combine the nutritional parameters most useful in predicting the outcome of major gastrointestinal surgery. The aim of this study was to define retrospectively a multifactorial prognostic nutritional index adapted to this purpose. Seventy-eight patients on whom one or more total or partial visceral resection were performed in nonemergency conditions were included in this study. Statistical analysis was carried out to determine correlations between the preoperative nutritional parameters and the postoperative complications such as: a) wound rupture and anastomotic leakage; b) severe sepsis; c) death. Delayed hypersensitivity, assessed as normal or abnormal, together with plasmatic albumin and transferrin levels, the thresholds of which were respectively determined at 35 g/l and 2.2 g/l, were selected as the factors with the greatest predictive value. For the prognosis of postoperative severe complications and death, the sensitivity and specificity of an index using the association of these three parameters were respectively 82.7 p. 100 and 51 p. 100 with positive and negative predictive values of 50 p. 100 and 83.3 p. 100.