Impact of a simulation-based training in hand hygiene with alcohol-based hand rub in emergency departments.

BACKGROUND: Hand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT). METHODS: The study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge. RESULTS: In total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B (P=.04). In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish (P=.003) but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29 (scale of 0-5; P<.001). CONCLUSION: This study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.

Eyelid inflammation: An uncommon cause in occidental countries.

BACKGROUND: Myiasis designates the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) and is the fourth most common travel-associated skin disease. Furuncle is the most common aspect of cutaneous myiasis. CASE PRESENTATION: A 24-year-old Caucasian female had been back from Cap-Vert. She described pruritus, slight pain, and the sensation of a foreign body moving in the eyelid. Physical examination showed a single furuncle-like nodule with surrounding erythema and a central pore of the upper eyelid through which a serosanguinous fluid was exuding. A larval end was visible to the naked eye through the aforementioned pore. Treatment consisted of the application of petroleum jelly (Vaseline®) to produce localized hypoxia. A transparent occlusive dressing was set for a duration of 2 h. The larva, Cordylobia antropophaga, spontaneously externalized to breathe and was extracted. DISCUSSION: There is an increase in travelers returning from tropical countries. Consequently, travel-associated dermatoses are increasing in non-endemic countries. Context of travel and typical clinical presentation strongly suggested to evoke a cutaneous myiasis. The typical furuncular lesion is a papule or nodule with a central punctum that exudes serosanguinous or purulent fluid. Ultrasound can be used to confirm the diagnosis. Treatment consists of three techniques: methods producing localized hypoxia to force emergence of the larvae, application of toxic substances to the eggs and larvae, and mechanical or surgical debridement. Surgery and antibiotics are usually unnecessary. Prevention of furunculous myiasis is based on vector control and individual actions to improve hygiene.

Febrile abdominal pain revealing Horton's disease.

BACKGROUND: Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. CASE PRESENTATION: A 68-year-old Caucasian woman consulted in an emergency department for febrile abdominal pain with inflammatory syndrome. Abdomen was soft with right-side flank sensitivity. A contrast-enhanced CT scan showed aortitis from the descending aorta to the iliac arteries without complication. Because of age, clinical presentation and aortitis, Horton disease was suspected. The temporal artery biopsy showed a histological aspect of degenerative endarteritis with intimal thickening and luminal stenosis. High-dose corticosteroid therapy was introduced which improved clinical conditions and resulted in the amendment of the pain. DISCUSSION: In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned.