[Critical study of surveillance of nosocomial infections]. / Etude critique de la surveillance des infections nosocomiales.

The institution of a continuous surveillance program is a compulsory prerequisite to the effective control of nosocomial infections. This is actually the main task of the Committee for Nosocomial Infection Control as ruled by the decree of 8 May 1988. The methodology of this surveillance relies on the continuous collection of data. It must apply to hospitals of any size and lead to practical actions, at the general or local level according to circumstances. Data concern patients and staff as well. They must be collected from different sources among which the bacteriology and hygiene laboratories play an important role. However infection records from wards constitute the cornerstones for the surveillance program: the personnel involved in the filling of the forms must be clearly identified. The scope of the surveillance and analytical methods are also discussed: a comprehensive control of the whole hospital associated with incidence measurement appears to be the best approach. Prevalence surveys are also performed. They allow a better control of continuous surveillance processes. However these processes will only be profitable if the data to be recorded have been previously specified. It is of importance to get the most comprehensive data about infectious hazards. One might rely not on global infection rates per hospital, as they have no significance, but on specific infection rates in correlation with body sites or risk factors.

[Where is the experience of "Pilot-Hospitals" in hospital hygiene? First approach of a quality label]. / Où en est l'expérience des "hôpitaux-pilotes" en hygiène hospitalière? Première approche d'un label de qualité.

The testing of "Pilot-Hospitals", which started in early 1990, is being continued and expanded: the continuous monitoring of cross infections in "Pilot-Hospitals" according to one single methodology, the one recommended by the Council of Europe, has enabled us to record and to analyse 5,389 reports of infections for the year 1990. Urinary tract infection is the most common site of nosocomial infection (36.5%), followed by broncho-pulmonary complications (22%), local complications (15%) and septicaemias (12.2%). Enterobacteria, and especially Escherichia coli, predominate and Staphylococci infections, especially coagulase-negative Staphylococci, increase. According to the wish of the "Académie Nationale de Médecine de France", which required us to establish a Quality Label which could be applied to the various hospitals, "Pilot-Hospitals" are progressively establishing the criteria of this label. At present, eleven criteria have been kept: the first three ones are inherent in the Recommendations of the Council of Europe and require the introduction of a continuous monitoring of nosocomial infections, the setting up of an Infection Control Committee--which meets at least three times a year--, as well as a pluri-disciplinary training scheme. The eight other criteria emphasize the necessity for an operational cell in hospital hygiene, according to the size of the hospital, and determination of a personnel ratio assigned to the cell according to the number of beds occupied and to the type of activity of the department.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pilot hospitals: hope for improving the control of nosocomial infections]. / Les hôpitaux-pilotes: un espoir pour améliorer la lutte contre les infections nosocomiales.

Nosocomial infections are both poorly studied and quantified (between 3.68% to 21% depending on the author). Not only do they seriously affect patients but they are also extremely expensive both in direct and indirect costs as shown by actual cases. To prevent these infections efficiently, hospitals have to continuously monitor nosocomial infections within their departments, thus providing at any time, information about the primordial factors and enabling early stage intervention and the interruption of the "contamination-infection" chain. The Recommendations of the Council of Europe, in particular Recommendation R(84)20, have enabled this to be put into practice: the departments of 35 pilot hospitals have decided to declare their nosocomial infections, recording and processing their data with the same software; global processing is provided free of charge by the International Association for Hospital Hygiene Research. Six months after the start of the operation, the first conclusions are highly positive with 2794 notification forms received (a very good answer rate) showing in particular that more than 50% of nosocomial infections are due to three main entry points [urinary catheter (26%), intubation (13.3%), natural cavities (11.2%)] and three predominant germs [Staphylococcus aureus (22%), Escherichia coli (18.9%), Pseudomonas aeruginosa (11.9%)].

[Microbiological aspects of nosocomial risks of suction bottles]. / Aspects microbiologiques des risques nosocomiaux des flacons d'aspiration.

The suction and collection of more or less contaminated biological fluids or regurgitated matter in reusable glass bottles may be responsible for nosocomial infections. Based on a study conducted in 49 cases, the authors try to demonstrate the microbiological risks in the operating theatre of changing and transport of these bottles and the risks for the environment and the hospital staff in the cleaning of these bottles. The connection to the vacuum system was found to be contaminated in 26.1% of cases, the environment of the waste evacuation and cleaning zone was contaminated in 59.2% of cases and, in 28.6% of cases, the microorganism detected was identical to that in the bottle. All of these factors suggest that a disposable system, although apparently more expensive, ensures a greater degree of safety, avoiding the problems related to transport emptying and elimination of these bottles.

Reduction of infection after cardiac surgery: a clinical trial.

Between January 1, 1975, and June 1, 1984, 3,275 patients underwent cardiac operations with cardiopulmonary bypass. No operations were performed in 1978. In Phase I of the study, general operating rooms were used for cardiac operations, and standard methods of antisepsis and asepsis were used. Phase II began in January, 1979, with the opening of two specially constructed operating rooms with complete separation of incoming and outgoing personnel and supplies, and with a laminar airflow system. All personnel scrubbed 3 minutes and changed into autoclaved clothing before entering the operating suite, and scrubbed again for 5 minutes before putting on gowns. By Phase III, which began in July, 1982, all additional protocols against infection were in place including strict techniques in the intensive care unit and a continuous antiinfection surveillance program. In Phase I, 7.3% (70% confidence limits [CL] 6.4 to 8.2%) of patients had an infectious complication; in Phase II, 2.7% (CL 2.3 to 3.2%), and in Phase III, 0.8% (CL 0.5 to 1.2%). The reductions were similar in the four subtypes of infection (superficial presternal infection, mediastinitis, endocarditis, and septicemia). The study indicates that improving the surgical environment, improving the surgical and operating room protocols, and increasing the awareness of the dangers of infection among the personnel can strikingly reduce the incidence of infections after cardiac operations.

[Asepsis and hospital architecture: the surroundings of the operating theatre (author's transl)]. / Asepsie et architecture hospitalière: les abords de la salle d'opération.

The author contends one can not plan an operatief theatre and its organization, if it is dissociated from its immediate dependencies, entrances and exists. a) The necessity of the following dependencies is discussed: 1. an anesthetic room forming a sas between the entrance hall for the patient and the operating room that makes possible the preop. preparation; 2. an area where the surgeons may prepare, corectly ventilated and reserved to the entrance of the surgical team; 3. a reserve of sterile equipment in immediate contact with the operating threater; 4. a disposal area for the linen and soiled material and that may serve to the transfer of the patient after the operation, given the wastes be evacuated in thermosealed bags. b) The circuits of the personel is then considered with a study of the one way cloak-rooms, and an example is given. Then comes the introduction in these circuits of the so-called septic operating room and of room for decontamination of instruments that can be superimposed with the place of evacuation of the equipment. In conclusion, the author mentions the evacuation of atmospheric particles released in the operating theatre and the methods of improving asepsis. He suggests the surgeon be very critic concerning the techniques proposed by the advertising.