Risques biologiques : nouveautés

risquebiologiquesVoici de nouvelles publications sur les risques biologiques, trouvées en avril et mai. On y trouve notamment : des lignes directrices sur l’évaluation des risques en biosécurité; des articles sur des risques et défis spécifiques au bloc opératoire et au travail en laboratoire. Plusieurs articles traitent de l’hygiène des mains : comment faire, comment inciter les gens à y adhérer, et même une revue systématique sur comment protéger les mains lorsqu’on doit si souvent les nettoyer. Les sujets en hygiène et salubrité vont de l’entretien des locaux aux punaises de lit en passant par les moississures, et on propose une utilisation innovatrice des appareils mobiles sans toucher.

Ressource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)Plusieurs articles sont en accès restreint, c’est indiqué par un cadenas noir. On peut obtenir ces articles par achat auprès de l’éditeur ou par prêt entre bibliothèques.

Accédez aux contenus par thématique :
Biosécurité
Bloc opératoire
Hygiène des mains
Hygiène et salubrité
Travail en laboratoire

Biosécurité

Évaluation locale des risques
Source : aem , février 2018

La présente ligne directrice décrit les pratiques exemplaires pour réaliser une évaluation locale des risques dans une organisation où sont manipulés ou entreposés des agents pathogènes humains, des agents zoopathogènes, des toxines ou toute autre matière infectieuse réglementée. Les risques associés à la manipulation et l’entreposage d’agents pathogènes et de toxines peuvent être réduits en appliquant les mesures d’atténuation des risques de biosécurité et de biosûreté appropriées établies au cours du processus d’évaluation des risques.

Bloc opératoire

Door openings in the operating room are associated with increased environmental contamination
Source : American Journal of Infection Control Prépublication, mai 2018

Door openings in the operating room (OR) have been hypothesized to increase OR environmental contamination. This study measured average colony-forming units (CFU) in the OR as a function of door openings and other potentially important variables. Bacterial settle plates were placed inside and outside of laminar airflow (LAF) by both exit doors, on the instrument table, and on the back instrument table (if applicable) for 48 orthopedic and general surgery procedures. CFU data were paired to Staphylococcus aureus colonization status, door openings, surgery duration, time of day, OR location, number of staff, use of warming devices, temperature, and humidity. The number of door openings in the OR and surgery duration were significantly associated with increased CFU in the OR overall and outside of LAF. However, under LAF conditions, only the number of OR personnel was significantly associated with increased CFU.

Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?Ressource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

Airflow distribution in the operating room plays an important role in ensuring a clean operating microenvironment and preventing surgical site infections (SSIs) caused by airborne contaminations. The objective of this study was to characterize the airflow distribution in proximity to a patient in an orthopedic operating room. This study showed that the downward airflow from the laminar airflow system varies in each case with different surgical arrangement, such as the position of the operating lamp. The results indicate that the interaction of thermal plumes from a patient and the downward laminar airflow may dominate the operating microenvironment. Authors conclude that the airflow distribution in proximity to a patient is influenced by both the surgical facility and the presence of medical staff. A thermal manikin may be an economical and practical way to study the interaction of thermal plumes and downward laminar airflow. The provision of higher clean airflow rate in the operating microenvironment may be an effective way to prevent the development of SSIs caused by indoor airborne contamination.

Covering the instrument table decreases bacterial bioburden: An evaluation of environmental quality indicatorsRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

Certain regulatory agencies have suggested that covering the operating room instrument table during periods of nonuse may decrease the bioburden on the table. This study shows that instrument table covers decrease bioburden on the instrument table during static and dynamic conditions; authors conclude that they should therefore be considered for use during periods of nonuse and during active surgery to decrease bioburden near the instruments.

How to better monitor and clean irregular surfaces in operating rooms: Insights gained by using both ATP luminescence and RODAC assaysRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

This study assesses cleaning of different surface types in an OR. Before and after cleaning, flat, covered surfaces (mattresses and side tables) were more likely to pass as “clean” by ATP assay than uncovered, irregularly shaped surfaces (overhead lights, door handles, and anesthesia keyboards). Irregularly shaped surfaces were more likely to pass by RODAC assay than by ATP assay after cleaning. Results suggest that irregularly shaped surfaces in operating rooms may require enhanced covering, cleaning, and monitoring protocols compared to more regularly shaped surfaces, and authors recommend that disposable covers be used on irregularly shaped high-touch surfaces in ORs.

Hygiène des mains

A multimodal intervention to improve hand hygiene compliance in a tertiary care centerRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

Healthcare-associated infections (HAIs) are a major threat to patient safety worldwide. HAIs are mainly transmitted via the hands of healthcare workers (HCWs), and HCW compliance with hand hygiene (HH) practices is reportedly low. Therefore, multimodal interventions are needed to develop effective HH improvement strategies. In this study, we assessed the effect of multimodal interventions on improvement of HH compliance. Conducted in 2 intensive care units from August 2016 to October 2016, the study encompassed 3 phases: pre-intervention (20 days), intervention (1 month), and post-intervention (20 days). A total of 53 HCWs, including physicians, nurses, and housekeeping staff, were included in the HH audit. The audit was analyzed by direct observation and by a completed knowledge, attitude, and practice (KAP) questionnaire. A total of 6350 HH opportunities were recorded; the results were 34.7%, 35%, and 69.7% for hand hygiene complete adherence rate (HHCAR), hand hygiene partial adherence rate (HHPAR), and hand hygiene adherence rate (HHAR), respectively. The HHCAR in the pre-intervention and post-intervention phases were 3% and 70.1%, respectively. In the post-intervention phase, we observed a significant improvement in KAP of the study group. Authors conclude that significant improvement in HH compliance can be achieved through a systematic, multidimensional intervention involving all types of HCWs.

Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance?Ressource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

Innovative methods to ensure better compliance in hand hygiene are urgently needed. The aim of this study was to determine if WiFi-based hand hygiene dispenser-driven self-assessment systems (Wireless Fidelity, WiFi-dispenser) can support the work of infection control teams. Our results suggest that the continuous monitoring of dispenser usage can be a valuable addition to infection prevention and control programs, when used in a bundle in combination with conventional hand hygiene training.

Hand hygiene adherence in relation to influenza season during 6 consecutive yearsRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

Hand hygiene (HH) is the single most important measure in reducing the burden of healthcare-acquired infections. Based on 12,740 HH opportunities observed during 6 consecutive years at our tertiary care center, HH adherence among healthcare workers (HCWs) was significantly better during influenza season compared to non-influenza periods, after controlling for important covariables. This finding suggests that HH awareness is increased during influenza periods, which could have implications for HCW education.

Hand hygiene compliance rates: Fact or fiction?Ressource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

The Australian mandatory national hand hygiene program requires rates for 3 quarterly periods annually. Human audits for 2 years and automated surveillance were compared for 2 teaching wards, and the magnitude of the Hawthorne effect (in which individuals modify an aspect of their behavior in response to their awareness of being observed) was not trivial. The magnitude of the Hawthorne effect was highest on the less compliant ward (53-66 percentage points), whereas the effect on the more compliant ward was high but half as great (25-37 percentage points). Authors conclude that while mandatory compliance necessitates accuracy that only automated surveillance can achieve, daily hand hygiene ambassadors or reminder technology could harness clinicians’ ability to hyperrespond to produce habitual compliance.

Hand hygiene: Just do it
Source : Hospital Employee Health 37(4), avril 2018

Healthcare workers who ignore the constant admonition to wash their hands between patients may inadvertently spread multidrug-resistant superbugs while drawing a citation from a visiting Joint Commission surveyor.

Implementation of multimodal infection control and hand hygiene strategies in acute-care hospitals in Greece: A cross-sectional benchmarking surveyRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, mai 2018

In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing hand hygiene in 17 acute-care hospitals. Surveyed hospitals are, on average, at an intermediate level in hand hygiene practice but require improvements on training-education, evaluation-feedback, and safety climate. Ensuring adequate IPC nurse staffing levels and systematically implementing multimodal IPC programs may lead to substantial improvements.

Interventions for preventing occupational irritant hand dermatitisRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : Cochrane Database of Systematic Reviews (4), 2018

Occupational irritant hand dermatitis (OIHD) causes significant functional impairment, disruption of work, and discomfort in the working population. People at particular risk include hairdressers, nurses, cleaners, builders, and people who work in the dye, printing, metal, and food industries. The condition is relatively common and affects about 5 to 20 out of 10,000 full-time workers per year. Different preventive measures such as protective gloves, barrier creams and moisturisers can be used, but it is not clear how effective these are. Preventing OIHD from developing is important because it is difficult to clear once it starts. The objective of this review is to assess the effects of primary preventive interventions and strategies (physical and behavioural) for preventing OIHD in healthy people (who have no hand dermatitis) who work in occupations where the skin is at risk of damage due to contact with water, detergents, chemicals or other irritants, or from wearing gloves. This is an update of a Cochrane review which was previously published in 2010.

Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals
Source : American Journal of Infection Control Prépublication, avril 2018

Speaking up by healthcare professionals (HCPs) to their colleagues is increasingly acknowledged as an important way to intercept errors, mitigate harm, and reduce risks to patient safety, such as healthcare-associated infections. Non-adherence to infection prevention rules is a typical situation in which speaking up by HCPs is warranted. This study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Highlights of this study : healthcare professionals who observe breaches in infection control practices often do not speak up. Risk to patients and past voicing behaviors motivate them to do so, but resignation contributes to withholding voice. Profession, and hierarchy within profession impact likelihood to speak up. Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.

The Effects of Social Influence on Nurses’ Hand Hygiene BehaviorsRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : Journal of Nursing Administration 48(4), avril 2018

The aim of this article is to describe the associations of nurses’ hand hygiene (HH) attitudes, subjective norms, and perceived behavioral control with observed and self-reported HH behavior. Nurses’ subjective norm and perceived control are associated with observed and self-reported HH performance. Healthcare workers overestimate their HH performance. Findings suggest future research to explore manipulators of these variables to change nurses’ HH behavior.

Use patterns and frequency of hand hygiene in healthcare facilities: Analysis of electronic surveillance data
Source : American Journal of Infection Control Prépublication, mai 2018

This extensive dataset, monitoring nearly 4000 healthcare workers and more than 6 million data points, provides a detailed description of current hand hygiene practices of hospital staff. Alcohol-based handrub (ABHR) was used more frequently than handwashing. Job function was found to affect hand hygiene frequency, with nonclinical staff and nursing staff demonstrating elevated rates of hand hygiene. Nonclinical staff had elevated hand hygiene frequencies, suggesting they are entering patient rooms on a very frequent basis. This finding merits further study to ensure that these employees are not underappreciated as a vector for infection. With respect to occupational exposure, even job functions with higher-than-average hand hygiene frequency rates produced upper-level estimates of less than 10 uses/hour for ABHR and less than 3 uses/hour for handwash. These data-driven estimates provide a hand hygiene frequency rate that can, and should, be used to design a realistic and representative repeated-use study to evaluate the safety of ABHRs and handwashes used by healthcare workers.

Wettability of hands during 15-second and 30-second handrub time intervals: A prospective, randomized crossover studyRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, avril 2018

At present, the shortest recommended application time of alcoholic handrubs is an application interval of 30 seconds. The aim of this study was to investigate whether a 15-second application time achieves a comparable wettability of hands to a 30-second handrub application. No difference was observed between the wetted areas of the hands after 15 seconds or 30 seconds of handrub application. A significant difference was observed between the wetted areas of hands in trained volunteers compared with untrained volunteers, irrespective of application time. Based on our results, a 15-second application time is equal to 30-second application time in terms of wettability of hands. The improvement of wettability after training underlines the necessity to instruct new and untrained health care workers in hand antisepsis. Using fluorescent handrubs may be a feasible method to control and retrain hand hygiene techniques of long-time employees.

Hygiène et salubrité

Effect of pulsed xenon ultraviolet room disinfection devices on microbial counts for methicillin-resistant Staphylococcus aureus and aerobic bacterial coloniesRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control 46(6), avril 2018

Inadequate environmental disinfection represents a serious risk for health care–associated infections. Technologic advancements in disinfection practices, including no-touch devices, offer significant promise to improve infection control. We evaluated one such device, portable pulsed xenon ultraviolet (PX-UV) units, on microbial burden during an implementation trial across 4 Veterans Affairs hospitals. Overall, PX-UV reduced MRSA and ABC counts by 75.3% and 84.1%, respectively, versus only 25%-30% at control sites. Adjusting for baseline counts, manually cleaned rooms had significantly higher residual levels than PX-UV sites. Bedrails, tray tables, and toilet handrails also showed statistically superior PX-UV disinfection. Using PX-UV in routine cleaning suggest a practical strategy when integrated into daily hospital operations.

Employee health steps up in a rough flu season: Shot-or-mask policies drive vaccination
Source : Hospital Employee Health 37(4), avril 2018

Employee health professionals stepping up to protect workers and patients during a severe flu season can become part of the outbreak they are trying to prevent. Perhaps the greatest incentive for immunization is a policy — implemented in hopsitals, health departments, and in some cases as state law — that unvaccinated healthcare workers must wear a mask when on duty.

Environmental services versus HAIs
Source : Health facilities management , mai 2018

Staff responsible for environmental services (ES) must understand the science of cross-contamination and work to prevent it. ES staff are the front line of defense against pathogens. Because they are typically in every room every day, they indirectly interact with every patient and visitor in the facility. Without the proper training and precautions, the ES staff member potentially could carry a pathogen throughout the facility that could infect patients, visitors, physicians and the clinical staff, as well as being at risk themselves.

Quand il y a des punaises de lit…
Source : Bye bye les microbes! Bulletin du Comité de prévention des infections dans les services de garde et écoles du Québec 21(2), 2018

Ce numéro porte sur les fameuses punaises de lit. Nous vous invitons à le consulter pour en connaître davantage, notamment au sujet de la prévention de la propagation et des mesures à mettre en place lorsqu’il y a une infestation.

Rate of contamination of hospital privacy curtains in a burns/plastic ward: A longitudinal studyRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : American Journal of Infection Control Prépublication, avril 2018

Since hospital patient privacy curtains can harbor bacteria, are high-touch surfaces, and are cleaned infrequently, they may be involved in pathogen transmission. The aim of this longitudinal prospective study was to understand curtain contamination to inform curtain hygiene protocols, thereby minimizing the role of curtains in pathogen transmission. Results showed that patient privacy curtains became progressively contaminated with bacteria, including MRSA. Between days 10 and 14 after being hung, curtains showed increased MRSA positivity. This may represent an opportune time to intervene, either by cleaning or replacing the curtains.

Surfaces contaminées par des moisissures : Que faire ?
Source : INRS, mai 2018

Lorsque les moisissures ont colonisé un local, il est important de suivre une stratégie de lutte raisonnée, expliquée dans ce document. Il s’agit, en premier lieu, de supprimer les causes de la prolifération des moisissures, en agissant notamment sur l’humidité du local. Dans un second temps, les surfaces sont nettoyées/désinfectées en respectant des mesures de sécurité particulières. Enfin, pour éviter le retour des moisissures, il convient d’assurer le bon entretien du bâtiment.

Unobtrusive touch-free interaction on mobile devices in dirty working environmentsRessource en accès restreint (acheter à l'éditeur ou demandez un prêt entre bibliothèques)
Source : Human Factors and Ergonomics in Manufacturing & Service Industries Prépublication, mai 2018

In this work, we propose a new mode of interaction using hand gestures captured by the back camera of a mobile device. Using a simple intuitive two-finger picking gesture, the user can perform mouse click and drag-and-drop operations from the back of the device, which provides an unobstructed touch-free interaction. This method allows users to operate on a tablet and maintain full awareness of the display, which is especially suitable for certain working environments, such as the machine shop, garage, kitchen, gym, or construction site, where people’s hands may be dirty, wet, or in gloves. The speed, accuracy, and error rate of this interaction have been evaluated and compared with the typical touch interaction in an empirical study. The results show that, although this method is not, in general, as efficient and accurate as direct touch, participants still consider it an effective and intuitive method of interacting with mobile devices in environments where direct touch is impractical.

Travail en laboratoire

Conception des laboratoires d’analyse biologique
Source : INRS, mai 2018

Ce guide a pour but d’aider les personnes chargées de la conception ou de la rénovation d’un laboratoire d’analyses biologiques à réaliser leur projet dans le respect des mesures de prévention des risques, plus particulièrement des risques biologiques. Différents types de laboratoires d’analyses biologiques sont évoqués d’analyses industrielles. Ce document dépeint les activités des laboratoires et décrit les fonctionnalités, les aménagements et les exigences de conception spécifiques à chaque pièce.

Occupational infection and needle stick injury among clinical laboratory workers in Al-Madinah city, Saudi Arabia
Source : Journal of Occupational Medicine and Toxicology 13, mai 2018

Clinical laboratory workers face biohazard such as needlestick injury and occupational infection on a daily basis. In this study, we examined self-reported frequency of occupational infection and needlestick injury among the clinical laboratory workers in Al- Madinah, Saudi Arabia. Approximately 33% of respondents to the study questionnaire had experienced occupational infection while 24% had experienced a needlestick injury. Approximately, 49% reported that they always recap needle after use, whereas 15% reported doing that most of the times. Occupational infection, needlestick injury and recapping needles after use were associated with lack of training on biosafety. Authors conclude that interventions related to biosafety and infection control and the use of needlestick prevention devices might be useful in lowering such frequency.

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