Les infections du site opératoire (ISO) sont classées au 3ème rang des infections associées aux soins les plus fréquentes en France. Des approches épidémiologiques " classiques " de prévention ont permis une réduction des taux d'ISO d'environ 50% en 20 ans. Malgré ces progrès, les taux d'incidence et le nombre brut d'ISO restent notables en France. De nouveaux outils permettraient d'améliorer la compréhension et la prévention des ISO. Lors d'une approche clinique de la prévention des ISO, nous avons évalué l'efficacité d'éponges de collagène imprégnées de gentamicine pour la prévention des ISO chez des patients à haut risque bénéficiant d'un pontage aorto-coronarien avec double artères mammaires internes. Des Dans un second temps, une approche, épidémiologique, avait pour objectif d'étudier l'accord des hygiénistes et des chirurgiens impliqués dans la surveillance des ISO de 10 pays Européens dans le diagnostic des ISO. La finalité était d'évaluer l'intérêt de la publication des taux d'ISO dans un objectif de benchmarking. La dernière approche était comportementale. Nous avons tout d'abord réalisé une revue systématique de la littérature afin d'évaluer l'état actuel des connaissances concernant l'impact des comportements des équipes opératoires sur la survenue d'ISO ou sur des marqueurs du risque infectieux. Enfin, nous avons présenté le protocole d'une étude en cours de réalisation sur l'évaluation des déplacements des personnels durant 63 interventions de chirurgie cardiaque et orthopédique, enregistrés de manière objective et continue par l'intermédiaire d'un système automatique de capture de mouvement. Ces données seront corrélées à des marqueurs du risque infectieux. / Surgical site infection (SSI) constitutes the third most frequent healthcare associated infection in France. “Classic” epidemiological approaches have already allowed to decrease SSI rate of approximately 50% in 20 years. Despite these improvements, the incidence rate and the crude number of SSI stay important in France. New tools may improve the understanding and the prevention of SSI. In first, through a clinical approach of the SSI prevention, we have evaluated the efficacy of a gentamicin-impregnated collagen sponge reduce sternal wound infections in high-risk cardiac surgery patients. Secondly, an epidemiological approach had the objective to assess the agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe and evaluate the interest of the public reporting of SSI rate in a view of benchmarking. Finally, a behavioural approach has begun by a systematic descriptive review of the literature to evaluate the current evidence regarding the influence of staff behaviours on the infectious risk in operating room. Then, we have presented the protocol of a study in progress on the assessment of movements in the operating room during 63 procedures of cardiac and orthopaedic surgery, recorded with an objective and continuous manner using a motion capture system. These data will be correlated to surrogates of the infectious risk.

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background Caesarean section deliveries are the most common procedures performed by obstetricians in Zimbabwe. Surgical site infections (SSI) following caesarean section delivery result in increased hospital stay, treatment, cost, hospital readmission rates and related maternal morbidity and mortality. There is no national surveillance system for SSIs in Zimbabwe, however, information is available on number of cases of post-operative wound infection after caesarean section, but the denominator and definition used is not consistent. The objective of this study were develop and strengthen the surveillance system in Zimbabwe, to establish a clinical-based system in a setting with limited microbiological access, to measure post-operative SSI after caesarean section and to describe the associated risk factors and to determine whether feedback of SSI data has any effect on the surgical site infection incidence rate. Methodology This was a before and after study with two rolling cohort periods conducted at two Central hospitals in Harare, Zimbabwe. An Infection Prevention and Control (IPC) intervention was conducted in-between. During the pre-intervention period, baseline demographic and clinical data were collected using a structured questionnaire, and during the post-intervention period the impact of the interventions was measured. Convenience sampling was employed. Results A total of 290 women consented to participate in the study in the pre intervention period, 86.9% (n= 252) completed the 30-days post-operative follow-up and the incidence rate of SSI was 29.0% (n=73, 95% CI:23.4-35.0) Interventions developed included: training in Infection Prevention and Control for health workers; implementation of a protocol for cleaning surgical instruments; dissemination of information on post-operative wound management for the women. After implementation of the intervention, 314 women were recruited for the post-intervention, 92.3%(n= 290) completed the 30-day follow-up and there was a significant (p<0.001) reduction in the incidence rate of SSIs to 12.1 % (n=35, 95% CI: 8.3 -15.8) during this period. Development of SSI after caesarean section was found to be significantly associated with emergency surgery (p<0.001), surgical wound class IV (p=0.001) and shaving at home (p<0.001) at both pre- intervention and post-intervention periods. Stellenbosch University https://scholar.sun.ac.za iii Conclusion This study shows that caesarean section can be performed with low incidence of SSI if appropriate interventions such as training in IPC, adequate cleaning of equipment and education in wound-care for the mother are adhered to. It also demonstrated a simple surveillance data collection tool can be used on a wide scale in resource limited countries to assist policy makers with monitoring and evaluation of SSI rates as well as assessment of risk factors. / AFRIKAANSE OPSOMMING: Agtergrond Keisersnitte is die mees algemene prosedure wat uitgevoer word deur obstetriese dokters in Zimbabwe. Chirurgiese wond infeksies wat op keisersnitte volg lei tot verlengde hospitaal verblyf, behandeling, koste, heropname koerse en verwante moederlike morbiditeit en mortaliteit. Alhoewel daar geen nasionale waaktoesig sisteem vir chirurgiese wondinfeksies is nie, is informasie beskikbaar vir ‘n aantal gevalle wat post-operatiewe wondinfeksie na ‘n keisersnit onwikkel het, maar die noemer en definisie word inkonsekwent gebruik. Die doel van hierdie studie was om die waaktoesig sisteem in Zimbabwe te ontwikkel en te versterk, om ‘n klinies-gebasseerde sisteem te vestig in ‘n opset met beprekte mikrobiologiese toegang, om postoperatiewe chirurgiese wond infeksies na keisersnitte te meet en om die geassosieerde risikofaktore te beskryf en om vas te stel of terugvoering van chirurgiese wondinfeksie data enige effek op die infeksiekoerse na keisersnitverlossings gehad het. Metodologie Hierdie was ‘n voor-en-na studie met twee kohort periodes uitgevoer by twee sentrale hospitale in Harare, Zimbabwe. ‘n Infeksievoorkoming en –beheer intervensie was tussenin uitgevoer. Tydens die pre-intervensie periode was basislyn demografiese en kliniese data ingesamel deur middel van ‘n gestruktureerde vraeboog, en gedurende die post-intervensie fase was die impak van die intervensies gemeet. Gerieflikheidsteekproefneming was geimplementeer. Resultate ‘n Totaal van 290 vroue het toestemming verleen om aan die studie deel te neem in die pre-intervensie periode, waarvan 86.9% (n=252) die 30 day post-operatiewe opvolg voltooi het en die insidensiekoers van chirurgiese wondinfeksies was 29.0% (n=73, 95% CI:23.4-35.0) Intervensies wat onwikkel was het ingesluit: opleiding in Infeksie Voorkoming en -Beheer vir gesondheidswerkers; die implementering van ‘n protokol om chirurgiese instrumente skoon te maak; disseminering van informasie oor post-operatiewe wondhantering vir vroue. Na die implimentering van die intervensie was 314 vroue gewerf in die post-intervensie fase, waarvan 92.3% (n=290) die 30 dae opvolg voltooi het. Daar was ‘n beduidende (p<0.001) verlaging in die insidensiekoers van chirurgiese wondinfeksies na 12.1% (n=35, 95% CI: 8.3-15.8) gedurende hierdie periode. Stellenbosch University https://scholar.sun.ac.za v Daar was bevind dat chirurgiese wondinfeksies beduidend geassosieer was met noodchirurgie (p<0.001), chirurgiese wondklassifikasie IV (p=0.001) en skeer van hare by die huis (p<0.001) by beide die pre-intervensie en post-intervensie periodes. Gevolgtrekking Hierdie studie wys dat keisersnitte uitgevoer kan word met ‘n lae insidensie van chirurgiese wondinfeksies indien toepaslike intervensies, soos opleiding in infeksievoorkoming en beheer, voldoende skoonmaak van toerusting en opvoeding in wondsorg vir die moeders. Dit het ook aangedui dat ‘n eenvoudige data-insameling instrument op ‘n wye basis gebruik kan word in beperkte-hulpbron lande om beleidmakers te help met monitering en evaluering van chirurgiese wondinfeksie koerse, asook die assessering van risikofaktore.

Bakgrund: Under 1800-talet fick Florence Nightingale ner dödligheten efter kirurgi bland annat genom att hålla en renare operationsmiljö. De medicinska framstegen har tagit exponentiella kliv och omvårdnaden försöker hålla takten. Studier visar dock att hälso- och sjukvårdspersonalens följsamhet till hygienriktlinjer är bristande. För att vårdrelaterade infektioner såsom postoperativ sårinfektion inte ska ta fäste, urholka sjukvårdsbudgeten och orsaka patienten vårdlidande behöver samtlig operationspersonal ta hygienfrågan på största allvar, utan undantag. Syfte: Syftet var att studera operationspersonalens följsamhet till hygienriktlinjer på två sjukhus i södra Sverige. Metod: Studien var en kvantitativ observationsstudie som genomfördes med ett strukturerat protokoll. I protokollet fanns faktorer som särskilt studerade om allt av personalens hår och skägg var täckt med operationsmössan vid allmän- och infektionskänslig kirurgi. Det observerades även om personalen använde skor med hel ovansida som var avtorkningsbar. Resultat: Resultatet visade en näst intill fullständig följsamhet till hygienriktlinjer vid infektionskänslig kirurgi. Vid allmän kirurgi fanns förbättringar att genomföra av samtlig operationspersonal. Personal som inte arbetade i operationssåret var den population som hade sämst följsamhet till de utvalda riktlinjerna. Slutsats: Kunskap och ansvar till hygienriktlinjer kan leda till ökad patientsäkerhet och minskat lidande för patienten. / Background: Florence Nightingale saved lives by keeping the environment clean before, during and after surgery in the mid-19th century. The knowledge in medicine has developed in exponential steps and the nursing care is trying to keep up. Studies show that compliance to hygiene guidelines are low. The routines to prevent surgical site infections need to be taken seriously, without exceptions, to prevent the infections to cause suffering both for individuals and the hospitals budgets. Aim: The purpose of this study was to study the OR staff´s compliance to hygiene guidelines at two south Swedish hospitals. Method: The study was a quantitative observational study. Data have been collected at two different southern Swedish hospitals during 152 surgeries. The observation was structured and followed a special protocol that observed if hair and beard is covered with a hood/other coverage and what type of shoes that the staff wear in the OR. It was also observed if surgeries that need ultraclean environment, as implant surgery, was respected with the extended guidelines. Results: The results showed that there where almost complete compliance to the hygiene guidelines during ultraclean surgeries. During other surgeries it showed that improvements could have been done by all staff in the OR. The staff that was working in the OR but not in the wound, close to the patient had lowest compliance. Conclusion: Knowledge and discipline to hygiene rules may lead to improvement in patient safety and diminished patient suffering.

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Hospital Universitário Antonio Pedro / A micobacteriose pós-cirúrgica (MPC) vem emergindo nos últimos anos no Brasil e no mundo como uma infecção relacionada à assistência a saúde, representando um grave problema de saúde pública. Em 2006, vários casos foram informados à Secretaria de Estado de Saúde do Rio de Janeiro (SES/RJ). A partir de março daquele ano, teve início um trabalho conjunto dessa Secretaria e do Ministério da Saúde, que definiu diretrizes para a confirmação do surto/epidemia, para o levantamento das causas, para a identificação das espécies do patógeno envolvido e para estabelecer medidas de prevenção e controle. Este estudo teve como objetivo descrever os aspectos clínicos e sociodemográficos dos pacientes atendidos no Serviço de Infectologia do Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense, com diagnóstico de MPC no período 2006-2009. Casuística e métodos: De abril de 2006 a junho de 2009 foram atendidos no Serviço de Infectologia do HUAP 125 pacientes encaminhados pela SES/RJ por serem casos suspeitos ou confirmados de micobacteriose não tuberculosa adquirida após procedimentos cirúrgicos. Os pacientes chegaram ao HUAP com a ficha própria de notificação de caso de MPC preenchida com os dados da identificação, do procedimento relacionado à infecção, da abordagem diagnóstica e da terapêutica prévia. O tratamento medicamentoso obedeceu às diretrizes estabelecidas pela SES/RJ e pela Agência Nacional de Saúde. Os dados contidos nestas fichas, bem como outras informações concernentes à evolução clínica, tratamento dispensado no HUAP e resposta terapêutica, foram inseridos em um banco de dados especialmente desenvolvido para a pesquisa. Resultados: A maior parte dos casos de MPC ocorreu em pacientes do sexo feminino (77,6%) e a colecistectomia laparoscópica foi o procedimento cirúrgico mais frequente (48,8%). A média do período de incubação foi de 41 dias e a mediana de 31 dias, O sinal clínico mais comum foi a presença de secreção (86,5%), seguida da de nodulações (65,6%). A maior parte dos casos apresentou lesões superficiais e múltiplas (44,8%). Em 45,6% dos casos foram colhidos suabes e tecido para cultura antes do início do tratamento e a positividade deste material foi de 43,5%, valor significantemente maior que o observado quando a coleta de material foi feita após o início do tratamento (16,7%). O tratamento com três fármacos (claritromicina, etambutol e terizidona) foi feito em 90,4% (113/125) dos pacientes, com duração média de 226 dias e mediana de 229 dias. Foram submetidos a pelo menos uma abordagem cirúrgica 77,6% (97/125) dos casos, principalmente aqueles que apresentavam lesões profundas (44/56). Efeitos adversos foram observados em 62,4% (78/125) dos casos, sendo boca amarga o mais frequente. Conclusão: Apesar do longo tempo de tratamento com múltiplos fármacos, a grande maioria dos pacientes aderiu ao tratamento e evoluiu para a cura sem recidivas. / Post-surgical mycobacteriosis (PSM) is emerging as a serious public health problem in Brazil and in the world. In 2006 a number of infections were reported to the Secretary of Health in the Rio de Janeiro State. Starting in March of this year, a joint effort was initiated by this Secretary and the Ministry of Health, in order to set up guidelines to confirm the outbreak/epidemic, to identify its causes, to identify the species of the pathogen involved, and to establish measures of prevention and control. The aim of this work was to describe the clinical and sociodemographic findings of the patients treated at the Infectious Diseases Service of Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense, who had PSM from 2006 to 2009. Patients and Methods: From April 2006 to June 2009, 125 patients were referred by the Secretary of Health of the Rio de Janeiro State to HUAP with suspected or confirmed PSM. Each patient arrived at HUAP had a PSM case report form with data on identification, infection-related procedures, diagnostic approaches, and previous therapy. The treatment was defined by the Secretary of Health of the Rio de Janeiro State and the Health National Agency. The data from these case report forms, as well as other information associated with clinical evolution, treatment at HUAP, and therapeutic response were inserted into a database specially developed for this research. Results: Most PSM cases occurred in female patients (77.6%) and laparoscopic cholecystectomy was the most frequent surgery (48.8%). The mean incubation period was 41 days (median: 31 days). The most common presentation was drainage (86.5%) and nodules (65.6%). Most cases had multiple and superficial lesions (44.8%). Swab and tissue cultures were performed before treatment in 45.6% of the patients and their positivity was 43.5%, value significantly higher than that found when the specimens were obtained after the onset of treatment (16,7%). Most patients (90.4% - 113/125) were treated with a combined therapy using 3 drugs (clarithromycin, ethambutol and terizidone), with a mean duration of 226 days (median: 229 days). Surgical debridement was performed in 77.6% (97/125) of the cases, mainly in those with deep tissues lesions (44/56). Drug adverse effects occurred in 62.4% (78/125) of the cases, and bitter taste was the most common. Conclusion: In spite of multiple-drug and long-term treatment, most patients adhered to therapy and evolved to cure without relapses.

No description available.

Bakgrund: Postoperativa sårinfektioner orsakar lidande för den drabbade patienten och kostnader för patienten, vården och samhället. Intraoperativ kontamination av operationsinstrumenten är en av källorna till dessa infektioner. Operationssjuksköterskan är ansvarig för aseptiken och operationsinstrumenten.   Syfte: Syftet med denna pilotstudie var att mäta graden av bakteriell kontamination över tid på operationsinstrument som används vid öppen neurokirurgi samt observera utvalda källor till kontamination under samma tid. Metod: Denna studie designades som en kvantitativ icke-experimentell observationsstudie. Datainsamlingen skedde under hösten 2015 och bestod av omhändertagandet av specifika instrument som använts av operatören under operationen efter förutbestämd åtgången knivtid. Bakterieodlingar på dessa instrument skedde sedan på laboratorium enligt en förutbestämd metod och graden av kontamination mättes genom observation av mängden colony forming units (CFU). Resultaten presenteras i form av förändringar av mängden CFU. Resultat: Fem operationer observerades och tio odlingar utfördes på tio instrument. Totalt tio CFU registrerades under samtliga observationer. Ingen signifikant ökning av antal CFU kunde observeras från en till två timmars knivtid (P=0,156). Antal dörröppningar ökade från 3,4 till 9,0 och antal personer på operationssalen ökade från 5,4 till 5,8. Slutsats: Trots det ringa antal observationer som ingick i denna studie tyder resultaten på god aseptik och minimal bakteriell kontamination på operationsinstrumenten under operationens två första timmar. Ytterligare forskning med längre observationer, fler observationer och observationer kring annan typ av kirurgi behövs. / Background: Post-operative surgical site infections (SSI) cause suffering for the afflicted patient and is a great cost for the patient, the health care system and society. Intra-operative contamination of surgical instruments is one of the sources of these infections. The operating room nurse is responsible for preventing infections. Purpose: The purpose of this pilot-study was to measure the degree of bacterial contamination over time on surgical instruments used in open neurosurgery as well as to observe specific sources of contamination during this time. Method: The design was a quantitative nonexperimental observational study. The data collection took place during autumn 2015 and consisted of the sampling of specific instruments used by the surgeon during surgery after preset elapsed operating times. Bacterial culturing on these instruments was then carried out at a laboratory according to a preset routine and the degree of contamination was measured by observing the amount of colony forming units (CFU). The results are presented as changes in CFU. Results: Five operations were observed and ten bacterial culturings were conducted on ten instruments. A total of ten CFU was registered during all observations. No significant increase in the number of CFU could be observed from one to two hours of elapsed surgery (P=0,156). The amount of door openings increased from 3,4 to 9,0 and the number of personnel in the operating room increased from 5,4 to 5,8. Conclusion: Despite the small number of observations included in this study the results indicate good aseptics and minimal bacterial contamination on the surgical instruments during the first two hours of surgery. Further research with longer observations, more observations and observations on other forms of surgery is needed.

No description available.

Les microbiotes humains sont considérés comme des organes supplémentaires impliqués dans des pathologies diverses, y compris infectieuses. Les déséquilibres des microbiotes, ou dysbioses, créent des niches écologiques pathologiques ou pathobiomes. Ce nouveau paradigme de l'infection s'applique tout particulièrement aux infections opportunistes. Dans ce travail, nous considérons des infections associées aux soins (IAS), les infections du site opératoire en chirurgie cardiaque, comme le résultat d'une pathologie de niche et nous étudions la dynamique des communautés et des populations microbiennes comme conditions d'émergence et de succès de l'agent infectieux. La diversité et la dynamique du microbiote chirurgical superficiel et profond de patients opérés pour pontage aorto-coronarien montrent un remplacement partiel du microbiote pré-opératoire par un microbiote spécifique avec une résilience partielle lors de la cicatrisation. Un lien significatif est observé entre la composition microbiotique et les marqueurs de risque infectieux. Le suivi de la structure de population d'un agent pathogène reconnu en chirurgie cardiaque, Propionibacterium acnes, montre des fréquences différentielles de phylotypes selon les phases opératoires. La spécificité du microbiote opératoire consiste en une forte diversité de bactéries à Gram négatif dont certaines ont été décrites dans le microbiote de la peau saine. Nous avons réalisé une identification au niveau de l'espèce de ces bactéries de la peau saine qui s'avèrent atypiques parmi les bactéries humaines connues car elles évoquent une origine environnementale. Le réservoir cutané et non environnemental d'un pathogène opportuniste, Roseomonas mucosa, est démontré et trois populations de pathogène opportuniste à réservoir environnemental et/ou humain (Pseudomonas aeruginosa, Ochrobactrum antropi, O. intermedium) sont étudiés en termes de structure de population pour préciser les conditions de leur transmission et leur succès infectieux dans le contexte général du pathobiome et des niches écologiques perturbées. Ce contexte général permet d'organiser les résultats obtenus à diverses échelles (communauté, populations, espèces, phylotypes) pour proposer une vision intégrée et originale de la microbiologie des IAS. / Human microbiota are now considered as supplementary organs involved in diseases such as infections. Microbiota disequilibrium named dysbiosis creates impaired ecological niches (pathobiomes). This new paradigm of infection is particularly relevant for opportunistic infections. In this study, we consider one major type of healthcare associated infection (HAI), the surgical site infections after cardiothoracic surgery as a pathology of niche. We study the dynamics of microbial communities and populations as conditions for emergence and success of infectious agents.The diversity and dynamics of superficial and deep surgical microbiota in patients undergoing coronary artery bypass grafting show a partial replacement of the pre-operative microbiota by a specific surgical microbiota with partial resilience during healing. Significant links are found between microbiota composition and scores for infectious risk. The population structure of Propionibacterium acnes, a pathogen complicating cardiac surgery, shows variable frequencies of phylotypes according to operative stages. Surgical microbiota appears specific with high diversity of Gram-negative bacteria, some of them being previously described in healthy skin microbiota. At the species-level, these bacteria appear atypical among known human bacteria because they are related to environmental bacteria. We demonstrate the cutaneous reservoir of the opportunistic pathogen Roseomonas mucosa deemed, until now, to be environmental. Three populations of opportunistic pathogens (Pseudomonas aeruginosa, Ochrobactrum anthropi, O. intermedium) are structured in order to precise their transmission and their infectivity in the general context of impaired ecological niche and pathobiome.The results obtained at various microbiological scale (community, population, species, phylotype) are organized in this general context in order to delineate an original integrative vision of HAI.