Les infections nosocomiales sont définies comme des infections contractées lors d’un séjour dans un établissement de soins. En matière de sécurité sanitaire, celles-ci sont déterminées par le principe de prévention et de précaution. En droit français, les infections nosocomiales ont longtemps été indemnisées en conséquences de solutions prétoriennes. Ce régime indemnitaire repose aujourd'hui sur le principe de la responsabilité sans faute qui a été consacré par la loi du 4 mars 2002. Toutefois la difficile prise en charge de cette indemnisation par les assureurs conduisit à l’adoption d’un nouveau régime découlant de la loi du 30 décembre 2002. Ces lois successives ont rendu complexe et ambigu le mécanisme de la réparation des dommages causés par les infections nosocomiales. Le constat résulte du fait qu’il manque une définition juridique de l’infection nosocomiale, outil essentiel à la pérennité du système indemnitaire mis en place pour la réparation des dommages causés par ces infections. / Nosocomial infections are infections acquired during a stay in a health care institution. From the sanitary safety point of view, they are defined by the prevention principle and the precautionary principle. According to the French law, the nosocomial infections have long been compensated by a case law. Nowadays, this compensation system is based on the principle of liability without fault laid down by the law of the 4th of March 2002. However, the reluctance of the insurers to assume this compensation led to the adoption of a new system resulting from the law of the 30th of December 2002. Because of these successive laws, the compensation mechanism for the damages due to nosocomial infections has been made more complex and ambiguous. This observation stems from the lack of a legal definition of the nosocomial infection, an essential tool for ensuring the sustainability of the compensation system for the damages caused by these infections

Nosokomiale Infektionen bei Früh- und Neugeborenen stellen aufgrund ihrer hohen Inzidenz und Mortalität eine große Herausforderung für die moderne Versorgung dar. Außerdem sind sie Indikatoren für die Pflegequalität, wie auch Verletzungen und Gefäßschädigungen. In dieser retrospektiven Querschnittsstudie wurden die epidemiologische Situation nosokomialer Infektionen auf den neonatologischen Stationen der Universitätskinderklinik Leipzig für das Jahr 2006 beleuchtet, die Abhängigkeit der genannten Komplikationen von Plegepersonalqualifikation und –quantität untersucht, sowie die Stationsauslastung und Personalbesetzung mit deutschen Empfehlungen verglichen. Die Inzidenz systemischer Infektionen lag sowohl auf der neonatologischen Intensiv- als auch auf der Nachsorgestation unter dem deutschlandweiten Durchschnitt. Dagegen traten Lokalinfekte wie Windel-/ Mundsoor und Konjunktivitiden häufig auf. Das beobachtete Keimspektrum zeigte das aus der Literatur bekannte Bild, multiresistente Keime traten nicht auf. Bei der Untersuchung der Abhängigkeiten zeigte sich für die Intensivstation eine signifikante Häufung von Candidainfektionen bei geringerer Stationsauslastung und höherer Personalbesetzung, unabhängig von der Qualifikation des Personals. Auf der Nachsorgestation wurde eine vermehrte Zahl systemischer Infektionen bei höherem Anteil von Schwestern am Gesamtpersonal festgestellt. Beide Stationen waren gegenüber den Empfehlungen fast das ganze Jahr überbelegt und unterbesetzt. Gründe für die gefundenen Abhängigkeiten wurden vermutet in Informationsverlust und Trittbrettfahrerproblemen in größeren Kollektiven und verstärkter minimal-handling-Pflege und verstärkter Hygiene-Compliance in Stresssituationen. Die geringe Inzidenz systemischer Infektionen spricht für eine sichere Pflege und ist demnach sehr positiv zu bewerten, trotzdem sollten die Hintergründe für das Auftreten der Lokalinfekte, auch wenn sie meist einen milden Verlauf zeigten, überprüft werden. Eine Gesamtbeurteilung der Pflege ist anhand der gemachten Untersuchungen nicht möglich, da aufgrund der Retrospektive keinerlei Faktoren wie Belastungseinschätzung der Schwestern, Lerneinschätzung der Schüler oder Betreuungseinschätzung der Eltern einfließen konnten.

When patients develop new-onset infections after hospital admission, the origin of the infection is typically assumed to be nosocomial; however, ambulances are potentially unexplored reservoirs for emerging pathogens. This study seeks to identify the scope of bacterial contamination in rural East Tennessee ambulances. Though universal precautions and cleaning procedures aim to reduce the spread of infectious diseases to provider and patient, little is known about the bacterial microbiome of ambulances. To the best of our knowledge, this is the first study of its kind to be performed in the state of Tennessee and the first since the introduction of UVGI units as an ambulance-based COVID-19 infection control measure. Our dissemination of post-pandemic findings may impact ambulance sanitation measures and will add to the national and global knowledge pertaining to the microbiome of emergency medical patient transport systems. Ambulances in East Tennessee were sampled using environmental sampling contact plates. At least one active ambulance unit for each EMS service underwent sampling. Three samples were obtained from each of three areas: the floor of the ambulance transport area, the rear door panel inside the transport area and stretcher. The plates were then incubated at 30-35C for 48 hours. Colony counts were manually performed before the plates were shipped for species identification via MALDI-TOF DNA analysis by MIDI laboratories (Newark, DE). One plate from each ambulance door and stretcher was sent for bacterial identification. Only one sample returned free of growth. All floor samples, several stretcher samples, and three door samples presented vast growth with colonies too numerous to count. The results from bacterial identification showed all flora were human commensal flora or environmental flora. The flora found on ambulance doors with opportunistic capabilities are as follows: Staphylococcus hominis, Staphylococcus epidermidis, Enterobacter cloacae, Enterobacter xinagfangensis, Bacillus cereus, Klebsiella oxytoca, and Bacillus subtilis; and the flora found on the stretchers with opportunistic capabilities are as follows: Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus cohnii ssp urealyticus, Bacillus cereus, Corynebaccterium mucifaciens, Staphylococcus pettenkoferi, Klebsiella oxytoca, Staphylococcus capitis, Bacillus subtillis, and Staphylococcus caprae. In this era of increasing antibiotic resistance, it is concerning that several microbes with pathogenicity were found, including species that often confer the spread of resistance such as Klebsiella oxytoca and Enterobacter cloacae. Overall, the finding of numerous diverse colonies does not support adequate sanitation of the ambulances. Further study is required to identify the most effective sanitation methods, and further metagenomic study is needed to explore the presence of genes that facilitate the spread of microbial resistance.

Background: Antimicrobial resistance (AMR) is a global public health challenge since infection with resistant organisms may cause death, can spread across the community, and increase health care costs at individual, community and government level as more expensive antimicrobials will have to be made available for the treatment of infections caused by resistant bacteria. This calls for urgent and consolidated efforts in order to effectively curb this growing crisis, to prevent the world from slipping back to the pre-antibiotic era. The World Health Organization made a call in 2011 advocating for strengthening of surveillance and laboratory capacity as one-way of detecting and monitoring trends and patterns of emerging AMR. Knowledge of AMR guides clinical decisions regarding choice of antimicrobial therapy, during an episode of bacteraemia and forms the basis of key strategies in containing the spread of resistant bacteria. The current study focused on Staphylococcus aureus (SA), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA), as they are common hospital acquired infections which are prone to developing resistance to multiple antibiotics. Aim: The aim of this project was to assess and utilize the laboratory information system (LIS) at the National Health Laboratory Services (NHLS), as a tool for reporting AMR and monitoring resistance patterns and trends over time of clinical isolates of SA, KP and PA, cultured from the blood of patients admitted to seven tertiary public hospitals in three provinces in South Africa. Methods: A retrospective and prospective analysis was done on isolates of SA, KP, PA from blood specimens collected from patients with bacteraemia and submitted to diagnostic microbiology laboratories of the NHLS at seven tertiary public hospitals in three provinces in South Africa. These hospitals comprised the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Hospital (CBH), Helen Joseph Hospital (HJH), Steve Biko Pretoria Academic Hospital (SBPAH), Groote Schuur Hospital (GSH), Tygerberg Hospital (TH) and the Universitas Hospital of the Free State (UH). For retrospective analysis, data submitted during the period July 2005 to December 2009 were used and for prospective analysis, data relating to AMR in SA, KP, PA, collected by the Group for Enteric, Respiratory and Meningeal disease Surveillance in South Africa, (GERMS-SA) from July 2010 to June 2011 were used. AMR in these three pathogens to commonly used antimicrobial drugs was systematically investigated. Multivariate logistic regressions models were used to assess factors associated with AMR. In addition, a systematic review of research done to date on AMR in bacterial pathogens commonly associated with hospital-acquired infections was conducted in order to understand the existing antimicrobial surveillance systems and baseline resistance patterns in South Africa. Results: A total of 9969 isolates were reported from the retrospective dataset. These were 3942 (39.5%) SA, 4466 (44.8%) KP and 1561 (15.7%) PA. From the prospective dataset, a total of 3026 isolates were reported, 1494 (49.4%) SA and 1532 (50.6%) KP isolates respectively. The proportion of invasive bacteraemia was higher in the <5 year old children. Nearly all strains of SA in South Africa were resistant to penicillin, and >30% up to as high as 80% were resistant to methicillin-related drugs among~560 invasive SA isolates over the two year period. Methicillin resistant Staphylococcus aureus (MRSA) rates significantly differed between hospitals (p=<0.001). The proportion of MRSA isolates in relation to methicillin-susceptible strains showed a declining trend from 22.2% in 2005 to 10.5% in 2009 (p=0.042). Emerging resistance was observed for vancomycin: 1 isolate was identified in 2006 and 9 isolates between July 2010-June 2011, and all except 1 were from Gauteng hospitals. The study found increasing rates of carbapenem-resisant KP of 0.4% in 2005 to 4.0% in 2011 for imipenem. The mean rate of extended spectrum beta lactamase (ESBL-KP) producing KP was 74.2%, with the lowest rate of 62.4% in SBPAH and the highest rate of 81.3% in UH, showing a significant geographical variation in rates of resistance (p=0.021). PA showed a tendency for multi-drug resistance with resistance rates of >20% to extended spectrum cephalosporins, fluoroquinolones and aminoglycosides respectively. Emerging resistance in PA isolates was observed to colistin, showing a resistance rate of 1.9% over the 5 years period. In the multivariate model, age <5 years, male gender, and hospital location were factors significantly associated with MRSA, while ESBL-KP was significantly associated with age <5 years and hospital location. Concluding remarks: The study has clearly demonstrated that AMR is relatively common in South Africa among children <5 years. Enhancement of continued surveillance of nosocomial infections through use of routine laboratory data should be reinforced as this will facilitate effective interpretation and mapping of trends and patterns of AMR. Therefore, the LIS as a tool for gathering such data should be strengthened to provide reliable AMR data for improved understanding of the extent of the AMR, and present evidence on which future policies and practices aimed at containing AMR could be based. Key words: Laboratory information system, Trends, Patterns, Antimicrobial resistance, Bacterial pathogens, Nosocomial infections, Surveillance, Bacteraemia, Blood culture.

<p><strong><br /></strong></p> / <p><strong>In Canada the incidence of yeast infections have increased over the past decade, which in turn has resulted in the increased mortality and morbidity rates among the immuno-compromised patients. Yeasts are ubiquitous in nature and constitute a healthy portion of human skin and gut flora. Factors such as the urban settings and food have been previous shown to influence the yeast flora people harbour. This makes us believe that to effectively tackle the rising yeast infections in Canada we need to not only conduct epidemiological yeast studies in clinical settings but should also understand the diversity and distribution of them in the urban environment. This thesis constitutes of an epidemiological fungemia study and an urban environmental yeast profiling study conducted in the city of Hamilton.</strong></p> <p><strong> </strong></p> <p><strong>In the first chapter of the thesis I discuss the results of the epidemiological candidemia study. We noticed that over the past decade the mean age of the population with candidemia in hospitals within Hamilton has increased by 10 years. DNA fingerprinting analysis suggested that 33% of the blood stream</strong><strong><em>Candida</em></strong><strong> </strong><strong>isolates from January 2005 to February 2009 belonged to 18 clusters, some of which were shared between wards and hospitals. we found that for each of the four species, strains isolated closer to each other temporally were overall genetically more similar to each other as well, which suggested that nosocomial sources likely caused repeated candidemia infections. The study is the first of its sort in Canada and the results of this chapter are expected to aid infection control practitioners in the Hamilton hospitals and make the stay of patients in hospitals safer.</strong></p> <p><strong> </strong></p> <p><strong>In the second chapter, we discuss the diversity and distribution of yeasts prevalent on trees in and around Hamilton. We identified a total of 88 environmental yeasts belonging to 20 species (based on ITS sequence data). The yeast populations were highly heterogeneous in both species and genotype composition. Among the 14 tree species sampled, yeasts were frequently found on cedar, cottonwood and basswood. Interestingly all the</strong><strong> <em>Candida parapsilosis</em> </strong><strong>strains were found from pine tree only. Some of the potential environmental factors shaping the distribution of yeast populations in Hamilton are discussed.</strong></p> / Master of Science (MSc)

Yes / It is estimated that 5-10% of hospitalised patients in developed countries contract hospital acquired infections (HAI). Increasing levels of antimicrobial resistance manifested by many HAI-causing pathogens such as Acinetobacter spp in the intensive care unit (ICU) setting present a significant challenge to those managing these infections. Consequently, much attention has been focused on the prevention of HAIs. Particular emphasis has been placed on interventions intended to interrupt patient-to-patient transmission of pathogens, such as enhanced hand hygiene and identification of patients colonised with methicillin-resistant Staphylococcus aureus (MRSA) using rapid DNA-based screening techniques. However, comparatively little attention has been given to the hospital environment, including water supplies, as a source of nosocomial pathogens of importance for patients on the critical care unit. This article reviews the role of hospital water sources in the epidemiology of HAI and new technologies which can be employed in the prevention and control of such infections.

La investigación “Beneficios del uso del apósito con clorhexidina en la prevención de infecciones por el catéter venoso central en el paciente crítico”, tuvo como objetivo determinar los beneficios del uso del apósito con clorhexidina para prevención de infecciones por catéter venoso central. Se desarrolló mediante una metodología de investigación secundaria bajo el enfoque de la enfermería basada en la evidencia, para lo cual se formuló la pregunta clínica ¿Cuáles son los beneficios del uso del apósito con clorhexidina para prevención de infecciones por catéter venoso central en el paciente crítico? Se realizó la búsqueda de la información en bases de datos como BVS, Scielo, Epistemonikos, Pubmed y Cochrane de donde se obtuvo un total de 761 artículos, de los cuales, finalmente solo quedaron 7 investigaciones que fueron validadas con la guía de Gálvez Toro, siendo la investigación sujeta a revisión “Apósito impregnado de clorhexidina para la profilaxis de complicaciones relacionadas con el catéter venoso central: una revisión sistemática y un metaanálisis”, a la cual se aplicó la guía CASPe, el cual tuvo un nivel de evidencia 1++ y grado recomendación A según guía SIGN. Finalmente para dar respuesta a la pregunta se determinó que el apósito impregnado de clorhexidina es beneficioso en la reducción de riesgo de infecciones del torrente sanguíneo relacionados al uso de catéter venoso central en una unidad de cuidados intensivos. / The research “Benefits of the use of a dressing with chlorhexidine in the prevention of infections due to the central venous catheter in critically ill patients” aimed to determine the benefits of the use of a dressing with chlorhexidine for the prevention of infections due to a central venous catheter. It was developed through a secondary research methodology under the approach of evidence-based nursing, for which the clinical question was formulated: What are the benefits of using chlorhexidine dressing for the prevention of central venous catheter infections in critically ill patients? The information was searched in databases such as BVS, Scielo, Epistemonikos, Pubmed and Cochrane, from which a total of 761 articles were obtained, of which, finally, only 7 investigations remained that were validated with the guide of Gálvez Toro. The research being subject to review “Chlorhexidine-impregnated dressing for the prophylaxis of complications related to the central venous catheter: a systematic review and meta-analysis”, to which the CASPe guideline was applied, which had a level of evidence 1++ and recommendation grade A according to SIGN guide. Finally, to answer the question, it was determined that the chlorhexidine-impregnated dressing is beneficial in reducing the risk of bloodstream infections related to the use of a central venous catheter in an intensive care unit.

Clostrioides difficile is a common cause of nosocomial (hospital-acquired) infections. Patients receiving antibiotic treatment experience dysbiosis of gut microbiota, and C. difficile, normally held in check by the various other organisms, takes this opportunity to propagate. Symptoms of infection generally include diarrhea, colitis, dehydration, and fever. Understanding that C. difficile generally only causes illness when it is the dominant bacterium (i.e. when growth is relatively unchecked by other microbes), it is appropriate to investigate potential competitive organisms that may be introduced after antibiotic courses or during active C. difficile infection to effectively displace it. Fecal samples from the University of Central Florida Lift fecal collection station were aseptically plated onto modified cycloserine cefoxitin fructose agar (CCFA). Visually remarkable colonies (certain colonies that looked unique in comparison to others) were restreaked on new plates of the same media to verify growth, then transferred to brain heart infusion-supplemented (BHIS) plates for propagation. Colonies were inoculated in glycerol stocks for storage, then grown in BHIS liquid media to prepare for identification. Genomic extraction was performed on each sample, and spectrophotometric quantification and gel electrophoresis were executed to confirm successful extraction. Genomic samples will be sent to an external laboratory for identification via polymerase chain reaction and Sanger sequencing. We hypothesize that at least one bacterial strain from the fecal collection station will potentially inhibit C. difficile infection. Should such an organism be identified, it follows that the efficacy of its application in conventional hospital settings may be examined. Current regulation of fecal microbiota transplants, an effective therapeutic practice, is cumbersome, and changing the classification of fecal transplants may improve timeliness and effectiveness of treatment.

The purpose of the study was to develop practice guidelines to promote adherence to infection control standards in a specific hospital in Manzini, Swaziland. It was a qualitative, descriptive and explanatory design which utilised an in-depth unstructured face to face interview data collection method done to nine (9) registered nurse participants. A qualitative content analysis was conducted to identify prominent themes and patterns, smaller units of data were named and coded according to the contents they represented. Four themes emerged from data analysis, they were; working environment for nurses, nurse’s descriptions of infection control standards, nurse’s challenges regarding adherence to infection control standards and nurses expressed needs. The findings revealed possible contributing factors to non-adherence to infection control standards by participants and therefore denoted to a serious need for development of general guidelines to promote adherence to infection control standards, these guidelines were presented. / Health Studies / M. A. (Health Studies)

The purpose of the study was to develop practice guidelines to promote adherence to infection control standards in a specific hospital in Manzini, Swaziland. It was a qualitative, descriptive and explanatory design which utilised an in-depth unstructured face to face interview data collection method done to nine (9) registered nurse participants. A qualitative content analysis was conducted to identify prominent themes and patterns, smaller units of data were named and coded according to the contents they represented. Four themes emerged from data analysis, they were; working environment for nurses, nurse’s descriptions of infection control standards, nurse’s challenges regarding adherence to infection control standards and nurses expressed needs. The findings revealed possible contributing factors to non-adherence to infection control standards by participants and therefore denoted to a serious need for development of general guidelines to promote adherence to infection control standards, these guidelines were presented. / Health Studies / M. A. (Health Studies)