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Background The objectives were to describe outpatients’ psychosocial characteristics and to identify the prevalences of unanticipated hospital admission immediately following outpatient surgery and of severe complications in outpatients at one month after ambulatory surgery. Methods A prospective cohort study was conducted during one month in Rouen University Hospital in January 2017. An anonymous questionnaire was administered in outpatients before hospital discharge. After another month after discharge, data regarding unanticipated hospital admission (primary endpoint) and readmission for complication related to ambulatory surgery and risk factors of readmission depending on psychosocial level (secondary endpoint) were collected from patient medical records. Data included demographic and psychosocial characteristics information on surgery and anesthesia. Results A total of 598 outpatients were included during a month, which represented 85.7% of the outpatients of the hospital unit. The mean age was 50.8 years old (SD = 19.8), the sex ratio male/female was 0.68. Among the outpatients, 93.8% had an ASA Physical Status of I or II. There were 23.5% ophthalmic surgeries, 19.0% gynecological surgeries, 17.7% orthopedic surgeries, 8.3% plastic surgeries; 47.5% of operations were carried out under general anesthesia and 16.6% under regional anesthesia. Twenty percent of outpatients lived alone and 2.6% lived alone and socially isolated; 1.6% of outpatients returned home as a pedestrian and 3.4% used public transportation; 13.7% of outpatients were not accompanied for the first night after surgery. There were 11 (1.84%) unanticipated hospital admissions (7 for medical reasons, 1 for surgery and 3 for organizational difficulty). There were 11 (1.84%) patients that returned in hospital in the 30 days that followed the surgery with 3 readmissions. There was no difference between patients with low socioeconomic status and other patients for unanticipated hospital admission or readmission (working outpatients versus not working, P = 0.42, outpatients with primary, middle or secondary education versus higher education, P = 1.00). Conclusions In our study, the prevalence of unanticipated hospital admission and readmission was low and comparable to the literature. In this work, the psychosocial level was not a risk factor of unanticipated hospital admission or readmission after ambulatory surgery.

Resume En France, la legislation impose d’informer tout patient hospitalise du risque d’infection nosocomiale (IN) et de sa survenue effective. En milieu psychiatrique, des difficultes dans l’application de cette reglementation peuvent etre attendues du fait des pathologies rencontrees. L’objet de ce travail etait d’evaluer les connaissances, l’opinion et les pratiques des professionnels de sante en psychiatrie, en matiere d’information sur les IN. Un autoquestionnaire anonyme a ete complete par 114 professionnels de sante exercant dans quatre etablissements ayant une activite psychiatrique en Haute-Normandie. Le niveau de connaissance des obligations reglementaires etait juge satisfaisant dans 7,0 % des cas. Seuls 5,3 % des professionnels declaraient informer systematiquement les patients non infectes. En cas de survenue d’une IN, l’information etait systematiquement donnee au patient par 13,2 % des professionnels. Alors que les professionnels etaient largement favorables a plus d’information sur les IN (86,0 %), le deficit de connaissances et de pratique constate dans notre etude temoigne probablement a la fois de la faible frequence et gravite des IN en psychiatrie et de difficultes specifiques de communication avec les patients : des methodes de communication adaptees a ces patients devraient etre developpees.

Introduction Suite aux nouvelles recommandations sur la prise en charge des infections urinaires (IU) communautaires de l’adulte (SPILF, 2014), nous avons souhaite realiser une enquete sur la pertinence des examens cytobacteriologiques des urines (ECBU) dans les etablissements d’hebergement pour personnes âgees dependantes (EHPAD) de la region. Methodes Une enquete retrospective par auto-questionnaire a ete realisee par les EHPAD de la region. L’inclusion s’est faite d’avril a juin 2015 a partir des ECBU envoyes au laboratoire de biologie medicale. Le questionnaire comportait une fiche reprenant les principales caracteristiques de l’etablissement et de ses residents ainsi qu’une fiche pour chaque ECBU realise (motifs, BU, prescription, realisation et antibiotherapie). Resultats Trente-deux etablissements ont participe a l’enquete. Trois cent trente-trois fiches ECBU ont ete recues. Les caracteristiques des patients etaient : âge median 87 ans (34 a 105), deux tiers de femmes (253/333) et deux tiers avec un GIR ≤ 2 (204/302). Des signes cliniques positifs etaient presents pour 72 % des patients (239/333). L’ECBU etait prescrit par le medecin dans 82 % des cas (272/332) et realise par l’IDE dans 83 % des cas (273/333). Les resultats des ECBU etaient : 62 % (207/331) positifs, 19 % (32/331) negatifs et 19 % (32/331) polymicrobiens. Les germes retrouves dans les ECBU positifs etaient principalement : Escherichia coli (66 %, 137/207), Proteus (11 %, 23/207), Klebsiella (6 %, 12/207). Une antibiotherapie etait presente chez 61 % (201/330) des patients (C3G : 31 %, 62/201, Fluoroquinolones : 29 %, 58/201). Parmi les ECBU realises, 24 % (79/333) etaient consideres comme non pertinents. Enfin, la proportion d’ECBU realises a l’initiative de l’IDE etait significativement (p = 0,03) plus importante parmi les ECBU non pertinents (25 %, 20/79) que parmi les ECBU pertinents (15 %, 38/253). Conclusion Cette enquete regionale a permis de mettre en evidence une heterogeneite des pratiques de prise en charge diagnostique et therapeutique des infections urinaires en EHPAD. Un outil d’« aide a la demarche diagnostique d’une infection urinaire du sujet âge » a ete elabore suite a ce travail.

A multicentre practice assessment study on peripheral intravenous catheters (PVC) utilization was carried out in 920 healthcare facilities (HCF) in France in 2010. Breaches in practices were observed particularly for insertion and maintenance of PVC. The objective was to evaluate the impact of the study practices on implementation of corrective measures.

French legislation makes mandatory for healthcare providers the disclosure of hospital infection (HI) risk and actual occurrence to the patient. Given the specific diseases encountered in psychiatry, some difficulties may be expected in practical application of this regulation.The aim of our study was to describe the knowledge, declared practices and opinions of healthcare workers (HCW) in psychiatry concerning information for patients about HI.We randomly selected doctors, nurses and head nurses from four hospitals with psychiatric activity in Normandy. The HCW were asked to self-complete an anonymous questionnaire, including data describing the responding HCW and questions aiming at describing his/her knowledge, attitude in routine daily practice and opinion about information to patients about HI.One hundred and forty-one HCW were initially selected, of which 114 (80.9%) eventually agreed to complete the questionnaire. Only eight HCW (7.0%) were considered to have a correct overall knowledge of legal obligations. Main errors concerned the obligation to inform the patient of the HI risk according to the medical procedures that are to be performed (43.9% of correct answers) and the obligation to inform the patient of the HI risk according to his/her medical condition (46.5%). The obligation to inform the patient of the occurrence of a HI was largely known (84.2%). HCW usually giving information about the risk of HI to patients without HI accounted for 5.3%. Main reasons advocated for not informing patients were a low level risk of HI in psychiatry (80.4%) and the lack of patients' demand (59.8%). In the case of HI occurrence, the percentage of HCW routinely informing patients was 13.2%. HCW systematically informing the patient's family about the occurrence of HI accounted for 9.6%. A large proportion of HCW supported delivering information to patients about HI (86.0%). HCW expected from information better approval of prevention programs by the patients (87.7%) but feared an increased anxiety in patients (75.4%) and a higher rate of care refusal (48.2%).Whereas a very large proportion of HCW in psychiatry support delivering information to patients about HI, our study shows HCW's lack of awareness of regulations and lack of declared practices. Among factors explaining this contrast, a lower perceived HI risk and severity level are to be mentioned. Training programs focusing on risk and mechanisms of HI could be offered to professionals in psychiatry. The issue of specific communication difficulties with psychiatric patients should be addressed as well. In order to develop information on HI, specific methods suited to those patients should be developed.

Handrubbing with alcohol-based hand rub (AHR) is a validated alternative to handwashing. The aims of this study were to compare knowledge and declared use of AHR between different categories of healthcare worker (HCW), and to assess factors associated with the use of AHR. A standardized questionnaire was sent to all HCWs in a tertiary care university hospital. The following data were collected for each HCW: job title (physician, nurse, nursing assistant or other), sources of information about AHR; knowledge and perception of AHR and declared use of AHR in daily practice instead of unmedicated or antiseptic soap. Of 5238 questionnaires, 1811 were returned. Physicians had better knowledge about AHR than other HCWs. HCWs' knowledge of AHR efficacy and skin tolerance were independently associated with the use of AHR instead of unmedicated or antiseptic soap. The declared use of AHR differed according to professional category.

The aim of this study was to compare the efficacy of surgical hand rubbing (SHR) with the efficacy of surgical hand scrubbing (SHS), and to determine the costs of both techniques for surgical hand disinfection. A review of studies reported in the literature that compared the efficacy of SHS and SHR was performed using MEDLINE. The costs of SHR and SHS were estimated based on standard hospital costs. The literature showed that SHR had immediate efficacy that was similar to that of SHS, but SHR had a more lasting effect. SHR reduced costs by 67%. In conclusion, SHR is a cost-effective alternative to SHS.

Introduction et objectifs Alerte : Quatre cas groupes d’hepatite A, 3 soignants et une patiente, ont ete diagnostiques dans un service hospitalier entre le 16 et le 20/01/08. Le diagnostic a ete confirme par la presence d’IgM anti-VHA. Une investigation a ete menee pour identifier la source de l’infection. Materiels et methodes L’enquete a envisage le risque de transmission alimentaire et le risque de transmission par contact : gestion des excretas, revue des dossiers cliniques des patients hospitalises dans le service dans le mois precedant les signes cliniques des cas (periode d’incubation). Les serums ont ete adresses au Centre National de Reference pour typage des souches (analyse de la region VP1/2A) et mesure de l’avidite des IgG anti-VHA. Resultats Lors de l’enquete, qui a ecarte la contamination d’origine alimentaire, 2 cas supplementaires ont ete identifies : un agent de la blanchisserie le 01/02/08 et une technicienne de laboratoire le 23/02/2008. Les 6 cas etaient infectes par une meme souche de genotype IA. Sur les 87 dossiers revus, un patient a presente une cytolyse du 4/12/07 au 13/01/08. Le diagnostic d’hepatite A a ete porte retrospectivement sur la presence d’IgM anti-VHA dans un serum du 07/02/2008 dans lequel une souche identique a celle des 6 autres cas a ete identifiee. Une avidite des IgG anti-VHA a 81 % suggerait une infection evoluant depuis plus de 2 mois, resultat coherent avec la date de debut de la cytolyse. Ce patient a ete hospitalise dans le service du 12/12/07 au 12/02/08 apres un sejour de 15 jours en reanimation suite a une noyade. Conclusion L’enquete a note des locaux vetustes, l’absence de supports muraux pour solution hydro-alcoolique, le rincage des bassins a la douchette, un souseffectif en personnel avec des patients tres dependants, contexte favorisant la transmission directe et indirecte du virus de l’hepatite A.

The frequent use of peripheral venous catheters (PVC) generate a significant number of infections. Since 2005, a standard recommendation edited by the French Society for Hospital Hygiene has been promoted in healthcare facilities (HCF). In 2009, the French Group for Evaluation of Practices concerning Hospital Hygiene (GREPHH) has provided an evaluation tool for PVC practices. The objective was to evaluate practices during utilisation of PVC in healthcare facilities (HCF).