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The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). Heterogeneity of risk across wards is still poorly described. We measured CPIs in 15 clinical wards across three hospitals using wearable sensors over 36 hours in spring 2020. This data was combined with a transmission model to estimate and compare transmission risks across wards. We found a four-fold range of epidemic risk between wards, with patients frequently presenting high risk to patients and healthcare workers (HCWs). Using a simulation study, we then assessed the potential impact on global risk of targeting individuals for prevention based on their contact patterns. We found that targeting individuals with the highest cumulative contact hours was most impactful. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk.One Sentence SummaryWe measured contacts between staff, patients and visitors in 15 hospital wards, and used models to predict epidemic risk and evaluate interventions.

Summary Worldwide dissemination of carbapenemase-producing Enterobacterales (CPE) has led to national and international guidance recommending the implementation of cohorting in healthcare settings. However, in view of recent data regarding the spread of extended-spectrum β-lactamase-producing Enterobacterales, the usefulness of this measure in non-outbreak settings is questionable; here, individual contact isolation may be sufficient to control the risk of dissemination. A narrative review of the literature was conducted and the role of cohorting discussed. CPE are responsible for outbreaks in healthcare settings, which are considered the epicentre of spread of resistance strains. CPE are responsible for adverse effects such as increases in hospital stay and costs, fewer therapeutic options and thus higher risk of clinical failures and mortality. Environment and materials have also been reported as contaminated with CPE and may be the source of outbreak. Even if guidelines and publications have supported implementation of cohorting, there are no randomized studies to demonstrate that this measure should be mandatory. Most studies are descriptive and cohorting is usually one of several other measures to control outbreaks. Cohorting is not adapted to all healthcare settings, requiring human and material resources. Other measures must be strengthened such as compliance with hand hygiene, antibiotic stewardship, and surveillance of contact patients. Individual risk factors for acquisition should also be evaluated. In conclusion, local epidemiology and resources must be assessed before implementing cohorting.

IntroductionA new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analyzing clinical presentation on admission and the determinants associated with direct admission or transfer to intensive care units (ICUs) in hospitalized COVID-19 patients.Patients and MethodsIn this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients were prospectively collected and analyzed. The outcome was admission/transfer to intensive care units compared with total hospital stay in medical wards according to patient characteristics.ResultsOf the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of admission/transfer to ICUs with male gender (OR, 1.99 [95%CI, 1.07-3.73]), temperature (OR, 1.37 [95% CI, 1.01-1.88] per degree Celsius increase), abnormal lung auscultation on admission (OR, 2.62 [95% CI, 1.40-4.90]), elevated level of CRP (OR, 6.96 [95% CI, 1.45-33.35 for CRP>100mg/L vs CRP10 days vs time ConclusionsClinical and biological features on admission and time until admission were associated with admission to ICUs. Signs to predict worsening on admission could be partially associated with the time until admission. This finding reinforces the need for appropriate guidelines to manage COVID-19 patients in this time window.

BackgroundHazardous drugs pose risks to health care workers. To reduce the risk of occupational exposure for all workers, several protective and monitoring measures have been recommended and implemented over the past two decades. This study was undertaken to describe traces contamination with ten antineoplastic drugs in the oncology care unit of two university hospitals.MethodsIn this descriptive interrupted time series study, data was collected in two hospitals (a pediatric hospital and an adult hospital) in two consecutive years (12 December 2017 and 27 March 2018, defined as Period 1; 17 April 2019 and 12 June 2019, defined as Period 2). In both Period 1 and Period 2, 36 sites were sampled in each inpatient care unit to explore the contamination of surfaces with hazardous drugs.ResultsA total of 144 samples from the oncology care unit of the two hospitals were obtained for measurement. Overall, 40 % (58/144) of the sampling sites were positive for at least one hazardous drug. In the pediatric centre, 50 % (18/36) and 36 % (13/36) of the sites sampled in Period 1 and Period 2, respectively, were positive for at least one hazardous drug, whereas in the adult hospital, the percentage of sites that were positive for at least one hazardous drug was 19 % (7/36) in Period 1 and 56 % (20/36) in Period 2.ConclusionThe surfaces of inpatient care units sampled in this study were contaminated with antineoplastic drugs, and contamination was present throughout the care units (including structures, furniture, medical equipment, and office equipment). Hospitals’ environmental surveillance programs should encompass inpatient care units.

International audience; BACKGROUND: Cohorting carbapenemase-producing Enterobacteriaceae (CPE) carriers during hospitalization limits in-hospital spreading.OBJECTIVE: To identify risk factors for CPE acquisition among contacts of an index patient in non-cohorted populations.METHODS: A multicentre retrospective matched case-control study was conducted in five hospitals. Each contact patient (case) who acquired Klebsiella pneumoniae (KP)-OXA-48 from an index patient was compared to three contact (controls) with the same index patients matched with hospitalization in the same unit and similar exposure times.RESULTS: Fifty-one secondary cases and 131 controls were included. By univariate analysis, exposure time (odds ratio: 1.06; 95% confidence interval: 1.02-1.1; P = 0.006), concomitant infection at admission (3.23; 1.42-7.35; P = 0.005), antimicrobial therapy within the last month before hospitalization (2.88; 1.34-6.2; P = 0.007), antimicrobial therapy during the exposure time (5.36; 2.28-12.6; P

Lyon Study Group on Covid19 infection (Geriatric section- Alphabetic order): Adrait, A, Benoist F, Castel-Kremer E, Chuzeville M, Dupin AC, Doh S, Kim B, Favrelle L, Hilliquin D, Kanafer N, Marion E, Martin-Gaujard G, Moyenin Y, Paulet-Lafuma H, Ricanet A, Saadatian-Elahi M, Vanhems P.

Background: Surfaces in health care centres are often contaminated with traces of antineoplastic drugs. Such contamination should be limited as much as possible, to reduce workers’ exposure. Objectives: The primary objective was to monitor environmental contamination with 9 antineoplastic drugs in oncology pharmacy and patient care areas of Canadian health care centres. The secondary objective was to explore the use of sodium hypochlorite as a cleaning agent for cyclophosphamide contamination. Methods: This cross-sectional evaluation was conducted from January to April 2018. Twelve standardized sites were sampled at each participating centre: 6 in the oncology pharmacy and 6 in patient care areas. Six of the antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, gemcitabine, 5-fluorouracil, and irinotecan) were quantified by ultra-performance liquid chromatography – tandem mass spectrometry. For the other 3 antineoplastic drugs (docetaxel, paclitaxel, and vinorelbine), samples were screened for contamination but not quantified. The effect of using sodium hypochlorite as a cleaning agent was evaluated with a Kolmogorov-Smirnov test for independent samples. Results: Of 202 Canadian centres invited, 79 participated. A total of 887 surface samples were analyzed, 467 from pharmacy areas and 420 from patient care areas. Cyclophosphamide was the drug most often found as a contaminant (32.2% [286/887] of samples positive, 75th percentile of measured contamination 0.0017 ng/cm², 90th percentile 0.021 ng/cm²). The front grille inside the hood (80.8% [63/78] of samples positive for at least one antineoplastic drug), treatment chair armrest (78.9% [60/76]), storage shelf in pharmacy (61.5% [48/78]), and floor in front of the hood (60.3% [47/78]) were the most frequently contaminated surfaces. Cleaning with a sodium hypochlorite solution was highly variable. Among centres that reported using sodium hypochlorite to clean armrests on patient chairs, the concentration of cyclophosphamide was lower (0.00866 versus 0.0300 ng/cm², p = 0.014). Conclusions: Despite growing awareness and implementation of new safe-handling guidelines, surfaces in health care centres were contaminated with traces of many antineoplastic drugs. Providing centres with attainable goals (e.g., 75th to 90th percentile relative to other similar centres) would help in identifying the sampling sites where improvements are needed and in achieving lower surface contamination. RESUME Contexte : Les surfaces dans les centres de sante sont souvent contaminees par des traces de medicaments antineoplasiques. Une telle contamination devrait etre limitee autant que faire se peut afin de reduire l’exposition des employes a ces produits. Objectifs : L’objectif principal consistait a mesurer la contamination environnementale provenant de neuf medicaments antineoplasiques dans la section de la pharmacie oncologique et celle des soins offerts aux patients dans des centres de soins de sante canadiens. L’objectif secondaire consistait a explorer l’action nettoyante de l’hypochlorite de sodium pour eliminer la contamination par la cyclophosphamide. Methodes : Cette evaluation transversale a ete menee de janvier a avril 2018. Des echantillons ont ete preleves dans douze endroits standardises de chaque centre participant : six dans la section de la pharmacie oncologique et six dans celle des soins donnes aux patients. La presence de six des medicaments antineoplasiques examines (cyclophosphamide, ifosfamide, methotrexate, gemcitabine, 5-fluorouracil et irinotecan) a ete quantifiee par chromatographie liquide a haute performance (HPLC) avec spectrometrie de masse en tandem. Quant aux trois autres echantillons de medicaments antineoplasiques (docetaxel, paclitaxel et vinorelbine), ils ont ete analyses pour rechercher la presence d’une contamination qui n’a pas ete quantifiee. L’action nettoyante de l’hypochlorite de sodium a ete evaluee a l’aide d’un test de Kolmogorov-Smirnov pour les echantillons independants. Resultats : Sur 202 centres canadiens invites a participer a l’etude, 79 ont repondu a l’invitation. L’analyse a porte sur 887 echantillons de surfaces des lieux selectionnes : 467 dans la section de la pharmacie et 420 dans la section des soins donnes aux patients. La cyclophosphamide etait le medicament contaminant le plus souvent decele (32,2 % d’echantillons positifs [286/887], 75e percentile de contamination mesuree 0,0017 ng/cm², 90e percentile 0,021 ng/cm²). La grille frontale a l’interieur de la hotte de laboratoire (80,8 % des echantillons [63/78] etaient positifs pour au moins un medicament antineoplasique), l’accoudoir de la chaise du patient (78,9 % [60/76]), l’etagere de stockage dans la pharmacie (61,5 % [48/78]) et le sol en face de la hotte (60,3%[47/78]) etaient les surfaces le plus souvent contaminees. L’usage d’une solution d’hypochlorite de sodium pour le nettoyage variait grandement d’un centre a l’autre. Dans les centres qui indiquaient utiliser cet agent pour nettoyer les accoudoirs des chaises du patient, la concentration de cyclophosphamide sur les accoudoirs etait moins elevee (0,00866 contre 0,0300 ng/cm², p = 0,014). Conclusions : Malgre la prise de conscience et la mise en place croissantes de nouvelles lignes directrices en matiere de manipulation securitaire, les surfaces de certains endroits des centres de sante sont contaminees par des traces de nombreux medicaments antineoplasiques. La fixation d’objectifs atteignables pour les centres (p. ex., entre le 75e et le 90e percentile par rapport aux autres centres similaires) aide a determiner les sites d’echantillonnage ou des ameliorations sont necessaires et a diminuer la contamination des surfaces.

Resume L’endemie d’enterobacteries secretrices de beta-lactamase a spectre elargi (EBLSE) que nous vivons actuellement est liee a la diffusion d’un mecanisme de resistance plasmidique au sein des enterobacteries et particulierement l’espece Escherichia coli . Cette situation epidemiologique necessite un niveau d’observance eleve des precautions standards et une maitrise de la prescription antibiotique. D’autres mesures complementaires peuvent etre justifiees de par les donnees epidemiologiques locales. Lutter contre la diffusion de ce mecanisme de resistance est une priorite dans la mesure ou sa diffusion fait le lit de la diffusion des Enterobacteries productrices de carbapenemase.

The aim of this study was to review the literature regarding the external contamination of commercial vials by antineoplastic drugs. A PubMed and CINAHL searches from 1 January 1990 to 1 May 2018 was performed with the terms: « antineoplastic agents », « environmental monitoring », « drug packaging », « vials » and « contamination ». Articles that presented results on the external contamination of commercial vials were included. Twenty-four articles were identified from 11 countries. A total of 4248 vials were sampled from 28 manufacturers. Traces were found on 56% (2379/4248) of vials. A maximum of 150 000 ng was measured on a glass vial of fluorouracil. This literature review showed that the exterior of the majority of commercial antineoplastic vials was contaminated. Manufacturers should limit this contamination. Centres are also encouraged to clean the vials on receipt. Personal protection equipment should be worn at all steps of the drug-use process.

International audience; no abstract