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Objective: To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU)., Design: Prospective, randomized, controlled, parallel-group, nonblinded clinical trial., Setting: Medical ICUs of 2 French university hospitals., Participants: Five hundred adults with an expected length of stay in the ICU greater than 48 hours., Interventions: For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators., Main Outcome Measure: MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions., Results: In the intent-to-treat analysis ([Formula: see text]), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups ([Formula: see text]). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group ([Formula: see text]), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; [Formula: see text]). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; [Formula: see text])., Conclusions: Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation., Trial Registration: Clinicaltrials.gov identifier: NCT00151606.

Background: Owing to systemic inflammatory response syndrome, the diagnosis of post-operative infection after cardiopulmonary bypass is difficult to assess in children with the usual clinical and biological tools. Procalcitonin could be informative in this context., Methods: Retrospective study in a paediatric intensive care unit. Blood samples were collected as soon as infection was clinically suspected and a second assay was performed 24 hours later. Using referenced criteria, children were retrospectively classified into two groups: infected and non-infected., Results: Out of the 95 children included, 14 were infected. Before the third post-operative day, procalcitonin median concentration was significantly higher in the infected group than in the non-infected group - 20.24 nanograms per millilitre with a 25th and 75th interquartile of 15.52-35.71 versus 0.72 nanograms per millilitre with a 25th and 75th interquartile of 0.28 to 5.44 (p = 0.008). The area under the receiver operating characteristic curve was 0.89 with 95% confidence intervals from 0.80 to 0.97. The best cut-off value to differentiate infected children from healthy children was 13 nanograms per millilitre with 100% sensitivity - 95% confidence intervals from 51 to 100 - and 85% specificity - 95% confidence intervals from 72 to 91. After the third post-operative day, procalcitonin was not significantly higher in infected children - 2 nanograms per millilitre with a 25th and 75th interquartile of 0.18 to 12.42 versus 0.37 nanograms per millilitre with a 25th and 75th interquartile of 0.24 to 1.32 (p = 0.26). The area under the receiver operating characteristic curve was 0.62 with 95% confidence intervals from 0.47 to 0.77. A procalcitonin value of 0.38 nanograms per millilitre provided a sensitivity of 70% with 95% confidence intervals from 39 to 89 for a specificity of 52% with 95% confidence intervals from 34 to 68. After the third post-operative day, a second assay at a 24-hour interval can improve the sensitivity of the test., Conclusions: Procalcitonin seems to be a discriminating marker of bacterial infection during the post-operative days following cardiopulmonary bypass in children.

Objective: Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession., Material and Method: During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database., Results: 169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments., Conclusion: Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

Objectives: To know nosocomial infections (NI) rates among newborns and hospitalised children according to age and units of hospitalisation,, Methods: In 2001, the Comité technique des infections nosocomiales (CTIN) initiated a one-day prevalence survey on an arranged date. It was conducted by the 5 centres de coordination de lutte contre les infections nosocomiales (C.CLIN). Paediatric data only were analysed dividing them into 2 groups: newborns (NB) up to 28 days old, whether in maternity, neonatology or intensive care units, and children (CH) from 29 days to 18 years old with separate analysis for surgery, cancer units and intermediate care and rehabilitation centres (ICRC)., Results: The survey included 21 596 children under 18 years old: 9136 NB and 12,460 CH, i.e. 7.1% of the total hospital population on that one given day. A total of 2.6% of the patients were infected, with 1.2% of NB and 3.3% of CH. There were 1.09 infections per patient. 456 different microorganisms were responsible for 562 infections, i.e. 81.1%: 18,6% Staphylococcus aureus of which 26.7% were methicillin resistant (MRSA), 21.9% Staphylococcus epidermis, 21.9% enterobacteries, 10.3% Pseudomonas aeruginosa, 4.4% Candida albicans, and 4.2% rotavirus. NB and CH infection factors were studied separately. Selective criteria for hospitalised NB were: gender: male(P < 0.05), level of gravity (P < 0.05), surgery (P < 0.001), catheter (P < 0.01) and hospital type (P < 0.01). For EN, criteria were severity score (P < 0.01), surgery (P < 0.001), catheter (P < 0.01), and hospital type (P < 0.01). The rate for patients hospitalised in cancer units was 13.2% with no significant factors found. The rate of infected patients in intensive care units was 7.8% for NB and 16.2% for CH, with 9.6% neonatal, 30.8% heart condition, 26.3% non-specialised units and 14.2% children units. ICRC infection rate was 4.5% while surgery units had a rate of 1.9% with 2.4% orthopaedic, 0.7% children units, 2.0% non-specialised units and 8.1% neurosurgery., Discussion: The 2001 NI level showed a significant fall from 3.5% in the 1996 survey (all ages) to 2.4%. However, including newborns from private maternity units into the survey may have partly lowered this level. MRSA levels have also dropped from 46% in 1996 to 27% in 2001. It is difficult to compare international data as definitions vary. Furthermore, it should be possible to separate newborns from older children as well as specifying the type of units involved. Infected patients levels are generally lower in the French surveys, no matter the age group or units studied than in other surveys., Conclusion: This survey has enabled the monitoring of the children population in maternity units, on a given day, in France. It showed that the rate of NI in the paediatric population seems low compared to previous data or other countries'data. Efforts need to be made in order to lower it further. Incidence surveillance method is preferable to single out which risk factors can be acted upon. Standardized national protocols are offered to maternity units and should soon be available for newborns units as well as older children units.

Two cases of Mycobacterium haemophilum infection in renal-transplant patients occurred in the same hospital department. This raised the possibility that infection may have been acquired in hospital.