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Background: Standard operating rooms (SOR) are assumed to be the best place to prevent microbial contamination when performing tissue procurement. However, mobilizing an operating room is time and cost consuming if no organ retrieval is performed. In such case, non-operating dedicated rooms (NODR) are usually recommended by European guidelines for tissue harvesting. Performing the tissue retrieval in the Intensive care unit (ICU) when possible might be considered as it allows a faster and simpler procedure., Objective: Our primary objective was to study the relationship between the risk of microbial contamination and the location (ICU, SOR or NODR) of the tissue retrieval in heart-beating and non-heart-beating deceased donors., Materials and Method: We retrospectively reviewed all deceased donors' files of the local tissue banks of Montpellier and Marseille from January 2007 to December 2014. The primary endpoint was the microbial contamination of the grafts. We built a multivariate regression model and used a GEE (generalized estimating equations) allowing us to take into account the clustered structure of our data., Results: 2535 cases were analyzed involving 1027 donors. The retrieval took place for 1189 in a SOR, for 996 in a hospital mortuary (NODR) and for 350 in an ICU. 285 (11%) microbial contaminations were revealed. The multivariate analysis found that the location in a hospital mortuary was associated with a lower risk of contamination (OR 0.43, 95% CI [0.2-0.91], p = 0.03). A procurement performed in the ICU was not associated with a significant increased risk (OR 0.62, 95% CI [0.26-1.48], p = 0.4)., Conclusion: According to our results, performing tissue procurement in dedicated non-sterile rooms could decrease the rate of allograft tissue contamination. This study also suggests that in daily clinical practice, transferring patients from ICU to SOR for tissue procurement could be avoided as it does not lead to less microbial contamination., Competing Interests: The authors have declared that no competing interests exist.

The aim of the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes (IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home (NH) staff on quality indicators (QIs) and functional decline and emergency department (ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large-scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Background: Primary percutaneous coronary intervention (PCI) is the preferred management for patients with acute ST-segment elevation myocardial infarction (STEMI) if performed in a timely manner by experienced providers. Patients can access a PCI facility by three routes: prehospital STEMI diagnosis by emergency medical services (EMS) and direct transport by EMS to a PCI facility (EMS-PCI); visit to a hospital emergency department (ED) followed by referral to an on-site PCI facility (ED-PCI); or transfer from the ED to a PCI facility in another hospital (ED-transfer-PCI)., Aims: To assess the implementation rate in France of the guidelines recommending that STEMI patients be transported by EMS to a PCI facility and to compare the times between symptom onset and PCI for these three routes., Methods: We used the results of the pilot testing of a national quality indicator programme on STEMI in 64 hospitals, providing data on patient characteristics, referral route and symptom-onset-to-needle time. We compared delays for each route in a Cox proportional-hazard model., Results: In a population of 1217 patients, median symptom-onset-to-needle time was 186minutes (Q1 133; Q3 292) for the EMS-PCI route, 237minutes (Q1 165; Q3 368) for the ED-PCI route and 305minutes (Q1 230; Q3 570) for the ED-transfer-PCI route. A total of 70.8% of patients were transported by EMS as recommended. After adjustment for age, symptom onset period (weekends/nights) and history of cardiovascular disease, the EMS-PCI route was associated with the shortest symptom-onset-to-needle times. The hazard ratio was 0.71 [0.59-0.86] for the ED-PCI route and 0.67 [0.52-0.86] for the ED-transfer-PCI route., Conclusion: STEMI patients receive prompter care after prehospital diagnosis and direct transport to a PCI facility by EMS than by visiting a hospital ED. Use of this referral route should be further encouraged in France as approximately one-third of STEMI patients are still presenting directly to the ED., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: The repatriation of patients from foreign hospitals can foster the emergence and spread of multidrug-resistant bacteria (MRB). We aimed to evaluate the incidence of MRB in patients treated in foreign hospitals and repatriated by international inter-hospital air transport in order to better manage these patients and adjust our procedures., Methods: The records from all consecutive aeromedical evacuations and overseas repatriations carried out by Mondial Assistance France between December 2010 and November 2011 were reviewed for this study. Only inter-hospital transfers with inpatient destination of an acute care unit were considered. Patients were allocated to one of two groups: those identified as MRB carriers at their arrival in France and those who were not identified as such (either negative for MRB or not tested). Data were compared between the two groups., Results: Analysis was performed on 223 patients: 16 patients (7%) were identified as MRB carriers. Compared with confirmed non-MRB patients, MRB carriers came more frequently from a high-risk unit (88% vs 59%, p = 0.05) and had a longer foreign hospital stay [13 (3-20) vs 8 (6-14) d, p = 0.01]., Conclusions: The occurrence of MRB among patients repatriated from foreign hospitals is noted in a significant minority of such individuals transferred back to their home country. The typical MRB patient was admitted to a high-risk unit in a foreign hospital prior to repatriation with longer foreign hospital admissions. The prospective identification of these patients prior to transport is difficult. While these factors are associated with MRB presence, their absence does not rule out highly resistant bacterial colonization. A systematic review of this important medical issue is warranted with the development of guidelines., (© 2012 International Society of Travel Medicine.)

In France there are no clear guidelines for the transfer of severely head-injured patients, due to the difficulties of combining the requirements of a safe transfer with the necessity of a rapid, adapted and specialized management. These various aspects are discussed in order to facilitate the definition of local strategies for the initial orientation of severely head-injured patients to a centre adapted for severe head trauma management.