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ObjectivesTo analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign.DesignSingle-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios.Setting4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021.OutcomeThe primary outcomes were the effects of attributes’ levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from −10 to +10.ResultsAmong all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit–risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy.DiscussionVaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit–risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.

Tuberculosis is a human disease caused by Mycobacteriumtuberculosis, and transmitted by airborne pathway. Documented cases of tuberculosis infection in healthcare workers have been reported in both developed and developing countries. Early recognition of potentially infectious cases, immediate implementation of airborne precautions and prompt medical treatment of cases, are required to lower the risk of disease transmission. Molecular biology techniques allow earlier diagnosis. In the event of non-compliance with airborne precautions, the investigation will further have to establish exhaustive lists of potentially exposed healthcare workers and patients, looking for cases of latent tuberculosis infections whose treatment should help avoid active tuberculosis disease.

Background This study aimed to assess, by rapid tests, the immune status against COVID-19 among Healthcare Workers (HCW) with history of symptoms, and for whom SARS-CoV-2 detection was either not documented or negative. Methods Whole blood by finger prick and serum samples were taken from HCW for use with 2 rapid lateral flow tests and an automated immunoassay. Results Seventy-two HCWs were included, median duration between symptoms onset and serology sampling was 68 days. Anti-SARS-CoV-2 antibodies were detected by rapid test in 11 HCW (15.3%) and confirmed in the 10 with available serum by the automated immunoassay. The frequency of ageusia or anosmia was higher in participants with SARS-CoV-2 antibodies (P = 0.0006 and P = 0.029, respectively). Conclusions This study, among symptomatic HCW during the first wave in France, showed that 15% had IgG anti-SARS-CoV-2, a higher seroprevalence than in the general population. Rapid lateral flow tests were highly concordant with automated immunoassay.

Background: Healthcare workers (HCWs) are prioritised for COVID-19 vaccination, but coverage is staggering in France below 70%. Analysing their vaccination preferences is crucial to understand suboptimal uptake and identify levers to increase acceptance among those hesitating. Methods: : We conducted an online single-profile discrete choice experiment (DCE) among a snowballing sample of French HCWs, recruited during December 2020 to January 2021. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios. The effects of attributes’ levels on hypothetical acceptance were evaluated using mixed logit models, and on vaccine eagerness (certainty of decision, from -10 to +10) using linear random effect models. Results: Among 4346 participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared to 90% efficacy: odds ratio 0.05, 95%-CI 0.04-0.06), and the mention of a positive benefit-risk balance (compared to absence of severe and frequent side effects: OR 0.40, 0.34-0.46. The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared to no indirect protection: OR 4.10, 3.49-4.82 and 2.87, 2.34-3.50, respectively. Predicted acceptance was 93.8% for optimized communication on mRNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control; and reduced with lower vaccine efficacy. Discussion: Vaccine promotion towards HCWs who hesitate or refuse vaccination, should avoid the notion of benefit-risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.

Resume Introduction Une consultation dediee aux professionnels de sante symptomatiques a ete ouverte au debut de l'epidemie de COVID-19, afin de repondre aux besoins specifiques de cette population. L'objectif de ce travail etait d'estimer la frequence du portage nasopharynge du SARS-Cov-2 chez les personnels de sante symptomatiques suspects de COVID-19, et de determiner les facteurs associes a ce portage. Methodes Etude descriptive des caracteristiques cliniques et epidemiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des donnees cliniques et des resultats du test RT-PCR a ete conduit a l'aide de formulaires standardises. Resultats Des 522 consultants, 308 exercaient a l'Hopital et 214 a l'exterieur. Ils avaient des formes benignes de COVID-19 et des signes cliniques non specifiques a l'exception de l'agueusie/anosmie, significativement plus frequente chez ceux avec RT-PCR positive. Le taux de positivite de la RT-PCR etait globalement de 38 %, sans difference significative selon la profession, superieur chez les consultants exterieurs (47 % versus 31 %). A l'hopital, ce taux etait significativement moindre pour les personnels symptomatiques des secteurs de soins, compare aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p Conclusions Ces donnees confirment l'impact fort du COVID-19 sur les professionnels de sante. Les taux de positivite plus eleves chez les professionnels symptomatiques exercant en dehors de l'hopital, comparativement a ceux exercant a l'hopital, pourraient s'expliquer en partie par une penurie en equipements de protection et par des difficultes d'acces au diagnostic virologique, qui etaient plus importants en dehors de l'hopital quand l'epidemie a commence.

Résumé Introduction Une consultation dédiée aux professionnels de santé symptomatiques a été ouverte au début de l'épidémie de COVID-19, afin de répondre aux besoins spécifiques de cette population. L'objectif de ce travail était d'estimer la fréquence du portage nasopharyngé du SARS-Cov-2 chez les personnels de santé symptomatiques suspects de COVID-19, et de déterminer les facteurs associés à ce portage. Méthodes Étude descriptive des caractéristiques cliniques et épidémiologiques des consultants, conduite du 5 mars au 17 avril 2020. Le recueil des données cliniques et des résultats du test RT-PCR a été conduit à l'aide de formulaires standardisés. Résultats Des 522 consultants, 308 exerçaient à l'Hôpital et 214 à l'extérieur. Ils avaient des formes bénignes de COVID-19 et des signes cliniques non spécifiques à l'exception de l'agueusie/anosmie, significativement plus fréquente chez ceux avec RT-PCR positive. Le taux de positivité de la RT-PCR était globalement de 38 %, sans différence significative selon la profession, supérieur chez les consultants extérieurs (47 % versus 31 %). À l'hôpital, ce taux était significativement moindre pour les personnels symptomatiques des secteurs de soins, comparé aux personnels des plateaux techniques et laboratoires (24 %, versus 45 %, p = 0,006 et 54 %, p

We evaluated an elvitegravir–cobicistat–emtricitabine–tenofovir alafenamide single-tablet regimen for human immunodeficiency virus postexposure prophylaxis. The completion rate and adherence were good, and the tolerance was acceptable; no seroconversion was observed. We confirm that this regimen could be appropriate for postexposure prophylaxis.

Objectives To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. Materials and methods 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. Results Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine “often” or “very often”. Conclusions Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Tuberculosis is a human disease caused by Mycobacteriumtuberculosis, and transmitted by airborne pathway. Documented cases of tuberculosis infection in healthcare workers have been reported in both developed and developing countries. Early recognition of potentially infectious cases, immediate implementation of airborne precautions and prompt medical treatment of cases, are required to lower the risk of disease transmission. Molecular biology techniques allow earlier diagnosis. In the event of non-compliance with airborne precautions, the investigation will further have to establish exhaustive lists of potentially exposed healthcare workers and patients, looking for cases of latent tuberculosis infections whose treatment should help avoid active tuberculosis disease.

Introduction Les professionnels travaillant en etablissements de sante (PES) sont particulierement exposes au risque d’infection par le SARS-CoV-2. Une enquete a ete mise en place afin d’objectiver l’impact de la pandemie sur cette population specifique. Materiels et methodes Un web questionnaire a ete propose mi-avril 2020 a tous les etablissements de sante (ES) publics ou prives. Les ES volontaires saisissent de maniere hebdomadaire le nombre de nouveaux PES infectes et les deces attribuables. Un cas est defini comme tout salarie, symptomatique ou non, teste positif pour le SARS-CoV-2 par RT-PCR, ou par serologie (a partir de juillet 2020) ou par test antigenique (a partir de novembre 2020) ou reconnu comme infecte par la cellule « COVID-19 » ou le referent infectiologue de l’ES. La region, le type d’ES, la categorie professionnelle et le service sont egalement recueillis. Les proportions de PES infectes ont ete estimees en rapportant le nombre de cas aux donnees de la Statistique annuelle des etablissements de sante 2019. Resultats Plus de 1300 ES ont participe au moins une fois a l’enquete. Entre le 1er mars 2020 et le 29 mars 2021, 76 089 PES, correspondant a 8 % des PES exercant dans les ES participants ont ete infectes par le SARS-CoV2, avec 19 deces attribuables. Parmi ces PES, la majorite (72 %) etaient des soignants. La repartition hebdomadaire du nombre de cas montre 3 pics de contamination en mars, octobre 2020 et janvier 2021. Les 2 professions ayant declare le plus de cas etaient les infirmiers (24 % des cas) et les aides-soignants (21 % des cas). Les aides-soignants et les kinesitherapeutes rapportaient les plus grandes proportions de PES infectes, respectivement 9,5 % et 9,0 % que ce soit pendant la 1re vague ou la 2e vague. Les PES contamines declaraient principalement avoir travaille dans des services de MCO (33 %) ou SSR/SLD (12 %). Des disparites regionales dans la proportion de PES infectes ont ete observees. Conclusion Cette enquete met en evidence l’impact important de la pandemie parmi les PES, avec les memes tendances temporelles et geographiques qu’en population generale. Peu de pays rapportent ainsi une proportion de PES infectes estimee a l’echelle nationale. Les professions avec des contacts frequents et prolonges avec les patients (aides-soignants, kinesitherapeutes) sont les plus touchees proportionnellement. Des campagnes de prevention ciblees seraient necessaires. Cette enquete se poursuit tant que necessaire.

Introduction Afin de documenter les circonstances des contaminations par le SARS-CoV-2, une enquete nationale a ete conduite aupres des professionnels de sante. Materiels et methodes Un questionnaire a ete mis en ligne le 17 avril 2020. Pouvait etre inclus tout professionnel de sante (IDE, aide-soignant, medecin, kine, technicien de laboratoire, pharmacien, manipulateur radio, brancardier, psychologue, dieteticien, dentiste…) pour lequel un diagnostic de COVID-19 a ete pose, quel que soit son mode d’exercice (etablissement de sante, liberal, etablissement medicosocial…). Les donnees collectees portaient sur l’activite, le type de tâches realisees, le port de protections et l’existence d’eventuels contacts avec des cas (professionnels, extra-professionnels), dans les 2 semaines precedant la date de debut des symptomes. Resultats Entre le 17 avril et le 9 juin 2020, 2129 questionnaires ont ete renseignes. Les infirmiers (678), les medecins (477), et les aides-soignants (296) etaient les categories les plus representees. Ils exercaient en etablissements de sante (ES) pour 1446 d’entre eux et 403 en ville ; les autres repondeurs exercaient dans le secteur medicosocial. La repartition geographique des declarants se rapprochait des resultats du recensement national des cas de contamination limite au personnel soignant en ES. Dans les deux semaines precedant leurs symptomes, 287/2129 (13,5 %) des declarants avaient exerce dans le cadre d’un interim ou d’un renfort en etablissement de sante. Lors des entretiens avec les patients (en face a face, a moins d’un metre), 416/1446 (29 %) des soignants en ES, et 217/403 (53 %), en ville, ne portaient jamais de masque. En ville, 169/403 (42 %) des soignants contamines realisaient des visites a domicile. Parmi les 870/1146 (76 %) soignants qui ont declare avoir participe a des reunions de travail, 558/870 (64 %) ne portaient jamais de masque ou en portaient parfois a cette occasion. En salle de repos, lors des pauses, 1235/1446 (85 %) soignants ne portaient pas de masque ou le portaient occasionnellement. Six cent trois (28 %) repondeurs ont declare avoir ete en contact, sans masque, avec un collegue ayant une infection confirmee a COVID-19, pendant ses symptomes ou durant les precedentes 72 h. En dehors de leur activite professionnelle, 278/2129 (13 %) professionnels contamines ont ete en contact avec au moins un cas suspecte ou confirme d’infection a COVID-19. Conclusion Cette enquete reposait sur la participation volontaire des soignants ayant eu une COVID-19. Les resultats preliminaires montrent un defaut d’utilisation des mesures de protection parmi les tâches realisees, notamment pour les professionnels de ville, quelle qu’en soit la raison. La reconnaissance d’un contact extra-professionnel parait faible. En revanche, le role de la contamination entre soignants sur leur lieu d’exercice parait etre un determinant important de la contamination des soignants.

We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (p

The authors had for objective to evaluate the air-tightness of FFP2 respirator masks used by healthcare workers, with a quantitative fit-test protocol.This test measures the number of ambient particles inside and outside the respirator mask. The ratio between both is called fit-factor. The fit-test is successful for an FFP2 respirator mask when the fit-factor is equal or superior to 100. The tests were performed in three hospitals. Nine types of FFP2 respirator masks were fit-tested, classified in three groups: hard shell, duckbill, and flat-fold respirator masks.One hundred and eighty fit-tests were performed. Less than a third of the fit-tests were successful (35/130). The rate of successful tests was higher with flat-fold (57.5%, 23/40) than with duckbill (18.3%, 11/60), or hard shell respirator masks (3.3%, 1/30), (P0.05). Zero to 60% of healthcare workers had a successful fit-test with the respirator masks used in each hospital. This percentage increased with the number of tested respirator masks. No 100% success rate was ever reached in any hospital with the three tested respirator masks.Duckbill, and flat-fold respirator masks seem to be better adapted for healthcare workers than hard shell respirator masks. It seems necessary to implement new recommendations for respiratory protection in France. At least two types of respirator masks with various sizes and shape should be available and fitting controls should be performed with respirator masks that are worn by healthcare workers exposed to infectious risks.

Resume Les professionnels de soins et les personnels de laboratoire sont exposes a des risques infectieux variables selon l’activite. Les germes potentiellement transmissibles a l’occasion d’un accident exposant au sang (AES) y sont nombreux, meme si dominent les trois virus VIH, VHC et VHB. L’activite de prelevement est particulierement a risque. Les donnees disponibles concernent essentiellement les etablissements de sante. Une etude a cependant ete conduite en laboratoires de biologie medicale pour evaluer l’activite de prelevement, connaitre les materiels utilises pour ce geste et estimer le niveau de risque d’exposition au sang. Les etudes realisees montrent que la prise en compte du risque lie au sang a conduit a une diminution significative des AES dans les etablissements de sante. La prise en compte de ce risque est plus recente dans les laboratoires et les AES restent plus frequents chez les personnels de laboratoires que chez les infirmieres des etablissements de soins. Les efforts doivent etre poursuivis dans le sens de la prevention et de la prise en charge des AES : formation et information des personnels, generalisation de l’utilisation des systemes de prelevement sous vide qui cohabitent encore trop souvent avec des materiels inadaptes, protocole ecrit de conduite a tenir en cas d’AES.

L’INRS a ete sollicite au moment de l’epidemie d’Ebola de 2014–2015 par le groupe SPILF COREB Emergences 1 pour realiser une synthese concernant les tenues et les procedures de deshabillage des soignants intervenant aupres de patients a haut risque. Il est vite apparu que les tenues preconisees n’etaient pas d’utilisation facile pour la prise en charge de patients, en particulier s’agissant des combinaisons concues pour les milieux industriels. Aussi, un groupe de travail a ete constitue en partenariat avec le GERES afin de reflechir a une tenue mieux adaptee aux activites de soins. Un etat des lieux a d’abord ete realise aupres des fabricants permettant de repertorier les combinaisons de protection contre les risques infectieux, de types 3B et 4B, actuellement disponibles sur le marche. Cela a mis en evidence la complexite du choix des combinaisons si l’on veut tenir compte de l’ensemble de leurs performances (niveau de resistance au passage d’agents infectieux, niveau de resistance a la dechirure, niveau de resistance des coutures…). Pour permettre aux etablissements de sante de mieux se preparer a la survenue d’une nouvelle epidemie d’un agent hautement infectieux, le cahier des charges concernant les tenues a ete actualise. Les etapes critiques lors du retrait ont egalement ete soulignees. Afin d’etre pret le moment venu, il est essentiel d’anticiper le choix de la tenue, de former et d’entrainer regulierement les equipes aux techniques d’habillage et deshabillage avec les equipements de protection individuelle retenus. La communication presentera l’ensemble des criteres de choix d’une combinaison de protection, ainsi que les points de vigilance dont il faut tenir compte.

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.

Au moment de l’epidemie d’Ebola de 2014–2015, est vite apparue la necessite de mise a disposition de tenues tres couvrantes face au risque majeur d’exposition aux liquides biologiques lors de la prise en charge possible de patients suspects secretants (atteints de vomissements, diarrhee, hemorragies) ou confirmes de Maladie a virus Ebola (MVE). Les solutions techniques variees choisies par les etablissements (combinaisons, casaques, masques, ecrans faciaux…) et les difficultes liees tant au port de ces tenues qu’aux phases d’habillage et de deshabillage sont vite remontees du terrain. L’INRS a donc ete sollicite par le groupe SPILF COREB Emergences 3 pour realiser une synthese des procedures existantes dans les etablissements de sante de reference habilites 4 (ESRH) pour l’habillage et le deshabillage des soignants susceptibles d’intervenir aupres de ces patients a haut risque. Cela a permis d’etablir des propositions sur la composition de la tenue et les procedures de retrait afin de proteger les soignants. Cependant, les types de tenues utilises dans ces situations ne sont pas d’utilisation facile pour la prise en charge de patients, en particulier, les combinaisons concues pour les milieux industriels. Aussi, un groupe de travail a ete constitue en partenariat avec le GERES afin de reflechir a un cahier des charges pour une tenue mieux adaptee aux activites de soins. A ce jour, la premiere etape a consiste a faire un etat des lieux aupres des fabricants. Un questionnaire a ete etabli afin de repertorier les vetements de protections actuellement disponibles sur le marche et leurs caracteristiques. En parallele, un travail a debute sur les points critiques en termes de risque de contamination lors de l’utilisation des tenues actuellement recommandees en France.

Background Exposure to hepatitis B virus (HBV) remains a serious risk to healthcare workers (HCWs) in endemic developing countries owing to the strong prevalence of HBV in the general and hospital populations, and to the high rate of occupational blood exposure. Routine HBV vaccination programs targeted to high-risk groups and especially to HCWs are generally considered as a key element of prevention strategies. However, the high rate of natural immunization among adults in such countries where most infections occur perinatally or during early childhood must be taken into account. Methodology/Principal Findings We conducted a cross sectional study in 207 personnel of 4 occupational groups (medical, paramedical, cleaning staff, and administrative) in Niamey’s National Hospital, Niger, in order to assess the prevalence of HBV markers, to evaluate susceptibility to HBV infection, and to identify personnel who might benefit from vaccination. The proportion of those who declared a history of occupational blood exposure ranged from 18.9% in the administrative staff to 46.9% in paramedical staff. Only 7.2% had a history of vaccination against HBV with at least 3 injections. Ninety two percent were anti-HBc positive. When we focused on170 HCWs, only 12 (7.1%) showed no biological HBV contact. Twenty six were HBsAg positive (15,3%; 95% confidence interval: 9.9%–20.7%) of whom 8 (32%) had a viral load >2000 IU/ml. Conclusions/Significance The very small proportion of HCWs susceptible to HBV infection in our study and other studies suggests that in a global approach to prevent occupational infection by bloodborne pathogens, a universal hepatitis B vaccination of HCWs is not priority in these settings. The greatest impact on the risk will most likely be achieved by focusing efforts on primary prevention strategies to reduce occupational blood exposure. HBV screening in HCWs and treatment of those with chronic HBV infection should be however considered.

Objectives.To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings.Design.This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI.Setting.Sixty-one hospitals in France.Results.More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, x2 test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account.Conclusions.Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

In anesthetized rats, intrathecal (i.t.) administration, at the upper thoracic level of the spinal cord of fenoldopam (a selective dopamine D1-receptor agonist) or quinpirole (a selective D2-receptor agonist) decreased blood pressure (BP) and heart rate (HR) in a dose-dependent manner. Apomorphine, a nonselective DA receptor agonist, produced similar effects. Apomorphine-induced hypotension was competitively antagonized by either SCH 23390 or remoxipride, selective D1- and D2-receptor antagonists, respectively, but only remoxipride antagonized the bradycardia. Furthermore, SCH 23390 antagonized the hypotensive effect of fenoldopam but did not change that induced by quinpirole. Remoxipride antagonized the hypotensive effect of quinpirole but did not alter the hypotensive effect of fenoldopam. Quinpirole-induced bradycardia was antagonized only by remoxipride. Bradycardia elicited by fenoldopam did not appear to be generated by dopamine receptor stimulation, as suggested by the lack of blocking effects of SCH 23390 and remoxipride. Data obtained with fenoldopam were corroborated with use of SK&F 38393, another dopamine D1-receptor agonist. We conclude that hypotensive effects of i.t.-administered DA receptor agonists appear to result from activation of spinal D1- and D2-receptors whereas bradycardia is related only to activation of spinal D2-receptors.

Objectives.To evaluate safety-engineered devices (SEDs) with respect to their effectiveness in preventing needlestick injuries (NSIs) in healthcare settings and their importance among other preventive measures.Design.Multicenter prospective survey with a 1-year follow-up period during which all incident NSIs and their circumstances were reported. Data were prospectively collected during a 12-month period from April 1999 through March 2000. The procedures for which the risk of NSI was high were also reported 1 week per quarter to estimate procedure-specific NSI rates. Device types were documented. Because SEDs were not in use when a similar survey was conducted in 1990, their impact was also evaluated by comparing findings from the recent and previous surveys.Setting.A total of 102 medical units from 32 hospitals in France.Participants.A total of 1,506 nurses in medical or intensive care units.Results.A total of 110 NSIs occurring during at-risk procedures performed by nurses were documented. According to data from the 2000 survey, use of SEDs during phlebotomy procedures was associated with a 74% lower risk (P < .01 ). The mean NSI rate for all relevant nursing procedures was estimated to be 4.72 cases per 100,000 procedures, for a 75% decrease since 1990 (P < .01); however, the decrease in NSI rates varied considerably according to procedure type. Between 1990 and 2000, decreases in the NSI rates for each procedure were strongly correlated with increases in the frequency of SED use (r = 0.88; P < .02).Conclusion.In this French hospital network, the use of SEDs was associated with a significantly lower NSI rate and was probably the most important preventive factor.

Introduction – objectifs En 2011, des entretiens ont identifie des freins chez les infirmiers (IDE) : vaccin juge inutile car non obligatoire et perception de risques tres faibles ; position cristallisee par les polemiques liees a la gestion de la grippe H1N1 en 2009, Une enquete a ete conduite pour evaluer l’impact sur la CVG d’un positionnement actif des IDE (relais d’opinion aupres de leurs collegues) dans le geste vaccinal. Materiels et methodes Enquete realisee en 2011-2012 dans le reseau GERES en 3 volets : 1/etat des lieux de la CVG ; 2/demarche de recherche-action dans un sous-groupe des etablissements du volet 1 (recrutement d’IDE relais de vaccination dans chaque site et formation pour acquerir des connaissances et outils de communication engageante pour la campagne de vaccination 2012-2013) ; 3/recueil des taux de CVG dans les etablissements a l’issue de cette campagne. Resultats 72 etablissements ont participe au volet 1 (CHR-CHU 12 %, CH : 65 % ; 481 lits-mediane). 14 d’entre eux (CHR-CHU : 21,5 %, CH : 57 % ; 846 lits-mediane) ont participe au volet 2 (22 IDE formes) dont 3 avec l’appui de psychosociologues. Les effectifs etaient stables entre 2010 et 2012 dans chaque groupe et la repartition par categorie professionnelle etait identique (medecins : 13-17 %, IDE : 24-27 %, autres paramedicaux : 26-29 %, administratifs : 23- 26 %). Entre 2010 et 2012, la CVG a augmente dans le groupe des 14 etablissements : de 12 a 14 % en global, de 9,6 a 17 % chez les IDE (CVG stable dans les 58 autres : 13,6 % en global, 12 % chez les IDE). Conclusion Une tendance a l’augmentation encourageante mais faible est observee dans les etablissements ayant mis en place une demarche active avec relais IDE de vaccination. Les taux de VAG 2013-2014 seront recueillis afin de s’assurer du maintien de la dynamique et des actions engagees.

Introduction – objectifs Le dispositif hospitalier de prise en charge des expositions accidentelles a risque viral professionnelles (AES) et sexuelles (EAV) est complexe. Si les C-CLIN assurent une surveillance nationale des AES, il n’existe aucune surveillance des EAV. Les rapports d’activite des COREVIH offrent un releve tres partiel et heterogene de cette activite. Materiels et methodes L’objectif a ete de tester la pertinence d’une grille type de recueil des AES/EAV et d’identifier les difficultes de recueil. Methodes : la grille a ete adressee en mai 2013 aux services referents VIH, SAU, CDAG/CIDDIST, UMJ et Espaces Sante au travail des hopitaux des COREVIH IDF Nord et Ouest pour le recueil des donnees AES/EAV 2012. Resultats 13 hopitaux ont participe. 2 688 expositions a risque ont ete recensees (EAV : 42 %, AES : 39 %, non precise : 19 %). Un traitement (TPE) a ete prescrit pour 9 % des AES (86/109) et 72 % des EAV (727/1007). 26 % des EAV sont suivis a M2 et 15 % a M3/M4. Seuls 6 SAU sont en mesure de renseigner le nombre d’expositions et 1 seul peut donner le % de TPE. Il n’est pas possible de connaitre leur devenir : 8/13 services referents peuvent fournir les details concernant le suivi. Seul 1 hopital a pu faire un travail precis sur le recrutement et le devenir des AES grâce a l’implication d’un TEC a temps plein 2 mois. Conclusion La prise en charge des AES/EAV represente un volume d’activite non negligeable. Les difficultes de recueil des donnees sont majeures faute de moyens (plusieurs points d’entree, intervenants multiples, absence de tracabilite) rendant difficiles une evaluation de l’activite dans les etablissements et une surveillance nationale. Proposer a certains COREVIH ou certains etablissements volontaires d’engager une surveillance pourrait etre une alternative a la surveillance nationale.

In anesthetized rats, intrathecal (i.t.) administration, at the upper thoracic level of the spinal cord of fenoldopam (a selective dopamine D1-receptor agonist) or quinpirole (a selective D2-receptor agonist) decreased blood pressure (BP) and heart rate (HR) in a dose-dependent manner. Apomorphine, a nonselective DA receptor agonist, produced similar effects. Apomorphine-induced hypotension was competitively antagonized by either SCH 23390 or remoxipride, selective D1- and D2-receptor antagonists, respectively, but only remoxipride antagonized the bradycardia. Furthermore, SCH 23390 antagonized the hypotensive effect of fenoldopam but did not change that induced by quinpirole. Remoxipride antagonized the hypotensive effect of quinpirole but did not alter the hypotensive effect of fenoldopam. Quinpirole-induced bradycardia was antagonized only by remoxipride. Bradycardia elicited by fenoldopam did not appear to be generated by dopamine receptor stimulation, as suggested by the lack of blocking effects of SCH 23390 and remoxipride. Data obtained with fenoldopam were corroborated with use of SKF 38393, another dopamine D1-receptor agonist. We conclude that hypotensive effects of i.t.-administered DA receptor agonists appear to result from activation of spinal D1- and D2-receptors whereas bradycardia is related only to activation of spinal D2-receptors.

In conscious freely moving rats, administration of apomorphine (179 nmol), a dopamine receptor agonist, into the intrathecal (i.t.) space decreased mean aortic blood pressure (MBP) and heart rate (HR). Both the magnitude and the time of appearance of the response varied according to the spinal level of administration. The largest and immediately appearing effect was observed after the injection at the upper thoracic site, whereas the magnitude of the responses was smaller with an immediate or slightly delayed (0.5-1.5 min) onset at lower thoracic and midcervical levels. More caudal responses appeared to be due to spreading of the drug along the spinal axis (onset in 1-2 min after administration). Behavioral responses (stereotyped movements) were observed within 2-3 min after administration and were nearly the same whatever the site of administration. These results corroborate, as do those provided by i.t. injections of tritiated apomorphine, the spinal origin of cardiovascular effects of i.t. apomorphine. Furthermore, spinal transection at the T5-T7 level did not change the magnitude and duration of decreases in MBP and HR elicited by i.t. apomorphine injected at the T2-T4 level. Moreover, this procedure enhanced responses to i.t. administration at the T9-T10 level. In conclusion, these results favor the existence of a spinal site of action for the cardiovascular effects of apomorphine. Furthermore, they indicate that spinal transection is accompanied by development of a hypersensitive phenomenon (of a mechanism to be determined).

A new dopaminergic system, the spinal cord dopaminergic system, has been described recently (Skagerberg et al., 1982). Furthermore, we previously demonstrated the presence of dopaminergic receptorsites in the rat spinal cord (Demenge et al., 1981). These receptor sites are located in all parts of the spinal gray, but are in higher density in the dorsal horn and in the zona intermedia.

A new dopaminergic innervation has been described quite recently: the dopaminergic spinal cord system. In this review are presented the different steps which lead to the individualization of this dopaminergic system and the reported results actually available concerning its probable anatomical organization. Finally, most of the data which illustrate the possible functions of this system are discussed. Interestingly, its participation in the transmission of nociceptive signals and the control of cardiovascular patterns appear now well established. Such functional implications give new information on the possible targets of central dopaminergic agonists and antagonists, particularly at the cardiovascular level.