Depuis 2004, un palmarès annuel des bonnes pratiques dans la lutte contre les infections nosocomiales – c'est-à-dire contractées dans un cadre hospitalier – est publié par le ministère de la santé. Ce palmarès est au cœur d'une polémique, depuis que L'Express l'a utilisé pour dresser une "liste noire", sur laquelle figurent 162 hôpitaux et cliniques. Ces centres de soins, selon l'hebdomadaire, sont coupables d'une "absence de suivi des malades opérés". Un sujet très sensible : chaque année, 750 000 personnes, soit un patient sur 20, contracte une infection nosocomiale, et 4 000 en meurent. Roselyne Bachelot a annoncé, mercredi, l'extension du plan spécifique de lutte contre ces infections lancé en 2005. Manou Wehrell, directrice de la clinique Claude Bernard à Ermont, épinglée par L'Express, qualifie de "grave et faux" le qualificatif "mauvais suivi des patients" utilisé par l'hebdomadaire. Elle souligne qu'"un seul critère défaillant mène à exclusion du palmarès [des hôpitaux les plus sûrs]" et qu'il "ne représente pas ce qu'il se passe sur le terrain." Selon elle, l'"article mériterait une réponse", et "pense que le syndicat va le faire."

At least 30 children have died of "infections" in a hospital in the town of Behrampore in India's eastern state of West Bengal, doctors say. The children died over the past week in a government-run general hospital in the state's Murshidabad district.

Timeouts to wash hands and put on hairnets, a simple checklist to ensure that such seemingly obvious precautions are done, and advertising campaigns directed at everyone from the most senior doctors to the poorest of patients have been credited with drastically reducing the number of serious infections at New York City’s public hospitals. Since 2005, central-line bloodstream infections, which stem from bacteria invading a catheter leading to the heart and can often be fatal, have fallen 55 percent in adult intensive care units at the city’s 11 public hospitals, according to statistics released last week. Ventilator-associated pneumonia, caused by bacteria in breathing tubes and which also can be fatal, declined by 78 percent. Before the hospital system began cracking down on them in late 2005, preventable infections were considered part of the collateral damage of advanced lifesaving techniques, such a routine occurrence that few people questioned their prevalence, or the deaths that resulted from them. In fact, there had been a perverse financial upside to hospital-based infections, since they filled beds that might otherwise be empty. But changes in government reimbursements have driven New York’s public hospitals, which serve the city’s poorest patients, to tackle the problem.

Abstract: Objective: To estimate the prevalence of pediatric health care-associated infections (HAI) in Canadian acute care hospitals. Methods: A point-prevalence study conducted in February 2002 in 25 hospitals across Canada. Information on HAI, utilization of antimicrobial agents and invasive devices, isolation precautions, and microbial etiology was collected. Results: Nine hundred ninety-seven children were surveyed. Ninety-one HAI were detected in 80 patients for a prevalence of 91 per 1000 patients surveyed. Bloodstream infections were the most common HAI (3% of patients; 34% of all HAI). The prevalence of patients with HAI was 8%, ranging from 0% in trauma/bum units to 19% in the pediatric intensive care units, and 27% in transplant units. By multivariate logistic regression analysis, having a central venous catheter (OR, 2.54; 95% CI, 1.46-4.40) or endotracheal tube with mechanical ventilation (OR, 2.59; 95% CI, 1.16-5.76) were independently associated with an HAI, as were being in isolation (OR, 2.90; 95% CI, 1.54-5.45), and receiving antimicrobial agents (OR, 9.27; 95% CI, 4.71-18.52). Conclusion: In this first national point-prevalence study in Canada, the prevalence of HAI was similar to that reported in other industrialized countries. These data will also be useful to provide an estimate of the health burden of pediatric HAI in Canada.

BACKGROUND/OBJECTIVES: To review the evidence on the effects of interventions to improve hospital design and construction on the occurrence of nosocomial infections (NI). Technical facilities such as air conditioning / HVAC systems do not fall within the scope of this study. Design: Systematic review of experimental and non-experimental hospital architecture intervention studies in intensive care units (ICU), surgical departments (SD), isolation units (IU), and hospitals in general (HG). METHODS: DATA SOURCES: Studies dating from 1975 in English, French, German, Italian and Spanish, regardless of format, identified in seven medical databases, reference lists, personal collections, and expert consultation. Main Outcome Measure: Nosocomial (hospital-acquired) infection. RESULTS: 178 scientific articles were identified (ICU: 41; SD: 83; IU: 7; HG: 47), however, none of these described a meta-analysis, systematic review or a randomised controlled trial. The majority of articles were categorised in the lowest level of evidence (expert judgement, consensus statements, reports). Of the 178 articles, only 17 described completed concurrent or historical cohort studies matching the inclusion criteria (ICU: 9; SD: 4; IU: 2; HG: 2). The interventions generally included a move to other (new) premises or renovation (more space per hospital bed, more single rooms, better facilities). However, in many studies the staff / patient ratio was also improved. Some studies showed lower infection rates after intervention, but one cannot generalise on this finding because confounders could not be controlled completely and study populations were frequently small. DISCUSSION: The lack of stringent evidence linking hospital design and construction with the prevention of NI is partly attributable to the complex, multifactorial nature of these infections, and it is likely that some improvement will be seen if basic conditions such as the availability of sufficient space, isolation capacity, and facilities for hand washing are met. However, to our present knowledge other factors, especially the improper hand hygiene of medical staff (which in turn is a more severe problem in narrow, overcrowded, wards) have greater impact. Well-designed studies that systematically investigate interventions to prevent NI, in this case improvement of hospital architecture, are required.

Infections acquired in hospitals, which take a heavy toll on patients, arise mainly from poor hygiene in hospital procedures, not from how sick patients were when they were admitted, according to three new studies. The studies, published yesterday in the American Journal of Medical Quality, provide new evidence for experts who argue that hospitals could prevent many of the growing number of infections that afflict patients nationwide, cost billions of dollars to treat and are responsible for thousands of deaths each year.

La résistance des bactéries aux antibiotiques est un problème de santé publique, comme l'ont rappelé deux récentes affaires. Dix-neuf personnes sont mortes d'une infection nosocomiale dans des hôpitaux et maisons de retraite du Nord-Pas-de-Calais depuis le début de l'année, selon un bilan publié mercredi 27 septembre par les autorités sanitaires. Et trois décès sont survenus voici plusieurs mois au CHU de Bicêtre (Val-de-Marne) (Le Monde du 26 septembre). Une circulaire des services du ministère de la santé datée du 23 mars 2006 rappelle que "les résistances bactériennes aux antibiotiques sont un problème majeur de santé publique, et leur émergence et leur sélection, qui compromettent fortement leur efficacité, sont largement liées à la surconsommation d'antibiotiques". Le phénomène touche tous les pays industrialisés, mais la France compte "parmi les pays ayant en Europe la plus forte exposition aux antibiotiques et les taux de résistance les plus élevés", constate la circulaire.