[Management of epidemics of nosocomial infections].
Although nosocomial outbreaks contribute less than 10% of all nosocomial infections, they are a significant cause for concern because of their unpredictability, frequent association with instrumentation, and potential lethality in critically-ill patients. Also, they are commonly due to organisms that are atypical or resistant to antimicrobials. As soon as a nosocomial outbreak is suspected, a rigorous investigation should be undertaken. After the appropriate institutional measures, a case-definition should be developed, and the space and time patterns of the cases should be determined. Confirmation should be obtained that the number of cases is larger than usual, and working hypotheses regarding the source and mode of transmission should be developed. Even at this early descriptive stage, recommendations for prevention should be made. If needed, the investigation should be carried further by a case-control study aimed at identifying risk factors, a molecular analysis of the organisms, and examination of samples taken from the environment. A review of hygiene procedures is useful in many cases.
Astagneau
P
P
CCLIN Paris-Nord, Institut Biomédical des Cordeliers, l'Ecole de Médecine, Paris, France.
Duneton
P
P
D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D012307:Risk Factors; D011795:Surveys and Questionnaires
Conduite à tenir devant une épidémie d'infections nosocomiales.