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Rouveix E.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Bouvet E.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Vernat F.,COREVIH Ile de France Ouest | Chansombat M.,COREVIH Ile de France Nord | And 2 more authors.
Medecine et Maladies Infectieuses

Background: Post-exposure prophylaxis (PEP) relies on procedures allowing quick access to treatment in case of accidental exposure to viral risk (AEV). Occupational blood exposure (OBE) affects mainly caregivers; these accidents are monitored and assessed by the inter-regional center for nosocomial infections (C-CLIN), occupational physicians, and infection control units. They are classified apart from sexual exposure for which there is currently no monitoring. Methods: Data was extracted from the COREVIH (steering committee for the prevention of HIV infection) 2011 activity reports (AR), available online. Data collection was performed using a standardized grid. Results: Twenty-four out of 28 AR were available online. Nine thousand nine hundred and twenty AEV were reported, 44% of OBE, and 56% of sexual and other exposures. PEP was prescribed in 8% of OBE and in 77% of sexual exposures. The type of PEP was documented in 52% of the cases. Follow-up was poorly documented. Conclusion: AR provide an incomplete and heterogeneous review of exposure management without any standardized data collection. The difficulties encountered in data collection and monitoring are due to differences in care centers (complex patient circuits, multiple actors) and lack of common dedicated software. Sexual exposures account for 50% of AEV and most are treated; but they are incompletely reported and consequently not analyzed at the regional or national level. A typical AR collection grid is being studied in 2 COREVIH, with the objective to improve collection and obtain useful national data. © 2014 Elsevier Masson SAS. Source

Pellissier G.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Yazdanpanah Y.,Service de Maladies Infectieuses et Tropicales | Yazdanpanah Y.,French Institute of Health and Medical Research | Adehossi E.,Hopital National de Niamey | And 10 more authors.

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. © 2012 Pellissier et al. Source

Ciotti C.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Pellissier G.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Rabaud C.,Groupe detude sur le risque dexposition des soignants aux agents infectieux GERES | Lucet J.-C.,Unite dhygiene et de lutte contre les infections nosocomiales | And 2 more authors.
Medecine et Maladies Infectieuses

Objective: The authors had for objective to evaluate the air-tightness of FFP2 respirator masks used by healthcare workers, with a quantitative fit-test protocol. Materials and methods: 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. Results: 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), (P< 0.05). 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. Conclusion: 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. © 2012. Source

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