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Biomedical subjects

E Bouvet

Publications and source records attributed to E Bouvet.

At least 19 recordsLinked to original sources
PubMed1995

[Risks of accidental exposure to blood in the operating room. Results of a multicenter prospective study. Groupe d'Etude sur les Risques d'Exposition au Sang].

A multicentric prospective trial was conducted to evaluate the frequency and kind of blood exposure in operating room. From march to june 1992, 3554 procedures were observed in 22 surgical units (visceral, orthopaedic and vascular), with 129 surgeons, 133 residents and 216 nurses. Statistic analysis was done on Epi Info 5 (CDC Atlanta) and EGRET (Statistic and Epidemiology Research Corporation, Seattle). 11.7% of procedures were the case for an incidental blood exposure: 4.2% for percutaneous exposure; 8.4% for cutaneous or mucosal exposure. Rates change with the surgical specialty. Surgeons were involved in 50.7% of percutaneous exposure and 58.7% of the cutaneous or mucosal exposures, especially when they were operators (respectively 2 and 5.6% person-act). A significative rate was founded between incidental blood exposure and the length of procedure, the sepsis character of the procedure, but not with emergency or number of globular units transfused. To diminish the incidental blood exposure and its risks, this data suggests three kinds of practice: a better work for vaccination; in our study 59% of surgeons declare an adequate vaccination against hepatitis B; a best operative hygiene, with knowing of risks factor of blood exposure, depending of the kind of procedure, changing between different units; the use of protections: non coated dressing, double gloving, ocular protection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Focus on the role of ventilation and ultraviolet rays in preventing nosocomial transmission of tuberculosis in health care facilities. Groupe de travail sur la prévention de la transmission nosocomiale de la tuberculose (Direction Générale de la Santé)].

Recent episodes of nosocomial tuberculosis, sometimes due to multiresistant strains, in HIV infected patients in the USA has led to the need for new prevention measures against the transmission of Mycobacterium tuberculosis in health care facilities. Tuberculosis is transmitted in Pflügge droplets generated when contagious persons cough. After drying, the droplets become aerosolized solid particles which are rapidly dispersed by air flow within the patient's room. People exposed to the same air are thus at high risk of being contaminated. If the air pressure in the patient's room is higher than the rest of the facility, the air coming form the room may contaminate personnel and other patients elsewhere in the facility. Infecting particles can be eliminated rapidly if the room air is ventilated outdoors. If the ventilation is strong enough so that air constantly circulates from the corridor into the room, infecting particles can no longer diffuse to the rest of the ward. It is also possible to use ultraviolet C light to disinfect the air, either within the room or within the ventilation system. These two basically simple systems are the fundamental environmental and prevention measures needed to limit tuberculosis spread in health care facilities. These methods are however technically complex, costly and require constant evaluation and maintenance by specialized personnel. In addition the potential side effects of ultraviolet waves could considerably reduce their application. These environmental methods, which are complementary methods, only have a meaning if the elementary measures for preventing the transmission of tuberculosis are correctly applied.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1992

[Epidemiology of minor salmonellosis].

Epidemiological data concerning non Typhi salmonella infections in France and other industrialized countries are characterized by the important increase of S. enteritidis salmonellosis due to raw or insufficiently cooked eggs products since 1987, increase of salmonellosis among immunosuppressed patients, particularly patients with AIDS. There is a new interest for non typhi salmonellosis instead of typhoid fever which is regularly declining in industrialized countries.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Infectious respiratory complications of AIDS].

Respiratory infections are particularly frequent in HIV infection. They depend upon the degree of immunodeficiency, the geographical region and a possible prophylaxis. Bronchopneumopathies caused by pyogenic organisms (notably pneumococci) appear when the number of T4 lymphocytes is little reduced. Pulmonary tuberculosis, particularly frequent in Africans and Haitians, occurs in patients with moderate immunodeficiency (T4 between 200 and 300/mm3). HIV infections modify the epidemiology of tuberculosis in Africa, but also in the USA and probably in Europe. Despite a well-established prophylaxis, pneumocystosis, which develops when the number of T4 cells falls below 200/mm3, is the opportunistic pathology which in most cases points to AIDS in the USA and in France. Atypical mycobacterial infections (Mycobacterium avium complex) and CMV infections occur at a late stage of the disease in patients with severe immunodeficiency. Noticeable advances have recently been made in the treatment of these complications.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Occupational risk of exposure to blood in nurses. Results of a one-year monitoring of the risk for nurses in 17 hospitals].

To evaluate the incidence of risk factors for exposure of health care providers to patients' blood, a prospective multicenter study was carried out in 1990 in 17 hospitals in continental France. 521 nurses from 20 departments of medicine and 9 intensive care nurses participated in the study. Trained investigators documented exposures to blood using a standardized questionnaire and carried out monthly 24 hours cross-sectional surveys to determine the number of high risk procedures performed on a given day. One hundred and eighty-three exposures to blood were documented, for an incidence of 0.35/nurse/year. Needle-stick injuries were the most common events (75%). Exposure to blood occurred during a sampling procedure in 48% of cases, an infusion-related procedure in 20% of cases, and an injection in 17% of cases. Comparisons of rates of procedures associated with needle-stick injuries and of procedures performed during a typical day demonstrated differences in the magnitude of the risk associated with each procedure: infusion-related procedures carried the greatest risk, followed by venous blood sampling procedures. Sixty-four percent of exposures to blood occurred after completion of the procedure. Forty-nine percent of documented exposures to blood would probably not have occurred if universal infection control recommendations (CDC, DGS) had been implemented. Twenty-seven percent of exposures to blood involved HIV-positive patients, who accounted for only 7% of patients managed in the participating centers during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Outcome of prognostic factors of infectious endocarditis over a 16 year period. Apropos of 471 cases].

Four hundred and seventy one cases of infective endocarditis (IE) were reviewed: 338 native valve IE and 133 prosthetic valve IE (42 early and 91 late IE). Two periods were compared: 1973-1980 (250 cases) and 1981-1988 (221 cases). There was a decrease in native valve IE (78% to 64%) and an increase in late prosthetic valve IE (13% to 27%), little change with respect to age, causal cardiac disease, delay in diagnosis (except in native valve IE, 39 to 29 days), or frequency of complications, especially cardiac (50% and 51%). However, global mortality decreased from 41% to 27% (p < 0.001). The evolution of the frequency of cardiac complications, cardiac surgery and mortality for the two periods was: for native valve IE respectively 53% to 42%, 41% to 37%, 37% to 20% (p < 0.005); for early prosthetic valve IE respectively, 45% to 55%, 41% to 55%, and 82% to 50% (p < 0.05); for late prosthetic IE, respectively 34% to 69%, 34% to 69% and 37% to 36%. The frequency of surgery had therefore little influence on prognosis except in early prosthetic valve IE. The percentage of infections which could not be controlled medically decreased from 17% to 11%. The mortality of unoperated patients decreased from 46% to 28% (p < 0.01), suggesting more effective antibiotherapy, and the mortality of operated patients fell from 34% to 26%. Global surgical mortality was 35% in the acute phase (positive valve culture), 14% after sterilisation (p < 0.001) and the corresponding frequencies of paravalvular leaks was 17% and 4% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Resting energy expenditure is increased in stable, malnourished HIV-infected patients.

Resting energy expenditure (REE) was measured by reference to body composition in 50 malnourished patients with human immunodeficiency virus (HIV) infection and compared with that of 14 healthy subjects. Among HIV patients, 40 had acquired immune deficiency syndrome (AIDS) and 10 had AIDS-related complex (ARC). All were in stable condition and had a previous history of progressive wasting, ie, a mean body weight loss of 14.2 +/- 8.1 kg over 16.6 mo (range 2-49 ms). The mean REE was 14% higher than estimated basal energy expenditure (EBEE), according to the Harris and Benedict formula. Thirty-four patients (68%) were classified as hypermetabolic (REE greater than 110% EBEE). The best predictable variable for REE was fat-free mass (FFM), as determined by an anthropometric method (r = 0.72; P less than 0.001). The mean REE was 12% higher in HIV patients than in the control group FFM (156 +/- 19 vs 124 +/- 17 kJ.kg FFM-1.d-1). We concluded that in stable and malnourished HIV patients, the progressive wasting may be partly related to an increase in REE. The mechanism of this hypermetabolic state remains to be established.

Body Composition↗
PubMed1991

Prevention of sexually transmitted diseases: a randomised community trial.

STUDY OBJECTIVE: The aim was to evaluate the effectiveness of a programme for the prevention of sexually transmitted diseases which affect fertility. DESIGN OF THE PREVENTION PROGRAMME: The programme took place in six French geographical departments. Three of these, randomly selected, served as experimental departments while the other three were matched with the first three and served as controls. DESIGN OF THE EVALUATION: Genital discharge was used as the indicator of a sexually transmitted disease. In each department, about 40 voluntarily participating general practitioners (263 in total) gathered information on the frequency of infected patients and on their characteristics, both before and after the campaign. PATIENTS: Before and after the programme respectively, 412 and 288 women and 117 and 94 men with a genital discharge were described. MEASUREMENTS AND MAIN RESULTS: After the programme, tests for chlamydia trachomatis were prescribed more often to both women and men with a discharge in the experimental departments. The characteristics of women having consulted a general practitioner with a discharge differed according to the department group studied. In the experimental departments, the women were younger than those in the control departments and had fewer sexual partners. In contrast to the results obtained for women, no behavioural changes were observed among men with a discharge. CONCLUSIONS: The results may indicate a decreased risk in spread of infection. Methodological problems associated with such a design are discussed. There is a need to develop specific messages aimed at changing male sexual behaviour. The study design has implications for the best strategy in delivering prevention messages to the general population which are relevant to the present AIDS epidemic.

Adolescent↗