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Biomedical subjects

Stéphane Hugonnet

Publications and source records attributed to Stéphane Hugonnet.

At least 19 recordsLinked to original sources
PubMed2007

The effect of workload on infection risk in critically ill patients.

OBJECTIVE: There is growing evidence that low nurse staffing jeopardizes quality of patient care. The objective of the study was to determine whether low staffing level increases the infection risk in critical care. DESIGN: Observational, single-center, prospective cohort study. SETTING: Medical intensive care unit of the University of Geneva Hospitals, Switzerland. PATIENTS: All patients admitted over a 4-yr period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Study variables included all infections acquired in critical care, daily nurse-to-patient ratio, demographic characteristics, admission diagnosis and severity score, comorbidities, daily individual exposure to invasive devices, and selected drugs. Of a cohort of 1,883 patients totaling 10,637 patient-days, 415 (22%) developed at least one healthcare-associated infection while in critical care. Overall infection rate was 64.5 episodes per 1000 patient-days. Infected patients experienced higher mortality with a longer duration of stay both in critical care and in the hospital than noninfected patients (all p < .001). Median 24-hr nurse-to-patient ratio was 1.9. Controlling for exposure to central venous catheter, mechanical ventilation, urinary catheter, and antibiotics, we found that higher staffing level was associated with a >30% infection risk reduction (incidence rate ratio, 0.69; 95% confidence interval, 0.50-0.95). We estimated that 26.7% of all infections could be avoided if the nurse-to-patient ratio was maintained >2.2. CONCLUSIONS: Staffing is a key determinant of healthcare-associated infection in critically ill patients. Assuming causality, a substantial proportion of all infections could be avoided if nurse staffing were to be maintained at a higher level.

Aged↗
PubMed2006

Increased incidence of sexually transmitted infections in Geneva, Switzerland.

BACKGROUND: Focal outbreaks of sexually transmitted infections (STIs) such as syphilis and gonorrhoea have been reported in the large cities of Western Europe over the past few years. The aim of our study was to determine whether a similar trend is observed in Geneva and the situation with regard to HIV infection. METHODS: We review the incidence of syphilis, gonorrhoea, Chlamydia trachomatis and HIV in Geneva from 1999 to 2004. RESULTS: Figures indicate a steady and sustained increase in the incidence of syphilis, gonorrhoea and Chlamydia trachomatis in Geneva since 1999 that is maintained into 2004. As for HIV, the number of positive testings in Switzerland has stabilised and primary infection figures do not indicate an increase in newly acquired infections in Geneva. CONCLUSION: The situation in Geneva is similar to that observed elsewhere in Western Europe and indicates the need of public health interventions.

Chlamydia Infections↗
PubMed2005

Learning from imbalanced data in surveillance of nosocomial infection.

OBJECTIVE: An important problem that arises in hospitals is the monitoring and detection of nosocomial or hospital acquired infections (NIs). This paper describes a retrospective analysis of a prevalence survey of NIs done in the Geneva University Hospital. Our goal is to identify patients with one or more NIs on the basis of clinical and other data collected during the survey. METHODS AND MATERIAL: Standard surveillance strategies are time-consuming and cannot be applied hospital-wide; alternative methods are required. In NI detection viewed as a classification task, the main difficulty resides in the significant imbalance between positive or infected (11%) and negative (89%) cases. To remedy class imbalance, we explore two distinct avenues: (1) a new re-sampling approach in which both over-sampling of rare positives and under-sampling of the noninfected majority rely on synthetic cases (prototypes) generated via class-specific sub-clustering, and (2) a support vector algorithm in which asymmetrical margins are tuned to improve recognition of rare positive cases. RESULTS AND CONCLUSION: Experiments have shown both approaches to be effective for the NI detection problem. Our novel re-sampling strategies perform remarkably better than classical random re-sampling. However, they are outperformed by asymmetrical soft margin support vector machines which attained a sensitivity rate of 92%, significantly better than the highest sensitivity (87%) obtained via prototype-based re-sampling.

Algorithms↗
PubMed2005

Knowledge of standard and isolation precautions in a large teaching hospital.

OBJECTIVE: To assess the level of knowledge regarding and attitudes toward standard and isolation precautions among healthcare workers in a hospital. METHOD: A confidential, self-administered questionnaire survey was conducted in a random sample of 1500 nurses and 500 physicians in a large teaching hospital. RESULTS: A total of 1,241 questionnaires were returned (response rate, 62%). The median age of respondents was 39 years; 71.9% were women and 21.2% had senior staff status. One-fourth had previously participated in specific training regarding transmission precautions for pathogens conducted by the infection control team. More than half (55.9%) gave correct answers to 10 or more of the 13 knowledge-type questions. The following reasons for noncompliance with guidelines were judged as "very important": lack of knowledge (47%); lack of time (42%); forgetfulness (39%); and lack of means (28%). For physicians and healthcare workers in a senior position, lack of time and lack of means were significantly less important (P < .0005). On multivariate linear regression, knowledge was independently associated with exposure to training sessions (coefficient, 0.33; 95% confidence interval, 0.08 to 0.57; P = .009) and less professional experience (coefficient per increasing professional experience, -0.024; 95% confidence interval, -0.035 to -0.012; P < .0005). CONCLUSIONS: Despite a training effort targeting opinion leaders, knowledge of transmission precautions for pathogens remained insufficient. Nevertheless, specific training proved to be the major determinant of "good knowledge".

Adult↗
PubMed2005

Nosocomial bacteremia: clinical significance of a single blood culture positive for coagulase-negative staphylococci.

OBJECTIVES: To describe the epidemiology of nosocomial coagulase-negative staphylococci (CoNS) bacteremia and to evaluate the clinical significance of a single blood culture positive for CoNS. DESIGN: A 3-year retrospective cohort study based on data prospectively collected through hospital-wide surveillance. Bacteremia was defined according to CDC criteria, except that a single blood culture growing CoNS was not systematically considered as a contaminant. All clinically significant blood cultures positive for CoNS nosocomial bacteremia were considered for analysis. SETTING: A large university teaching hospital in Geneva, Switzerland. RESULTS: A total of 2,660 positive blood cultures were identified. Of these, 1,108 (41.7%) were nosocomial; CoNS were recovered from 411 nosocomial episodes (37.1%). Two hundred thirty-four episodes of CoNS bacteremia in the presence of signs of sepsis were considered clinically relevant and analyzed. Crude mortality and associated mortality were 24.4% and 12.8%, respectively. Associated mortality was similar among patients with one positive blood culture and those with two or more (16.2% vs 10.8%, respectively; P = .3). Mortality rates after bacteremia for patients with a single positive blood culture and for those with two or more were 15.3% and 7.0%, respectively, at day 14 (RR, 2.2; CI95, 0.87-5.46) and 20.8% and 11.3%, respectively, at day 28 (RR, 1.9; CI95, 0.9-3.8). On multivariate analysis, only age and a rapidly fatal disease were independently associated with death. CONCLUSION: CoNS bacteremia harbor a significant mortality and a single positive blood culture in the presence of signs of sepsis should be considered as clinically relevant.

Adult↗
PubMed2004

Hand hygiene among physicians: performance, beliefs, and perceptions.

BACKGROUND: Physician adherence to hand hygiene remains low in most hospitals. OBJECTIVES: To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians. DESIGN: Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene. SETTING: Large university hospital. PARTICIPANTS: 163 physicians. MEASUREMENTS: Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence. RESULTS: Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence. LIMITATIONS: Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. CONCLUSION: Physician adherence to hand hygiene is associated with work and system constraints, as well as knowledge and cognitive factors. At the individual level, strengthening a positive attitude toward hand hygiene and reinforcing the conviction that each individual can influence the group behavior may improve adherence among physicians. Physicians who work in technical specialties should also be targeted for improvement.

Adult↗
PubMed2004

Impact of ventilator-associated pneumonia on resource utilization and patient outcome.

OBJECTIVE: To assess the effect of ventilator-associated pneumonia on resource utilization, morbidity, and mortality. DESIGN: Retrospective matched cohort study based on prospectively collected data. SETTING: Medical intensive care unit of a university teaching hospital. PATIENTS: Case-patients were all patients receiving mechanical ventilation for 48 hours or more who experienced an episode of ventilator-associated pneumonia. Control-patients were matched for number of discharge diagnoses, duration of mechanical support before the onset of pneumonia among case-patients, age, admission diagnosis, gender, and study period. RESULTS: One hundred six cases of ventilator-associated pneumonia were identified in 452 patients receiving mechanical ventilation. The matching procedure selected 97 pairs. Length of stay in the intensive care unit and duration of mechanical ventilation were greater among case-patients by a mean of 7.2 days (P< .001) and 5.1 days (P< .001), respectively. Median costs were $24,727 (interquartile range, $18,348 to $39,703) among case-patients and $17,438 (interquartile range, $12,261 to $24,226) among control-patients (P < .001). The attributable mortality rate was 7.3% (P = .26). The attributable extra hospital stay was 10 days with an extra cost of $15,986 per episode of pneumonia. CONCLUSION: Ventilator-associated pneumonia negatively affects patient outcome and represents a significant burden on intensive care unit and hospital resources.

Aged↗
PubMed2004

Dynamics of bacterial hand contamination during routine neonatal care.

OBJECTIVE: To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care. SETTING: The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland. METHODS: Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves. RESULTS: One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination. CONCLUSIONS: These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.

Alcohols↗
PubMed2004

Cost implications of successful hand hygiene promotion.

We evaluated the costs associated with a sustained and successful campaign for hand hygiene promotion that emphasized alcohol-based handrubs. The total cost of the hand hygiene promotion corresponded to less than 1% of the costs associated with nosocomial infections. Successful hand hygiene promotion is probably cost-saving.

Alcohols↗
PubMed2004

Nursing resources: a major determinant of nosocomial infection?

PURPOSE OF REVIEW: There is growing concern that changes in nurse workforce and hospital-restructuring interventions negatively impact on patient outcomes. This review focuses on the association between understaffing and health-care-associated infections. RECENT FINDINGS: There is a large number of studies showing that overcrowding, understaffing or a misbalance between workload and resources are important determinants of nosocomial infections and cross-transmission of microorganisms. Importantly, not only the number of staff but also the level of their training affects outcomes. The nurse workforce is ageing, mainly due to fewer individuals' engaging in a nursing career. This phenomenon, combined with cost-driven downsizing, contributes to a nursing shortage, and this tendency is not expected to revert unless important system changes are implemented. The causal pathway between understaffing and infection is complex, and factors might include lack of time to comply with infection control recommendations, job dissatisfaction, job-related burnout, absenteeism and a high staff turnover. SUMMARY: The evidence that cost-driven downsizing and changes in staffing patterns causes harm to patients cannot be ignored, and should not be considered as an inevitable outcome. More research is needed to better define the optimal patient-to-nurse ratio in various hospital settings and to estimate the economical impact of the nursing shortage. All quality-improvement interventions should carefully take into account systems and processes to be successful, as the issue of staffing is essentially a structural problem.

Cross Infection↗
PubMed2004

Nosocomial bloodstream infection and clinical sepsis.

Primary bloodstream infection (BSI) is a leading, preventable infectious complication in critically ill patients and has a negative impact on patients' outcome. Surveillance definitions for primary BSI distinguish those that are microbiologically documented from those that are not. The latter is known as clinical sepsis, but information on its epidemiologic importance is limited. We analyzed prospective on-site surveillance data of nosocomial infections in a medical intensive care unit. Of the 113 episodes of primary BSI, 33 (29%) were microbiologically documented. The overall BSI infection rate was 19.8 episodes per 1,000 central-line days (confidence interval [CI] 95%, 16.1 to 23.6); the rate fell to 5.8 (CI 3.8 to 7.8) when only microbiologically documented episodes were considered. Exposure to vascular devices was similar in patients with clinical sepsis and patients with microbiologically documented BSI. We conclude that laboratory-based surveillance alone will underestimate the incidence of primary BSI and thus jeopardize benchmarking.

Adolescent↗
PubMed2004

An application of one-class support vector machine to nosocomial infection detection.

Nosocomial infections (NIs)---those acquired in health care settings---are among the major causes of increased mortality among hospitalized patients. They are a significant burden for patients and health authorities alike; it is thus important to monitor and detect them through an effective surveillance system. This paper describes a retrospective analysis of a prevalence survey of NIs done in the Geneva University Hospital. Our goal is to identify patients with one or more NIs on the basis of clinical and other data collected during the survey. In this two-class classification task, the main difficulty lies in the significant imbalance between positive or infected (11%) and negative (89%) cases. To cope with class imbalance, we investigate one-class SVMs which can be trained to distinguish two classes on the basis of examples from a single class (in this case, only "normal" or non infected patients). The infected ones are then identified as "abnormal" cases or outliers that deviate significantly from the normal profile. Experimental results are encouraging: whereas standard 2-class SVMs scored a baseline sensitivity of 50.6% on this problem, the one-class approach increased sensitivity to as much as 92.6%. These results are comparable to those obtained by the authors in a previous study on asymmetrical soft margin SVMs; they suggest that one-class SVMs can provide an effective and efficient way of overcoming data imbalance in classification problems.

Algorithms↗
PubMed2003

Ventilator-associated pneumonia: caveats for benchmarking.

OBJECTIVE: To determine the influence of using different denominators on risk estimates of ventilator-associated pneumonia (VAP). DESIGN AND SETTING: Prospective cohort study in the medical ICU of a large teaching hospital. PATIENTS: All consecutive patients admitted for more than 48 h between October 1995 and November 1997. MEASUREMENTS AND RESULTS: We recorded all ICU-acquired infections using modified CDC criteria. VAP rates were reported per 1,000 patient-days, patient-days at risk, ventilator-days, and ventilator-days at risk. Of the 1,068 patients admitted, VAP developed in 106 (23.5%) of those mechanically ventilated. The incidence of the first episode of VAP was 22.8 per 1,000 patient-days (95% CI 18.7-27.6), 29.6 per 1,000 patient-days at risk (24.2-35.8), 35.7 per 1,000 ventilator-days (29.2-43.2), and 44.0 per 1,000 ventilator-days at risk (36.0-53.2). When considering all episodes of VAP (n=127), infection rates were 27.3 episodes per 1,000 ICU patient-days (95% CI 22.6-32.1) and 42.8 episodes per 1,000 ventilator-days (35.3-50.2). CONCLUSIONS: The method of reporting VAP rates has a significant impact on risk estimates. Accordingly, clinicians and hospital management in charge of patient-care policies should be aware of how to read and compare nosocomial infection rates.

Adolescent↗
PubMed2003

Noma: an "infectious" disease of unknown aetiology.

Noma (cancrum oris) is a devastating gangrenous disease that leads to severe tissue destruction in the face and is associated with high morbidity and mortality. It is seen almost exclusively in young children living in remote areas of less developed countries, particularly in Africa. The exact prevalence of the disease is unknown, but a conservative estimate is that 770000 people are currently affected by noma sequelae. The cause remains unknown, but a combination of several elements of a plausible aetiology has been identified: malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, and an unidentified bacterial factor acting as a trigger for the disease. This review discusses the epidemiology, clinical features, current understanding of the pathophysiology, and treatment of the acute phase and sequelae requiring reconstructive surgery. Noma may be preventable if recognised at an early stage. Further research is needed to identify more exactly the causative agents.

Africa↗
PubMed2003

Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern.

OBJECTIVE: Although alcohol-based hand rinses and gels have recommended application times of 30 to 60 seconds, healthcare workers usually take much less time for hand hygiene. We compared the efficacies of four alcohol-based hand rubs produced in Europe (hand rinses A, B, and C and one gel formulation) with the efficacy of the European Norm 1500 (EN 1500) reference waterless hand antisepsis agent (60% 2-propanol) at short application times. DESIGN: Comparative crossover study. SETTING: Infection Control Program laboratory of a large tertiary-care teaching hospital. PARTICIPANTS: Twelve healthy volunteers. INTERVENTION: Measurement of residual bacterial counts and log reduction factors following inoculation of fingertips with Staphylococcus aurens American Type Culture Collection (ATCC) 6538, Pseudomonas aeruginosa ATCC 15442, and a clinical isolate of Enterococcus faecalis. RESULTS: All hand rinses satisfied EN 1500 standards following a single application for 15 and 30 seconds, but reduction factors for the gel formulation were significantly lower for all tested organisms (all P < .025). CONCLUSIONS: Under stringent conditions similar to clinical practice, all three hand rinses proved to be more efficacious than the marketed alcohol-based gel in reducing bacterial counts on hands. Further studies are necessary to determine the in vivo efficacy of alcohol-based gels and whether they are as efficacious as alcohol-based rinses in reducing the transmission of nosocomial infections.

Anti-Infective Agents, Local↗