In support of a Public Health struggle
«Nosocomial infections also called hospital-acquired infections (HAIs) are infections contracted in a health care establishment. For a HAI, the infection is considered as such when it was absent at the admission. When the infectious state of the patient at the admission is unknown, the infection is classically considered as nosocomial if it appears after 48 hours of hospitalization.»
Definition of the French Higher Council of Public Hygiene (CSHPF)
«We call AEB (Accidental Exposure to Blood) any contact with some blood or a biological liquid contaminated by some blood and containing a cutaneous injury (injection, cut) or a projection on a mucosa or a damaged skin (wounds, eczema, excoriations)»
Bilan CCLIN Sud-EST
a sensitive area.
In 2009, the magazine “Sciences Sociales et Santé” raised this question: “nosocomial Infections: a collective risk in the process of normalization?”
This article described the evolution and the ups and downs of the fight of public health against the nosocomial infections which started in the 1980s: “ever since places in whom the sick are gathered have existed, the hospitable fevers and other hospitable “decay diseases” have fed for a long time the representation of the hospital as a Death House. [..] The hospital is just as much a “creator of diseases” than an institution intended to cure. If some precursors […] tried by the mid-19th century to fight against this plague, it is necessary to wait “for “the pasteurization of the medicine” and his concrete applications that are the development of the asepsis as a technique and that of hygiene as a discipline, so that the hospitable mortality due to these infections begins to decline, but never disappearing.
The problem is considered for the first time by a ministerial circular of 1973, creating in every Hospital a Committee of Fight against The Infections (CLIN).
The end of 1980s was marked by a real raising awareness to this problem of public health, ” awareness created by the fear of the AIDS and the associated occupational hazards among which the Accidental Blood Exposure (ABE), particularly dreaded”. Therefore, in 1988, a decree established the regulation of the CLIN for purposes of supervision of IN and of staff training.
It will be necessary to wait for the 90s and for the first public scandals relieved by victims’ associations to accelerate the coordinated coverage of this problem.
In 1999, a decree forces every public or private care facility to set up a CLIN within it, to be equipped with a team of operational hospital hygiene and to define an annual program of preventive action, supervision, information, training and assessment.
The first CLINs are born after a salutary awareness.
The short-stay prevalences average in Europe, based on an analysis of published studies conducted by the ECDC, is around 7%. On this basis and according to this same analysis, 4 million patients would be infected by nosocomial infections each year. These would cause 37,000 deaths. RAISIN 2010
27 years of maturation.
From then on, aware of the urgency to deal with what could be one of the most important sanitary fights of this beginning of the 21st century, diverse entities contributed to a national monitoring programme to fight against nosocomial infections.
In 2001, the RAISIN (Nosocomial Infection Warning and Surveillance Investigation Network) was created in partnership between the CCLIN (Centers Coordinating the Fight against the Nosocomial Infections) and The Institute of health monitoring (InVS) of which one of the missions of monitoring, vigilance and alert is dedicated to nosocomial infections and resistance to antibiotics.
The RAISIN is now formed of five surveillance and monitoring networks: antibiotics consumption, Multi-Resistant Bacteria (MRB), Accidental Blood Exposure (ABE), the Surgical-Site Infections (SSI), and the infections in Intensive Care Unit (ICU).
Document 10 ans du RAISIN – 2011
The DGSO produced simultaneously annual dashboards concerning nosocomial infections, real tools opposable to care facilities. These data give an exhaustive vision of the current situation and propose a classification of the various care facilities compared to their activity of risk prevention regarding nosocomial infections.
In 2015, The HAS takes care, for the first time, of the project management of the data collection campaign of the LIN Assessment, previously realized by the DGOS, and becomes, both for the healthcare professionals and for the other actors, the reference interlocutor of the indicators of the theme IAS (HAI: Healthcare Associated Infections), the terminology widening the notion of nosocomial infection.
The last report remains encouraging as for the efforts produced by the care facilities regarding the quality and the safety in healthcare: “91,2 % of the care facilities are in class A or B, that is a progress of more than 5 % with regard to 2012.
These results underline an undeniable maturity and reflect the constant investment of facilities in the prevention of the nosocomial infections. […] Nevertheless some areas remain perfectible”.
By 2015, a large majority of care facilities are well rated for their investment in combating IAS. Indicator HAS 2016
According to the same analysis, the 4 million IN in Europe would lead to 37 000 deaths. RAISIN 2010
Blowing hot and cold
In 2006, a Senate report proposed these figures: “we admit collectively that, in France, 6 to 7 % of the hospitalizations are complicated by a more or less serious nosocomial infection, that is approximately 750.000 cases on the 15 million annual hospitalizations.”
In 2011, during the 10th anniversary of the RAISIN, the quote was: “the nosocomial infections reach 5 to 10 % of the patients hospitalized in Europe and 5 % in France. They represent 2,8 % of the deaths in hospitals.”
This evolution, confirmed by the good behavior of France in the epidemiological studies, connotes the awareness and the utility of the actions that have been launched for 27 years.
But the nosocomial infections still represent a substantial percentage of the deaths in hospitals and as the Senate report says: “The proportion of those which could be avoided by a better prevention (hygiene measures, adapted premises…) is estimated at 30 %.”
in support of a fight of public health
This current situation urges the authorities of Health to continue the fight posed by the understanding and the prevention of the infections associated with the care and to undertake a deeper reflexion process, turning in particular to the actors involved with biotechnologies.
In 2015, a national program for the prevention of healthcare associated infections (PROPIAS) is set up: “the stages of a patient’s journey through the care system is the main thread behind PROPIAS. The cross-cutting approach of most of the actions will allow the healthcare professionals, regardless their place of practice, to be actively involved in the expected objectives. ”
To come along with the prevention of the infectious risk and its medical coverage, the PROPIAS proposes 3 axes among which ” the reduction of the infectious risks associated to the invasive acts all along the health path.”
HSBI funded its purpose and its raison-d’être on that axis, and based thereby its research and the development of its innovations.