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Quoi de neuf dans les techniques de désinfection des chambres de réanimation ?

What’s New in Room Decontamination in the Intensive Care Unit?

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Réanimation

Résumé

L’environnement joue un rôle majeur dans la transmission croisée des micro-organismes. Le bionettoyage standard est microbiologiquement insuffisant. Son amélioration est primordiale pour le contrôle des endémies et des épidémies bactériennes. C’est pourquoi des systèmes automatisés de désinfection des surfaces par voie aérienne à base de peroxyde d’hydrogène (H2O2) sont de plus en plus utilisés en complément du bionettoyage terminal. Deux technologies existent à ce jour: l’aérosolisation et la vaporisation. Les vaporisateurs d’un gaz sec d’H2O2 sont les plus étudiés: ils présentent une efficacité microbiologique in vitro et in situ. Leur utilisation a permis à diverses reprises d’endiguer des endémies et des épidémies bactériennes. Les études sont encore trop rares pour permettre de conclure définitivement à l’efficacité des aérosolisateurs d’H2O2. Les autres technologies (ultraviolets, ozone, dioxyde de chlore, vapeur d’eau, filtres d’air haute performance, ultramicrofibres, biocides à base de cuivre) sont insuffisamment étayées par des études pour être recommandées. Tous ces systèmes engendrent un surcoût et un délai d’attente supplémentaire entre deux admissions. De plus, leur innocuité n’est pas prouvée.

Abstract

The environment plays a central role in the transmission of hospital-acquired pathogens. Current cleaning methods are microbiologically ineffective. Improvements in environmental cleaning are associated with a decrease in the rate of hospital-acquired infections. To improve terminal cleaning, automated room disinfection systems containing hydrogen peroxide (H2O2) are more and more considered. Two technologies are available: aerosolization and vaporization. Dry-H2O2 vaporization is microbiologically efficient (in vitro and in situ). Its use is associated with endemic colonization and outbreak control. H2O2 aerosolization effectiveness is still in assessment. Evidence is lacking to recommend others technologies (ultraviolet, ozone, chlorine dioxide, steam, high-efficiency particulate air-filtration, ultra microfiber, copper-based biocide). All methods are associated with extra-cost and longer waiting-time between two admissions. Safety for healthcare workers is not proved.

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Authors and Affiliations

  1. Centre de réanimation, hôpital R.-Salengro, CHRU de Lille, F-59037, Lille cedex, France

    C. Blazejewski & S. Nseir

  2. Université Lille-Nord-de-France, F-59000, Lille, France

    C. Blazejewski, F. Wallet & S. Nseir

  3. Centre de biologie-pathologie, institut de microbiologie, boulevard du Professeur-Leclercq, F-59037, Lille cedex, France

    F. Wallet

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  1. C. Blazejewski
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  2. F. Wallet
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Correspondence to S. Nseir.

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Blazejewski, C., Wallet, F. & Nseir, S. Quoi de neuf dans les techniques de désinfection des chambres de réanimation ?. Réanimation 23, 256–262 (2014). https://doi.org/10.1007/s13546-014-0884-y

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