- CHU de Rouen

Transcription

- CHU de Rouen

Veille documentaire Médecine du travail du personnel hospitalier - Juillet 2006 - CHU Rouen
Veille documentaire
Médecine du travail du personnel hospitalier
- Literature Follow-up : occupational health for Healthcare Workers -
Juillet 2006
Objectif
L'objectif de ce travail est de fournir un outil de veille aux médecins du travail concernant les nouvelles
connaissances scientifiques relative à la santé au travail des personnels de soins. La priorité est
donnée aux documents en français. Ce travail est réalisé par les documentalistes de l'équipe CISMeF
et le service de médecine du travail et de pathologie professionnelle du CHU de Rouen (Dr JF
Gehanno), dans le cadre d'un projet financé par la CNRACL (Caisse Nationale de Retraites des
Agents des Collectivités Locales). Les résultats proposés sont issus de la surveillance mensuelle
d'une sélection de périodiques, de sites Internet d'organismes spécialisés et des bases de données
CISMeF, PubMed et BDSP.
La veille juridique est réalisée par l’ISTNF (Institut de santé du nord de la France).
Pour obtenir un document, vous pouvez vous adresser à la BIUM (http://www.bium.univ-paris5.fr/) ou
à l'INIST-CNRS (http://www.inist.fr/).
Sommaire
1. Allergies
2. Bonnes pratiques................................................................................................................... p. 2
3. Conditions de travail et santé psychologique ........................................................................ p. 3
4. Hygiène et gestion des risques ............................................................................................. p. 8
5. Infections nosocomiales ........................................................................................................ p. 8
6. Risques biologiques .............................................................................................................. p. 9
6.1 Accident d'exposition au sang .............................................................................. p. 11
6.2 Contamination soignant-soigné ............................................................................ p. 12
6.3 Transmission aérienne
6.4 Transmission de contact....................................................................................... p. 13
6.5 Vaccination ........................................................................................................... p. 13
7. Risques chimiques .............................................................................................................. p. 15
8. Risques physiques
8.1 Rayonnements ionisants ...................................................................................... p. 16
8.2 Troubles musculo-squelettiques ........................................................................... p. 18
9. Violence ............................................................................................................................... p. 19
10. Autres ................................................................................................................................ p. 21
Veille juridique ......................................................................................................................... p. 22
1
1. Allergies
2. Bonnes pratiques
- Documents en anglais :
Spine J. 2006 Jan-Feb;6(1):72-7.
An independent AGREE evaluation of the Occupational Medicine Practice Guidelines.
Cates JR, Young DN, Bowerman DS, Porter RC.
Private practice of chiropractic orthopedics, 200 N. 6th Street, Oregon, IL 61061, USA.
[email protected]
BACKGROUND AND CONTEXT: A large number of practice guidelines are being produced by
numerous organizations. Health-care professionals need to critically evaluate these practice guidelines
to understand whether they are well constructed and representative of the preponderance of evidence.
The guideline development process should be precise and rigorous to ensure that the results are
reproducible and not vague. PURPOSE: To evaluate the quality of the second edition of the practice
guidelines published by the American College of Occupational and Environmental Medicine (ACOEM
Guidelines). STUDY DESIGN/SETTING: Four appraisers used the AGREE (Appraisal of Guidelines
Research and Evaluation) guideline evaluation instrument to evaluate the ACOEM Guidelines.
METHODS: The Guidelines were evaluated with the AGREE guideline evaluation instrument. The
AGREE instrument has been widely adopted around the world, and the authors recommended that it
be adopted as the standard of guideline construction process evaluation in the United States. The
instrument standardizes the quantitative assessment of quality for a guideline's development process
across six domains that include: scope and purpose, stakeholder involvement, rigor of development,
clarity and presentation, application, and editorial independence. Scores from four assessors were
collected and interpreted. Additionally, each evaluator selected one of four global assessment choices:
"strongly recommended for use in practice," "recommended for use with some modification or
proviso," "not recommended as suitable for use in practice," or "unsure". RESULTS: The ACOEM
Guidelines scored highest in the dimensions that evaluated reporting of the guideline's scope and
purpose (79.63) as well as clarity and presentation (86.81). The guideline scored much lower in the
remaining areas that included stakeholder involvement (46.06), rigor of development (26.59),
application (31.48), and editorial independence (19.17). The global assessment was unanimous with
all four evaluators assessing the guideline as recommend with proviso. CONCLUSIONS: Many of the
Guidelines recommendations were consistent with current literature and guidelines; however, the
AGREE assessment instrument evaluates the guideline development process and not the content. All
the evaluators thought the content of the guidelines was substantially better than the documentation of
the guideline construction process. The ACOEM Guidelines appear to have content consistent with
their stated objectives, but the reporting of the guidelines construction process, particularly the rigor of
recommendation development, is flawed, and the recommendations may not be valid owing to
possible evidence selection deficiencies. The reader should consider these flaws and limitations when
using the guideline. The reader should consider utilizing guidelines of higher quality when possible.
Future guidelines should incorporate better reporting and give closer attention to guideline
construction.
Publication Types: Evaluation Studies - MeSH Terms: Attitude of Health Personnel - Clinical
Competence - Comparative Study - Evaluation Studies - Guideline Adherence* - Humans Occupational Medicine/standards* - Practice Guidelines* - Quality Control - United States
Ann Intern Med. 2006 Jun 5; [Epub ahead of print]
Meta-Analysis: Effect of Long-Acting {beta}-Agonists on Severe Asthma Exacerbations and
Asthma-Related Deaths.
Salpeter SR, Buckley NS, Ormiston TM, Salpeter EE.
Santa Clara Valley Medical Center, San Jose, California, and Cornell University, Ithaca, New York.
BACKGROUND: Long-acting beta-agonists may increase the risk for fatal and nonfatal asthma
exacerbations. PURPOSE: To assess the risk for severe, life-threatening, or fatal asthma
exacerbations associated with long-acting beta-agonists. DATA SOURCES: English- and non-Englishlanguage searches of MEDLINE, EMBASE, and Cochrane databases; the U.S. Food and Drug
Administration Web site; and references of selected reviews through December 2005. STUDY
SELECTION: Randomized, placebo-controlled trials that lasted at least 3 months and evaluated longacting beta-agonist use in patients with asthma. All trials allowed the use of as-needed short-acting
beta-agonists. DATA EXTRACTION: Outcomes measured were Peto odds ratio (OR) and risk
2
difference of severe exacerbations requiring hospitalization, life-threatening exacerbations requiring
intubation and ventilation, and asthma-related deaths. The OR for asthma-related deaths was
obtained from the Salmeterol Multi-center Asthma Research Trial (SMART). DATA SYNTHESIS:
Pooled results from 19 trials with 33 826 participants found that long-acting beta-agonists increased
exacerbations requiring hospitalization (OR, 2.6 [95% CI, 1.6 to 4.3]) and life-threatening
exacerbations (OR, 1.8 [CI, 1.1 to 2.9]) compared with placebo. Hospitalizations were statistically
significantly increased with salmeterol (OR, 1.7 [CI, 1.1 to 2.7]) and formoterol (OR, 3.2 [CI, 1.7 to 6.0])
and in children (OR, 3.9 [CI, 1.7 to 8.8]) and adults (OR, 2.0 [CI, 1.1 to 3.9]). The absolute increase in
hospitalization was 0.7% (CI, 0.1% to 1.3%) over 6 months. The risk for asthma-related deaths was
increased (OR, 3.5 [CI, 1.3 to 9.3]), with a pooled risk difference of 0.07% (CI, 0.01% to 0.1%).
Limitations: The small number of deaths limited the reliability in assessing this risk, and 28 studies did
not report information on the outcomes of interest. CONCLUSIONS: Long-acting beta-agonists have
been shown to increase severe and life-threatening asthma exacerbations, as well as asthma-related
deaths.
http://www.annals.org/cgi/content/abstract/144/12/904
3. Conditions de travail et santé psychologique
- Documents en français :
Mémoire pour l'obtention du diplôme de cadre de santé., 100p., ann., réf. 5p., 12/2005
Cadre et épuisement professionnel des soignants : quels remèdes ?
DALLE GOUDET (Karine), BARAILLE (Denis) / dir.
Assistance Publique-Hôpitaux de Paris. (A.P.H.P.). Institut de Formation des Cadres de Santé.
(I.F.C.S.). Paris. FRA / com.
L'hypothèse de recherche de ce mémoire est la suivante : "l'implication des infirmières et aidessoignantes dans des projets peut limiter la démotivation et ainsi prévenir l'apparition du syndrome
d'épuisement professionnel".
En entretenant la motivation, l'implication, en reconnaissant son personnel et en utilisant un
management participatif, l'encadrement peut en effet lutter contre une installation insidieuse d'un
épuisement professionnel.
Une analyse qualitative par catégorie socioprofessionnelle (aides-soignants, infirmiers et cadres) et
par service a été réalisée grâce à des entretiens semi directifs.
Il en ressort que le cadre peut prévenir le burn out en organisant au mieux le travail, en entretenant
une bonne ambiance, en témoignant de la reconnaissance et en motivant le personnel autour de
l'élaboration de projet.
L'implication dans des projets n'est ainsi pas la première prévention du burn out.
Elle arrive seulement après une bonne organisation du travail. (Adapté du R.A.).
Mots-clés BDSP : Epuisement professionnel, Cadre infirmier, Motivation, Souffrance, Stress,
Prévention, Rôle du professionnel, Mémoire fin étude, Management participatif
In Revue de l'infirmière, 2006 - Numéro 121 - pp: 35-37
Epuisement professionnel des soignants (L')
M. Guimelchain-Bonnet, P. Macrez
Fréquent dans la relation d'aide, l'épuisement professionnel a essentiellement été étudié dans les
services de réanimation et de soins palliatifs. Selon certaines études, 25 à 40 % des soignants
seraient épuisés.
Article de périodique
Enquête PRESST-NEXT, 2005
Santé et satisfaction des soignants au travail en France et en Europe
Madeleine Estryn-Behar, Olivier Le Nézet, Carine Jasseron, Jean-François Caillard
http://www.next.uni-wuppertal.de/download/fr/BrochurePRESSTNEXT2005french.pdf (5,45 Mo)
English : http://www.next.uni-wuppertal.de/download/BrochurePRESSTNEXTEN2005.pdf
3
Travail de nuit : l'aliénation du choix.
FABIUS MBOKOKO (Rita), GILIOLI (Christian) / dir.
Les infirmiers sont conscients de la pénibilité du travail de nuit, mais ils y restent pour des raisons
familiales quand bien même celles-ci n'existent plus.
Ce paradoxe s'explique par une sorte d'effet d'hystérésis, la cause disparaissant sans entraîner la
disparition de l'effet.
Ce dernier permet de supposer qu'il existe un point de basculement à partir duquel les infirmiers de
nuit ne reprendront plus de leur propre gré un poste de jour et/ou d'après-midi.
Le cadre de santé doit montrer à l'infirmier de nuit l'intérêt de revoir son choix dès l'apparition des
premiers signes d'épuisement physique et intellectuel afin de préserver la qualité des prestations
fournies au patient. (Extrait R.A.).
Mots-clés BDSP : Travail nocturne, Infirmier, Epuisement professionnel
J Nurs Manag. 2006 May;14(4):289-99.
A longitudinal study of job stress in the nursing profession: causes and consequences.
Gelsema TI, van der Doef M, Maes S, Janssen M, Akerboom S, Verhoeven C.
Department of Psychology, Leiden University, the Netherlands. [email protected]
AIM AND BACKGROUND: This study examines the influence of changes in work conditions on stress
outcomes as well as influence of changes in stress outcomes on work conditions. As such, it answers
questions still open in the literature regarding causality of work environmental characteristics and the
health of nurses. METHOD: A complete, two wave panel design was used with a time interval of 3
years. The sample consisted of 381 hospital nurses in different functions, working in different wards.
RESULTS: Changes in work conditions are predictive of the outcomes, especially of job satisfaction
and emotional exhaustion. The strongest predictors of job satisfaction were social support from
supervisor, reward and control over work. The strongest predictors of emotional exhaustion were work
and time pressure and physical demands. Reversed relationships were also found for these outcomes.
CONCLUSION: The results of this study are consistent with transactional models of stress that
indicate that stressors and stress outcomes mutually influence each other. To prevent nurses from a
negative spiral, it seems of importance to intervene early in the process.
MeSH Terms: Adult - Attitude of Health Personnel* - Burnout, Professional/epidemiology - Burnout,
Professional/etiology - Burnout, Professional/psychology* - Causality - Female - Health Facility
Environment/organization & administration - Hospitals, University - Humans - Internal-External Control
- Interprofessional Relations - Job Satisfaction* - Longitudinal Studies - Male - Middle Aged Netherlands/epidemiology - Nursing Methodology Research - Nursing Staff, Hospital/organization &
administration - Nursing Staff, Hospital/psychology* - Organizational Innovation - Professional
Autonomy - Questionnaires - Regression Analysis - Reward - Social Support - Workload Workplace/organization & administration - Workplace/psychology*
Alta RN. 2006 Apr;62(4):8-9.
A zero tolerance abuse policy--what does an RN need to consider?
Davies C.
CARNA's Nursing Practice Standards and the CNA Code of Ethics for Registered Nurses support RNs
in their practice and provide guidance when questions about practice arise, facilitate problem-solving
and provide a focus on the values, beliefs and responsibilities that RNs have when providing nursing
care, even at those times when it may seem that a patient may not want their help.
MeSH Terms: Alberta - Codes of Ethics - Humans - Nurse-Patient Relations/ethics - Nursing
Staff/ethics - Nursing Staff/organization & administration* - Nursing Staff/psychology - Occupational
Health* - Patient Advocacy/ethics - Patient Advocacy/psychology - Practice Guidelines* - Safety
Management/ethics - Safety Management/organization & administration* - Violence/ethics Violence/prevention & control* - Violence/psychology - Workplace/organization & administration* Workplace/psychology
Publication Types: Review
4
Acad Med. 2006 May;81(5):436-9.
Combating the stress of residency: one school's approach.
Dabrow S, Russell S, Ackley K, Anderson E, Fabri PJ.
Division of General Pediatrics, University of South Florida, Tampa, Florida, USA.
[email protected]
Residency is a time of stress and turmoil for many residents. The stresses are varied and great, often
involving both personal and professional issues. One institutional mechanism that has been shown to
help residents cope with stress is the use of residents' wellness, or assistance, programs. The
University of South Florida (USF) College of Medicine developed the USF Residency Assistance
Program (RAP) in 1997, modeled after business employee assistance programs but tailored to
enhance the well-being of residents. The program was developed in an organized, thoughtful manner
starting with a Request for Proposals to all local employee assistance programs and the selection of
one of these to run the program. The RAP is broad-based, readily available, easily accessible, totally
voluntary and confidential, and not reportable to the state board of medicine. It is well integrated into
all residency programs and has had excellent acceptance from the administration; information about
access to the RAP is available to all residents through multiple venues. The cost is minimal, at only
seven cents a day per resident.The authors present data from the eight years the RAP has been
operating, including information on program use, referral rates, acceptance, and types of problems
encountered. One suicide occurred during this time period, and the RAP provided a significant role in
grief counseling. Assistance programs are critical to the well-being of residents. The USF program
presents a model that can be used by other programs around the country.
MeSH Terms: Academic Medical Centers/organization & administration* - Burnout,
Professional/prevention & control* - Confidentiality - Contract Services - Florida - Health
Promotion/organization & administration* - Health Promotion/utilization - Humans - Internship and
Residency/manpower - Internship and Residency/organization & administration* - Mental Health
Services/organization & administration* - Mental Health Services/utilization - Occupational Health
Services/organization & administration* - Occupational Health Services/utilization - Physician
Impairment/psychology* - Program Development - Program Evaluation
Int J Nurs Pract. 2006 Jun;12(3):136-42.
Compassion fatigue and nursing work: can we accurately capture the consequences of caring
work?
Sabo BM.
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
[email protected]
Health outcomes and, in particular, patient health outcomes have become a driving force within healthcare delivery. Little emphasis has been placed on the potential health consequences for nurses
providing care and caring within the health-care system. Compassion fatigue (or secondary traumatic
stress) has emerged as a natural consequence of caring for clients who are in pain, suffering or
traumatized. This paper sheds light on how nursing work might impact the health of nurses by
exploring the concept of compassion fatigue. Limitations of current instruments to measure
compassion fatigue are highlighted, and suggestions for future direction are presented.
MeSH Terms: Adaptation, Psychological - Burnout, Professional/diagnosis - Burnout,
Professional/etiology - Burnout, Professional/prevention & control - Burnout, Professional/psychology*
- Cost of Illness - Empathy* - Health Status - Helping Behavior - Humans - Job Satisfaction - Models,
Nursing - Models, Psychological - Nurse's Role/psychology - Nurse-Patient Relations* - Nursing
Methodology Research - Nursing Staff/organization & administration - Nursing Staff/psychology* Occupational Health - Workload
Enquête PRESST-NEXT, March 2006
Effects of harassment on Work Ability Index among European nurses. Different ages make a
difference?
Donatella Camerino
Department of Occupational Health, University of Milan
http://www.next.uni-wuppertal.de/download/camerino2006.pdf
5
Nurs Econ. 2006 Mar-Apr;24(2):67-76, 55.
Organizational characteristics and their effect on health.
Way M, MacNeil M.
University at Buffalo, Niagra Falls, Ontario, Canada.
There is a complex relationship between work, employee health, and successful business results. At
the individual level, multiple factors including physical, psychological, and social aspects of the work
environment affect workers' health and well-being. At the organizational level, the consequences of
unhealthy work environments may be traced to a decrease in the quality of service and products, and
a loss in productivity. A brief overview of the contemporary literature on workplace stressors is
presented to help identify future research directions.
MeSH Terms: Humans - Job Satisfaction - Models, Organizational - Nursing Staff/organization &
administration* - Occupational Diseases/prevention & control - Occupational Health* - Organizational
Culture* - Outcome Assessment (Health Care)/methods - Personnel Loyalty - Personnel
Management/methods - Personnel Turnover - United States - Workload - Workplace
J Nurs Manag. 2006 May;14(4):310-7.
Taking a lead on stress: rank and relationship awareness in the NHS.
Collins M.
School of Allied Health Professions, University of East Anglia, Norwich, Norfolk, UK.
[email protected]
Recent legislation from the Health and Safety Executive will have a significant impact on the
expectations of how an organization manages stress. This paper considers the need for more
awareness of risk assessment and risk management that takes into account the systemic antecedents
of stress. It is suggested that assessment of organizational stress levels should include qualitative and
quantitative methods of data collection to analyse the cumulative wear and tear on staff that
contributes to the experience of workplace stress. This paper explores the importance of leadership
within organizational hierarchies. Rank and status dynamics are identified as a potentially significant
source of workplace stress. It is proposed that training in rank dynamics and relationship awareness
are potential mediators in reducing workplace stress. The National Health Service could be a leader in
establishing organizational well-being through patterns of leadership and relationship that tackles the
growing epidemic of workplace stress.
MeSH Terms: Adaptation, Psychological - Awareness - Burnout, Professional/prevention & control* Burnout, Professional/psychology - Cooperative Behavior - Great Britain - Health Services Needs and
Demand - Humans - Interprofessional Relations* - Leadership* - Nurse Administrators/organization &
administration* - Nurse's Role - Nursing Staff/organization & administration - Nursing
Staff/psychology* - Occupational Health - Organizational Culture - Planning Techniques - Power
(Psychology) - Risk Assessment - Risk Factors - Risk Management - Social Support - State
Medicine*/organization & administration - Workplace/organization & administration Workplace/psychology
6
J Aging Health. 2006 Jun;18(3):385-406.
The role of conflict resolution styles on nursing staff morale, burnout, and job satisfaction in
long-term care.
Montoro-Rodriguez J, Small JA.
Kent State University, USA.
This study focuses on the ability of nursing staff to interact wit h residents in a way that affects
positively on the nurses' well-being and occupational satisfaction. It investigates the role of coping
skills related to staff-resident interactions, in particular, the use of conflict resolution styles and their
influence on the level of morale, burnout and job satisfaction of nursing professionals. A selfadministered questionnaire was used to collect information from 161 direct care nursing staff. The
authors used a multiple regression procedure to examine the influence of predictors on nursing staff
outcomes. Multivariate analyses indicated that nurses' psychological morale, occupational stress, and
job satisfaction are influenced by conflict resolution styles, after controlling by individual
characteristics, work demands, and work resources factors. The findings highlight the importance of
considering personal coping abilities to foster positive staff-resident interactions and to increase
nurses' morale and job satisfaction.
MeSH Terms: Adaptation, Psychological - Attitude of Health Personnel - Burnout, Professional* Canada - Conflict (Psychology)* - Depersonalization/psychology - Humans - Interprofessional
Relations - Job Satisfaction* - Long-Term Care/manpower - Models, Theoretical - Morale* Negotiating/methods* - Nurses/psychology* - Nursing/organization & administration* - Nursing
Methodology Research - Personnel Turnover - Stress, Psychological - United States Workload/psychology
Acad Med. 2006 Jun;81(6):577-82.
Viewpoint: enhancing the professional fulfillment of physicians.
Brown S, Gunderman RB.
Indiana University School of Medicine, Indianapolis, Indiana 46202-5200, USA.
Academic medical ce nters (AMCs) devote countless hours to studying the diagnosis and treatment of
disease, yet little or no time to determining the factors that enhance or detract from physicians'
professional fulfillment. This is unfortunate because physicians' degree of professional engagement,
the quality of care they provide, and their tendency to burn out all depend on the fulfillment they find in
work.Indeed, if AMCs are to thrive, it is vital to understand and promote the professional fulfillment of
physicians. This article reviews the sources of professional fulfillment among physicians and outlines
ways to enhance it within physicians' organizations.
MeSH Terms: Academic Medical Centers* - Adult - Aged - Burnout, Professional/psychology* Humans - Income - Job Satisfaction* - Middle Aged - Physicians/psychology*
J Nurs Manag. 2006 May;14(4):300-9.
Working conditions, psychosocial resources and work stress in nurses and physicians in chief
managers' positions.
Lindholm M.
Department of Nursing, Malmo University, Sweden. [email protected]
The study investigated whether psychosocial work conditions, professional network, job support, social
network and support, sick leave and salary were associated with work stress in nurses in chief
manager' positions above ward level and physicians in clinical director positions. A sample consisting
of 205 nurses and 274 physicians in chief managers' positions at higher structural level answered a
questionnaire. Odds ratios were used for estimating the bivariate association between work stress and
psychosocial resources. The result showed that both nurse managers (OR 6.8; 95% CI: 3.5-13.5) and
clinical directors (OR 6.7; 95% CI: 3.6-12.5) exposed to high job demands had a significantly higher
probability of high level of work stress. The results also indicated that the available psychosocial
resources taken together inside and outside work did not balance the experienced work stress in
nurse managers and the clinical directors who were exposed to high work demands. No relation was
found between work stress and sick leave and salary.
MeSH Terms: Absenteeism - Adaptation, Psychological - Adult - Attitude of Health Personnel* Burnout, Professional/etiology - Burnout, Professional/psychology* - Decision Making, Organizational Female - Humans - Internal-External Control - Interprofessional Relations - Job Description - Job
Satisfaction - Male - Middle Aged - Multivariate Analysis - Nurse Administrators/organization &
administration - Nurse Administrators/psychology* - Nursing Methodology Research - Physician
Executives/organization & administration - Physician Executives/psychology* - Professional Autonomy
- Questionnaires - Salaries and Fringe Benefits - Social Support* - Sweden - Workload Workplace/organization & administration - Workplace/psychology*
7
4. Hygiène et gestion des risques
REVUE DE L'INFIRMIERE, vol.119, p. 25-27, réf.bibl., 03/2006
Hygiène des mains : des produits mieux adaptés aux soignants.
CHARLES (Eric)
Acte répétitif fondamental pour les infirmières, le lavage des mains doit faire l'objet de toutes les
vigilances.
Panorama des produits, détail des procédures recommandées et des critères de choix pour un
meilleur confort des soignants et une plus grande sécurité des patients. (NDLR).
East Mediterr Health J. 2005 Sep-Nov;11(5-6):929-42.
Adherence to universal precautions among laboratory personnel in Lebanon.
Kahhaleh JG, Jurjus AR.
Faculty of Public Health, Lebanese University, Beirut, Lebanon.
To evaluate the present situation and plan future directions with regard to implementation of universal
precautions in laboratories testing blood samples, we carried out a national cross sectional study in
2003 on a representative sample of laboratories in Lebanon. We compared the results with those of a
1993 study. We found that the education profile of staff had improved, being now more specialized in
laboratory science. The discrepancies between what technicians knew, believed in and practised and
what was observed in the field improved to some extent in most variables. Disposal of needles and
syringes had improved greatly but disposal of blood-contaminated material had not. Given the risks of
improper practice, a policy of universal precautions is essential and regular training should be carried
out so that staff know and practise the universal precautions and correct laboratory procedures.
MeSH Terms: Attitude of Health Personnel* - Blood Specimen Collection/standards - Clinical
Competence/standards - Cluster Analysis - Cross-Sectional Studies - Educational Status - Guideline
Adherence/standards* - Health Knowledge, Attitudes, Practice* - Health Services Needs and Demand
- Humans - Inservice Training - Laboratory Infection/epidemiology - Laboratory Infection/prevention &
control - Laboratory Infection/transmission - Laboratory Personnel*/education - Laboratory
Personnel*/psychology - Lebanon/epidemiology - Medical Waste Disposal/standards - Occupational
Health - Organizational Policy - Practice Guidelines* - Protective Clothing/utilization - Questionnaires Research Support, Non-U.S. Gov't - Sampling Studies - Universal Precautions* Workplace/organization & administration - Workplace/psychology - Substances: Medical Waste
Disposal
5. Infections nosocomiales
Hygiènes, Vol.13, n 6, 12/2005
Numéro thématique : Infections nosocomiales virales.
AHO-GLELE (L.S.), LEJEUNE (B.)
Au sommaire de ce numéro thématique d' "Hygiènes" consacré aux infections nosocomiales virales : Infections nosocomiales virales : un sujet qui reste d'actualité (réf.
NosoBase 16645) - Importance croissante de virus comme pathogènes nosocomiaux et méthodes
pour la maîtrise environnementale (réf.
NosoBase 16646) - Infections nosocomiales à rotavirus (réf.
NosoBase 16647) - Infections nosocomiales à coronavirus humains chez l'enfant (réf.
NosoBase 16649) - Infections dues au Virus Respiratoire Synctial (réf.
NosoBase 16650) - Infections dues au virus de la varicelle et du zona et leur prévention (réf.
NosoBase 16651) - Transmissions nosocomiales de l'hépatite C de patient à patient, liées à
l'anesthésie générale dans l'inter-région Nord en 2001-2002 (réf.
NosoBase 16652) - Infection grippale et à virus respiratoire cyncytial chez les sujets âgés vivant en
institution (réf.
NosoBase 16653) - Isolement et infections nosocomiales virales (réf.
NosoBase 16654) - Activité virucide des antiseptiques et désinfectants (réf.
NosoBase 16655) - Chimioprophylaxie des infections nosocomiales virales (réf.
NosoBase 16656) - Infections nosocomiales virales : augmentation de la durée de séjour et impact
économique (réf.
8
NosoBase 16657).
Mots-clés BDSP : Infection, Virus, Prévention, Infection nosocomiale, Hygiène hospitalière
In Revue du cadre de santé, 2006 - Numéro 24 - pp: 26...
Risque infectieux et protection respiratoire
C. Moesh, A. Menudier
Les maladies infectieuses sont au premier plan des préoccupations de santé publique en France
comme dans la plupart des pays, tant dans le cadre de la lutte contre les infections nosocomiales que
de l'élaboration de programmes de prévention et de protection des personnels de santé, que de la
qualité des soins aux patients.
6. Risques biologiques
In Premières Informations Premières Synthèses, Juin 2006 - N 26.1
Expositions aux agents biologiques dans le milieu de travail en 2003 (Les)
DARES
2,6 millions de personnes, soit 15 % des salariés, exercent des activités professionnelles pouvant les
exposer à des agents biologiques. Seuls certains de ces agents biologiques sont pathogènes ou
peuvent le devenir dans des circonstances particulières.54 % des salariés exposés le sont du fait de
contacts avec des agents biologiques d'origine humaine, 8 % parce qu'ils sont en contact avec des
animaux et 23 % parce qu'ils travaillent à des activités comme l'assainissement ou la manipulation de
déchets ou de produits alimentaires.
Plus de la moitié des salariés potentiellement exposés aux agents biologiques appartiennent au
secteur « santé-action sociale ». Dans ce secteur, 66 % des salariés sont exposés. D'autres secteurs
exposent également une fraction non négligeable de leurs salariés : l'agriculture (33 %), les industries
agricoles et alimentaires (31 %), les services personnels et domestiques (27 %) et la recherche et
développement (24 %). Ces activités recouvrent cependant des expositions d'intensité très variable à
une vaste famille d'agents biologiques présentant différents types de dangers, dont la plupart sont peu
importants
rapport
Accès à la version intégrale : http://www.travail.gouv.fr/IMG/pdf/2006.06-26.1.pdf
In DMT (Documents pour le Médecin du Travail), n 106, 2ième trimestre 2006
Influenza aviaire, grippe aviaire et menace de pandémie : un nouvel enjeu en santé au travail.
LE BACLE C., DUCLOVEL-PAME N., DURAND E.
"Ce dossier médico-technique, construit en 5 parties, propose un état des lieux sur les virus influenza,
l'influenza aviaire, la grippe saisonnière, la grippe aviaire et le risque de pandémie grippale. Il aborde
également la question du risque de grippe aviaire chez les professionnels exposés. Les mesures de
prévention qui seraient à mettre en place en fonction de chaque situation sont abordées.
L'annexe résume les princiaples recommandations élaborées par le ministère de la Santé pour les
établissements hospitaliers."
Article de péiodique
Accès à la version intégrale : http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObjectaccesParReference/TC%20107/$File/TC107.pdf
9
Obstet Gynecol. 2006 May;107(5):1207-8.
ACOG Committee Opinion. Number 332, May 2006 (replaces No. 203, July 1998): Hepatitis B
and hepatitis C virus infections in obstetrician-gynecologists.
Committee on Gynecologic Practice, ACOG.
Hepatitis B and hepatitis C may be transmitted form patients to health care workers and from health
care workers to patients. To reduce the risk, all obstetrician-gynecologists who provide clinical care
should receive hepatitis B virus vaccine. Obstetrician-gynecologists who are hepatitis B surface
antigen positive and e antigen positive should not perform exposure prone procedures until they have
sought counsel from an expert review panel. Because the risk of hepatitis C virus transmission is lower
than that of hepatitis B virus transmission, routine testing of health care workers is not recommended,
and hepatitis C virus-positive health care workers are not required to restrict professional activities.
MeSH Terms: Disease Transmission, Patient-to-Professional/prevention & control* - Disease
Transmission, Professional-to-Patient/prevention & control* - Gynecology* - Hepatitis B/diagnosis Hepatitis B/prevention & control - Hepatitis B/transmission* - Hepatitis C/diagnosis - Hepatitis
C/prevention & control - Hepatitis C/transmission* - Humans - Obstetrics*
Eur Respir J. 2006 Jun 28; [Epub ahead of print]
Health care workers with tuberculosis infected during work in the Netherlands.
de Vries G, Sebek MM, Lambregts-van Weezenbeek CS.
Public Health Service Rotterdam, The Netherlands.
The risk of health care workers (HCWs) for tuberculosis (TB) attributable to occupational exposure is
difficult to determine as well as the conditions contributing to this risk. The objective of the study was
to determine which tuberculosis (TB) cases among health care workers (HCWs) in the Netherlands
were infected during work and to analyse factors that contributed to infection and subsequent
disease.The total study population consisted of 101 cases over a five-year period. In 67 (66%) the
route of infection could be determined by epidemiological and microbiological information. Of these
cases, 42% (28/67) were due to infection at work in the Netherlands, 28% (19/67) community acquired
and 30% (20/67) infected abroad.The 28 cases infected at work were subject to an in depth analysis.
Delayed diagnosis of the index case, especially in the elderly patient, was the main cause of patientto-HCW transmission; in some circumstances inadequate infection control measures contributed to
transmission.A high suspicion of TB by the clinician, adequate infection control measures by hospital
authorities and early identification of latent TB infection by occupational and public health specialists
are relevant to prevent tuberculosis among health care workers.
Can J Anaesth. 2006 Feb;53(2):122-9.
Intubation of SARS patients: infection and perspectives of healthcare workers.
Caputo KM, Byrick R, Chapman MG, Orser BJ, Orser BA.
Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
PURPOSE: The ou tbreak of severe acute respiratory syndrome (SARS) in 2003 presented major
challenges to the safety of anesthesiologists and other healthcare workers (HCWs). This study
determined the incidence of SARS transmission to HCWs who intubated patients and analyzed the
concerns of HCWs regarding personal and patient safety. METHODS: Healthcare workers who
performed tracheal intubation in 10 Toronto hospitals were identified using the Ontario Public Health
database. A questionnaire was used to collect information from the HCWs. To determine if the
patterns of personal protection or concerns changed over time, data were analyzed according to
whether the intubation occurred during SARS 1 (February 23 to April 21) or SARS 2 (April 22 to July
1). RESULTS: Thirty-three HCWs who performed 39 intubations on 35 SARS patients were
interviewed. Three of 23 HCWs (13%) acquired SARS during SARS 1 whereas none (0/10) acquired
SARS during SARS 2. Personal protection increased from SARS 1 to SARS 2 and HCWs' concerns
changed over time. During SARS 1, concerns focused on the need for personal protective equipment
whereas during SARS 2, concerns focused on the need for strict training and patient care protocols.
HCWs perceived that their experiences were ineffectively integrated into risk management protocols.
CONCLUSIONS: Protection guidelines failed to completely prevent the transmission of SARS to
HCWs. Nine percent of the interviewed HCWs who intubated patients contracted SARS. A Risk
Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice
guidelines.
MeSH Terms: Adult - Aged - Aged, 80 and over - Disease Outbreaks - Disease Transmission, Patientto-Professional/prevention & control* - Humans - Intubation, Intratracheal* - Middle Aged Ontario/epidemiology - Protective Devices - Research Support, Non-U.S. Gov't - Severe Acute
Respiratory Syndrome/epidemiology - Severe Acute Respiratory Syndrome/prevention & control* Severe Acute Respiratory Syndrome/therapy - Severe Acute Respiratory Syndrome/transmission*
10
6.1 Accident d'exposition au sang
Maîtrise des sciences sanitaires et sociales, option cadres experts en soins, 09/2005
Connaissances et comportements des infirmières face au risque de piqûre ; influence de la
perception du risque.
NION (Nathalie), ASTAGNEAU (Pascal) / dir.
Université de Paris 13 Paris Nord. Paris. FRA / com., Assistance publique-Hôpitaux de Paris.
(A.P.H.P.). Institut d'enseignement supérieur de cadres hospitaliers. (I.E.S.C.H.). Paris. FRA / com.
Les accidents exposant au sang et liquides biologiques, communément dénommés AES par les
professionnels hospitaliers représentent encore aujourd'hui une part importante des accidents à
l'hôpital.
Cette étude a pour objet de repérer les facteurs influençant le risque dans ce domaine et de proposer
des axes d'orientation pour améliorer la prévention de ce risque.
L'enquête concerne des professionnels infirmiers d'un Centre Hospitalo-Universitaire parisien.
Une évaluation de la "criticité ressentie" pour 17 gestes à risque a été calculée à partir de grilles
d'évaluation risque/fréquence remplies par les soignants interrogés.
En conclusion, la gestion des risques à l'hôpital suppose une prise en compte des croyances et
perceptions des individus.
Une réflexion concernant l'intégration de ces dimensions dans les projets d'actions est aujourd'hui
engagée dans les institutions. (Extrait du R.A.).
Mots-clés BDSP : Risque professionnel, Prévention, Evaluation, Soins infirmiers, Gestion risque,
Exposition sang
Je porte des gants pour ne pas me faire de mauvais sang.
BINEAU NAVARRE (Sylvie), MUNDVILLER (Sylvie) / dir.
Les accidents par exposition au sang touchent toutes les catégories de personnel soignant mais plus
spécialement les infirmières.
Une non observance des précautions standard est souvent à l'origine de ces accidents et parmi elles,
le non respect du port de gants.
L'objet de cette étude est de s'intéresser aux raisons qui poussent une infirmière à piquer sans gants
dans le cas de prélèvements sanguins et plus particulièrement si le risque d'exposition par contact est
sous-estimé vis-à-vis du risque de piqûre.
Le rôle du cadre en matière de gestion des risques et garant de la sécurité sanitaire apportée aux
patients est primordial.
Il se révèle essentiel en matière de dynamique d'équipe et de réflexion autour des soins pour amener
à une sensibilisation et une vigilance de l'équipe face au risque de banalisation du soin et des risques
inhérents. (Extrait du R.A.).
Mots-clés BDSP : Risque professionnel, Prévention, Protection, Soins infirmiers, Exposition sang
Dermatol Surg. 2006 May;32(5):717-20.
Combination forceps fuse both safety and efficiency.
Henry LB, Pellowski DM, Davis DA.
Department of Dermatology, University of Arkansas, Little Rock, Arkansas 52206, USA.
BACKGROUND: Instrumentation prevents needle stick injury. OBJECTIVE: To review forceps that
insure safety and facilitate tissue-handling and knot-tying efficiency. METHOD: Medical literature
reports were reviewed using Ovid. Commercially available instruments were qualitatively tested.
RESULTS: Suture platforms securely hold suture needles and can be used during knot tying. A wide
range of combination forceps have been invented and can be broadly categorized as either skin hook
or toothed combination forceps. CONCLUSIONS: Combination forceps fuse both efficiency and safety.
Skin hook forceps may eventually be the optimal combination instrument, but toothed combination
forceps are recommended.
MeSH Terms: Equipment Design - Humans - Needlestick Injuries/prevention & control* - Suture
Techniques/instrumentation*
11
J Hosp Infect. 2006 Jun 12; [Epub ahead of print]
Potential for reported needlestick injury prevention among healthcare workers through safety
device usage and improvement of guideline adherence: expert panel assessment.
Cullen BL, Genasi F, Symington I, Bagg J, McCreaddie M, Taylor A, Henry M, Hutchinson SJ,
Goldberg DJ.
Health Protection Scotland, Glasgow, UK.
A prospective survey was conducted over six months in order to estimate the proportion of reported
occupational needlestick injuries sustained by National Health Service (NHS) Scotland staff that could
have been prevented through either safety device introduction, improved guideline adherence,
guideline revision or a combination of these. This survey involved the administration of a standard
proforma to healthcare workers followed by an expert panel assessment. All acute and primary care
NHS Scotland trusts, the Scottish Ambulance Service and the Scottish National Blood Transfusion
Service were included. Proforma and expert panel assessment data were available for 64% of injuries
(952/1497) reported by healthcare staff. These injuries were all percutaneous. The expert panel
concluded that: 56% of all injuries and 80% of venepuncture/injection administration injuries would
probably/definitely have been prevented through safety device usage, 52% of all injuries and 56% of
venepuncture/injection administration injuries would probably/definitely have been prevented through
guideline adherence and 72% of all injuries and 88% of venepuncture/injection administration injuries
would probably/definitely have been prevented through either intervention. Multi-factorial analysis
indicated that injuries sustained through venepuncture/injection administration were significantly more
likely to be prevented through safety device usage [adjusted odds ratio (OR) 5.09, 95% confidence
intervals (CI) 3.11-8.31 and adjusted OR 2.70, 95% CI 1.64-4.45, respectively], and significantly less
likely to be prevented through guideline adherence (adjusted OR 0.26, 95% CI 0.11-0.60 and adjusted
OR 0.31, 95% CI 0.12-0.78, respectively). Injuries sustained after completing procedures were
significantly more likely to be prevented through safety device usage and guideline adherence. The
study's findings support the need for improvements to staff's adherence to needlestick injury
guidelines and appropriate implementation of safety devices for venepuncture and injection
administration.
6.2 Contamination soignant-soigné
In Bulletin du CCLIN Paris-Nord n 28, juin 2006
Gestion de l'information des patients exposés à un soignant tuberculeux
Expérience du Centre Hospitalier Victor Dupouy d’Argenteuil
Dr Thenault (Argenteuil, Service des actions de santé du Val d'Oise), Dr May-Michelangeli (EOH
d’Argenteuil)
"A l'occasion de la découverte d'un cas de tuberculose bacillifère chez un membre du personnel
soignant du Centre Hospitalier d'Argenteuil (CHA), une enquête de prophylaxie a été organisée autour
du cas index. S'est posé alors le problème du plan de communication. Qui informer ? Par quel canal ?
Quel contenu ?
Accès au texte intégral à partir de : http://www.cclinparisnord.org/Bulletin/Bulletin.html (voir n 28)
Information des patients exposés à un risque viral hématogène
Présentation du guide
Karin Lebascle, Anne Carbonne, Gilles Antoniotti pour le groupe de travail*
"La transmission nosocomiale des virus hématogènes (hépatite B, hépatite C et plus rarement VIH)
lors des soins, en dehors de la transfusion et de la greffe d'organe, est maintenant bien établie. Dans
la plupart des cas, le non-respect des règles d'hygiène en est à l'origine et est susceptible d'exposer
d’autres patients. Un guide méthodologique
a été réalisé afin d'aider les professionnels à informer au mieux les patients exposés à ce risque viral."
Accès au texte intégral à partir de : http://www.cclinparisnord.org/Bulletin/Bulletin.html (voir n 28)
12
Arch Virol. 2006 May;151(5):1025-30. Epub 2005 Dec 9.
Nosocomial transmission of hepatitis C virus from an anesthesiologist to three patients-epidemiologic and molecular evidence.
Stark K, Hanel M, Berg T , Schreier E.
Robert Koch-Institut Berlin, Berlin, Germany. [email protected]
Acute hepatitis C occurred in three patients who had undergone gynecologic surgery in an outpatient
clinic on a single day. Epidemiologic and virologic investigations revealed virus transmission from an
anesthesiologist with chronic hepatitis C. HCV sequencing demonstrated that all four persons were
infected by the same strain. The precise mode of transmission could not be elucidated but hygienic
standards had been severely neglected.
MeSH Terms: Adult - Anesthesiology - Base Sequence - Cross Infection/transmission* - Cross
Infection/virology - Disease Transmission, Professional-to-Patient* - Epidemiology, Molecular - Female
- Hepacivirus/classification - Hepacivirus/genetics - Hepacivirus/isolation & purification - Hepatitis
C/transmission* - Hepatitis C/virology - Humans - Middle Aged - Molecular Sequence Data Phylogeny - RNA, Viral/genetics - Research Support, Non-U.S. Gov't - Sequence Analysis, DNA Sequence Homology
Substances: RNA, Viral
Publication Types: Case Reports
6.3 Transmission aérienne
6.4 Transmission de contact
Gestion d'une épidémie de gale à la maison de retraite de Hirson mai - juin 2005
B. Dieusaert, D. Massenet, D. Moreau, A. Brenet, Y. Cren, M. Juillard, Z. Kadi, J-F. Mees, M.
Tatinclaux
"La gale est une affection que la mémoire collective rattache à la seconde guerre mondiale, à la
promiscuité et la mauvaise hygiène. Cependant les cas sporadiques en médecine de ville et les
épidémies en établissement de soins ou en résidence semblent en recrudescence au niveau national
et régional , comme en témoigne cet épisode
survenu à la maison de retraite de Hirson."
texte intégral à partie de : http://www.cclinparisnord.org/Bulletin/Bulletin.html (voir le n 28)
6.5 Vaccination
Ministère de la Santé et des Solidarités, Conseil Supérieur d'Hygiène Publique, section des maladies
transmissibles, 19 mai 2006
Avis du 19 mai 2006 relatif à la mise en oeuvre de la protection individuelle contre la grippe des
professionnels visés à l'article L 3111-4 du code de la santé publique par une obligation
vaccinale
recommandations concernant les obligations vaccinales des professionnels de santé en cas de grippe
saisonnière inter-pandémique et en cas de pandémie grippale confirmée
mots clés : épidémie ; exposition professionnelle ; facteur risque ; *grippe /prévention et contrôle ;
infection croisée /prévention et contrôle ; *personnel sanitaire ; saison ; *vaccination /législation et
jurisprudence ; vaccins antigrippaux
type : *recommandation professionnelle
http://www.sante.gouv.fr/htm/dossiers/cshpf/a_mt_190506_grippe_pro.pdf
13
J Hosp Infect. 2006 Jun;63(2):201-4. Epub 2006 Apr 18.
Coverage of hepatitis B vaccination in Swedish healthcare workers.
Dannetun E, Tegnell A, Torner A, Giesecke J.
Department of Communicable Disease Control, Landstinget i Ostergotland, Linkoping, Sweden;
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
The aim of this study was to assess how well the guidelines on vaccination against hepatitis B had
been implemented among healthcare workers (HCWs) at risk for blood exposure. A point-prevalence
survey was conducted in six departments of a university hospital in Sweden: the emergency room,
intensive care unit, postoperative unit, surgical theatre, department of anaesthesiology and the
laboratory for blood chemistry. All HCWs who worked in these departments during the 24h of the
survey were asked to complete a questionnaire. In total, 369 questionnaires were analysed. Seventynine percent (293/369) of HCWs had received at least one dose of vaccine, but only 40% (147/369)
reported that they were fully vaccinated and 21% (76/369) had not been vaccinated at all. The majority
of unvaccinated HCWs (72/76, 95%) stated that they would accept vaccination if offered. The main
barrier to better compliance with the guidelines is not lack of acceptance among the employees but the
failure of the employer to ensure that policies are implemented.
Infection. 2006 Jun;34(3):135-41.
Influenza Vaccination Coverages among Spanish Children, Adults and Health Care Workers.
Jimenez-Garcia R, Hernandez-Barrera V, Carrasco-Garrido P, Sierra-Moros MJ, Martinez-Hernandez
D, de Miguel AG.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey
Juan Carlos University, Alcorcon, Madrid, Spain.
BACKGROUND: This study aimed at describing influenza vaccination coverage among Spanish
children, adults and health care workers (HCWs). PATIENTS AND METHODS: We analyzed 27,791
questionnaires on subjects aged 6 months or over, drawn from the 2003 Spanish National Health
Survey. As the dependent variable, we took the answer to the question, "Did you (or your child) have a
flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation
(HCWs) and coexistence of chronic conditions. RESULTS: Overall influenza vaccination coverage for
the total sample was 19.58%. Coverage for the pediatric population was 5.55%, with 20.74% of those
with and 4.67% of those without chronic condition being vaccinated. Vaccination coverages were:
63.7% among subjects aged >/= 65 years; 30.5% among high-risk subjects aged < 65 years; and
19.65% among HCWs. CONCLUSIONS: We conclude that the available results show low levels of
influenza vaccination coverage among high-risk subjects aged under 65 years, children in particular,
and HCWs.
Infection. 2006 Jun;34(3):142-147.
Influenza Vaccination of Healthcare Workers: a Literature Review of Attitudes and Beliefs.
Hofmann F, Ferracin C, Marsh G, Dumas R.
Bergische Universitat Wuppertal, Fachbereich D-Abteilung Sicherheitstechnik, FG Arbeitsphysiologie,
Arbeitsmedizin und Infektionsschutz, Gaussstr. 20, 42097, Wuppertal, Germany, [email protected].
BACKGROUND: Influenza vaccination coverage among healthcare workers (HCW) is insufficient
despite health authority recommendations in many countries. Numerous vaccination campaigns
encouraging HCW to be vaccinated have met with resistance. We reviewed published influenza
vaccination programs in healthcare settings to understand the reasons for their success and failure, as
well as the attitudes and beliefs of HCW. METHODS: Relevant articles published up to June 2004
were identified in the MEDLINE/Pubmed database. RESULTS: Thirty-two studies performed between
1985 and 2002 reported vaccination rates of 2.1-82%. Vaccination campaigns including easy access
to free vaccine and an educational program tended to obtain the highest uptake, particularly in the
USA. Yet, even this type of campaign was not always successful. Two main barriers to satisfactory
vaccine uptake were consistently reported: (1) misperception of influenza, its risks, the role of HCW in
its transmission to patients, and the importance and risks of vaccination (2) lack of (or perceived lack
of) conveniently available vaccine. CONCLUSION: To overcome these barriers and increase uptake,
vaccination campaigns must be carefully designed and implemented taking account of the specific
needs at each healthcare institution.
14
7. Risques chimiques
GESTIONS HOSPITALIERES, vol. 453, p.117-121, tabl., graph., réf.bibl. 02/2006
Cahier n 197 - Pharmacie hospitalière.
Anticancéreux en unité de soins. Perception du risque par les infirmières.
PLARD (Christine), JOLY (Anne-Christine), TILLEUL (Patrick), PRUGNAUD (Jean-Louis), ALLOUCH
(Lydia)
Une bonne connaissance de la toxicité des produits et des pratiques permet en général de prendre les
mesures adéquates à une situation potentiellement à risque.
Cela est d'autant plus vrai pour les infirmières qui manipulent des chimiothérapies.
Pour connaître leur perception du risque "anticancéreux" et leur point de vue sur la centralisation,
dans l'optique de la généralisation de cette mesure collective de sécurisation des pratiques, un
questionnaire a été conçu et diffusé aux services concernés par la mise en oeuvre des
chimiothérapies.
Si les infirmières ont une bonne perception du risque "anticancéreux", des progrès peuvent être
apportés pour améliorer les connaissances en termes de pratiques quotidiennes et à la mise à
disposition d'informations pertinentes sur les mesures sécuritaires et les protocoles médicaux.
Hôpital, Centre anti cancéreux, Soins infirmiers, Pratique médicale, Médicament anticancéreux,
Infirmier, Risque professionnel, Information, Protection, Facteur risque, Enquête, Evaluation, Donnée
statistique, France, Chimiothérapie
Ind Health. 2006 Apr;44(2):225-9.
Indoor glutaraldehyde levels in the endoscope disinfecting room and subjective symptoms
among workers.
Katagiri H, Suzuki T, Aizawa Y, Kadowaki T.
Department of Public Health, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato,
Sagamihara 228-8555, Japan.
We measured the environmental glutaraldehyde (GA) levels during the disinfection of endoscopes and
also investigated the subjective symptoms of the workers engaged in that work. At 6 hospitals in the
Tokyo and Kanagawa area, 8 rooms for endoscope washing and disinfecting the endoscopy
equipment were surveyed. The geometric mean environmental GA levels in the 8 rooms were 1.3 to
19.6 ppb. The personal exposure levels at the time of replacing the antiseptic solution containing GA
in two of the disinfecting rooms were 94.2 and 84.9 ppb. Subjective symptoms such as ophthalmic,
nasal, respiratory, pharyngeal symptoms and nausea were more prevalent among workers than
controls as evidenced from the questionnaire survey.
MeSH Terms: Adult - Air Pollutants - Disinfection - Endoscopes* - Female - Glutaral/analysis* Humans - Japan - Middle Aged - Occupational Exposure - Personnel, Hospital*
Substances: - Air Pollutants - Glutaral
Food Chem Toxicol. 2006 Mar 29; [Epub ahead of print]
Sevoflurane-induced oxidative stress and cellular injury in human peripheral
polymorphonuclear neutrophils.
Wong CH, Liu TZ, Chye SM, Lu FJ, Liu YC, Lin ZC, Chen CH.
Department of Anesthesiology, Chang Gung Memorial Hospital at ChiaYi, and ChiaYi School, Chang
Gung Institute of Technology, Puzih City, ChiaYi County 613, Taiwan, ROC.
Sevoflurane is an inhalation anesthetic used for general anesthesia. Several studies have
demonstrated that reactive oxygen species (ROS) exist in cardioprotection when preconditioned with
sevoflurane. Moreover, sevoflurane can also directly trigger the formation of peroxynitrite. Up to now,
information pertinent to the effect of sevoflurane on cellular injuries in human polymorphonuclear
neutrophils (PMN) is scant. In this study, we demonstrated that sevoflurane significantly increases
intracellular H(2)O(2) and/or peroxide, superoxide, and nitric oxide (NO) in PMN within 1h treatment.
Intensification of intracellular glutathione (GSH) depletion in PMN has been demonstrated with the
presence of sevoflurane. Inhibition of sevoflurane-mediated intracellular H(2)O(2) and/or peroxide in
PMN by catalase, mannitol, dexamethasone, N-acetylcysteine (NAC) and trolox, but not superoxide
dismutase (SOD) pretreatment, was observed. Among them, catalase has the best effect scavenging
intracellular H(2)O(2) and/or peroxide, suggesting that H(2)O(2) is the major ROS during sevoflurane
treatment. Two apoptotic critical factors-lowering of the mitochondrial transmembrane potential
15
(DeltaPsi(m)) and activation of caspase 3/7-were significantly increased after 1h of sevoflurane
treatment. Apoptosis of PMN were determined by comet assay and flow cytometric analysis of annexin
V-FITV protein binding to the cell surface. Exposure of PMN to sevoflurane markedly increased
apoptosis in a dose-dependent manner. In summary, these results are important for demonstrating the
oxidative stress and cellular injury on sevoflurane-treated human PMN.
Gastroenterol Nurs. 2006 Mar-Apr;29(2):100-4.
Worker safety and glutaraldehyde in the gastrointestinal lab environment.
Cohen NL, Patton CM.
GI Lab, UPMC Presbyterian Shadyside, Pittsburgh, Pennsylvania 15232, USA. [email protected]
Glutaraldehyde is considered a high-level surgical disinfectant commonly used in the United States in
gastrointestinal lab environments. Glutaraldehyde requires proper ventilation when used as
glutaraldehyde vapors are known irritants to the skin, eyes, nose, and lungs without proper ventilation
in the work environment.Vapor concentration is the unit of measurement for the environmental
presence of glutaraldehyde. Safe levels of glutaraldehyde vapor concentrations are a significant issue
in the work environment. The American Conference of Governmental Hygienists has established and
reported safe and allowable limits for vapor concentration of glutaraldehyde. Unfortunately,
uncontrolled glutaraldehyde exposure in selected work environments is contributing to occupational
asthma. Environmental exposure to glutaraldehyde has been linked to respiratory sensitization of the
workers exposed and suggests the need for safe work environments anywhere glutaraldehyde is in
use.Gastrointestinal labs use high-level disinfectants like glutaraldehyde to safely and thoroughly
disinfect endoscopic instruments and accessories; however, there are worker-safety considerations
relevant to glutaraldehyde use. The purpose of this article is to identify and describe clinical issues and
challenges associated with worker safety and proper ventilation of glutaraldehyde in a gastrointestinal
environment. A multidisciplinary problem-solving approach for use in identification and intervention for
glutaraldehyde exposure and safety recommendations related to glutaraldehyde use as a high-level
disinfectant in one gastroenterology lab environment will be highlighted.
MeSH Terms: Air Pollutants, Occupational/adverse effects - Air Pollution, Indoor/adverse effects - Air
Pollution, Indoor/prevention & control - Asthma/chemically induced - Asthma/prevention & control Disinfectants/adverse effects* - Gastroenterology* - Glutaral/adverse effects* - Health Personnel* Health Promotion/organization & administration - Humans - Inhalation Exposure/adverse effects Inhalation Exposure/prevention & control* - Leadership - Maximum Allowable Concentration - Nurse
Administrators/organization & administration - Nurse Administrators/psychology - Nurse's Role Occupational Diseases/chemically induced - Occupational Diseases/prevention & control Occupational Exposure/adverse effects - Occupational Exposure/prevention & control* - Occupational
Health - Patient Care Team/organization & administration - Safety Management/organization &
administration – Ventilation
Substances: Air Pollutants, Occupational - Disinfectants - Glutaral
8. Risques physiques
8.1 Rayonnements ionisants
J.O n 137 du 15 juin 2006 page 9001, texte n 8
Arrêté du 15 mai 2006 relatif aux conditions de délimitation et de signalisation des zones
surveillées et contrôlées et des zones spécialement réglementées ou interdites
compte tenu de l'exposition aux rayonnements ionisants, ainsi qu'aux règles d'hygiène, de sécurité et
d'entretien qui y sont imposées
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SOCT0611077A
In HESA Newsletter, mars 2006, n 29
Effets sur la santé de faibles doses de radiations ionisantes
Nouveaus résultats épidémiologiques et perspectives
Gilbert Eggermont, Louis de Saint-Georges, Hans Vanmarcke
16
Radiat Prot Dosimetry. 2005;117(4):440-3. Epub 2005 Jun 14.
Occupational exposures of Chinese medical radiation workers in 1986-2000.
Weizhang W, Wenyi Z, Ronglin C, Liang'an Z.
Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical
College, Tianjin 300192, People's Republic of China.
Data on occupational exposures from medical uses of radiation in China during 1986-2000 are
presented. Individual dose monitoring results in the reports of monitoring centres in different provinces
in China during 1986-2000 were collected as the basic data. These data were summarised and then
analysed. From 1986 to 2000, in diagnostic radiology, nuclear medicine and radiotherapy, the annual
collective effective doses varied within the range 122.4-206.6, 5.4-9.3 and 4.1-10.3 man Sv,
respectively; the average annual effective dose in these categories varied within the range 1.5-2.2,
1.2-1.6 and 1.0-1.5 mSv, respectively. Almost all the average annual effective doses in medical uses
of radiation were <3 mSv in 1986-2000, and no monitored workers were found to have received an
occupational exposure >50 mSv in a single year or >100 mSv in a 5-y period. After 1990, the
protection status of medical radiation workers in China was sufficient.
MeSH Terms: China - Health Personnel* - Humans - Occupational Exposure* - Radiation Dosage Radiology* - Thermoluminescent Dosimetry
Br J Radiol. 2006 May;79(941):383-8.
Occupational radiation doses in interventional cardiology: a 15-year follow-up.
Vano E, Gonzalez L, Fernandez JM, Alfonso F, Macaya C.
Department of Radiology, Complutense University Medical School 28040 Madrid, Spain.
This report describes occupational radiation doses of interventional cardiologists over 15 years and
assesses action undertaken to optimize radiation protection. Personal dosimetry records of nine staff
cardiologists and eight interventional cardiology fellows were recorded using personal dosemeters
worn over and under their lead aprons. The hospital in which this study was conducted currently
performs 5000 cardiology procedures per year. The hospital has improved its facilities since 1989,
when it had two old-fashioned theatres, to include four rooms with more advanced and safer
equipment. Intensive radiation protection training was also implemented since 1989. Initially, some
individual dose values in the range of 100-300 mSv month(-1), which risked exceeding some
regulatory dose limits, were measured over the lead apron. Several doses in the range of 5-11 mSv
month(-1) were recorded under the apron (mean = 10.2 mSv year(-1)). During the last 5 years of the
study, after the implementation of the radiation protection actions and a programme of patient-dose
optimization, the mean dose under the apron was reduced to 1.2 mSv year(-1). Current mean
occupational doses recorded under the lead apron are 14% of those recorded during 1989-1992 and
those recorded over the apron are 14-fold less than those recorded during 1989-1992. The regulatory
dose limits and the threshold for lens injuries might have been exceeded if radiation protection
facilities had not been used systematically. The most effective actions involved in reducing the
radiation risk were training in radiation protection, a programme of patient-dose reduction and the
systematic use of radiation protection facilities, specifically ceiling-suspended protective screens.
MeSH Terms: Body Burden - Cardiology* - Education, Medical, Continuing - Follow-Up Studies Hospitals, University - Humans - Occupational Exposure* - Protective Clothing - Radiation Dosage Radiation Protection/methods - Radiology, Interventional* - Radiometry/instrumentation Radiometry/methods - Research Support, Non-U.S. Gov't
Radiat Prot Dosimetry. 2005;117(1-3):30-3. Epub 2006 Feb 3.
Personnel and patient doses: are there ethical consequences to the use of X-rays?
Faulkner K.
Quality Assurance Reference Centre, Unit 9 Kingfisher Way, Wallsend, Tyne and Wear, NE28 9ND,
UK. [email protected]
Interventional cardiology has witnessed a period of great technological change. The introduction of
new dedicated cardiology X-ray equipment, as well as advances in catheter and stent design, has
revolutionised clinical practice in cardiology. As a consequence, the number, range and complexity of
procedures have increased. This has meant that patients can be treated as outpatients without
requiring hospitalisation for surgery. The public are aware of these benefits and demand greater
access. However, these changes have had an impact on patient and staff doses and these are
reviewed. Simple approaches to dose reduction for patients and staff are illustrated. There are a
number of ethical issues concerning both patients and staff. For patients, these are related to informed
consent. For staff, the ethical issues are associated with dose control. These issues will be discussed.
MeSH Terms: Angioplasty, Transluminal, Percutaneous Coronary/methods - Cardiology/methods* Ethics, Medical - Health Personnel - Heart/radiography - Humans - Informed Consent - Occupational
17
Exposure* - Radiation Dosage - Radiation Protection - Radiometry - Research Subjects - Risk
Assessment - X-Rays*
8.2 Troubles musculo-squelettiques
In Objectif prévention, Volume 29 - no 3 - Juin 2006
Bas-Saint-Laurent, très actif en prévention des lésions (Le)
Yves Cormier
Nous vous présentons un bref aperçu des stratégies et des actions régionales mises en place par les
établissements du Bas-Saint-Laurent pour contrer les lésions attribuables à la mobilisation lourde des
clients.
Accès à la version intégrale : http://www.asstsas.qc.ca/documentation/op/op293014.pdf
PERFORMANCES, vol.26, 01-02 2006
Dossier - Santé et emploi. Dos et travail.
GARNIER DAUJARD (Eliane)
Le 2ème Forum Maintien dans l'Emploi, organisé le 26 avril 2005 à l'Espace Culturel "Le Forum" à
Chauny par les membres de la Commission "Maintien dans l'Emploi" du Programme Départemental
d'Insertion des Travailleurs Handicapés de l'Aisne (P.D.I.T.H.), a été consacré cette année au sujet
"Dos et Travail".
Ce Forum s'adressait aux partenaires des champs professionnels (chargés de prévention, DRH,
infirmières...), médical (médecins du travail, médecins conseils...) et social (COTOREP, services
sociaux...).
Cette journée, très appréciée par l'ensemble des participants, a atteint son objectif principal.
Elle a réuni de nombreux acteurs de maintien dans l'emploi et leur a permis d'acquérir des
connaissances utiles pour leur pratique professionnelle.
Lors de cette journée, des documents ont été remis aux participants, dont le texte ci-dessous résume
l'intervention de son auteur.
Mots-clés BDSP Condition travail, Risque professionnel, Posture, Organisation travail, Organigramme,
Impact, Lombalgie, Médecin travail, France
Ergo coachs, des agents de suivi à la sauce hollandaise (Les)
Dr Hanneke Knibbe, Rose-Ange Proteau
En Hollande, la présence des Ergo coachs a eu un impact assez important sur la santé et la sécurité
des travailleurs pour devenir obligatoire en 2001.
In DMT (Documents pour le Médecin du Travail), n 106, 2ième trimestre 2006
Études d'intervention ergonomique chez les soignants
EVANOFF B.
"Cet article fait la synthèse d'un séminaire tenu à l'INSERM en mars 2005. Il traite des études
d'intervention ergonomique visant à la réduction des troubles musculosquelettiques (TMS) d'origine
professionnelle selon trois axes.
Le premier, consacré aux aspects méthodologiques de la conception d'études ergonomiques sur les
TMS, explique notamment pourquoi ces études sont à la fois primordiales et difficiles. Le deuxième
fournit des informations générales sur les soignants ; on s'interroge sur les taux très élevés
d'accidents au sein de cette population et sur le rôle éventuel des interventions eronomiques. Le
dernier axe est consacré à une présentation succincte d'études d'intervention ergonomique chez les
personnels soignants, menées par le groupe de recherche du Dr B. Evanoff à St Louis, Etats-Unis, en
particulier la mise en oeuvre de lève-malades."
Accès à la version intégrale : http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObjectaccesParReference/TF%20148/$File/TF148.pdf
18
Lever par contrepoids ou levier à station debout ?
Paula Pless
Malgré le risque élevé de blessure, tant pour les clients que pour les soignants, la manoeuvre de lever
par contrepoids est souvent utilisée dans les soins de longue durée pour déplacer des clients
incapables de supporter leur propre poids.
Pleins feux sur l'innovation
Les travailleurs du secteur de la santé et des services sociaux sont des innovateurs, des gens
ingénieux, conscients et responsables de leur santé-sécurité et de celles de leurs collègues.
Statistiques : les TMS , toujours le danger numéro 1 !
Marie Josée Robitaille
"La majorité des accidents du travail du secteur de la santé et des services sociaux surviennent au
personnel de soins. "
article de périodique
Texte intégral : http://www.asstsas.qc.ca/documentation/op/op293010.pdf
Tendance en Amérique du Nord (La) : zéro soulèvement manuel
Jocelyn Villeneuve
Les travailleurs de la santé, qu’ils soient du Québec, du Canada ou des États-Unis, viennent toujours
en tête de liste quant à la prévalence des maux de dos, tout secteur industriel confondu.
9. Violence
Mémoire ENSP de Directeur d'Hôpital, 147p., anne., réf. 4p., 2005
La sécurité des personnes et des biens à l'hôpital : une gestion de risques à part entière.
(Analyse développée à partir de l'exemple de l'hôpital Rothschild, AP-HP).
AMRI (Karim)
Ecole Nationale de la Santé Publique. (E.N.S.P.). Rennes. FRA / com.
L'hôpital qui est de plus en plus confronté à la violence de la société, ne trouve généralement pas les
réponses adaptées pour lutter contre ce phénomène.
Si l'évolution de la violence en général fait l'objet d'analyses et de recherches à partir de statistiques
tenues par le ministère de l'intérieur, force est de constater que la malveillance à l'hôpital ne peut
s'appuyer sur aucun système d'observation ni sur aucune donnée chiffrée globalisée.
En développant ainsi cette culture de recensement informatisé et en poussant à l'extrême les apports
de la mutualisation, il n'est pas exclut qu'on puisse voir un jour au sein du ministère une entité chargée
d'en faire la synthèse.
Dès lors et dans tous les cas, les hôpitaux devront faire face à ce type de risques ayant dépassés le
stade de l'épiphénomène lequel permettait d'en reporter le traitement sine die.
Par conséquent, il ne s'agit pas d'appliquer un modèle unique applicable à tous les établissements
mais bien d'adopter des outils et des protocoles préalables à toute politique de lutte contre l'insécurité
dans les hôpitaux.
Ainsi, développer une vision judicieuse et stratégique dans ce domaine, passant par la mise en place
d'une gestion de risques ad hoc, s'appuie bien sur un bilan coûts-avantages.
Celui-ci qui doit mesurer l'ensemble des fonctionnalités au regard des coûts d'investissement devra
néanmoins intégrer les externalités positives.
Le bien-être liée à la sécurité générale tant pour les patients que pour le personnel, rappelé par les
récentes mesures prises par les autorités de tutelle invitent le directeur d'hôpital à s'y inscrire en
associant l'ensemble des acteurs du monde hospitalier. (R.A.).
Mots-clés BDSP : Insécurité, Violence, Hôpital, Agressivité, Sociabilité, Risque professionnel, Prise de
19
risque, Condition travail, Relation soignant soigné, Délit, Prise charge, Audit, Sécurité, Enquête,
Directeur, Malade, Assistance publique de Paris, Analyse, France, Gestion risque, Management
participatif
Mémoire ENSP de Directeur d'Hôpital, 74p., ann., réf. 8p, 2005
Le harcèlement moral dans les Établissements Publics de Santé : comment gérer les plaintes ?
Éléments de réflexion et proposition d'action pour le Centre Hospitalier du Pays d'Aix.
LEMAIRE (Delphine)
Les Établissements Publics de Santé se trouvent aujourd'hui confrontés à une augmentation des
plaintes de harcèlement moral et, de façon plus globale, à une utilisation croissante de ce terme pour
qualifier les relations de travail.
La Loi de Modernisation sociale du 17 janvier 2002 a introduit le harcèlement moral dans le droit
français.
Les EPS ont donc une obligation de prévention et de protection de leurs agents contre ce nouveau
risque professionnel.
Or, le phénomène de harcèlement moral paraît toutefois difficile à saisir.
Les cas de harcèlement avéré sont peu nombreux au regard de la multiplication des plaintes.
Le harcèlement moral semble alors être symptomatique d'une société qui vit mal son rapport au
travail.
Il est de la responsabilité du Directeur d'Hôpital, en raison des enjeux soulevés, de l'importance du
phénomène, et de son rôle au sein de l'institution hospitalière, de déplacer le débat, dans son
établissement, du niveau individuel à celui du collectif de travail.
Cela lui permet d'agir sur la situation et de tenter d'assurer un climat social aussi serein que possible
afin de mettre en place les réformes politiques hospitalières actuelles.
Les éléments de réflexion présentés dans ce mémoire ont conduit à l'élaboration d'un plan d'action
proposé au Centre Hospitalier du Pays d'Aix.
Celui-ci constitue une façon d'aborder la problématique du harcèlement moral en fonction d'une
histoire et d'un contexte local particuliers. (R.A.).
Mots-clés BDSP : Hôpital public, Plainte, Condition travail, Souffrance, Travail, Risque professionnel,
Management, Plan directeur, Amélioration, France, Harcèlement moral, Etude faisabilité
Hong Kong Med J. 2006 Feb;12(1):6-9.
Prevalence of workplace violence against nurses in Hong Kong.
Kwok RP, Law YK, Li KE, Ng YC, Cheung MH, Fung VK, Kwok KT, Tong JM, Yen PF, Leung WC.
Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong.
OBJECTIVES: To determine the prevalence and nature of workplace violence against nurses, and
how nurses deal with such aggression; and to identify the risk factors related to violence in the hospital
environment. DESIGN: Cross-sectional questionnaire study. SETTING: University teaching hospital,
Hong Kong. PARTICIPANTS: All nursing staff in the hospital, except nurses who were unable to read
Chinese or who did not have patient contact (eg those worked in administrative positions), were invited
to complete a questionnaire. MAIN OUTCOME MEASURES: Demographic data of the respondents,
incidence of and risk factors contributing to workplace violence. RESULTS: A total of 420 nurses
returned the completed questionnaire (response rate, 25%). Three hundred and twenty (76%; 95%
confidence interval, 72-80%) nurses reported abuse of any kind--verbal abuse, 73%; bullying, 45%;
physical abuse, 18%; and sexual harassment, 12%. Most (82%) nurses who experienced verbal
abuse tended to confide in friends, family members, or colleagues. Some (42%) ignored the incident.
Risk factors for workplace violence included: working in male wards and in certain specialties such as
the Accident and Emergency Department, Community Nursing Service, and the Orthopaedics and
Traumatology Department. CONCLUSION: Workplace violence against nurses is a significant problem
in Hong Kong. Further large-scale studies should be conducted to more closely examine the problem.
MeSH Terms: Adaptation, Psychological - Cross-Sectional Studies - Female - Hong
Kong/epidemiology - Hospitals, University - Humans - Interprofessional Relations - Male - Nursing
Staff, Hospital* - Occupational Health* - Prevalence - Professional-Family Relations - Questionnaires Risk Factors - Sex Factors - Specialties, Nursing - Violence/statistics & numerical data* - Workplace
20
10. Autres
Mémoire ENSP de Directeur d'Hôpital, 85p., ann., réf. 13p., 2005
D'une obligation réglementaire à la mise en place d'une dynamique d'établissement. L'exemple
de la rédaction du document unique relatif aux risques professionnels au Centre Hospitalier
d'Armentières.
SOUPLET (Isabelle)
Le caractère risqué du travail reconnu, les pouvoirs publics ont constamment amélioré les systèmes
de réparation existants et accru leurs exigences envers l'employeur en matière de gestion de risques.
Omettre celle-ci, c'est désormais s'exposer à voir sa faute inexcusable, voire sa responsabilité pénale,
reconnue.
Sous l'impulsion du droit communautaire, a été imposée la rédaction d'un document unique, exhaustif
recensant tous les risques.
Cependant, concrètement, quel intérêt un directeur d'hôpital peut-il avoir à lancer un tel chantier ?
Comment rédiger un document opérationnel dans un établissement qui regroupe une centaine de
profession ? Au Centre Hospitalier d'Armentières, la démarche, a été saisie, non comme une
contrainte juridique, mais comme une opportunité.
La direction, fidèle au management participatif, a distribué à tous les agents un questionnaire sur les
risques professionnels et rédigé le document sur la base des résultats de l'enquête.
Le bilan est très positif, même si la démarche est encore perfectible. (R.A.).
Mots-clés BDSP : Hôpital, Travail, Risque professionnel, Accident travail, Maladie professionnelle,
Méthodologie, Condition travail, Prévention, Jurisprudence, Evolution, Directeur, Questionnaire,
Résultat, France, Management participatif
Thèse pour le diplôme d'état de docteur en médecine., vol.7, 199 p., 2006
Grossesse et travail en milieu hospitalier : risques professionnels et attitude pratique.
RICHARD (Céline)
Université de Picardie Jules Verne. Amiens. FRA / com.
Mots-clés BDSP : Grossesse, Grossesse risque, Personnel hospitalier, Exposition professionnelle,
Intoxication professionnelle, Morbidité professionnelle, Risque professionnel, Médecine travail,
Médecin travail
Cancer Causes Control. 2006 Feb;17(1):39-44.
Breast cancer and night work among Norwegian nurses.
Lie JA, Roessink J, Kjaerheim K.
Cancer Registry of Norway, Institute of Population-based Cancer R esearch, N-0310, Oslo,
Montebello, Norway. [email protected]
OBJECTIVE: Previous studies have suggested an association between breast cancer and night work.
We evaluated the relationship among Norwegian nurses. METHODS: A case-control study, nested
within a cohort of 44,835 nurses educated between 1914 and 1980 was performed, based on a
registry of all Norwegian nurses. Four controls were individually matched by year of birth to each of
537 breast cancer cases that occurred during the period 1960-1982. The reconstruction of work
history and number of years with night work for each nurse was based on information from the nurse
registry, and data from three censuses. We used conditional logistic regression to calculate odds
ratios (ORs) and 95% confidence intervals (CIs), adjusted for total duration of work as a nurse and
parity. All statistical tests were two-sided. RESULTS: The adjusted OR of breast cancer among nurses
who worked nights for 30 or more years was 2.21 (CI 1.10-4.45) compared with those who did not
work nights after graduation from nursing school (p(trend) = 0.01). CONCLUSION: Our results are in
accordance with previous studies that find an association between night work and breast cancer risk
among women.
MeSH Terms: Adult - Breast Neoplasms/epidemiology* - Case-Control Studies - Circadian Rhythm Confidence Intervals - Female - Humans - Logistic Models - Norway/epidemiology - Nurses* - Odds
Ratio - Registries - Research Support, Non-U.S. Gov't - Risk Factors - Work Schedule Tolerance*
21
Veille juridique
J.O n 137 du 15 juin 2006 page 9001, texte n 8
Arrêté du 15 mai 2006 relatif aux conditions de délimitation et de signalisation des zones
surveillées et contrôlées et des zones spécialement réglementées ou interdites
compte tenu de l'exposition aux rayonnements ionisants, ainsi qu'aux règles d'hygiène, de sécurité et
d'entretien qui y sont imposées
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SOCT0611077A
Liens vers le site de l'ISTNF
- Décret n° 2006-354 du 24 mars 2006 Personnels des centres hospitaliers et universitaires
http://www.istnf.fr/pages/actualites/actualites_2.asp?annee=&mois=&typea=&c=7894C0&num=17595
8
Décret n° 2006-434 du 12 avril 2006 - Fonctionnaires handicapés.
http://www.istnf.fr/pages/actualites/actualites_2.asp?num=179924&annee=2006&mois=5&typea=Actu
alit%C3%A9%20juridique&c=99AED0
Décret n° 2006-501 du 3 mai 2006 - Fonction publique
alit%C3%A9%20juridique&c=7894C0
Décret n° 2006-555 du 17 mai 2006 - Accessibilité des établissements recevant du public
Décret n° 2006-565 du 17 mai 2006 - Recrutement des handicapés - Fonction publique hospitalière
alit%C3%A9%20juridique&c=99AED0
Décret n° 2006-564 du 17 mai 2006
Régime de travail à temps partiel - Fonction publique hospitalière
Arrêté du 2 juin 2006
Insertion des personnes handicapées dans la fonction publique
http://www.istnf.fr/pages/actualites/actualites_2.asp?num=188450&annee=2006&mois=&typea=&c=99
AED0
Liens vers le site Légifrance
Décret n° 2006-576 du 22 mai 2006 relatif à la médecine d'urgence et modifiant le code de la santé
publique (dispositions règlementaires )
http://www.legifrance.gouv.fr/texteconsolide/SQHXD.htm
Décret n° 2006-577 du 22 mai 2006 relatif aux conditions techniques de fonctionnement applicables
aux structures de médecine d'urgence et modifiant le code de la santé publique (dispositions
règlementaires)
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SANH0620665D
Arrêté du 25 avril 2006 relatif aux modalités de l'expérimentation de déclaration des événements
indésirables graves liés à des soins réalisés lors d'investigations, de traitements ou d'actions de
prévention autres que des infections nosocomiales.
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=SANP0621452A
22
Décret n° 2006-593 du 23 mai 2006 modifiant le décret n° 84-135 du 24 février 1984 portant statut des
personnels enseignants et hospitaliers des centres hospitaliers et universitaires
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=MENX0600058D
Arrêté du 2 juin 2006 fixant le contenu de la déclaration annuelle au fonds pour l'insertion des
personnes handicapées dans la fonction publique
http://www.legifrance.gouv.fr/WAspad/UnTexteDeJorf?numjo=FPPA0600043A
Arrêté du 2 juin 2006 portant nomination du directeur du fonds pour l'insertion des personnes
handicapées dans la fonction publique
Arrêté du 2 juin 2006 portant nomination au Comité national du fonds pour l'insertion des personnes
handicapées dans la fonction publique
23

- CHU de Rouen

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