The issue of nosocomial diseases has come to the fore lately as the low rate of vaccination of caregivers against covid-19 was singled out. This is why we wanted to look at how much weight covid-19 occupies among nosocomial infections, how the phenomenon may have evolved, who it affected, and under what circumstances.
What is nosocomial disease?
“Nosocomial infections are infections that are acquired in a healthcare setting. An infection is considered as such when it was absent on admission. When the infectious state of the patient on admission is unknown, the infection is classically considered to be nosocomial if it appears after 48 hours of hospitalization ”, explains the Ministry of Solidarity and Health.
How many people have contracted Covid-19 in hospitals in France?
The origins of the infection can be:
- endogenous: the patient becomes infected with his own germs “through an invasive act (see below) and / or because of a particular fragility”;
- exogenous: transmitted from one patient to another by the hands or working instruments of medical personnel; by the germs of the carrier staff; by contamination of the hospital environment.
What are the aggravating factors:
- age and pathology;
- certain treatments (antibiotics, immune system treatments)
- certain invasive procedures (urinary catheterization, catheterization, artificial ventilation and surgery).
A “covid effect” on the number of nosocomial diseases?
Covid-19 has indeed increased reports of nosocomial diseases, becoming the leading cause. Since March 2020, health establishments can report isolated or grouped cases of nosocomial Covid-19 occurring “during or after treatment”. According to the epidemiological bulletin published by Public Health France on January 21, 2021, 5,159 reports were issued in 2020. ” This number is significantly higher (+ 61%) than the number of reports issued in 2018 (n = 3,197) and 2019 (n = 3,219). In addition, in 2018 and 2019, the proportion of reports of bacteria highly resistant to emerging antibiotics (BHRe) represented just over 60% of reports. In 2020, nosocomial COVID-19 reports changed this dynamic, since they counted for more than 60% of all reports received. »Public health chart France
What are the modes of contamination?
The latest bulletin from Public Health France evoking the cases of nosocomial Covid-19, indicates that as of March 7, 2021, the main contamination hypotheses, among the reports of grouped cases (at least 3 cases) are as follows (a grouped case involving at least three people, the hypotheses can be multiple, which explains why we exceed 100%):
- fortuitous discovery of a case: 41%
- non-optimal barrier measures (including difficulties in applying good practices): 41%
- breaks and communications between staff: 23%
- visitors and families: 18%
- use of double rooms: 12%
- ambulatory patient: 11%
The reports of grouped cases (2,562 between January 1, 2020 and February 14, 2021) correspond to 42,929 cases: 25,847 patients, 17,072 professionals and 10 visitors.
What’s the trend?
In its weekly epidemiological update of December 10, 2020, Public Health France estimated that “The dynamics of these reports are correlated with that of the epidemic in the general population”. The charts disseminated by Public Health France on the occasion of the weekly epidemiological points highlight peaks in reports during weeks 11, 12, 13, 41, 42, 43 of 2020, namely from March 9 to 29, and from March 5 to October 29. Then drops after the implementation of the two confinements.
According to the latest bulletin from Public Health France, between January 1 and March 7, there were 3,932 nosocomial Covid-19 reports by health establishments, involving 49,277 cases: 29,980 patients, 19,287 caregivers and 10 visitors.
On reading the successive weekly points of Public Health France, we note a decrease in reports for the period December 20 – January 3 (from 2,547 to 2,729, or 91 per week, against 165 and 135 for the previous periods. Then increases for periods January 3-17 (128.5) and January 31 – February 14 (163) Figures are not consolidated for the following period.
Same evolution concerning the number of patients and professionals concerned behind these reports. A decrease observed at the end of 2020, before a increase in cases in January, and a slight decline during the first half of February (graph below). As with the number of reports, the data are not consolidated for the period following February 14.
Antoine Busnel
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