Background: Physician adherence to hand hygiene remains low in most hospitals.Objectives: To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians.Design: Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene.Setting: Large university hospital.Participants: 163 physicians.Measurements: Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence.Results: Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence.Limitations: Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. H and hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care-associated infections (1, 2). Despite the relative simplicity of this procedure, adherence to hand hygiene recommendations is unacceptably low, usually well below 50% (1-4). Risk factors for nonadherence have been extensively studied (1, 4 -7), and physicians have been repeatedly observed as being poor compliers (1,3,4,8,9). ConclusionAt our hospital, physician behavior did not improve substantially despite a hospital-wide hand hygiene promotion campaign that had a positive and marked effect on adherence among all other health care workers (1). That study highlighted the need for improved knowledge of behavior determinants among physicians.Promotion of hand hygiene behavior is a complex issue (7, 10 -12). Adherence to hand hygiene recommendations is influenced by knowledge; awareness of personal and group performance; workload; and type, tolerance, and accessibility of hand hygiene agents (2,4,12). Over the past 50 years in particular, the assumption that an individual's perceptions have a strong effect on his or her behavior gave birth to social cognitive models of human behavior (13). Some of these models have been applied to individual factors (that is, knowledge, attitude, intentions, beliefs, and perceptions) to help build strategies that improve specific health behaviors (14). To date, individual cognitive factors related to hand hygiene have not been adequately studied among physicians. Our study aim...

A routine protocol for diagnosing Clostridium difficile-associated diarrhoea (CDAD) based on both faecal-cytotoxin detection and toxigenic culture was adopted by the microbiology laboratory of the St Luc-UCL University Hospital in Brussels in 1997. A toxigenic culture is a faecal culture followed, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production. The results obtained over the past 7 years in the hospital are reviewed here. A total of 10 552 diarrhoeal stools from 7042 patients were analysed, of which 9494 were negative for all tests. A total of 1058 samples (10 %) from 794 patients were culture-positive, of which 460 (4 . 4 %) were positive for a faecal cytotoxin. The remaining 598 cultures were tested for toxin A on colonies; 355 of them were positive, which is 3 . 4 % of the total, and the remaining 243 (2 . 3 %) were negative. The positivity of the faecalcytotoxin assay was statistically linked to the number of colonies observed on the culture plate. In conclusion, over a 7 year period, toxigenic culture allowed the diagnosis of 355 cases of CDAD that would have been missed by a protocol using a faecal-cytotoxin assay alone. In terms of both patient care, prevention of environmental contamination and prevention of risk of a hospital outbreak, it is proposed that these results justify the recommendation to perform both faecal-toxin assay and culture in routine medical practice.

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an Expert's workshop on resistance and MRSA decolonization. When compared to chlorhexidine and mupirocin, respectively, PVP-I 10% and 7.5% solution had rapid and superior bactericidal activity against MRSA in in vitro and ex vivo studies. Notably, PVP-I 10% and 5% solutions were also active against both chlorhexidine-resistant and mupirocin-resistant strains, respectively. Unlike chlorhexidine and mupirocin, available reports have not observed a link between PVP-I and the induction of bacterial resistance or cross-resistance to antiseptics and antibiotics. These pre-clinical findings also translate into clinical decolonization, where intranasal PVP-I significantly improved the efficacy of chlorhexidine wash and was as effective as mupirocin in reducing surgical site infection (SSI) in orthopedic surgery. Overall, these qualities of PVP-I make it a useful alternative decolonizing agent for the prevention of S. aureus infections, but additional experimental and clinical data are required to further evaluate the use of PVP-I in this setting.

hThe incidence of verocytotoxin-producing Escherichia coli (VTEC) was investigated by PCR in all human stools from Universitair Ziekenhuis Brussel (UZB) and in selected stools from six other hospital laboratories in the Brussels-Capital Region, Belgium, collected between April 2008 and October 2010. The stools selected to be included in this study were those from patients with hemolytic-uremic syndrome (HUS), patients with a history of bloody diarrhea, patients linked to clusters of diarrhea, children up to the age of 6 years, and stools containing macroscopic blood. Verocytotoxin genes (vtx) were detected significantly more frequently in stools from patients with the selected conditions (2.04%) than in unselected stools from UZB (1.20%) (P ‫؍‬ 0.001). VTEC was detected most frequently in patients with HUS (35.3%), a history of bloody diarrhea (5.15%), or stools containing macroscopic blood (1.85%). Stools from patients up to the age of 17 years were significantly more frequently vtx positive than those from adult patients between the ages of 18 and 65 years (P ‫؍‬ 0.022). Although stools from patients older than 65 years were also more frequently positive for vtx than those from patients between 18 and 65 years, this trend was not significant. VTEC was isolated from 140 (67.9%) vtx-positive stools. One sample yielded two different serotypes; thus, 141 isolates could be characterized. Sixty different O:H serotypes harboring 85 different virulence profiles were identified. Serotypes O157:H7/H؊ (n ‫؍‬ 34), O26:H11/H؊ (n ‫؍‬ 21), O63:H6 (n ‫؍‬ 8), O111:H8/H؊ (n ‫؍‬ 7), and O146:H21/H؊ (n ‫؍‬ 6) accounted for 53.9% of isolates. All O157 isolates carried vtx2, eae, and a complete O island 122 (COI-122); 15 also carried vtx1. Non-O157 isolates (n ‫؍‬ 107), however, accounted for the bulk (75.9%) of isolates. Fifty-nine (55.1%) isolates were positive for vtx1, 36 (33.6%) were positive for vtx2, and 12 (11.2%) carried both vtx1 and vtx2. Pulsed-field gel electrophoresis revealed wide genetic diversity; however, small clusters of O157, O26, and O63:H6 VTEC that could have been part of unidentified outbreaks were identified. Antimicrobial resistance was observed in 63 (44.7%) isolates, and 34 (24.1%) showed multidrug resistance. Our data show that VTEC infections were not limited to patients with HUS or bloody diarrhea. Clinical laboratories should, therefore, screen all stools for O157 and non-O157 VTEC using selective media and a method for detecting verocytotoxins or vtx genes. V erocytotoxin-producing Escherichia coli (VTEC), also called Shiga toxin-producing E. coli (STEC), is associated with diarrhea, often bloody, that may be complicated with hemorrhagic colitis and the life-threatening hemolytic-uremic syndrome (HUS), especially in children and the elderly (29). VTEC is characterized by its ability to produce one or more phage-encoded verocytotoxins, VT1 and VT2, that show distinct immunogenic and genetic properties (42). Multiple subtypes of VT1 (VT1a, VT1c, and VT1d) and VT2 (VT2a to VT2g), with significant diff...