Recommandations nationales pour la prévention de la transmission croisée : quoi de neuf pour la pratique quotidienne en réanimation ?

Control and prevention of the emergence and spread of multidrug-resistant bacteria (MDR-bacteria) remains a priority of the French national program for nosocomial infections control. Since the ministerial recommendations in 1999, significant changes have occurred (widespread introduction of hydro-alcoholic hand-rub products [HAP], emergence of new MDR-bacteria…) making it necessary to produce a new guideline at the national level. The French Society of hospital Hygiene has produced this document in 2009 using formal consensus method. This article aims to summarize the most important recommendations for intensive care units (ICU): update and enhancement of standard precautions, replacement of antiseptic washing by HAP, proper use of gloves (limited to the protection of healthcare workers against the viral risk during contact with biological fluids). The recommendations about complementary contact measures remain controversial, limited to geographic isolation and reinforcement of standard precautions. Systematic screening policy in ICU is strongly recommended in epidemic situation for MRSA and ESBL producing Enterobacteriaceae. Indications of decontamination are strictly limited. These guidelines are potentially adaptable to each hospital epidemiology, and to local practices and resources.