{"id":1755,"date":"2003-10-01T01:00:00","date_gmt":"2003-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/circulaire-prions-du-14-mars-2001-deux-ans-apres-modalites-pratiques-dapplication-dans-une-unite-dendoscopies-digestives-dun-centre-hospitalier-general\/"},"modified":"2018-10-20T18:39:30","modified_gmt":"2018-10-20T16:39:30","slug":"circulaire-prions-du-14-mars-2001-deux-ans-apres-modalites-pratiques-dapplication-dans-une-unite-dendoscopies-digestives-dun-centre-hospitalier-general","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/circulaire-prions-du-14-mars-2001-deux-ans-apres-modalites-pratiques-dapplication-dans-une-unite-dendoscopies-digestives-dun-centre-hospitalier-general\/","title":{"rendered":"CIRCULAIRE \u00ab PRIONS \u00bb DU 14 MARS 2001, DEUX ANS APRES: MODALITES PRATIQUES D\u2019APPLICATION DANS UNE UNITE D\u2019ENDOSCOPIES DIGESTIVES D\u2019UN CENTRE HOSPITALIER GENERAL"},"content":{"rendered":"

2003<\/strong><\/p>\n

A. Fleury1, P. Martres2, F. L\u00e9mann2, P. Hervio1, G. Laurens3, O. Danne1
\nService d\u2019H\u00e9pato-Gastro-Ent\u00e9rologie1, Laboratoire de Bact\u00e9riologie-Virologie-Hygi\u00e8ne2, Service de Pharmacie3, H\u00f4pital Ren\u00e9 Dubos, Pontoise<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02003-09-08 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Objectifs : La circulaire DGS\/DH N\u00b0 138 du 14 mars 2001 relative \u00e0 la pr\u00e9vention du risque de transmission d\u2019agents transmissibles non conventionnels (ATNC) prend en compte le risque iatrog\u00e8ne li\u00e9 au nouveau variant de la Maladie de Creutzfeldt-Jakob (MCJ) et pr\u00e9conise entre autres l\u2019utilisation de l\u2019acide perac\u00e9tique pour la d\u00e9sinfection des endoscopes. Nous avons \u00e9valu\u00e9 le surco\u00fbt g\u00e9n\u00e9r\u00e9 par ces nouvelles recommandations puis avons mis en oeuvre uniquement les mesures financ\u00e9es.<\/p>\n

Mat\u00e9riel et m\u00e9thodes : Apr\u00e8s avoir d\u00e9fini avec le CLIN les actes \u00e0 risque de transmission des ATNC, nous avons \u00e9valu\u00e9 les cons\u00e9quences financi\u00e8res de la nouvelle circulaire en terme d\u2019usure et de temps d\u2019immobilisation des endoscopes, de consommation de d\u00e9tergent et d\u00e9sinfectant \u00e0 base d\u2019acide perac\u00e9tique, d\u2019acquisition de mat\u00e9riel \u00e0 usage unique. Avec l\u2019appui du CLIN, un financement \u00e0 la hauteur du co\u00fbt des mesures \u00e9valu\u00e9es a \u00e9t\u00e9 demand\u00e9 \u00e0 la Direction de l\u2019H\u00f4pital. Seules les mesures financ\u00e9es ont \u00e9t\u00e9 mises en place.<\/p>\n

R\u00e9sultats : Dans l\u2019Unit\u00e9 d\u2019Endoscopies Digestives du Centre Hospitalier de Pontoise (600 lits), le co\u00fbt de la mise en place des nouvelles recommandations de la circulaire 138 a \u00e9t\u00e9 \u00e9valu\u00e9 \u00e0 100 000 euros par an au titre de d\u00e9penses d\u2019exploitation (achat d\u2019\u00e9quipement \u00e0 usage unique principalement), et \u00e0 80 000 euros au titre de d\u00e9penses d\u2019investissement (endoscopes, laveurs-d\u00e9sinfecteurs d\u2019endoscopes).
\nLe questionnaire de rep\u00e9rage des patients suspects, atteints ou pr\u00e9sentant des facteurs de risque de MCJ a \u00e9t\u00e9 actualis\u00e9 en juin 2001 et est syst\u00e9matiquement inclus dans le dossier m\u00e9dical. Il doit \u00eatre rempli pour tout patient admis.
\nTous les actes endoscopiques digestifs (3000 par an), quelles que soient les caract\u00e9ristiques du patient, ont \u00e9t\u00e9 consid\u00e9r\u00e9s comme des actes \u00e0 risque de transmission des ATNC car toute effraction, m\u00eame minime, d\u2019un tissu \u00e0 risque, ne peut \u00eatre exclue lors de l\u2019endoscopie. En cons\u00e9quence, un double nettoyage syst\u00e9matique de tous les endoscopes a \u00e9t\u00e9 mis en place gr\u00e2ce \u00e0 l\u2019acquisition d\u2019un deuxi\u00e8me laveur-d\u00e9sinfecteur r\u00e9pondant aux recommandations de la circulaire, \u00e0 la mise aux normes du laveur-d\u00e9sinfecteur d\u00e9j\u00e0 en service et au r\u00e9ajustement du parc d\u2019endoscopes (OLYMPUS\u00ae) compos\u00e9 actuellement de six vid\u00e9ocoloscopes, huit vid\u00e9ogastroscopes, deux vid\u00e9oduod\u00e9noscopes et de deux endoscopes optiques (nasogastroscope et fibroscope p\u00e9diatrique). La proc\u00e9dure de d\u00e9sinfection manuelle est r\u00e9alis\u00e9e pour les patients pr\u00e9sentant des facteurs de risque de MCJ et pour la d\u00e9sinfection initiale des endoscopes lorsqu\u2019ils ont \u00e9t\u00e9 stock\u00e9s plus de douze heures.
\nLe d\u00e9sinfectant \u00e0 base de glutarald\u00e9hyde a \u00e9t\u00e9 remplac\u00e9 par un d\u00e9sinfectant \u00e0 base d\u2019acide perac\u00e9tique, l\u2019ANIOXYDE\u00ae pour la d\u00e9sinfection manuelle et l\u2019APERLAN\u00ae pour la d\u00e9sinfection machine. Apr\u00e8s 2 ans d\u2019utilisation de l\u2019acide perac\u00e9tique de Juin 2001 \u00e0 Mai 2003, 1795 coloscopies, 3719 gastroscopies et 76 duod\u00e9noscopies ont \u00e9t\u00e9 r\u00e9alis\u00e9es et aucune d\u00e9t\u00e9rioration inhabituelle de tous les endoscopes notamment de leurs gaines n\u2019a \u00e9t\u00e9 constat\u00e9e. Cependant 60% du parc a \u00e9t\u00e9 acquis de fa\u00e7on contemporaine ou post\u00e9rieure au passage \u00e0 l\u2019acide perac\u00e9tique.
\nActuellement, l\u2019ensemble du mat\u00e9riel d\u2019endoscopie ancillaire \u00e0 usage unique n\u2019est pas financ\u00e9. Le mat\u00e9riel r\u00e9utilisable st\u00e9rilisable en endoscopie reste donc majoritaire.<\/p>\n

Conclusion : La plupart des recommandations de la circulaire \u00ab prions \u00bb est appliqu\u00e9e dans l\u2019Unit\u00e9 d\u2019Endoscopies Digestives de l\u2019h\u00f4pital de Pontoise gr\u00e2ce \u00e0 un financement sp\u00e9cifique. L\u2019utilisation pendant 2 ans d\u2019acide perac\u00e9tique n\u2019a entra\u00een\u00e9 aucun dommage important ni inhabituel vis \u00e0 vis d\u2019un parc d\u2019endoscopes OLYMPUS\u00e2 majoritairement r\u00e9cent. D\u2019autres \u00e9tudes sont n\u00e9cessaires pour valider la compatibilit\u00e9 entre l\u2019acide perac\u00e9tique et les endoscopes en attendant des donn\u00e9es plus pr\u00e9cises de la part des fabricants d\u2019endoscopes et de d\u00e9sinfectants.<\/p>\n","protected":false},"excerpt":{"rendered":"

2003 A. Fleury1, P. Martres2, F. L\u00e9mann2, P. Hervio1, G. Laurens3, O. Danne1 Service d\u2019H\u00e9pato-Gastro-Ent\u00e9rologie1, Laboratoire de Bact\u00e9riologie-Virologie-Hygi\u00e8ne2, Service de Pharmacie3, H\u00f4pital Ren\u00e9 Dubos, Pontoise Endoscopie – \u00a02003-09-08 –\u00a0CO – ________________________________ Objectifs : La circulaire DGS\/DH N\u00b0 138 du 14 mars 2001 relative \u00e0 la pr\u00e9vention du risque de transmission d\u2019agents transmissibles non conventionnels (ATNC) […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[14],"class_list":["post-1755","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-14"],"yoast_head":"\nCIRCULAIRE \u00ab PRIONS \u00bb DU 14 MARS 2001, DEUX ANS APRES: MODALITES PRATIQUES D\u2019APPLICATION DANS UNE UNITE D\u2019ENDOSCOPIES DIGESTIVES D\u2019UN CENTRE HOSPITALIER GENERAL - 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