Outpatient and oral management is suitable for infants 60-90 days old with urinary tract infections at low risk of bacteremia.

One previous study recommended oral and outpatient management for those infants aged 60-90 days with urinary tract infection (UTI) meeting the low-risk criteria identified: to be well-appearing and to have a procalcitonin value of < 0.7 ng/mL. A retrospective study was conducted, including infants aged 29 to 90 days with UTI from 2014 to 2019, to validate these low-risk criteria identified and determine the adherence to the new algorithm for managing these patients at the Emergency Department. Two hundred one patients were included; 105 (52.2%) were aged 60 to 90 days. Twelve (6%, 95% CI 3.4-10.1%) had bacteremia. One hundred thirty-six (67.7%) infants met low-risk criteria; none had a positive blood culture (0%, 95% CI 0-2.7%). Overall protocol adherence was 90.6%. One hundred and forty-four (71.6%) infants were admitted to the hospital; all patients meeting high-risk criteria were hospitalized. Among the 57 (28.4%) infants initially sent home, 4 (7.0%) required later hospital admission.Conclusions: A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants. What is Known: • Patients under 2-3 months of age with a presumptive urinary tract infection (UTI) are commonly hospitalized because of concerns regarding concomitant bacteremia. What is New: • A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.

[Intervention to reduce the impact of light and noise on sleep in an emergency department observation area]. / Intervención para reducir la repercusión en el sueño de la luz y el ruido en áreas de observación de urgencias.

OBJECTIVES: To study quality of patient rest before and after an intervention to reduce nighttime light and noise in the emergency department observation area of an urban hospital. MATERIAL AND METHODS: Quasi-experimental study in 2 groups before and after the intervention in the observation area of the Hospital Clínic de Barcelona. We administered a questionnaire about the quality of nighttime rest to assess the effect of light and noise on sleep. Light and noise were reduced by means of structural changes to the environment and through the introduction of protocols to modify how care plans were carried out at night. RESULTS: Fifty nurses participated in the pre-intervention study and 371 in the post-intervention study. Seventy-two percent and 91.37% of the patients reported resting well before and after the intervention, respectively (P< .001). Factors like pain, nursing care, or daytime naps do not affect sleep quality. CONCLUSION: Nighttime rest in emergency department observation areas is affected by ambient light and noise more than by other variables. Reducing light and noise at night can measurably improve patients' rest.

OBJETIVO: Conocer la calidad del descanso nocturno tras una intervención para minimizar la presencia de luz y el ruido nocturnos en las áreas de observación de urgencias (AOU) de un hospital urbano. METODO: Se realiza un ensayo clínico cuasiexperimental con un grupo preintervención (Grupo PRE) y otro posterior (Grupo POS) a la intervención, mediante cuestionario ad hoc sobre repercusión de luz y ruido en la calidad del descanso nocturno en el AOU del Hospital Clínic de Barcelona. La intervención consistió en cambios estructurales para reducir luz y el ruido ambientales, así como la instauración de un procedimiento normalizado de trabajo para modificar los planes de cuidados nocturnos. RESULTADOS: Se incluyeron en el Grupo PRE 50 enfermos y 371 en el Grupo POS. El grupo PRE declaró haber tenido un buen descanso en un 72% de los casos frente al 91% del grupo POS (p < 0,001). Factores como el dolor, las intervenciones enfermeras o el sueño diurno no repercutieron en la calidad del sueño. CONCLUSIONES: La luz y el ruido ambientales influyen en el descanso nocturno en AOU más que otras variables conocidas. Intervenciones sobre la luz y el ruido pueden mejorar objetivamente el descanso nocturno de los pacientes.