[Detection of a hepatitis A outbreak in Ceuta (Spain) through a microbiological surveillance system]. / Detección de un brote de hepatitis A en Ceuta a través del sistema de información microbiológica.

BACKGROUND: The Public Health Department of Ceuta informed the Spanish National Epidemiology Center of an increase in hepatitis A cases detected by the microbiological surveillance system. We conducted a study to confirm the outbreak and to initiate control measures. METHODS: A descriptive study and a case-control study were performed. A standardized telephone questionnaire was used to collect information on demographic characteristics, symptoms, and risk factors. RESULTS: Nineteen cases of hepatitis A were identified. Univariate analysis revealed an association between infection and eating raw vegetables (OR = 9.3; 95%CI: 1.5-57.6) or razor-shell (OR = 55; 95%CI: 4.3-703.4). In the logistic regression model, only razor-shell consumption remained a significant risk factor (OR = 36.1; 95%CI: 2.45-530.4). None of the 3 inspected restaurants had public health authorization or records of food purchase histories. CONCLUSIONS: We confirmed a hepatitis A outbreak associated with consumption of contaminated razor-shell in homes and restaurants. The microbiological surveillance system was the main means of detecting this outbreak.

[Incidence of adverse events in a general surgery unit]. / Incidencia de efectos adversos en un servicio de cirugía general.

OBJECTIVE: Clinical practice is an activity accompanied by risks and uncertainties. The objectives are: to determine the incidence of patients with adverse events (AE) in a general surgery unit; to analyse the associated factors; to consider their impact and to identify the prevention possibilities. PATIENTS AND METHOD: Ambispective study in patients taken care of in a general surgery unit in a tertiary hospital. Every admission was prospectively reviewed using a screening guide, with all the clinical histories that fulfilled screening criteria being examined retrospectively using a modular questionnaire. RESULTS: A total of 989 histories were reviewed, the positive predictive value (PPV) of the screening guide for AE was 53%. The accumulated incidence of patients with AE was 17.8% and the incidence density of AE was 1.92 for every 100 days of hospitalisation. Intrinsic and extrinsic risk factors were associated to greater risk of EA, the most frequent events being: nosocomial infections (54.4%), surgical problems (31.8%) and problems associated with medication (7.4%). A total of 66.8% of the AE were considered moderate, with 53.5% of all AE being preventable. CONCLUSIONS: The screening questionnaire was useful for the valuation of adverse events. AE are common in surgical patients which has an effect on the use of other hospital resources. The most important associated factors were: length of stay, surgical and extrinsic factors and surgical wound infection as the main AE. Two thirds of AE were considered moderate and half of all AE were considered avoidable.