Impact of the COVID-19 pandemic on the incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar.

BACKGROUND: Healthcare-associated infections (HAIs) in critical patients affect the quality and safety of patient care and increase patient morbidity and mortality. During the COVID-19 pandemic, an increase in the incidence of HAIs, particularly device-associated infections (DAIs), was reported worldwide. In this study, we aimed to estimate the incidence of HAIs in an intensive care unit (ICU) during a 10-year period and compare HAI incidence during the preCOVID-19 and COVID-19 periods. METHODS: A retrospective, observational study of HAIs in the medical-surgical ICU at The Cuban Hospital was conducted. DAIs included central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP). Data included the annual incidence of HAIs, etiology, and antimicrobial resistance, using definitions provided by the Centers for Disease Control and Prevention, except for other respiratory tract infections (RTIs). RESULTS: 155 patients with HAI infections were reported, from which 130 (85.5%) were identified during the COVID-19 period. The frequencies of DAIs and non-DAIs were higher during the COVID-19 period, except for Clostridium difficile infections. Species under Enterobacter, Klebsiella, and Pseudomonas dominated in both periods, and higher frequencies of Acinetobacter, Enterococcus, Candida, Escherichia coli, Serratia marcescens, and Stenotrophoma maltophila were noted during COVID-19 period. Device utilization ratio increased to 10.7% for central lines and 12.9% for ventilators, while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19 pandemic, with risks for CLABSI, VAP, and CAUTI increased by 2.79 (95% confidence interval, 0.93-11.21; p < 0.0050), 15.31 (2.53-625.48), and 3.25 (0.68-31.08), respectively. CONCLUSION: The incidence of DAIs increased during the pandemic period, with limited evidence of antimicrobial resistance observed. The infection control program should evaluate strategies to minimize the impact of the pandemic on HAIs.

Direct observation of hand hygiene can show differences in staff compliance: Do we need to evaluate the accuracy for patient safety?

Background: Direct observation of hand hygiene is the standard practice recommended by the World Health Organization to monitor its compliance. Objective: To evaluate the accuracy of hand hygiene observation performed by units' observers. Methods: A descriptive study was carried out in seven patient care units in a 75-bed community hospital in Qatar. Four trained nurses performed hand hygiene observation in May 2016, any day of the week and in different shifts, following the same methodology as routine units' observers. Hand hygiene opportunities were registered, including hand hygiene moments, staff category, and actions (handrubs, hand washing, missed hand hygiene, and gloves without hand hygiene). Results: During January-May 2016, routine monitoring reported 25,319 opportunities with a compliance of 89.2%, and 91.6% for nurses, 89.6% for physicians, and 85.1% for ancillary staff. Trained external observers reported 815 opportunities and compliance of 54.7%, with the highest compliance observed after blood and body fluid exposure (80.0%) and after patient contact (85.5%), and the lowest figures before patient contact (34.2%) and before aseptic procedure (34.0%). Conclusion: This study provides essential information about the accuracy of the monitoring procedure and the compliance of hand hygiene that requires immediate action to protect patients and staff from healthcare-associated infections.

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: findings of the International Nosocomial Infection Control Consortium.

OBJECTIVES: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. DESIGN: A prospective active surveillance before-after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance. SETTING: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey. PATIENTS: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals. INTERVENTIONS: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices. MEASUREMENTS: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention. MAIN RESULT: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study. CONCLUSION: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.

Glove perforation in selected surgical procedures in a general hospital in La Habana, Cuba.

Background: Surgical glove perforation constitutes a risk for the maintenance of aseptic technique and the risk of surgical site infection and occupational exposure to blood borne infections for healthcare workers. Aim: To identify the frequency of glove perforation in selected surgical procedures. Methods: A cross-sectional descriptive observational study was carried out in the surgical unit of the Joaquin Albarrán Hospital (La Habana, Cuba) during the period September-December 2019. Gloves used by surgeons in major urgent or elective surgical procedures were collected and tested for perforations. Findings: 757 gloves from 149 surgeons and 8 surgical specialties were tested and 95 (25.8%) had perforations. The highest frequencies of glove perforations were reported in vascular surgery (50.0%), proctology (37.9%), urology (28.0%) and general surgery (26.1%). The selected surgical procedures with the highest frequencies were open radical nephrectomy (87.5%), splenectomy (57.1%), open adenomectomy (55.6%), limb amputation (46.2%) and hysterectomy (41.7%). Glove perforation occurred more frequently in consultant surgeons (28.8%) than in residents (20.9%) (P = 0.021), in surgeons with more years of surgical experience (P = 0.003) and longer procedure duration (P = <0.001). Most glove perforations were identified in the left hand (64.1%), while 23.1% were in the right hand and 12.8% in both hands. 51.2% occurred in thumb and index finger. Differences in the patterns of glove perforation were observed among the different surgical procedures. Conclusions: Our findings provide insights into the risk of glove perforation during selected surgical procedures and the need for prevention strategies to reduce adverse consequences of glove perforation in patients and healthcare workers.

[Impact of a quality control program on antibiotic prescription in a hospital in Havana, Cuba]. / Impacto de un programa de control de la calidad de la prescripción de antibióticos en un hospital de La Habana, Cuba.

OBJECTIVE: Demonstrate the efficacy of a quality control program on antibiotic prescription in Joaquín Albarrán Hospital in Havana, Cuba. METHODS: An interventional study was conducted from 1 May 2008 to 31 March 2011. The study included evaluation of prescription quality, information feedback, educational activities, the operations of an antibiotic committee, and the preparation of protocols on antimicrobial drug use. A simple arithmetic graph of the time series was constructed, and the absolute values of the series percentages were compared. In order to verify the existence of a series trend, a simple linear regression model was applied. RESULTS: Antibiotic prescription was evaluated in 2 941 patients. An irregular series was observed, with inappropriate use in 30.7%-48.4% of these patients in the first three months analyzed. The value of the regression slope was close to zero, although it was negative and significantly different from zero (ß = -0.29; P = 0.02). CONCLUSIONS: The antibiotic control program improved the quality of prescribing for hospital patients.

Clinical relevance of Zika symptoms in the context of a Zika Dengue epidemic.

BACKGROUND: The clinical characteristics of the most frequent arbovirosis (Dengue, Zika, Chikungunya) are very similar, which is a diagnostic challenge for clinicians. OBJECTIVE: To identify the presence of clinical characteristics related to Zika virus infection confirmed by the laboratory in patients during an epidemic of co-infection with Zika and Dengue viruses. METHOD: Cross-sectional descriptive study of patients with clinical - epidemiological suspicion of Zika virus infection, who were admitted in the Hospital "Joaquín Albarrán" (La Habana, Cuba), during June 1 to October 31 of 2017. Demographic and symptoms and signs were recorded. By PCR for Zika virus (in blood or urine) the disease was confirmed. RESULTS: 1541 patients were studied. The most frequent symptoms and signs were rash (93.8%), pruritus (77.9%), arthralgia (60.0%), headache (50.8%), myalgia (46.1%), fever (34.7%), asthenia (31.7%), and conjunctivitis (27.9%). Zika virus infection was confirmed in 279 patients (18.1%). Greater frequency of arthralgia, asthenia, and diarrhea was demonstrated in Zika confirmed patients. CONCLUSION: Minor clinical relevance was observed in the symptoms or signs of arboviral disease to support the clinical diagnosis of Zika virus infections by clinician during a Zika-Dengue epidemic. The assessment of the temporality of the onset of Zika and Dengue symptoms of these infections is recommended to assist clinicians in the differential diagnosis.

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings.

BACKGROUND: Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available. METHODS: Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS: We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%). CONCLUSIONS: PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.

[Impact of a drink-driving detection program to prevent traffic accidents (Villa Clara Province, Cuba)]. / Impacto de un programa de detección de conductores bajo los efectos del alcohol en la prevención de accidentes de tráfico (provincia de Villa Clara [Cuba]).

OBJECTIVE: To determine the effectiveness of a method to reduce road traffic accidents and their consequences in the province of Villa Clara (Cuba). DESIGN: From May to October 2003, active surveillance of drink-driving was carried out. Analysis of chronological series was used. RESULTS: A total of 805 (12.46%) drivers were found to be under the effect of alcohol. Traffic accidents, deaths, and injuries decreased by 29.9%, 70.8% and 58.7%, respectively, in comparison with a similar period in 2002. The number of accidents in May, June, July, September and October fell below the historical low. The number of deaths was lowest in May, August and September. The number of injuries in July fell below the historical low. CONCLUSION: The interventions carried out proved useful in preventing traffic accidents and their consequences.

[Drunk driving in professional drivers in the Vía Blanca highway in Cuba]. / Ingestión de bebidas alcohólicas en conductores profesionales en la carretera de Vía Blanca (Cuba).

To determine the frequency of drunk driving in professional drivers (Via Blanca, Havana City), we carried out a descriptive study of 832 drivers selected by multistage stratified sampling. A structured interview with each driver was carried out to record the variables under study, and a breath alcohol test was subsequently performed. The frequency of drunk driving was 8.18% (95% CI, 5.94%-10.42%), with a predominance of drivers with alcohol levels

Reinfección, inmunidad y prevención de la transmisión en la COVID-19 / Reinfection, immunity and prevention of transmission of COVID-19

Introducción: La duración de la inmunidad natural generada por la COVID-19 está por definir, lo que determina la probable reinfección. Objetivo: Destacar la necesidad de mantener las medidas de prevención a propósito de un caso de reinfección en un trabajador sanitario. Presentación de caso: Paciente femenina de 48 años de edad con antecedentes de salud que, en junio, 2020 y marzo, 2021 se le diagnóstica la COVID-19, en ambos casos con el comportamiento de enfermedad sintomática leve. Después de 24 horas de comenzar con cefalea, mareos y tos seca se confirma el diagnóstico de infección por SARS CoV-2 con PCR positivo y umbral de ciclo (CT) en 24.84. Pasados 9 meses y 9 días de la infección original, y dos días posteriores a recibir la vacuna BNT162b2 (Pfizer-BioNTech), comienza con malestar general, tos seca, secreción nasal y dolor de garganta, con PCR positivo y CT de 17.61. Conclusiones: La posibilidad de la reinfección por la COVID-19 orienta la necesidad de fortalecer las acciones de prevención de la transmisión en instituciones de salud en tanto las evidencias científicas nos provean de recursos más eficaces para su control(AU)

Introduction: The duration of natural immunity generated by COVID-19 is yet to be defined, which determines the probable reinfection. Objective: To analyze issues related to natural infection and the need to maintain prevention practices regarding a case of reinfection in a health care worker. Case presentation: Forty-eight-year-old female patient without comorbidities who was diagnosed with COVID-19 in June 2020 and March 2021, in both cases as a mild symptomatic disease. Twenty-four hours after the onset with headache, dizziness, and dry cough, the diagnosis of SARS CoV-2 infection was confirmed by positive PCR and cycle threshold (CT) at 24.84. Nine months and nine days after original infection, and two days after receiving the BNT162b2 vaccine (Pfizer-BioNTech), the patient began with general malaise, dry cough, runny nose, and sore throat, with a positive PCR and CT of 17.61. Conclusions: The possibility of reinfection by COVID-19 points to the need to strengthen transmission prevention practices in healthcare facilities as long as scientific evidence provides us with more effective resources for its control(AU)

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module.

BACKGROUND: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. METHODS: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. RESULTS: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. CONCLUSIONS: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

COVID-19 y el problema de los tiempos en las estrategias de control / COVID-19 and the problem of the times in the control strategies

Introducción: En el proceso de cuidados de paciente con sospecha de infección por el nuevo coronavirus (COVID-19) se incluyen elementos que deben ser considerados en las estrategias de prevención de la transmisión. Objetivo: Describir, a partir de la presentación de un caso confirmado con COVID-19, la cronología de los cuidados del paciente sospechoso o confirmado con la enfermedad y la necesidad de optimizar los tiempos de diagnóstico en la prevención de su transmisión. Presentación de caso: Paciente masculino de 59 años de edad con antecedentes de Hipertensión arterial y gota, y de profesión taxista. Siete días anteriores al ingreso comienza con los síntomas clínicos y se le realiza prueba rápida para COVID-19, la cual resultó negativa. Al quinto día de ingreso de aislamiento en habitación privada se le realiza PCR y se confirma la infección por coronavirus. Se traslada a institución dedicada a la atención de estos pacientes donde presenta recuperación sin complicaciones. Se describen los intervalos de tiempo en relación con los cuidados en especial énfasis a la demora diagnóstica. Conclusiones: Se requiere un monitoreo de la dinámica de los cuidados de los pacientes sospechosos de COVID-19 con un especial enfoque en el fortalecimiento de la prevención de la transmisión nosocomial y en la comunidad(AU)

Introduction: In the process of caring for patients with suspected coronavirus infection (COVID-19), elements that must be considered in transmission prevention strategies are included. Objective: To describe, based on the presentation of a case confirmed with COVID-19, the chronology of patients suspected or confirmed with the disease and the need to optimize diagnosis times in the transmission prevention. Case presentation: Fifty-nine-year-old male patient with a history of high blood pressure and gout, working as a taxi driver. Seven days before admission, he began with symptoms. A rapid test for COVID-19 was performed, which was negative. On the fifth day of isolation in a private room, PCR was performed and coronavirus infection was confirmed. He was moved to an institution dedicated to the care of these patients where he recovered without complications. Time intervals concerning care are described with special emphasis on diagnostic delay. Conclusion: Monitoring of the care dynamics of patients suspected of COVID-19 is required with a special focus on strengthening the prevention of nosocomial transmission and the prevention of the spreading of the disease in the community(AU)

Prevención de infecciones quirúrgica en la formación de estudiantes de medicina y residentes de cirugía general / Prevention of surgical infections in the training of medical students and general surgery residents

Introducción: Las infecciones del sitio quirúrgico pueden prevenirse con la aplicación de las mejores evidencias científicas, que incluyen como elemento clave la educación de los profesionales de la salud. Objetivo: Evaluar en qué medida se incluyen los aspectos relacionados con la prevención de las infecciones del sitio quirúrgico en los currículos de los estudiantes de la carrera de medicina y los residentes de cirugía general, y se abordan los conocimientos y las habilidades por parte de los profesores. Métodos: Estudio descriptivo y transversal, que contó con la revisión documental de los programas de formación de estudiantes y residentes. Además, se aplicó un cuestionario a 9 profesores de la asignatura Cirugía General de los hospitales clínico quirúrgicos "Joaquín Albarrán" y "Manuel Fajardo", durante mayo-junio de 2018. Resultados: En la rotación por cirugía general y en el internado médico se dejó explícito el objetivo de prevenir las infecciones del sitio quirúrgico, mientras en la residencia se hizo menos énfasis en el tema. La enseñanza de la higiene de las manos, la profilaxis antibiótica y la notificación de infecciones resultaron prioritarias. Se observaron diferencias en el abordaje de temas en estudiantes y residentes, y las prácticas de prevención seleccionadas no fueron abordadas sistemáticamente en ambos grupos de educandos. Las habilidades requeridas para la prevención de las infecciones del sitio quirúrgico se consideraron sistemáticamente por la mayoría de los docentes. Conclusiones: Se ha demostrado la existencia de brechas en los currículos formativos, y en el desarrollo de los conocimientos y las habilidades relacionados con la prevención de las infecciones del sitio quirúrgico en estudiantes de medicina y residentes de cirugía general(AU)

Introduction: Surgical site infections can be prevented with the application of the best scientific evidence, which includes, as a key element, the education of health professionals. Objective: To assess the extent to which aspects related to the prevention of surgical site infections are included into the curricula of medical students and of general surgery residents, and the extent to which knowledge and skills are addressed by professors. Methods: Descriptive and cross-sectional study, which included documentary review of the training programs for students and residents. In addition, a questionnaire was applied to nine professors of the subject General Surgery from Joaquín Albarrán Clinical-Surgical Hospital and Manuel Fajardo Clinical-Surgical Hospital, in the period from May to June 2018. Results: In the General Surgery rotation and in the medical internship, the objective of preventing surgical site infections was made explicit, while less emphasis on the subject was made in the residence. Teaching hand hygiene, antibiotic prophylaxis, and notification of infections were a priority. Differences were observed among students and residents regarding the way they address topics, while the prevention practices chosen were not systematically addressed in both groups of learners. The skills required for the prevention of surgical site infections were systematically considered by the majority of professors. Conclusions: The existence of gaps in training curricula was shown, as well as regarding the development of knowledge and skills related to the prevention of surgical site infections in medical students and General Surgery residents(AU)

Componente crítico en las estrategias de atención médica, prevención y control de la COVID-19 / The critical component as part of the strategies for medical care, prevention and control of COVID-19

Introducción: La educación médica es un elemento de vital importancia para mejorar el desempeño de los profesionales de la salud en la lucha contra la pandemia de COVID-19. Objetivo: Identificar los elementos fundamentales relacionados con la educación médica en su relación con la atención médica a pacientes con COVID-19, y las estrategias de prevención y control. Desarrollo: Los aspectos relacionados con la atención médica de pacientes sospechosos y confirmados, y con la prevención y el control de la transmisión de infecciones en entornos comunitarios o en centros de salud, se describen como áreas fundamentales para la educación médica. Asimismo, después de controlar la pandemia, los educadores de salud tienen el desafío de evaluar la modificación requerida en los programas de capacitación de profesionales de la salud para lograr un alto rendimiento en los nuevos entornos epidemiológicos. Por este motivo se realizó una sistematización del conocimiento relacionado con los desafíos y el papel de la educación médica en la lucha contra la COVID-19. Conclusiones: Los educadores han tenido un desafío durante la epidemia de COVID-19 en la educación de los profesionales de la salud para enfrentar la epidemia, que será un mayor en el futuro debido a la necesidad de lograr la sostenibilidad de la educación y la revisión de los programas de capacitación para enfrentar la nueva realidad epidemiológica(AU)

Introduction: Medical education is vitally important for improving the performance of health professionals in the fight against the COVID-19 pandemic. Objective: To identify the fundamental elements related to medical education in its relationship with medical care of patients with COVID-19, as well as prevention and control strategies. Development: Aspects related to medical care of suspected and confirmed patients, as well as to the prevention and control of infection transmission in the community settings or in health centers, are described as fundamental areas for medical education. Furthermore, after controlling the pandemic, health educators are challenged to assess the required modification to health professional training programs in order to achieve high performance in new epidemiological settings. Therefore, a systematization was carried out of knowledge related to the challenges and the role of medical education in the fight against COVID-19. Conclusions: Educators have faced a challenge during the COVID-19 epidemic in educating health professionals to face the epidemic, which will be even greater in the future due to the need to achieve sustainability of education and revision of training programs to face the new epidemiological reality(AU)

Evolución de las recomendaciones para la prevención de la infección quirúrgica en cirugía de colon / Evolution of the Recommendations for Preventing Surgical Site Infection After Colon Surgery

RESUMEN Las infecciones del sitio quirúrgico constituyen un problema de calidad de los cuidados a la salud, las cuales son potencialmente prevenibles mediante la aplicación de guías de prevención basadas en evidencias. Se pretendedescribir la evolución histórica de las prácticas de uso profiláctico de antibióticos en cirugía de colon desde el siglo pasado. Se analizó literatura publicada en las últimas cinco décadas en MEDLINE, Infomed y otras fuentes secundarias. Se destaca la evolución del uso combinado de antimicrobianos (aminoglucósidos, penicilina, cefalosporinas y nitroimidazoles) asociados a la preparación enérgica del colon en la década de los 70 del pasado siglo. Numerosos antimicrobianos y prácticas han sido ensayados para demostrar que el uso de antibióticos para el control de las bacterias aerobias y anaerobias, administrados por vía oral e intravenosa, logra la prevención de hasta el 75 por ciento de las infecciones del sitio quirúrgico en cirugía de colon. Las evidencias científicas orientan hacia la necesidad del uso de profilaxis antibióticos orales más intravenosas asociados a la preparación mecánica del colon(AU)

ABSTRACT Surgical site infections are a concern with respect to quality of health care. Surgical site infections are potentially preventable through the application of evidence-based prevention guidelines. The aim is to describe the historical evolution of practicing prophylactic use of antibiotics in colon surgery since the last century. We analyzed the literature published in the last five decades in MEDLINE, Infomed and other secondary sources. The evolution is highlighted of the combined use of antimicrobials (aminoglycosides, penicillin, cephalosporins, and nitroimidazoles) associated with the vigorous preparation of the colon in the 1970s of the last century. Numerous antimicrobials and practices have been tested to demonstrate that the use of antibiotics to control aerobic and anaerobic bacteria, administered orally and intravenously, achieves the prevention of up to 75 percent of surgical site infections in colon surgery. Scientific evidence points to the need for the use of more intravenous oral antibiotic prophylaxis associated with mechanical preparation of the colon(AU)

[Effect of weight reduction on lipids and lipoprotein (a) serum levels]. / Efecto de la reducción de peso en los valores de lípidos y lipoproteína (a).

BACKGROUND AND OBJECTIVE: A quasi-experimental study to determine the effects of a body weight reduction treatment on lipids and lipoprotein (a) serum levels. PATIENTS AND METHOD: Ponderal and lipidogram values were determined in 69 premenopausic obese women before and after treatment. Differences were determined at a given time and at intervals. RESULTS: Apart from a high fasting HDLc, a reduction of the lipid values was observed. CONCLUSIONS: Our results suggest that weight reduction modifies favourably the lipid profile in premenopausic obese women.

Latent tuberculosis infection in healthcare workers at a community hospital in Qatar.

UNLABELLED: Routine screening of latent tuberculosis infection (LTBI) is recommended as an essential component in the prevention of TB transmission in healthcare facilities. OBJECTIVE: To determine the prevalence of LTBI among healthcare workers (HCWs) in a community hospital. METHODS: A descriptive study was carried out at The Cuban Hospital from August 2012 to May 2013 for newly hired medical staff. As part of the preemployment evaluation, the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-G) were performed. The information regarding the demographics, profile, experience as HCWs, any previous contact with TB patients and travels abroad were collected. ANALYSIS: Test of independence, Student's t test and Wilcoxon Mann-Whitney were used. For hypothesis testing, a significance level of 0.05 was adopted. RESULTS: TST results were positive in 14 subjects (6.9%), of which 11 were nurses, and 12 were females. QFT-G results were positive in six subjects (3.0%), who were older than those with negative results (44.5 vs. 38.9 years) and had more experience as HCW (21.7 vs. 16.8 years). Compared with subjects negative for QFT-G, positive subjects reported a higher frequency of both direct contact with tuberculosis patients (83.3% vs. 25%) and previous travels to countries with high TB incidence. CONCLUSION: Incidence of LTBI was low, especially when QFT-G results were considered, highlighting the history of traveling to countries with high TB incidence as an associated key factor.

Infección asociada a dispositivos en Unidad de Cuidados Intensivos. Oeste de Qatar / Device-associated infection in an Intensive Care Unit. Western Qatar

Introducción: Las infecciones asociadas a dispositivos en unidades de cuidados intensivos tienen un gran impacto. Objetivo: Describir la incidencia y adherencia en el cumplimiento de intervenciones preventivas de infecciones asociadas a dispositivos en la Unidad de Cuidados Intensivos del Hospital Cubano en Qatar. Material y Métodos: Se realizó una vigilancia prospectiva en la UCI de 6 camas entre enero de 2013 y diciembre de 2016. Se recolectaron datos sobre cumplimiento de intervenciones preventivas para inserción y mantenimiento de dispositivos. Se analizaron las tasas de infección, la razón de utilización del dispositivo y el cumplimiento de prácticas. Resultados: La media de Neumonía asociada a la ventilación fue de 2,61 por 1 000 días de ventilación, las tasas de infección, cero para Infección del tracto urinario asociado al catéter y del torrente sanguíneo por dispositivo vascular. La utilización del ventilador fue superior (0,32) (p = 0,000) en comparación con los datos de la Red Nacional de Seguridad Sanitaria de los Estados Unidos (0,24), las del catéter venoso central y el catéter urinario fueron similares 0.33, 0.54 (p = 0,000), respectivamente. La adherencia a las intervenciones preventivas para el ventilador fue de 99 por ciento y 98,2 por ciento durante 2013 y 2014, y 100 por ciento después, las relacionadas con el uso del dispositivos vasculares centrales fue de 100 por ciento, mientras con el catéter urinario tuvo la cifra más baja en 2013 (97,9 por ciento ), 2015 (98,3 por ciento) y 2016(99,6 por ciento). Conclusiones: Existió baja incidencia de infecciones asociadas a dispositivos relacionadas con la adherencia al programa integral de control de infecciones en la Unidad de Cuidados Intensivos(AU)

Introduction: Device-associated infection (DAI) in intensive care units have a major impact on morbidity, mortality, and costs. Objective: To describe the incidence and adherence of a DAI and the bundle compliance in an intensive care unit at a community hospital in Western Qatar. Material and Methods: A prospective surveillance was conducted in a 6-beds medical-surgical intensive care unit from Jan 2013 to December 2016. Data about clinical, laboratory, and other diagnostic information were collected to satisfy the criteria for infection. DAI rates, device utilization ratio (UR) and bundle compliance were analyzed, and comparison with 2013 US data was performed. Results: The pooled mean of ventilator-associated pneumonia rates was 2.61 per 1000 ventilator days, and zero for catheter-associated urinary tract and central line bloodstream infections. The ventilator UR was superior (0.32) (p =0.000) than the National Health System Network (NHSN) data (0.24); the use of the central line bundle and the urinary catheter were similar (0.33, 0.54) (p=0.000), respectively. The compliance with bundle elements for ventilator was 99 percent and 98.2 percent for 2013 and 2014 respectively, and 100 percent compliance afterward. The compliance with central line bundle was 100 percent during the study period, whereas the compliance with urinary catheter bundle had the lowest figure in 2013 (97.9 percent), 98.3 percent in 2015, and 99.6 percent in 2016, related to bag contact with the floor. Conclusions: The study has shown the low incidence of device-associated infections related to a comprehensive infection control program in the Intensive Care Unit(AU)

Participación de los pacientes en la prevención de las infecciones del sitio quirúrgico / Patient Involvement if Preventing Surgical Site Infections

RESUMEN Introducción: Las infecciones del sitio quirúrgico constituyen las más frecuentes infecciones relacionadas con los cuidados de la salud y la educación de los pacientes, y los cuidadores constituye un elemento esencial para su prevención. Objetivo: Evaluar los elementos esenciales relacionados con la participación de los pacientes en la prevención de las infecciones del sitio quirúrgico. Método: Utilizando como fuente de información PubMed y la Joint Comission International se sintetizaron los aspectos relacionados con la prevención de las infecciones del sitio quirúrgico. Desarrollo: La educación del paciente transcurre desde el periodo preoperatorio hasta la total recuperación del paciente y constituye un criterio requerido para acreditar los sistemas de gestión de la calidad en instituciones de salud. Debe enfocarse en la modificación positiva de riesgos como la higiene preoperatoria, la abstención del hábito de fumar, el control glicémico en pacientes diabéticos, el uso de medicación inmunosupresora, la movilización temprana de los pacientes, los cuidados de la herida y la identificación y manejo oportuno de infecciones. Conclusiones: Se debe promover la participación activa del paciente y su familia en los cuidados de salud y el uso de las tecnologías educativas disponibles(AU)

ABSTRACT Introduction: Surgical site infections are the most frequent infections associated with health care. The education of patients and caregivers is an essential element for their prevention. Objective: To evaluate the essential elements associated with the participation of patients in the prevention of surgical site infections. Method: Using PubMed and the Joint Commission International as a source of information, we synthesized aspects related to the prevention of surgical site infections. Development: Patient education is carried out from the preoperative period until the patient's full recovery and is a required criterion to accredit quality management systems in health institutions. It should focus on the positive modification of risks such as preoperative hygiene, abstention from smoking, glycemic control in diabetic patients, the use of immunosuppressive medication, early mobilization of patients, wound care, and identification and timely management of infections. Conclusions: The active participation of the patient and the family in health care and the use of available educational technologies should be promoted(AU)

Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the International Nosocomial Infection Control Consortium (INICC).

OBJECTIVE: This study sought to assess the effect of the multidimensional approach developed by the International Nosocomial Infection Control Consortium (INICC) on the reduction of ventilator-associated pneumonia (VAP) rates in patients hospitalized in an adult intensive care unit (AICU) in an INICC member hospital in Havana, Cuba. METHODS: We conducted a prospective surveillance pre-post study in AICU patients. The study was divided into two periods:baseline and intervention. During the baseline period, we conducted active prospective surveillance of VAP using the Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definition and INICC methods. During the intervention period, we implemented the INICC multidimensional approach for VAP, in addition to performing active surveillance. This multidimensional approach included the following measures: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback of VAP rates and performance feedback of infection control practices. The baseline rates of VAP were compared to the rates obtained after intervention, and we analyzed the impact of our interventions by Poisson regression. RESULTS: During the baseline period, we recorded 114 mechanical ventilator (MV) days, whereas we recorded 2350MV days during the intervention period. The baseline rate of VAP was 52.63 per 1000MV days and 15.32 per 1000MV days during the intervention. At the end of the study period, we achieved a 70% reduction in the rate of VAP (RR, 0.3; 95% CI, 0.12-0.7; P value, 0.003.). CONCLUSIONS: The implementation the INICC multidimensional approach for VAP was associated with a significant reduction in the VAP rate in the participating AICU of Cuba.