[Impact of the restriction of family visits due to the pandemic on the clinical evolution of the hospitalized geriatric patient]. / Repercusión de la restricción de visitas familiares por la pandemia en la evolución clínica del paciente geriátrico hospitalizado.

The restriction of family accompaniment of hospitalised patients has consequences for the patient, family and professionals. The aim of this study was to analyse the opinion of healthcare professionals on the family presence in the care and recovery of hospitalised geriatric patients. A descriptive, observational, multicentre study was carried out by means of a survey addressed to professionals from hospitals in Madrid. A total of 314 professionals (43.6% nurses, 26.1% nursing assistants, 15.6% doctors) from different hospitals responded. Eighty percent (95%CI: 75%-84%) stated that the restriction of visits hindered the patient's recovery and 84% (95%CI: 80%-88%) stated that the family care cannot be substituted by professionals, although it can be improved through training and increased staffing (91%). Seventy percent think that when patients are alone, they eat and drink less, suffer more bronchial aspiration and delirium, and have greater difficulty in hygiene and mobilisation. Healthcare professionals recognised that the care provided by patients' relatives facilitates their recovery.

[Adequacy of pre-surgical hand hygiene in an university teaching hospital in Madrid (Spain).] / Adecuación de la higiene prequirúrgica de manos en un hospital universitario de Madrid.

OBJECTIVE: We know the importance of hand hygiene in the prevention of healthcare-associated infections. However, its compliance is still a challenge. Moreover, when it is complied with, as in the case of preoperative hygiene, there are few studies on the proper performance of the technique. The aim of this paper is to assess adequacy of pre-surgical hand hygiene in operating room staff of different surgical specialities at a university teaching hospital in Madrid. METHODS: A cross-sectional study was made. Adequacy of pre-surgical hand hygiene was assessed in operating room staff of the different specialities and professional categories by direct covert observation. It was evaluated in 852 opportunities during the months of October, November and December 2020. A specific form was designed for data collection, following the recommendations of the World Health Organisation (WHO). Adequacy was described with frequency distributions of the different groups observed. Whether Chi-square or Fisher's exact tests were used to compare the different categories. RESULTS: Pre-surgical hand hygiene opportunities were evaluated, 75.5% in surgeons and 24.5% in nurses. Overall compliance with pre-surgical hand hygiene technique was 80.5 % (686). The most frequent surgical service evaluated was General Surgery with 240 observations. The professional category with the best adequacy was nursing (86.1%) and the surgical service one was Traumatology (90.2%). An stopwatch was used by some 25.8% of the evaluated professionals, with an adequate hygiene time of 96,8% (p<0,05) for that group. CONCLUSIONS: The overall adequacy of pre-surgical hand hygiene in the operating room professionals is high. Significant statistically differences in adequacy are found between professional categories and surgical specialities, with better compliance in nursing staff and in Traumatology. Better results are achieved by the use of an stopwatch.

OBJETIVO: Sabemos la importancia que tiene la higiene de manos en la prevención de infecciones asociadas a la asistencia sanitaria. Sin embargo, a día de hoy, su cumplimiento, es un reto. Además, cuando se cumple, como es el caso de en la higiene prequirúrgica, pocos estudios hay sobre la adecuada realización de la técnica. El objetivo de este estudio fue evaluar la adecuación de la higiene de manos prequirúrgica en profesionales de quirófano de un Hospital Universitario de Madrid. METODOS: Se realizó un estudio descriptivo trasversal. Se evaluó la adecuación de la higiene de manos prequirúrgica mediante observación directa y enmascarada en 852 oportunidades durante los meses de octubre, noviembre y diciembre de 2020. Se consideró adecuada la higiene de manos si ésta se realizaba según la técnica correcta y durante el tiempo indicado. La adecuación de la higiene de manos se describió con la distribución de frecuencias y las diferencias entre categorías se compararon con la prueba x2 de Pearson o prueba exacta de Fisher. RESULTADOS: Se evaluaron las oportunidades de higiene de manos prequirúrgica, el 75,5% en cirujanos y el 24,5% en personal de enfermería. La adecuación global de la higiene de manos fue del 80,5%. La categoría profesional con mejor adecuación fue Enfermería (86,1%) (p<0,05) y el servicio quirúrgico con mejor adecuación fue Traumatología (90,2%) (p<0,05). Un 25,8% de los profesionales evaluados utilizó el apoyo del cronómetro, consiguiendo este grupo una adecuación al tiempo de higiene del 96,8% (p<0,05). CONCLUSIONES: La adecuación global de la higiene de manos prequirúrgica en nuestros profesionales es muy alta. Se encuentran diferencias estadísticamente significativas de cumplimiento entre categorías profesionales y especialidades quirúrgicas, siendo mejor la adecuación en el personal de Enfermería y en la especialidad de Traumatología. El apoyo del cronómetro consigue mejores resultados en la adecuación al tiempo de higiene.

[Collaboration experience between hospitals and long-term care facilities for the care of COVID-19 patients.] / Experiencia de colaboración entre hospital y centros socio-sanitarios para la atención de pacientes con COVID-19.

OBJECTIVE: The disease produced by SARS-CoV-2 has led to severe situations and mortality in elderly people. The objective of this study was to describe the collaboration between hospital professionals and nursing homes when applying preventive measures for the transmission of COVID-19 and in the assistance of institutionalized patients. METHODS: A descriptive study was carried out in 4 centers with information collected by researchers in two moments of the COVID-19 pandemic. The information collected was related to the resources and knowledge of infection prevention, details about face-to-face and telematic assistance from the hospital team, as well as material, drugs provided, and clinical results. The variables studied were described by means of percentages, absolute frequencies and ratios; statistical chi-square tests and McNemar'test were used. RESULTS: The study was conducted in 4 centers with a total of 640 residents and an initial occupancy between 62% and 85%. Differences were found regarding the ratio of staff and knowledge of preventive measures of the transmission of SARS-CoV-2 infection, which was improved in the second period of the study. The number of face-to-face visits (from 5 to 22) and telematic visits (between 42 and 109 patients) were different in the 4 nursing homes, as well as the material provided, adapted to the needs of each center. The percentage of infected patients ranged from 6.1% to 90.2%, and the accumulated mortality in the second period ranged from 15.38% to 38.35% of the residents at the beginning of the pandemic. CONCLUSIONS: The collaboration between the professionals of healthcare centers and the hospital, adapted to the needs of each center, has allowed to improve the assistance to the residents and the coordination between the professionals, optimizing the available resources.

OBJETIVO: La enfermedad producida por SARS-CoV-2 ha provocado situaciones de mayor gravedad y mortalidad en las personas mayores. El objetivo de este estudio fue describir la colaboración entre profesionales del hospital y de las residencias en la aplicación de medidas de prevención de la transmisión de COVID- 19 y en la asistencia de pacientes institucionalizados. METODOS: Se realizó un estudio descriptivo en 4 centros sociosanitarios con información recogida por los investigadores en dos momentos de la pandemia por COVID-19. Se recogió información relacionada con los recursos y conocimiento de la prevención de infecciones, detalles sobre la asistencia presencial y telemática del equipo del hospital, así como material, fármacos suministrados y resultados clínicos. Las variables estudiadas se describieron mediante porcentajes, frecuencias absolutas y ratios y se utilizaron las pruebas estadísticas de chi cuadrado y el test de Mc-Nemar. RESULTADOS: Se realizó el estudio en 4 centros con un total de 640 residentes y una ocupación inicial entre el 62% y 85%. Se encontraron diferencias respecto al ratio de personal, conocimiento de medidas de prevención de transmisión de la infección por SARS-Cov 2, mejorando este último en el segundo periodo de estudio. El número de consultas presenciales (de 5 a 22) y telemáticas (entre 42 y 109 pacientes) fueron diferentes en las 4 residencias, así como el material aportado, adaptándonos a las necesidades de cada centro. El porcentaje de pacientes contagiados varió entre el 6,1% y el 90,2% y la mortalidad acumulada en el segundo periodo osciló entre el 15,38% y el 38,35% de los residentes que había al principio de la pandemia. CONCLUSIONES: La colaboración entre los profesionales de los centros sociosanitarios y del hospital adaptada a las necesidades de cada centro ha permitido mejorar la asistencia a los residentes y la coordinación entre los profesionales, optimizando los recursos disponibles.

[Evolution of hand hygiene adherence of health professionals of specialized care.] / Evolución de la adherencia a la higiene de manos en un hospital de la Comunidad de Madrid.

OBJECTIVE: Hand hygiene (HH) is essential for the prevention of health care-associated infections (HAIs). Compliance rates documented in Spain and internationally are low, although improvement is possible using some strategies and training. The aim of this study was to know the evolution of the adherence to the 5 moments for hand hygiene of the health professionals of the Hospital Universitario Fundación Alcorcón and to propose measures to implement it. METHODS: A direct observation study about the compliance of the 5 moments for HH in this hospital for seven years was carried out. Different professional groups received training, using the traditional method and simulation learning. The data was summarized using percentages and absolute frequencies. They were analyzed using SPSS version 21 for Windows. RESULTS: Adherence increased from 37% in 2011 to 57.8% in 2019. Compliance in the 5 moments was higher after patient contact than before it. Nurses were one of the groups with the highest compliance. CONCLUSIONS: Even though they have improved, compliance rates need to be maintained and to increase especially in moments as crucial as before an aseptic procedure. Training and the implementation of strategies are key.

OBJETIVO: La higiene de manos (HM) es fundamental para la prevención de las infecciones relacionadas con la atención sanitaria (IRAS). Los índices de cumplimiento documentados, tanto en España como internacionalmente, son bajos, aunque una mejoría es posible utilizando algunas estrategias y formación. El objetivo de este estudio fue conocer la evolución de la adherencia a los 5 momentos de higiene de manos de los profesionales sanitarios del Hospital Universitario Fundación Alcorcón, y plantear medidas para implementarla. METODOS: Se realizó un estudio de observación directa sobre el cumplimiento de los 5 momentos de HM en este hospital durante siete años. Diferentes colectivos profesionales recibieron formación, utilizando el método tradicional y aprendizaje mediante simulación. Se realizó un análisis descriptivo, con frecuencias absolutas y relativas. Se analizaron mediante SPSS versión 21 para Windows. RESULTADOS: La adherencia aumentó de un 37% en 2011 a un 57,8% en 2019. El cumplimiento en los 5 momentos fue más alto después del contacto con el paciente que antes de este. El personal de enfermería fue uno de grupos con mayor cumplimiento. CONCLUSIONES: Aunque han mejorado, se necesita mantener los niveles de cumplimiento, y aumentarlos sobre todo en momentos tan cruciales como antes de realizar una técnica aséptica. La formación y la implementación de estrategias son clave.

[Workers in primary health care and partner violence against women]. / Profesionales de atención primaria de Madrid y violencia de pareja hacia la mujer en el año 2012.

BACKGROUND: Morbidity associated to partner violence against women (PVAW) justify these patients repeated visits to Health Services. Primary Care is the ideal place for detectión and first aid, due to its easy accesibility and continuated assistance. Nevertheless, numbers show important difficulties to achieve this goal. Our aim is to find out the level of knowledge, opinions, awareness about organizacional barriers and improvement proposals suggested by the workers of primary care. METHOD: Cross-sectional descriptive study using an anonymous and voluntary survey during the months of August and September 2010, targeted to all professionals who perform their work in a Primary Care Area of Madrid. We made a descriptive analysis of variables and used chi(2) to compare the answers. RESULTS: Answer rate is 170 (21.4%). There are stereotypes regarding battered woman and perpetrador. 118 (70.7%) professionals believe that this is a major problem and 154 (91.7%) that usually goes unnoticed. 91 (55.2%) know their legal commitments. 73 (51.8%) think that there are organizational barriers, among them: the burden of care 50(29%), lack of specific training 40(23.5), lack of knowledge about the procedure to be followed 20(11.8%) and about the professional responsabilities 12 (7%). CONCLUSIONS: All profesional categoríes showed an average level of knowledge, except for social workers that was high. Primary Care workers think that PVAW is an important issue that usually goes unnoticed. Half of them know the legal commitments o detección. There are organizacional barriers and stereotypes.

[Characteristics of patients with methicillin-resistant Staphylococcus aureus infection]. / Características de los pacientes que presentan infección por Staphylococcus areus resistente a meticilina.

OBJECTIVE: To determine the epidemiological characteristics of infection by methicillin-resistant Staphylococcus aureus (MRSA) and changes in its prevalence in a tertiary hospital in the autonomous community of Madrid. METHOD: Between 2005 and 2007, we carried out a descriptive study of all patients with MRSA-positive cultures from the total number of admissions to the Fundación Alcorcón University Hospital. RESULTS: Of 251 MRSA-positive cultures, the infection was community-acquired in 138 patients (55%) while 112 patients (44.6%) were from nursing homes. The mean age of the patients was 76 years, with men representing 56.2% (141) of the sample. The median length of hospital stay was 17 days. Positive cultures were isolated from sputum in 21.9% (55), from blood cultures in 19.5% (49), from other locations in 19.9% (50) and from pressure ulcers, surgical wounds or urine in 55.8% of the patients (140). The latter could be classified as healthcare-related infections. The total infection rate was 5.540 per hundred. CONCLUSIONS: More than half of infected patients with MRSA infection were colonized. The most frequent locations were pressure ulcers and surgical wounds and consequently the risk of spread can be related to healthcare. In infected patients, the length of hospital stay was 4-5 times longer than average. The rate of hospital-acquired infection tended to decrease, while that of community-acquired infection increased during the study period. Hygiene measures should be implemented, quality of care should be improved, and health resources should be optimized.

[Knowledge of and opinions on violence against women among health professionals in specialized care]. / Conocimientos y opiniones de los profesionales de la salud de atención especializada acerca de la violencia de género.

OBJECTIVE: The aim of this study was to evaluate knowledge of gender violence among health workers/medical staff in specialized healthcare and their opinions on the subject. A further aim was to identify the organizational barriers perceived by these workers and their proposals to enhance the early detection of this phenomenon and care of victims. METHOD: We performed an observational, cross sectional study based on an anonymous survey of health workers/medical staff working in the pediatrics, obstetrics or emergency departments of two hospitals in health district 8 of Madrid. RESULTS: Overall, health professionals had average knowledge about gender violence. A total of 58.2% believed that physical abuse of women was associated with the lower social classes, while 72.8% believed that victims were uneducated women, housewives or foreigners; 67.6 % believed that aggressors were alcoholic, drug addicted or unemployed men. Almost all health professionals (97.7%) considered that gender violence against women was an important problem that usually went undetected. However, 66.7% did not include this phenomenon in the differential diagnosis of women with physical injuries. Notable among the organizational obstacles identified were workload, lack of training and information, and the absence of a protocol. CONCLUSIONS: Knowledge of gender violence among health professionals was average, with no significant differences between hospitals or among the three categories of staff surveyed. Stereotyped beliefs were found among health professionals who, nevertheless, believed they had an important role in detecting battered women. Reducing the organizational barriers detected could improve the care of these patients.