[Predictive model for nosocomial pneumonia in intensive care units]. / Modelo predictivo de neumonía nosocomial en unidades de cuidados intensivos.

BACKGROUND AND OBJECTIVE: Nosocomial pneumonia is the most common nosocomial infection in the intensive care units (ICUs) and contributes disproportionately to both poor outcomes and high cost of care in critically ill patients. In order to identify patients with greater risk of developing nosocomial pneumonia in ICUs, it is important to select the right preventive measures. PATIENTS AND METHOD: It was an observational study of 2 prospective cohorts of patients staying in the ICU for 24 h or more: the main cohort (n=1,184) and the validation cohort (n=554). A predictive model was constructed with the data of the main cohort using a logistic regression. Receiver operating characteristic (ROC) curves and predictive values for different cut points were obtained with the data of both cohorts. RESULTS: Eight variables were selected for the predictive model: parenteral nutrition, enteral nutrition, nasogastric intubation, tracheostomy, mechanical ventilation, previous surgery, coma and diabetes. In the main cohort, the model had a sensitivity of 81% and a specificity of 78.4% in predicting nosocomial pneumonia (Hosmer-Lemeshow statistic p=0.93; area under ROC curve=0.861; 95% confidence interval, 0.824-0.898). In the validation cohort, the area under ROC curve was 0.849 (95% confidence interval, 0.742-0.956). CONCLUSIONS: The resulting model presents satisfactory results in both cohorts. In addition, the variables used are simple, routinely available, and familiar to clinicians.

[Flu vaccination in healthcare workers]. / Vacunación antigripal en personal sanitario.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the trends in yearly vaccination coverage in healthcare workers. METHOD: Cross-sectional epidemiological study over fifteen seasons (1990-2005). Overall vaccination coverage and coverage by professional category was estimated annually. The chi-square test and Mantel-Haenszel test for linear trend were used for the statistical analysis. RESULTS: The greatest vaccination coverage was in the 2003-04 season (15.9%; 95% CI: 14.8-17) and the 2005-06 season (16.3%; 95% CI: 15.3-17.4). The medical staff and residents showed the highest coverage (30.1%). A positive trend was observed along the period. CONCLUSIONS: An increasing trend in influenza vaccination coverage has been observed in healthcare workers.

[EPINETAC study]. / Estudio EPINETAC.

Daily, health professionals face biological risks, which have important repercussions for their own health, while performing their professional duties. A system which records data that quantifies and specifies the causes of work place accidents, the instruments most frequently involved in accidents, the professional categories having the greatest exposure, the tasks most at risk and the types of lesions is fundamental in order to grasp the true dimensions of these problems related to accidents and serum-borne disease transmission. Such a data base-could lead to the necessity, and highlight the importance, to increase preventive and protective measures for health personnel. To meet this objective, the EPINETAC project has been developed thanks to the information provided by 106 centers having various degrees of participation during the different years this study has taken.

[Quality improvement program of nosocomial infection in colorectal cancer surgery]. / Programa de mejora de la infección nosocomial en cirugía por cáncer colorrectal.

BACKGROUND AND OBJECTIVE: The surgical-site infection (SSI) is a complication of colorectal neoplasia surgery. The objectives of the study were to identify the SSI risk factors associated with colon surgery and to describe a strategy of quality improvement using surgical-site rates. PATIENTS AND METHOD: Prospective cohort study of in-patients undergoing neoplasia colorectal surgery between 1st July 2002 to 30th June 2003. A descriptive analysis was implemented. Benchmarking was used as tool of quality improvement, and the outcomes were measured using the standardized infection ratio (SIR). To define the risk factors, the Chi square test and logistic regression test were used in univariate and multivariate analysis, respectively. RESULTS: 148 patients were included in the study. The SSI accumulative incidence rate (IA) was 10.14%, and the incidence rate was 6.47 SSI per 1000 days. The SIR was 1.53 the first semester and 1.02 the second one. The multivariate analysis identified two risk factors associated with SSI: unscheduled admission (odds ratio [OR] = 7.47, 95% confidence interval [CI] 2.03-27.48) and a risk index of American Society of Anaesthesiologists (ASA) > or = 3 (OR = 6.77, IC 95%, 1.15-39.84). CONCLUSIONS: An unscheduled admission and high risk ASA index were risk factors associated with SSI in patients undergoing colorectal surgery. The program of quality improvement based on benchmark achieved a reduction of SSI rates similar to the standard ones.

[Risk injuries at operating and delivery rooms. EPINETAC Project 1996-2000]. / Accidentes biológicos en quirófanos y salas de parto. Proyecto EPINETAC 1996-2000.

BACKGROUND AND OBJECTIVE: Surgical areas have long been considered risky with regard to occupational exposures to blood-borne pathogens. The objective of study was to describe and evaluate the risk of occupational exposure to blood-borne pathogens at operating and delivery rooms, from reports of injuries in health care workers. SUBJECTS AND METHOD: Transversal study of percutaneous injuries occurring in operating and delivery rooms which were registered in the Spanish surveillance system EPINETAC (Exposure Prevention Information Network Accidents) between 1996 and 2000. We recorded data from the exposed health care worker, from the accident itself and from the exposure source. The risk of exposition was calculated by logistic regression. The dependent variable was the exposition in operating/delivery rooms. We calculated the rate of exposure, total and by occupational categories, per 10,000 surgical procedures in 3 surgical specialties. RESULTS: There were 3,625 percutaneous injuries reported. The exposure risk was higher in midwives [OR 36.6 (CI 95% 19.61-68.52)] than in staff [OR 12.6 (CI 95% 10.21-15.71)] or training doctors [OR 12.8 (CI 95% 10.34-15.98)]. The highest risk turned up during use of material [OR 1.37 (CI 95% 1.05-1.79)] and during preparation of material for reuse [OR 1.81 (CI 95% 1.27-2.59)]. The exposure rate, in gynecologic procedures, was 34.36 injuries per 10,000, in digestive surgery it was 24.61 per 10,000, and in trauma surgery it was 18.92 per 10,000 surgical procedures. CONCLUSIONS: The risk of occupational exposure to blood-borne pathogens in staff and training doctors was higher in operating and delivery rooms than in others areas. Obstetric and gynecologic procedures exhibited the highest risk of exposure.

[Occupational exposures to blood and biological material in healthcare workers. EPINETAC Project 1996-2000]. / Exposición ocupacional a sangre y material biológico en personal sanitario. Proyecto EPINETAC 1996-2000.

BACKGROUND AND OBJECTIVE: The bloodborne injury is the most frequent risk in healthcare workers. Among them, the hollow-bore needlesticks are the most associated with the risk of acquire a bloodborne infection. In this study, occupational percutaneous injuries and risk factors associated to hollow-bore needlesticks registered in a national multicenter surveillance system are described. PATIENTS AND METHOD: Prospective and analytical study of percutaneous injuries registered in the surveillance system EPINETAC (Exposure Prevention Information Network) in Spain between 1996-200. A descriptive analysis of the variables related to the exposed healthcare worker, the exposure and their mechanism and the source patient is performed. The incidence rates were calculated by 100 occupied beds and by job category. A multivariable analysis is performed in order to know the risk factors most associated to hollow-bore needle. RESULTS: 16,374 percutaneous injuries has been registered, which 87% are hollow-bore needlesticks. The incidence rate has been 11.8 expositions per 100 occupied beds. Midwives are the most risky workers (9 injuries per 100 occupied beds). The risk factors most associated to hollow-bore needlesticks are the following: job category of midwife (OR = 7.5 95% CI, 4.1-13.7) and student nurse (OR = 2.1; 95% CI, 1.2-3.7), recapping (OR = 28.8; 95% CI, 16.5-50.6), working in venipuncture room (OR = 3.3; 95% CI, 1.2-9.5) or in the dialysis unit (OR = 2.5; 95% CI, 1.4-4.3). CONCLUSIONS: The incidence of occupational percutaneous injuries in Spain is similar to those described in other countries using comparable surveillance systems. The risk of hollow-bore needlestick is directly related to job category, work experience, work area and the activities that the healthcare worker does.

[Occupational exposure to multiresistant Mycobacterium bovis in a hospital in Saragossa, Spain]. / Exposición laboral a Mycobacterium bovis multirresistente en un hospital de Zaragoza.

BACKGROUND: Those working in a hospital environment are exposed to different occupational risks, although more specifically biological ones. One of the major risks is that of exposure by airborne transmission, more specifically, tuberculosis. This study is aimed at providing a description and analysis of the results of the implementation of an evaluation and surveillance protocol following occupational exposure to Multiresistant mycobacterium bovis (MRMb). METHOD: A male patient was diagnosed with MRMb infection at the Miguel Servet Hospital in Zaragoza in 1999 following ten days without respiratory isolation. During this period, he came into contact with 167 employees from different hospital departments. A surveillance and contact control protocol was prepared based on: completing a survey and undergoing an initial Mantoux (if the employee had previously tested negative for tuberculin), followed three months later by a chest X-ray and then a two-year clinical follow-up (check-ups every three months) for those having tested positive for tuberculin and no administering of chemoprophylaxis even though signs of infection were to have been found. RESULTS: Information was gathered on 160 employees (96%). A total of 94 employees (59%) had previously undergone a Mantoux, seven (7) having had tuberculosis. It was necessary for a follow-up to be conducted on sixty-one (61) employees who tested positive (29 previously positive and 32 detected in the initial Mantoux). No employee who had tested negative on an initial Mantoux tested positive on repeated testing three months later nor showed any symptoms indicative of transmission during the follow-up period. Some variables, such as age or working in the Infectious Disease Unit were related, on a statistically significant basis, to follow-up being required. CONCLUSIONS: The risk of occupational transmission following contact with MRMb might be similar to M. Tuberculosis, although further experience would be required in order to confirm this fact. Early diagnosis and availing of a protocol for implementing measures aimed at preventing and controlling this type of occupational exposure are of importance.