Basics concepts about asepsis and antiseptics. / Conceptos básicos sobre antisepsia y antisépticos.

During health care, the patient is exposed to a wide variety of microorganisms. Maximum hygiene in all care activities is therefore essential in order to reduce the cross-transmission of preventable infectious diseases. The 3 key mechanisms for the prevention of infection in health centers are cleaning, disinfection and sterilization. The scientific and rational use of disinfectants and antiseptics, and the correct application of aseptic techniques in the care of patients and in the handling and supply of materials are the fundamental considerations for the prevention of healthcare related infections. Adequate knowledge of the concepts and standards of use of antiseptics and disinfectants offers healthcare workers the essential tool needed to avoid the spread of infectious agents, while also establishing the scientific basis for their rational use. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

[Research on patient safety: needs and perspectives]. / La investigación sobre seguridad del paciente: necesidades y perspectivas.

A safe health care system requires applying procedures and practices that have demonstrated effectiveness in reducing errors, faults and adverse events in health care, but it also needs to update its knowledge on the factors that contribute to improve patient safety. Adverse events and patient safety are two sides of the same coin, clinical risk. We must ensure that the priority of health managers and providers is aimed at patient safety more than adverse events. They are some fundamental areas of research in patient safety: to estimate the magnitude and features of the clinical risk, to understand the factors contributing to the appearance of adverse events, to evaluate the impact of adverse events on health care system and to identify effective, feasible and sustainable solutions to achieve a safe health care. Key points of patient safety research projects are: aims of research, priority, data and information quality, available resources and methodology. The study of the patient safety and adverse events needs two complementary perspectives: a collective one, based on epidemiological methods and aimed at quantifying the risks in healthcare, and an individual one, based on qualitative methods, to analyze causes and factors contributing to adverse events. Several things are required to improve the patient safety research: better data and information systems, greater collaboration in training between developed and transitional countries, and wider dissemination of experiences and results of the projects. Key points of patient safety research projects are: aims of research, priority, data and information quality, available resources and methodology. The study of the patient safety and adverse events needs two complementary perspectives: a collective, based on epidemiological method and guided to quantifying the risks of healthcare, and another individual, based on qualitative methods, to analyze causes and contributing factors of adverse events. To improve the patient safety research are necessary: better data and information systems, bigger collaboration between developed and transitional countries training and wide dissemination of experiences and results of the projects.

[Absenteeism and associated factors in scheduled visits to a Preventive Medicine outpatient clinic]. / Absentismo, y factores asociados, en las citas programadas de una consulta externa de Medicina Preventiva.

BACKGROUND: Patient absenteeism in outpatient clinics represents a significant obstacle to the cost-effectiveness of healthcare. The aim of this study was to assess the frequency of absence of patients and its associated factors in scheduled visits to a Preventive Medicine department. PATIENTS AND METHODS: The cross-sectional study was carried out in the Service of Preventive Medicine of the Lozano Blesa University Clinical Hospital of Zaragoza. It included all the visits scheduled from 3 January to 31 March 2017. For each visit, the date and time were registered, together with the type (first or consecutive appointments), age, gender, town of residence, country of birth, and underlying disease. The Chi-squared test was used to determine the association between the variables and making the visit, with a multiple logistic regression analysis being performed on the variables in which a significant association was found. RESULTS: Of the total of 582 appointments studied, the absenteeism rate was 12.5% (73 out of 582; 13.7% for first appointments and 11.7% for consecutive appointments). Variables that revealed a significant association with patients not attending were: time (9.00-11:15 a. m.; OR=1.84; 95%CI: 1.10-3.08), day of the week (Mondays-Thursdays; OR=3.19; 95%CI: 1.12-9.07), country of birth (outside of Spain; OR=2.09; 95%CI:1.09-3.99), vaccination group (chronic kidney disease during pre-dialysis or dialysis; OR=3.59; 95%CI: 1.57-8.18), and age group (under 52 years old; OR=1.85; 95%CI: 1.08-3.19). CONCLUSIONS: The rate of absenteeism is at an intermediate position compared to the outpatient visits for other departments. The detection of associated factors makes it possible to plan specific measures for improvements that may reduce absences.

[The incidence and distribution of accidents with biological fluids among health personnel and the general population]. / Incidencia y distribución de accidentes con fluidos biológicos en personal sanitario y población general.

OBJECTIVES: To assess the informative usefulness of the Registry, to calculate the incidence rates of accident with biological fluids among health care workers and in the community, to know about the postaccident rate of seroconversion to HIV and to identify risk groups. METHODS: A descriptive study of the HIV records file of the Registry of Accidental Contacts to Biological Fluids in the Clinic Hospital of Zaragoza was conducted, between January 1987 and September 1993. The registry includes the reports of health care workers and the general population of Health Area III in Aragón (Spain), except for the Calatayud's Hospital. Incidence rates, rate ratios and their 95% confidence intervals were calculated. RESULTS: A total number of 595 accidents were reported, in none of them and HIV infection occurred subsequently. The incidence rate in health care workers was of 1.7 reports per 100 workers per year, while in the community it was of 8.1 per 100,000 people. The housekeeping staff was the group with a higher incidence (rate = 6.7; 95% IC: 3-14.8) and the type of accident more frequently described was needlestick injury. CONCLUSIONS: The incidence of reported accidents has increased in the community and in health care workers, which may be due to the increase in the reporting. In health care workers, the incidence in 1993 was within the range reported from other countries. The perception of risk is universal after accidents with unknown biological fluids. The correct disposal of material with biological contamination should be the more important preventive action.

[Surgical wound infection in urological patients. a four-year review]. / Infección de herida quirúrgica en pacientes urológicos. Revisión de los casos registrados en cuatro años.

INTRODUCTION: Surgical site infection (SSI) is a constant concern for health care professionals. OBJECTIVE: To ascertain the accumulated incidence (CI) rates of SSI, overall and by surgical procedure, at our department of urology, and to find areas for improvement. MATERIALS AND METHODS: A retrospective and analytical study was conducted (January 2004/December 2007) of 91 patients. Variables examined included age, sex, mean hospital stay, diagnosis, surgical procedure, infection site, organism, and department and hospital rates. Procedures performed in more than 2 patients were analyzed. Patients with SSI caused by an infectious condition were excluded. A descriptive statistical analysis, comparison of percentages, Chi-square test were performed as appropriate. RESULTS: Eighty-five males and 6 females with a mean age of 64.3+/-13.6 years were analyzed. The AI rate for the department was 1.99%, lower than for the rest of the hospital. Mean hospital stay was 22.4+/-17.9 days. According to the CDC criteria, there were 56 superficial (61.5%), 10 deep (10.9%) and 25 organ/space (27.4%) infections. Cultures were performed in 54infections (59.4%, lower than the hospital rate). Fifty percent of cultures were positive. Very high rates were found in cystectomy (25, 26.04%), adenomectomy (21, 16.00%) and urethroplasty (4; 10.26%), while the rates found for other procedures were lower than reported in the literature. CONCLUSIONS: Our overall SSI rates were similar to those of other urology departments and lower than the hospital rate. SSI rates in adenomectomy were very high and a study should be conducted to find areas for improvement. SSI rates in cystectomy were also very high, in agreement with previous reports, and must also be improved, as well as the percentage of wound cultures.