Impact of time of culture specimen collection on the recovery of Neisseria gonorrhoeae after a positive nucleic acid amplification test.

OBJECTIVES: Culture of Neisseria gonorrhoeae remains essential for antimicrobial resistance (AMR) surveillance. We evaluated the effect of time of specimen collection on culture yield following a positive nucleic acid amplification test (NAAT). METHODS: We retrospectively assessed N. gonorrhoeae culture yield among asymptomatic individuals (largely men who have sex with men) who attended for sexual health screening and had a positive NAAT. Participants underwent either same-day testing and notification (Drassanes Exprés) or standard screening with deferred testing. RESULTS: Among 10 423 screened individuals, 809 (7.7%) tested positive for N. gonorrhoeae. A total of 995 different anatomical sites of infection culture was performed in 583 of 995 (58.6%) of anatomical sites (Drassanes Exprés 278 of 347, 80.1%; standard screening 305 of 648, 47.1%; p<0.001). Recovery was highest when culture specimens were collected within 3-7 days of screening with only a slight drop in recovery when the interval extended to 7 days . Recovery from pharynx was 38 of 149 (25.5%) within 3 days, 19 of 81 (23.4%) after 4-7 days (p=0.7245), 11 of 102 (10.7%) after 8-14 days (p<0.0036) and 1 of 22 (4.5%) with longer delays (p=0.00287). Recovery from rectum was 49 of 75 (65.3%) within 3 days, 28 of 45 (62.2%) after 4-7 days (p=0.7318), 41 of 69 (59.4%) after 8-14 days (p=0.4651) and 6 of 18 (33.3%) with longer delays (p=0.0131). Median culture specimen collection time was 1 day within Drassanes Exprés vs 8 days within standard screening. Consequently, the overall culture yield was slightly higher within Drassanes Exprés (102/278, 36.6% vs 99/305, 32.5%; p=0.2934). CONCLUSION: Reducing the interval between screening and collection of culture specimens increased N. gonorrhoeae recovery in extragenital samples. Implementing a same-day testing and notification programme increased collection of culture samples and culture yield in our setting, which may help AMR surveillance.

Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification.

BACKGROUND: STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed 'Drassanes Exprés', a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention. METHODS: The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients' sample collection to notification and treatment are analysed. RESULTS: Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26-39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2-3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days. CONCLUSIONS: Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.

[Design and implementation of management strategies for the improvement in the implementation of the warnings of isolation in a pediatric hospital]. / Precauciones de aislamiento en un hospital pediátrico estrategias de gestión para mejorar su cumplimiento.

INTRODUCTION: children's Hospital Vail d'Hebron in 2007 children admitted 7086, requiring isolation 440 (6.2%). The purpose of this study was to raise the overall level of adherence to the basic precautions of isolation. The nursing management by objectives allowed us to raise as a management strategy in pediatric inpatient units, improved compliance with isolation measures, multidisciplinary goal framed the need for pediatric patient safety OBJECTIVES: to achieve compliance with the protocol of isolation described in 80-90% of patients. METHODOLOGY: it provides all pediatric units a dossier of consultation on the types of insulation and measures to follow, informative posters in the areas of work and training sessions. It develops and implements a standardized checklist for the proper performance of isolation measures in two of the six child health. RESULT: working in an MBO has focus and unify the resources for the improvement in the performance of isolates. In the units where they have implemented the checklist has found a fulfillment of isolation measures in 96% of cases. CONCLUSIONS: this experience has allowed us to confirm that the strategies carried out by monitoring compliance contribute to a more effective isolation measures hospital and export the model of implementation of the checklist to other pediatric units.

[Phlebitis in peripheral catheters (I). Incidence and risk factors]. / Flebitis en catéteres periféricos (I). Incidencia y factores de riesgo.

The type of pathology and the current therapeutic tendencies justify that endovenous therapy is the most frequently selected one. Although it has multiple advantages, it bears with it a series of infectious type complications (bacterial infections, phlebitis and thrombophlebitis). Even though bacterial infections in peripheral intravascular vessels have a low occurrence rate, which some authors list as between 1 and 2%, in central intravascular vessels, their occurrence is usually higher. Phlebitis is one of the complications most frequently associated with the use of peripheral intravascular catheters.

[Phlebitis in peripheral catheters (II). A study]. / Flebitis en catéteres periféricos (y II). Un estudio.

The study group consisted of 121 patients, 37 or 30.5% women and 84 or 69.4% men, checked into the Internal Medicine and Infectious Diseases Hospitalization Unit who bore a total of 215 peripheral venous catheters. The authors of this study detected a high level occurrence of phlebitis in patients using peripheral venous catheters, with a low average duration time, during the period in which the authors carried out their study.