[Principles of antisepsis, disinfection and sterilization]. / Fundamentos de antisepsia, desinfección y esterilización.

This article aims to provide a brief review of the main concepts on which the prevention and control of infection are based. Antisepsis comprises a set of techniques aimed at the total sterilization, or at most, disinfection, removing germs that contaminate an environment. Both procedures must be preceded by an environmental cleanup in the location in which they intend to be applied. The disinfection is carried out using biocides or germicides. Antimicrobial chemicals, that have mechanisms of action and resistances very similar to antibiotics, are generating concern due to the possibility of crossing genetic information that aggravates the problem of bacterial resistance. Most biocides can act as antiseptics, and applied to skin tissue, or disinfectants on inanimate materials. The spectrum of action of germicides depends on the product itself and external controllable factors: temperature, concentration, exposure time, etc. Sterilization techniques are primarily physical, by exposing the material to steam, or sterilizing gas, using autoclaves. Major advances are the use of low temperatures with shorter exposure times, in parallel with technological advances in instrumentation in order to avoid high temperatures and high use rotations due to workload.

[Comparative study between pregnancies induced for premature rupture of membranes and for prolonged pregnancy]. / Estudio comparativo entre gestaciones finalizadas electivamente por rotura prematura de membranas y por gestación cronológicamente prolongada.

BACKGROUND: To decrease maternal and fetal morbidity oftem is indicated the elective termination of pregnancy; when the cervix is unfavourable, it is possible to try to artificially reproduce these changes with exogenous prostaglandins. OBJECTIVES: Comparative evaluation of maternal and fetal results between patients in which cervical ripening is practiced with indication of premature rupture of membranes and those with prolonged pregnancy. MATERIAL AND METHOD: Historic cohorts study about pregnancies requiring cervical ripening, either for premature rupture of membranes or for gestational age > or = 41 weeks, in the "Miguel Servet" Hospital (Zaragoza, Spain), from 15/11/2005 to 15/05/2008. In all the cases dinoprostone (slow release vaginal system) was employed and the initial Bishop score was < 7. The main analysed outcomes were: intrapartum fetal heart monitoring characteristics, type of delivery, umbilical artery pH, Apgar score, hospitalization in neonatal unit requirement and time from cervical ripening start to delivery. RESULTS: Neonatal hospitalization was significantly more frequent in the ruptured membranes cohort (11.70% vs 2.33%); p = 0.001. This difference could be justified by gestational age (OR: 2,623. IC: 0.515-13.353. P = 0.246). It was observed more time cervical ripening - delivery in prolonged pregnancies cohort (25.96h vs 20.11h); p < 0.001. Umbilical cord medium pH was significantly superior in ruptured membranes group (7.25 vs 7.23); p = 0.017. No significant differences were observed in the rest of analyzed outcomes. CONCLUSIONS: Pregnancies electively ended for premature rupture of membranes are associated with a shorter time to delivery and a slightly superior umbilical cord pH than induced prolonged pregnancies. Neonatal hospitalization requirement is determined by gestational age but not by the rupture of the membranes. Cervical ripening in those patients has been demonstrated to be secure and effective.

[Efficiency and cost-effectiveness for a safety device]. / Efectividad y coste-efectividad de un dispositivo de seguridad.

When dealing with preventive measures, it is necessary to evaluate their effectiveness and to analyze the costs involved in implementing those measures. Therefore, the authors carried out a before-after intervention study on the use of a safe intravenous peripheral catheter in emergency ward services; this study included the participation by workers in selecting material by means of a Likert questionnaire. The effectiveness of a safe intravenous peripheral catheter was calculated comparing skin accidents caused by this device 40 months before and after its implantation. An economic analysis was calculated by means of a cost-effectiveness index fined as a "Euros spent for accident prevented" index. Workers who participated chose a passive safe intravenous peripheral catheter (p < 0.05). During the pre-intervention period, 17 intravenous peripheral catheter expositions were declared, during the post-intervention period, none were declared. The total net cost per intervention came to 36.606 Euro. The cost effectiveness index was 2.579,3 Euro for accident prevented.

[Cervical preinduction and oligoamnios]. / Preinducción cervical y oligoamnios.

BACKGROUND: Twelve percent of women with 41 weeks of gestation and more had oligoamnios. Physiopathological mechanism of this disease still is under discussion. OBJECTIVE: To evaluate perinatal result of patients with more than 41 weeks of gestation oligoamnios-preinduced. PATIENTS AND METHOD: Analytic-observational and retrospective cohorts study. Patients with more than 41 weeks of gestation, oligoamnios-preinduced, were included. All patients received dinoprostone and had a Bishop score lower than seven. Amniotic fluid index of five or lower suggests diagnosis of oligoamnios. Preinduction indication, characteristics of intrapartum fetal monitoring, umbilical artery pH, Apgar score, neonatal weight, and admission in a neonatal unit were the variables analyzed. RESULTS: Among the 96 patients, 28 (29.2%) constituted the exposed cohort and 68 (70.8%) the non-exposed one. Both groups were homogeneous in maternal age, parity and initial Bishop score. There weren't significant differences for way of delivery, cesarean section indications, meconium-stained amniotic fluid and umbilical cord pathology. Frequency of bradycardia was significantly higher in oligoamnios group (14.3 vs 1.5%), as well as Apgar score at first (mean of 8.86 vs 8.38) and fifth birth minute (mean of 9.89 vs 9.69). Fetal weight was significantly lower (3,298 vs 3,546 g) in oligoamnios group. Admission in neonatal unit was higher in the non-exposed cohort (1.47%). CONCLUSIONS: Newborns of patients with oligoamnios had a better Apgar score, lower fetal weight and higher frequency of intrapartum bradycardia (without neonatal damage). A further study may offer new conclusions.

[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.

Deceleration area and fetal acidemia.

AIMS: To compare the predictive ability for neonatal acidemia of individual components of intrapartum cardiotocography (CTG) described by National Institute of Child Health and Human Development (NICHD) system and deceleration area. DESIGN: Case-control study. SETTING: Spanish tertiary obstetrical hospital. POPULATION: CTG patterns of 102 acidemic fetus (umbilical arterial cord gas pH ≤7.10, base deficit (BD) > 8) and 102 nonacidemic controls (umbilical arterial cord gas pH > 7.10). METHODS: Two reviewers blind to clinical and outcome data analyzed the last thirty minutes before delivery of 204 fetal heart rate (FHR) tracings, extracting those features defined by NICHD and certain measures of FHR decelerations, including deceleration area, not considered by this system. OUTCOME MEASURES: The primary outcome was the predictive ability of NICHD features and non-NICHD deceleration measures for fetal acidemia. The secondary outcome was the impact of deceleration area in the last 30 min of labor on gasometry components (pH, BD and lactate). RESULTS: Minimal variability (area under the curve (AUC) 0.74), total number of late (AUC: 0.75) and prolonged decelerations (0.77) were the three NICHD features with the greatest predictive ability for fetal acidemia in the last thirty minutes of labor. Total deceleration area demonstrated the highest discrimination power (AUC: 0.83) of all the analyzed elements. For each cm2 the area increases in the last 30 min of labor, pH decreases 0.08 units, BD increases 0.272 mEq/L and lactate 0.183 mEq/L. CONCLUSIONS: Total deceleration area showed the greatest predictive ability for fetal acidemia and its measure could help to estimate intrapartum fetal acid-base status.

[A study of epilepsy according to the age at onset and monitored for 3 years in a regional reference paediatric neurology unit]. / Estudio de las epilepsias según la edad de inicio, controladas durante 3 años en una unidad de neuropediatría de referencia regional.

OBJECTIVE: A study of epilepsy, according to the age at onset of the crisis and its causes, monitored by a Paediatric Neurology Unit over a period of three years. PATIENTS AND METHODS: Historical cohorts study was conducted by reviewing the Paediatric Neurology medical records data base of epileptic children followed-up from 1 January 2008 to 31 December 2010. RESULTS: A total of 4,595 children were attended during the study period. The diagnosis of epilepsy was established in 605 (13.17%): 277 (45.79%) symptomatic, 156 (25.79%) idiopathic, and 172 (28.43%) with cryptogenic epilepsy. Absence epilepsy and benign childhood epilepsy with centro-temporal spikes are the idiopathic epileptic syndromes most prevalent, and the most prevalent symptomatic epilepsies are prenatal encephalopathies. More than one-quarter (26.12%) of epilepsies began in the first year of life, and 67.72% were symptomatic. Refractory epilepsy was observed in 25.29%, 42.46% with cognitive impairment, 26.45% with motor involvement, and 9.92% with an autism spectrum disorder, being more frequent at an earlier age of onset. CONCLUSIONS: The absence of a universally accepted classification of epileptic syndromes makes tasks like this difficult, starting with the terminology. A useful classification would be aetiological, with two groups: a large group with established aetiology, or very likely genetic syndromes, and another with no established cause. The age of onset of epilepsy in each aetiological group helps in the prognosis, which is worsened by refractoriness and associated neurodevelopmental disorders, and are generally worse at an earlier onset and in certain aetiologies.

[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.