Particle counting and microbiological air sampling: results of the simultaneous use of both procedures in different types of hospital rooms.

INTRODUCTION: In order to assess the relationship between the concentrations of airborne fungi and particles, particle counting was combined with fungal air sampling in several rooms of a hospital. METHODS: Concentrations of ≥0.5µm particles (P05) and ≥1µm particles (P1) were measured using a particle counter; fungal air sampling was performed with volumetric air samplers, which impacted air on Rodac plates with Sabouraud chloramphenicol agar. Particle counts were categorised according to ISO 14644-1 standard cut-off points; their association with fungal detection was assessed with Fisher's exact test. RESULTS: Forty-two simultaneous samplings were carried out: 24 in operating rooms, 13 in rooms for burns or haematology patients, 3 in pharmacy clean rooms, and two in other procedure rooms. Filamentous fungi were recovered in 5 samples, which also had higher particle counts. No fungi were detected in 12 samplings with both P05 and P1 concentrations below the maximum for class 6 clean rooms; 4 of 7 samplings with both concentrations within the range for class 8 clean rooms were positive for fungi. The association between fungal detection and higher particle counts was statistically significant, both for P05 (p=.004) and P1 (p=.003). There was a partial overlap between the concentrations of particles of samplings which were positive or negative for fungi. CONCLUSIONS: There is a relationship between the concentrations of P05 and P1 and airborne fungi in hospital rooms. When both P05 and P1 concentrations are below the maximum for class 6 clean rooms, a negative fungal detection can be predicted.

[Influenza vaccination in pregnant women. Coverage, practices and knowledge among obstetricians]. / Vacunación antigripal en gestantes. Cobertura vacunal y conocimientos y prácticas de los obstetras.

BACKGROUND AND OBJECTIVES: Women who are pregnant during influenza season have an increased risk of infection and severe clinical disease. Several national and international organizations currently recommend vaccination for pregnant women. We intended to estimate the influenza vaccination rate in a population of postpartum women attended in a tertiary hospital in Barcelona. Moreover, we assessed the knowledge and practice of obstetricians about influenza vaccination during pregnancy. METHODS: Two cross-sectional surveys were performed. Postpartum women who delivered from December 2007 to February 2008 were included. The sample of obstetricians was constituted by those who were working in hospital or primary care reference areas. RESULTS: Influenza vaccination rate was 4.1%. Healthy women represented 80.5% of our population. The vaccination rate in the group with comorbidities was 3.3%. The providers who recommended the vaccine more frequently were the midwife in 28.9% and the nurse in 18.4%. Among the obstetricians, 20.9% responded that the influenza vaccine was recommended in the first trimester of pregnancy and 65.1% said that it was recommended in the second or third trimester. In relation to practice, only 7% offered the vaccine in the first trimester and 20,9% in the second or third trimester. CONCLUSIONS: The influenza vaccination rate in pregnant women in our study is very low. Obstetricians showed a low level of knowledge about the current influenza vaccination recommendations, mainly in the case of first trimester of pregnancy and only few offered the vaccine in their practice.

[Main features of the new influenza virus a pandemic (H1N1)]. / Principales características de la pandemia por el nuevo virus influenza A (H1N1).

At the end of March 2009, a new influenza virus A (H1N1) of porcine origin was isolated in two children from California presenting flu-like clinical syndrome. This virus was initially disseminated in Mexico and US and then worldwide. Eight weeks later, it had reached 74 countries with almost 30,000 cases and had caused 145 deaths. The virus had also sustained community transmission in 6 countries. On June 11th, WHO stated the onset of a pandemic. The genetic combination of this virus is completely new, containing five segments of porcine origin, two avian, one human and a HA hemaglutinin adapted for human transmission, which is genetically and antigenically different compared with the H1N1 seasonal virus. Its transmissibility is slightly higher than the one observed in seasonal influenza and similar to previous pandemics. Its pathogenicity and virulence are low. Clinical manifestations are similar to seasonal influenza, with spontaneous resolution. Nevertheless, the variety of symptoms is large and range from asymptomatic to severe fatal pneumonia. The affected population is mainly young, aged under 30 years. Less than a half of the hospitalized patients in US and of the fatal cases in Mexico had concomitant chronic diseases or other baseline conditions. A specific monovalent vaccine against the virus is currently being produced in order to prevent and control the infection through the reduction of susceptible population.

[Polymyositis-dermatomyositis: incidence in Spain (1997-2004)]. / Polimiositis y dermatomiositis: incidencia en España (1997-2004).

BACKGROUND AND OBJECTIVE: Epidemiologic studies of polymyositis-dermatomyositis incidence in Spain are lacking. The aim of the study was to determine the incidence rates of dermatomyositis-polymyositis and their distribution in our country. MATERIAL AND METHOD: Observational and descriptive study. Data was obtained from hospital discharge code (CMBD) during the period 1997-2004. Sex, region and age were analysed. Raw and standardized incidence rates for each region studied were calculated as new cases/million population/year with 95% confidence interval (CI). Trend odds ratio (OR) was calculated by means of a logistic regression. RESULTS: Global incidence rate in polymyositis-dermatomyositis was 8.9 new cases/million population/year (CI 95%, 8.6-9.2); 3.9 (CI 95%, 3.7-4.1) for polymyositis and 4.9 (CI 95%, 4.7-5.2) for dermatomyositis. Rate differences between both diseases reached statistical significance (p < 0.001). Annual incidence rate decreased significantly across the period studied in both diseases with a trend OR of 0.95 (CI 95%, 0.93-0.97; p < 0.001) in dermatomyositis and 0.96 (CI 95%, 0.93-0.97; p < 0.001) in polymyositis. Both diseases were significantly more frequent in females (p < 0.001). The incidence rates for each region varies between 2.2 and 10.6 cases/million population/year in polymyositis and between 2.9 and 8.6 cases/million population/year in dermatomyositis. CONCLUSIONS: Incidence of dermatomyositis-polymyositis in Spain is similar to other countries. Decreased incidence observed across the period and the higher incidence of dermatomyositis could be explained because of a better diagnosis of these entities.

[Safety-engineered devices to prevent percutaneous injuries: cost-effectiveness analysis on prevention of high-risk exposure]. / Análisis coste-efectividad de dispositivos sanitarios diseñados para prevenir exposiciones percutáneas.

OBJECTIVE: To assess the efficiency of the replacement of several medical devices by engineered sharp injury (SI) prevention devices (ESIPDs). METHODS: The cost-effectiveness ratios of the replacement of medical devices in use by ESIPDs were estimated: their purchasing costs and the direct costs of sharp injury care were taken into account; the number of SI avoidable by each ESIPD was estimated from the 252 occupational SI notified by healthcare workers at a 1,300 bed hospital from March 2002 to February 2003. The relationship between ESIPD additional costs and the number of high-risk SI was estimated (SI were classified as high-risk if they met two or more of the following criteria: moderately-deep or deep injury, injury with a device previously inserted in an artery or vein, or with a device exposed to blood). RESULTS: ESIPDs order according to cost-effectiveness ratio: safety needle for implanted ports (-2.65 euro/SI avoided), followed by syringes with protective shield (869.79 euro/SI), resheathable winged steel needles, needleless administration sets, and short catheters with protective encasement. ESIPDs order according to relationship between additional costs and number of high-risk sharp injuries avoided: safety needles for implanted ports, followed by winged steel needles, hypodermic syringes, short catheter and needleless administration sets. CONCLUSIONS: Savings in SI care outweigh additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in assigning priorities; however the risks of SI by every device must be taken into account.

An approach to the study of potentially preventable nosocomial infections.

OBJECTIVE: To analyze a method that identifies potentially preventable nosocomial infections, as a tool to evaluate the performance of infection control programs through quantification of their potential for reducing nosocomial infections. METHODS: The database of the Study of the Prevalence of Nosocomial Infections in Spain (EPINE) was reanalyzed. The method was based on the use of false negatives of the classification table obtained from application of a fixed multiple logistic regression model, as an estimator of the number of potentially preventable nosocomial infections. RESULTS: The calculated number of patients with preventable infections was 7,493, which constituted 21.6% of the infected patients. Among hospital areas, intensive care had the lowest preventability rate (4.6%), whereas gynecology and obstetrics had the highest (40.6%). There was a significant inverse exposure-effect relationship between the proportion of preventable infections and the National Nosocomial Infections Surveillance (NNIS) System risk index. No correlation was observed between the prevalence of patients with nosocomial infection and the percentage of preventable infections. CONCLUSION: This analysis suggests that fewer nosocomial infections may be preventable in Spanish hospitals than previously assumed.

[Transmissibility and severity of the pandemic influenza A (H1N1) 2009 virus in Spain]. / Transmisibilidad y gravedad de la pandemia de gripe A(H1N1)2009 en España.

OBJECTIVES: To estimate the value of the basic reproduction number for the pandemic wave of influenza A (H1N1) 2009 in Spain and to assess its impact on morbidity and mortality in the Spanish population compared with those in the previous influenza season. METHODS: Data on the incidence of influenza and viral detections were obtained from the Spanish Influenza Surveillance System. Deaths from pandemic influenza were obtained from the Coordinating Center for Health Alerts and Emergencies of the Spanish Ministry of Health and Social Policy, and deaths from seasonal influenza during the period 2003-2008 were obtained from the National Statistics Institute. The reproduction number was estimated by two methods: firstly, by using the growth rate of the cumulative incidence of influenza during the exponential growth phase of the pandemic wave, and secondly (maximum likelihood estimation), through analysis the dates of onset of symptoms observed in pairs of cases based on generation time distribution. We calculated the fatality rate and mortality from influenza by comparing potential years of life lost in the pandemic season with those in previous interpandemic seasons. RESULTS: The start of the pandemic wave occurred in Spain earlier in week 40/2009 (from 4 to 10 October), with an absolute predominance of the new strain in the pattern of circulating viruses. The value of R(0) in the growth phase of the wave was 1.29 (95% CI: 1.25-1.33), estimated with the first method, and was 1.01 (95% CI: 0.99-1.03) with the second method. During the pandemic season, there were 318 deaths from pandemic influenza, affecting younger age groups than in previous interpandemic seasons. Consequently, the number of potential years of life lost in the pandemic season (11,612) was estimated at six times the adjusted annual average of the interpandemic influenza seasons for comparison (1,802). CONCLUSIONS: The estimates of R(0) for the growth phase of the pandemic wave were in the lower range of estimates of this parameter in previous pandemics. Mortality indicators calculated in the pandemic period showed an increase in deaths compared with previous interpandemic seasons, which was most pronounced in young patients.