[Effectiveness of influenza vaccine in preventing severe influenza]. / Efectividad de la vacuna antigripal en la prevención de la gripe grave.

INTRODUCTION: Influenza is one of the diseases with the greatest epidemiological impact and the greatest relevance in the management of health services. The flu vaccine can have great variability each season, so our objective was to know the effectiveness of the flu vaccine for the 2017/2018 season for the prevention of severe cases of flu in a general acute hospital in 385 beds. MATERIAL AND METHOD: Case control study. All hospitalized patients with laboratory confirmed influenza during the 2017/2018 season were included. Those who met the criteria for a severe case of influenza were considered cases. Those that did not meet the severity criteria were considered controls. The factors associated with the development of severe influenza were calculated. RESULTS: The effectiveness adjusted by age group and comorbidity was 60.7% (20.5-80.5). The vaccinated and unvaccinated groups were different in terms of age (P<.0381). The highest proportion of cases were concentrated in those over 65 years of age (45.5%). Vaccination status against severe influenza was found to be an independent protective factor (OR=.746; .694-.831). CONCLUSIONS: The effectiveness of influenza vaccination provided greater protection against infection and reduced the severity of influenza in hospitalized patients. These findings should be considered to improve vaccination strategies and achieve better vaccination coverage in the population at risk.

The Study on Safety in Hospitals in the Region of Madrid (ESHMAD) design: Screening and analysis of incidents and adverse events.

BACKGROUND: A Study related to Safety in Hospitals in the Region of Madrid (ESHMAD) was carried out in order to determine the prevalence, magnitude and characteristics of adverse events in public hospitals. This work aims to define a useful methodology for the multicenter study of adverse events in the Region of Madrid, to set out the preliminary results of the hospital enrollment and to establish a model of a strategy of training of trainers for its implementation. METHODS: ESHMAD was a multicenter, double phase study for the estimation of adverse events and incidents prevalence across the Region of Madrid. First phase comprehended a 1-day cross-sectional prevalence study, in which it was collected, through a screening guide, information about admission, patient characteristics, intrinsic and extrinsic risk factors, and the possibility of an adverse event or incident had happened during the hospitalization. Second phase was a retrospective nested cohort study, in which it was used a Modular Review Form for reviewing the positive screenings of the first phase, identifying in each possible adverse event or incident the classification of the patient safety event, clinical onset, root, and associated causes and factors, impact, and preventability. A pilot study was performed in an Internal Medicine Unit of a tertiary hospital. RESULTS: 34 public hospitals participated, belonging to 6 healthcare categories and with more than 10,000 hospitalisations aggregate capacity. 72 coordinators were enrolled in the strategy of training of trainers, which was performed through five on-site training workshops. In the pilot study, 45.2% patients were identified with at least one positive event of the screening. Of them, 48.1% (25 positive events) were identified as truly AE, with a result of 0.29 EA per analyzed patient. CONCLUSIONS: The ESHMAD protocol allows to estimate the prevalence of adverse events, and the strategy of training of trainers facilitated the spread of the research methodology among the participants.

Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS).

OBJECTIVE: To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. DESIGN: Retrospective cohort study. SETTING: Twenty-four Spanish hospitals. PARTICIPANTS: Patients of any age with a clinical record indicating an inpatient stay of >24 h and a discharge between 4 and 10 June 2005 (n = 5908). INTERVENTION: None. MAIN OUTCOME MEASURES: Percentage of AEs considered preventable. RESULTS: We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8-6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). CONCLUSIONS: In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care.

[Adverse events related to medication in hospitals from the Valencian Community. EPIDEA Study 2005-2013]. / Eventos adversos relacionados con la medicación en los hospitales de la Comunidad Valenciana. Estudio EPIDEA 2005-2013.

OBJECTIVE: To determine the prevalence of Adverse Events related to Medication (AEM) in hospitals of the Valencian Community in the 2005-2013 study period, and to describe the associated risk factors and their impact. METHODS: This study is based on data and methodology of the Study of Prevalence of Adverse Events in hospitals (EPIDEA), since its inception in 2005 until 2013. AEM produced in each year were analyzed. RESULTS: We identified 344 AEM that occurred in 337 patients, among 35,103 patients studied, giving a prevalence of patients with AEM of 0.96% (IC95% 0.89-1.07). The most prevalent intrinsic risk factors for AEM were hypertension, diabetes and cancer. The most prevalent extrinsic risk factors were peripheral venous catheter, urinary catheter and central venous catheter. Therapeutic groups most frequently involved were systemic antibiotics, cardiovascular drugs and antineoplastics. The 61.17% of AEM was classified as moderate, followed by 27.18% as mild and 11.65% as severe. The 33.99% of EAM caused increase of the patient's stay and 39.90% of EAM caused the re-entry of patient. The 58.5% of AEM were avoidable. Mild AEM were avoidable in 46.3%, moderate AEM were avoidable in 60.3% and severe AEM were in 75% (p = 0.013). CONCLUSIONS: The prevalence of patients with AEM in hospitals of the Community of Valencia for the period 2005- 2013 was 0.96%. More than half of AEM were preventable, and preventability increases significantly with the severity of the event.

[Factors that contribute to health care associated infections: how to prevent them]. / Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos.

OBJECTIVE: To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. METHOD: A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. RESULTS: A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). CONCLUSION: Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care.

Evaluación del estudio de contactos de tuberculosis en el Departamento de Salud 17 de Alicante / Assessment of tuberculosis contact tracing in the 17th health area in Alicante

Objetivo: Evaluar el estudio de contactos (EC) de tuberculosis realizado en nuestro servicio y analizar la demora en el diagnóstico y en la notificación de los casos de tuberculosis y el retraso en el inicio del EC. Material y métodos: Se realizó un estudio observacional retrospectivo de los casos índices de tuberculosis y sus contactos declarados, además de la adecuación del manejo de los contactos estudiados, y se calculó la demora en el diagnóstico y la notificación de los casos de tuberculosis y la demora en el inicio del estudio de contactos. Resultados: La tasa global de tuberculosis encontrada fue de 10,91 por 100.000 habitantes durante el total de años de estudio. Se identificaron 128 casos de tuberculosis y 635 contactos. Para todos los casos de tuberculosis, la mediana de la demora diagnóstica total fue de 45 días, de la demora en la declaración de tres días y de la demora en el inicio del estudio de contactos de 9,5 días. Entre los contactos evaluados se diagnosticaron ocho nuevos casos de tuberculosis. En el 94,5% de los contactos estudiados el manejo fue adecuado. Conclusión: El manejo de los contactos de tuberculosis fue en su mayor parte adecuado. La demora diagnóstica para los casos de tuberculosis fue elevada, mientras que el retraso en la notificación de los casos de tuberculosis y en el inicio del estudio de contactos, estuvieron en límites normales (AU)

Objective: To assess the tuberculosis (TB) contact investigations conducted in our Department and to analyze the delay in diagnosis and reporting of TB cases and the delay in starting the contacts investigations. Methods: We carried out a retrospective observational study of the reported tuberculosis index cases and their contacts. We analyzed the adequacy of management of contacts investigations and calculated the delay in diagnosis and reporting of TB cases in addition to the delay in the onset of contacts study. Results: The overall rate of tuberculosis found was 10.91 per 100,000 inhabitants during the total years of study. We identified 635 contacts of 128 tuberculosis cases. The median from total diagnostic delay was 45 days, from delay in the notification three days and from delay in the start of contact investigations 9,5 days for all TB cases. Among the assessed contacts were diagnosed eight new TB cases during contact investigations. In the 94.5% of studied contacts the management was adequate. Conclusion: The management of TB contacts was mostly adequate. The delay in diagnosis for tuberculosis cases was elevated. The delay in the notification of tuberculosis cases and the delay in the start of contacts investigations were found within normal limits (AU)

Factores que contribuyen a la infección relacionada con la asistencia sanitaria: cómo evitarlos / Factors that contribute to health care associated infections: how to prevent them

Objetivo. Identificar las características de los pacientes y de la asistencia asociadas con la infección relacionada con la atención sanitaria (IRAS) y determinar si existen diferencias entre las evitables (IRASE) y las que no lo son. Método. Estudio de cohortes retrospectivo basado en tres estudios españoles de eventos adversos ligados a la hospitalización. Se revisaron las historias clínicas valorando si la asistencia era la causante de IRAS e IRASE. Resultados. El 2,3% de los pacientes del estudio presentó una o más IRAS. El 60,2% fueron IRASE. Los que presentaron IRAS eran mayores que el resto, y presentaron mayor número de factores de riesgo intrínseco y extrínseco. Se observaron diferencias entre los pacientes que presentaron IRAS o IRASE en la presencia de algún factor de riesgo intrínseco. Los factores que mejor explicaron IRAS fueron distintos para cada una de las localizaciones más frecuentes. En el caso de las IRAS: catéter urinario (OR=2,4), catéter venoso central (OR=1,8) y sonda nasogástrica (OR=1,9); servicio de ingreso quirúrgico (OR=1,6) y estancia hospitalaria >1 semana (OR=7,5). Las estrategias identificadas para evitar IRAS fueron: técnica aséptica adecuada (25,5%), correcto seguimiento de los protocolos de sondaje vesical (20%) y de los cuidados y la valoración de vulnerabilidad de los pacientes (16,5%). Conclusiones. Entre los pacientes que presentaron IRAS y los que no presentaron se encontraron características diferenciadas. La evitabilidad es un juicio de valor independiente del de causalidad y se relaciona con si se han aplicado de forma correcta o no los protocolos. Identificar estos puntos en la asistencia permite establecer estrategias de mejora de la asistencia(AU)

Objective. To determine the patient and medical care characteristics of Health Care-Associated Infections (HCAI) and to determine whether or not there are any differences between those that may be avoidable. Method. A retrospective cohort study, based on three Spanish cohort studies of Adverse Events associated with hospitalization. The medical records were reviewed to assess whether or not the health care was the causing factor of the HCAI. We carried out the analyses using the same methodology as the National Study on the Adverse Effects associated with hospitalization (ENEAS). After reviewing the patient medical records to identify the HCAI associated factors, the reviewers gave a valued judgment on how likely the health care was the cause of the infection (HCAI) and whether there was evidence that they could have been avoided. Results. A total of 2.3% the patients in the study had one or more HCAI, with 60.2% of them being avoidable. The patients who had an HCAI were older and had a greater number of intrinsic and extrinsic risk factors. There was a significant difference in the presence of some intrinsic risk factor between patients who had an HCAI and those with an avoidable HCAI, but there were no differences as regards medical care extrinsic risk factors. The factors that best explained the HCAI were different for each one of the most common infection locations. Generally, the factors which best explained the HCAI were: urinary catheter (OR=2.4), nasogastric tube (OR=1.9) or central venous catheter (OR=1.8). Similarly, hospital admissions through a surgery department or a hospital stay longer than a week were identified as main factors, (OR=1.6), (OR=7.5), respectively. The best strategies to avoid an HCAI were: proper management of any aseptic technique and use of catheter (25.5%), a proper follow-up of the bladder catheterisation protocols (20%) and a proper health care follow-up of vulnerable patients (16.5%). Conclusion. Patients with an HCAI showed significant different characteristics from those who did not have an HCAI. The preventability is an independent valued judgment from the causality, and is associated to whether the proper protocol has been implemented or not. To identify these weaknesses enables us to establish strategies to improve the quality of medical care(AU)

Conocimientos y prácticas de odontólogos, auxiliares e higienistas dentales frente a los riesgos biológicos / Knowledge and practices of the dentist, dental assistant dental hygienist to control occupational biological risk

Objetivo. A diferencia de lo que ocurre en otros ámbitos sanitarios, en España existen pocas investigaciones sobre los profesionales de odontología y los riesgos biológicos debido principalmente a que es una profesión ejercida en el sector privado.El objetivo de este trabajo es valorar los conocimientos y prácticas de los odontólogos, auxiliares e higienistas dentales sobre este tipo de riesgos.Métodos. Estudio transversal descriptivo con información obtenida mediante entrevista personal a odontólogos y auxiliarese higienistas dentales (junio-octubre 2004) en ejercicio de su actividad en la ciudad de Alicante seleccionados a través del Anuario Dental Español de 2003.Resultados. Se completaron 91 entrevistas (53 a odontólogos y 38 a auxiliares e higienistas dentales). Del total de encuestados,el 80% considera que el VHB y VHC son los principales agentes de enfermedades infecciosas ligados a exposiciónlaboral. El 92% desconoce el riesgo promedio de infección por VIH entre el personal sanitario y el 75% el periodo de seguimiento post-exposición por VIH. La utilización de guantes (93%), gafas (98%), mascarilla (93%) y vacunación frente al VHB (90%) es elevada. Solo el 5,5% de los encuestados cumplía con todas las recomendaciones preventivas para el controlde infecciones.Conclusiones. Los resultados evidencian problemas de desconocimiento sobre riesgos biológicos, en especial en relacióncon la infección por VIH, que pueden generar miedos y prácticas erróneas. Causa preocupación la escasa aplicación de los procedimientos recomendados para el control de infecciones, siendo un elemento indispensable para la prevención de infecciones

Objective. In Spain, in contrast to other health professionals, there have been few studies on the biological risks of dental personnel, possibly because their profession is largely based in the private sector. The objective of this research is to assess the knowledge and practices of dentists, dental assistants and dental hygienists in relation to biological risks. Methods. A descriptive cross-sectional study was carried out with data obtained through face-to-face interviews with dentists, dental assistants and hygienists working in Alicante (June-October 2004). Interviewees were selected through the 2003 Spanish Dental Yearbook. Results. Ninety one interviews were conducted (53 with dentists, 38 with dental assistants and hygienists). Among dental assistants and hygienists).Among). Among all interviewees, 80% considered that hepaitis Band hepatitis C viruses are the main infectious agents related to their 80% considered that hepaitis B and hepatitis C viruses are the main infectious agents related to their occupational exposures. Also, 92% did not know the average risk of occupational HIV transmission for health personnel, and 75% was unaware of post-exposure prophylaxis for HIV. The use of gloves (93%), glasses (98%), masks (93%) and compliance with hepatitis B vaccination (90%) was high, but only 5.5% fulfilled all the preventive recommendations for the control infections. Conclusions. These results indicate a lack of knowledge among dental personnel about biological risks, particularly with respect to HIV infection, which may generate fear and erroneous practices. The limited compliance with all of the recommended proceduresfor infection control is cause for concern, as this is an essential element for the prevention of infections among health professionals