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

RESUMEN

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)

ABSTRACT

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)