Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse / Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used

ANTECEDENTES Y OBJETIVO: Durante la pandemia COVID-19 se ha producido un aumento de la demanda de mascarillas por parte de profesionales sanitarios y de la población general. En este contexto, se hace necesario sintetizar las características y las indicaciones de uso de los distintos tipos de mascarillas existentes. MATERIAL Y MÉTODOS: Se consultaron y recopilaron las diferentes recomendaciones difundidas por instituciones de reconocido prestigio, como la Organización Mundial de la Salud, The European Centre for Disease Prevention, The Centre for Evidence-Based Medicine o el Ministerio de Sanidad del Gobierno de España. RESULTADOS: Las instituciones consultadas aconsejan reservar las mascarillas filtering face piece (FFP) para el personal sanitario, especialmente en la realización de procedimientos generadores de aerosoles (PGA) (protección mínima de FFP2), y plantean posibles sistemas de reutilización durante épocas de escasez. Asimismo, se recomienda el uso de mascarillas quirúrgicas en profesionales que no realicen PGA y en población sintomática, existiendo variación en las indicaciones de uso para población general sana. CONCLUSIÓN: En situaciones de escasez de equipos de protección individual por pandemia de COVID-19 se debe establecer una priorización y racionalización de uso de cada tipo de mascarilla en función del usuario y de la actividad a realizar

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. / Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse.

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.

[Adverse events associated with the healthcare of patients with multimorbidity admitted to medium-long stay hospitals]. / Eventos adversos asociados a la asistencia del paciente pluripatológico ingresado en hospitales de crónicos.

BACKGROUND: Since medical practice involves risks, the aim of the health system is to promote and preserve health and to avoid, relieve and treat disease, while ensuring the quality of care. Patient safety is an essential component of the quality of care. OBJECTIVES: To determine the incidence and prevalence of adverse events in hospitalized patients with multimorbidity in a medium-long stay hospital, to analyze the patients and healthcare characteristics associated with adverse events, to assess their impact, and to identify the possibilities for prevention. MATERIAL AND METHODS: We performed a retrospective cohort study in a medium-long stay hospital in 2004, and a prevalence study once a year from 2005 to 2008. RESULTS: The incidence of patients with adverse events directly related to hospital care was 3.3%, and the prevalence of patients with adverse events associated with health care was 5.8%. In both studies, extrinsic risk factors and length of stay were related to a greater risk of adverse events. In the incidence study, most of the adverse events (68.7%) were moderate, while in the cross-sectional study, most (84%) were mild. Fifty percent of the AE increased the length of hospital stay, and 14.5% led to readmission to the incidence study. Most of the adverse events detected in both studies required additional treatments and procedures to be performed. Between 30% and 49% of the adverse events were considered avoidable. CONCLUSIONS: The incidence and prevalence of patients with adverse events in medium-long stay hospitals were lower than those found in acute-stay hospitals. The most frequent adverse events were related to medication in the incidence studies and with healthcare in the prevalence studies. Cohort studies are the most suitable type of study to assess the impact of adverse events. Sequential cross-sectional studies seem to be useful for identifying and performing surveillance of adverse events and allow strategies to reduce these events to be prioritized and the effectiveness of improvement programs to be assessed. Consequently, we recommend the introduction of this type of design to study adverse events in hospitals specializing in the care of patients with chronic diseases.

[Utility of the ENEAS study screening guide in a long-stay chronic care hospital]. / Utilidad de la guía de cribado del estudio ENEAS en un hospital de atención a enfermos pluripatológicos.

INTRODUCTION: Because of the characteristics of patients with multimorbidities, the methodology used in acute care hospitals is unsuitable to obtain valid results in long-stay chronic care hospitals. The present study aimed to determine the utility of the screening guide used in acute care hospitals to study adverse events (AE) in long-stay, chronic care hospitals and to identify the factors that could improve the adjustment of this screening guide to these hospitals. METHOD: We performed a retrospective cohort study from January 1 to December 31, 2004 and cross-sectional studies in 2005, 2006, 2007 and 2008 in a long-stay chronic care hospital. The variables studied were AE and incidents. We used the AE screening guide adapted to the Harvard study and the Spanish version of the Modular Review Form (MRF2) for case record review. Data analysis consisted of calculation of the global predictive value of the screening guide, the item-by-item predictive value, and the percentage of AE detected by each alert. RESULTS: Of the 19 criteria in the screening guide, the most frequently marked criterion in both the cohort and prevalence studies was criterion number 1 (prior hospitalization during the last year in patients less than 65 years old or prior hospitalization in the last 6 months in patients 65 years old or older). Of all the AE and complications detected, 57.2% were screened with warning criteria 17 and 19, corresponding to "another AE" and "any kind of nosocomial infection". Overall, the screening guide had positive predictive value (PPV) of 24.3% in the cohort study, and a PPV of 37.4% in the cross-sectional study when all types of AE were included (i.e. AE associated with healthcare, disease and incidents). Screening criteria 10 (new neurological deficit at hospital discharge), 11 (acute myocardial infarction, stroke or pulmonary thromboembolism during or after an invasive procedure), 12 (cardiorespiratory arrest or low Apgar score) and 13 (injury or complication related to abortion, amniocentesis, delivery or pre-delivery) were not marked in any type of study. CONCLUSIONS: The utility of the screening guide is low when used in a long-stay chronic care hospital. A new screening guide is required that excludes inefficient criteria and includes new, more specific criteria that take into account the characteristics of patients with multimorbidity.

Eventos adversos asociados a la asistencia del paciente pluripatológico ingresado en hospitales de crónicos / Adverse events associated with the healthcare of patients with multimorbidity admitted to medium-long stay hospitals

Introducción: La finalidad del sistema sanitario es promover y mantener la salud y evitar, aliviar y tratar la enfermedad asegurando la calidad de la asistencia, ya que la práctica médica va acompañada de riesgos. La seguridad del paciente es un componente esencial de la calidad asistencial. Objetivos: Estimamos la incidencia y la prevalencia de los eventos adversos en los pacientes pluripatológicos ingresados en un hospital de media o larga estancia, analizamos las características de los pacientes y de la asistencia que se asociaban a su aparición, estimamos su impacto en la asistencia e identificamos las posibilidades de prevención. Material y métodos: Estudio de cohortes retrospectivo en un hospital de media o larga estancia en 2004 y de prevalencia los años 2005 a 2008. Resultados: La incidencia de pacientes con eventos adversos asociados a la asistencia fue del 3,3%. La prevalencia de pacientes con eventos adversos asociados a la asistencia fue del 5,8%. En ambos tipos de estudio los factores de riesgo extrínseco y la duración de la estancia se asociaron a mayor riesgo de eventos adversos. En el estudio de incidencia, los más frecuentes fueron los moderados (68,7%) y en el de corte, los leves (84%). El 50% de los eventos adversos tuvieron como consecuencia un incremento de la estancia, y en un 14,5% el efecto adverso condicionó el reingreso en el estudio de incidencia. La mayoría de los eventos adversos detectados en ambos tipos de estudios requirieron pruebas diagnósticas y tratamientos adicionales. Se consideró evitable entre el 30 y el 49% de los eventos adversos. Conclusiones: La incidencia y la prevalencia de pacientes con eventos adversos en los hospitales de crónicos son menores que las encontradas en los hospitales de agudos. Los eventos adversos más frecuentes se relacionan con la medicación en los estudios de incidencia y con los cuidados en los de prevalencia. Los estudios de cohorte son los idóneos para estimar el impacto. Los de corte en abanico se muestran útiles para la vigilancia y la identificación de eventos adversos y permiten priorizar estrategias y valorar la efectividad de los programas de mejora; por lo tanto, son los que aconsejamos para su implantación en los hospitales de atención a pacientes con enfermedad de curso crónico (AU)

Background: Since medical practice involves risks, the aim of the health system is to promote and preserve health and to avoid, relieve and treat disease, while ensuring the quality of care. Patient safety is an essential component of the quality of care. Objectives: To determine the incidence and prevalence of adverse events in hospitalized patients with multimorbidity in a medium-long stay hospital, to analyze the patients and healthcare characteristics associated with adverse events, to assess their impact, and to identify the possibilities for prevention. Material and methods: We performed a retrospective cohort study in a medium-long stay hospital in 2004, and a prevalence study once a year from 2005 to 2008. Results: The incidence of patients with adverse events directly related to hospital care was 3.3%, and the prevalence of patients with adverse events associated with health care was 5.8%. In both studies, extrinsic risk factors and length of stay were related to a greater risk of adverse events. In the incidence study, most of the adverse events (68.7%) were moderate, while in the cross-sectional study, most (84%) were mild. Fifty percent of the AE increased the length of hospital stay, and 14.5% led to readmission to the incidence study. Most of the adverse events detected in both studies required additional treatments and procedures to be performed. Between 30% and 49% of the adverse events were considered avoidable. Conclusions: The incidence and prevalence of patients with adverse events in medium-long stay hospitals were lower than those found in acute-stay hospitals. The most frequent adverse events were related to medication in the incidence studies and with healthcare in the prevalence studies. Cohort studies are the most suitable type of study to assess the impact of adverse events. Sequential cross-sectional studies seem to be useful for identifying and performing surveillance of adverse events and allow strategies to reduce these events to be prioritized and the effectiveness of improvement programs to be assessed. Consequently, we recommend the introduction of this type of design to study adverse events in hospitals specializing in the care of patients with chronic diseases (AU)

Utilidad de la guía de cribado del estudio ENEAS en un hospital de atención a enfermos pluripatológicos / Utility of the ENEAS study screening guide in a long-stay chronic care hospital

Introducción: Las características peculiares de los pacientes pluripatológicos hacen que la metodología utilizada en los hospitales de agudos no sea aplicable directamente para la consecución de resultados válidos en hospitales de crónicos y larga estancia (HACLE). Por ello nos proponemos en este estudio conocer la utilidad de la guía de cribado usada en los hospitales de agudos para el estudio de eventos adversos en los HACLE e identificar los factores que puedan mejorar su adaptación a estos hospitales. Método: Estudio retrospectivo de cohortes desde el 1 de enero hasta el 31 de diciembre de 2004 y estudios transversales durante los años 2005, 2006, 2007 y 2008, en un hospital de atención a enfermos crónicos. Variables: efecto adverso (EA) e incidente. Se utilizó la Guía de cribado de EA adaptada del estudio de Harvard y la versión española del Cuestionario Modular para revisión de casos MRF2. Análisis de datos: se calculó el valor predictivo de la guía de cribado, en general y punto por punto, así como el porcentaje de EA que detectó cada alerta. Resultados: De los 19 criterios de la guía de cribado, el que fue marcado con mayor frecuencia tanto en el estudio de cohortes como en el de prevalencia, fue el criterio número 1 (Hospitalización previa durante el último año en paciente menor de 65 años u hospitalización previa en los últimos 6 meses en paciente de 65 o más años). Del total de EA o complicaciones detectadas, el 57,2% se cribó con los criterios de alerta 17 y 19, que corresponden a “algún otro EA” y “cualquier tipo de infección nosocomial”. En general, la guía de cribado presentó un valor predictivo positivo (VPP) del 24,3% en el estudio de cohorte y del 37,4% en el de corte considerando todo tipo de EA, es decir, tanto asociados a la asistencia como a la enfermedad e incidentes. Los criterios de cribado 10 (Déficit neurológico nuevo en el momento del alta hospitalaria), 11 (Infarto agudo de miocardio, accidente cerebrovascular agudo o tromboembolia pulmonar durante o después de un procedimiento invasivo), 12 (Parada cardiorrespiratoria o puntuación Apgar baja) y 13 (Daño o complicación relacionada con aborto, amniocentesis, parto o preparto) no se marcaron en ningún tipo de estudio. Conclusiones: La guía de cribado tiene escasa utilidad aplicada en los HACLE. Es necesaria una nueva guía de cribado que excluya los criterios poco eficientes e incluya nuevos criterios, más específicos, que tengan en cuenta las características peculiares de los pacientes pluripatológicos (AU)

Introduction: Because of the characteristics of patients with multimorbidities, the methodology used in acute care hospitals is unsuitable to obtain valid results in long-stay chronic care hospitals. The present study aimed to determine the utility of the screening guide used in acute care hospitals to study adverse events (AE) in long-stay, chronic care hospitals and to identify the factors that could improve the adjustment of this screening guide to these hospitals. Method: We performed a retrospective cohort study from January 1 to December 31, 2004 and crosssectional studies in 2005, 2006, 2007 and 2008 in a long-stay chronic care hospital. The variables studied were AE and incidents. We used the AE screening guide adapted to the Harvard study and the Spanish version of the Modular Review Form (MRF2) for case record review. Data analysis consisted of calculation of the global predictive value of the screening guide, the item-by-item predictive value, and the percentage of AE detected by each alert. Results: Of the 19 criteria in the screening guide, the most frequently marked criterion in both the cohort and prevalence studies was criterion number 1 (prior hospitalization during the last year in patients less than 65 years old or prior hospitalization in the last 6 months in patients 65 years old or older). Of all the AE and complications detected, 57.2% were screened with warning criteria 17 and 19, corresponding to “another AE” and “any kind of nosocomial infection”. Overall, the screening guide had positive predictive value (PPV) of 24.3% in the cohort study, and a PPV of 37.4% in the cross-sectional study when all types of AE were included (i.e. AE associated with healthcare, disease and incidents). Screening criteria 10 (new neurological deficit at hospital discharge), 11 (acute myocardial infarction, stroke or pulmonary thromboembolism during or after an invasive procedure), 12 (cardiorespiratory arrest or low Apgar score) and 13 (injury or complication related to abortion, amniocentesis, delivery or pre-delivery) were not marked in any type of study. Conclusions: The utility of the screening guide is low when used in a long-stay chronic care hospital. A new screening guide is required that excludes inefficient criteria and includes new, more specific criteria that take into account the characteristics of patients with multimorbidity (AU)

[Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report]. / Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008.

Study of the frequency of healthcare-related adverse events (AE) and of their effect on patients and impact on healthcare systems has markedly increased in recent years. Indepth individual analysis of the factors contributing to these events has allowed strategies to prevent or minimize the impact of AE to be developed. However, an epidemiologic perspective is needed to explore possible associations and generalize the recommendations that can be drawn from this type of analysis. Some aspects that should been considered while developing future strategies are discussed. These aspects include the importance of patient age and comorbidities on producing AE and the use of highly technological medicine, which is sometimes unnecessary. A culture of trust and confidentiality and a spirit of collaboration among organizations are indispensable to share and learn about the initiatives prompted by the study of AE and thereby improve patient safety in the national health service.

Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008 / Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report

El estudio sobre la frecuencia de los efectos adversos (EA) ligadosa la asistencia, su efecto en los pacientes y el impactoen los sistemas de salud ha experimentado un intenso impulsoen los últimos años. El análisis individual profundo de susfactores contribuyentes ha permitido el desarrollo de múltiplesestrategias para prevenirlos o minimizar su impacto, pero es necesariauna perspectiva epidemiológica para explorar estas posiblesasociaciones y generalizar las recomendaciones que sederiven de este análisis.Se comentan algunos de los aspectos que se deberían teneren cuenta para el desarrollo de estrategias futuras, como la importanciade la edad o las comorbilidades del paciente en la génesisde los EA y el alto grado de la instrumentalización de laasistencia (a veces innecesaria). Son imprescindibles una culturade confianza y confidencialidad y un espíritu de colaboraciónentre las organizaciones para poder compartir y aprenderde las iniciativas derivadas del estudio de los EA, y así mejorarla seguridad de los pacientes en el Sistema Nacional de Salud(AU)

Study of the frequency of healthcare-related adverseevents (AE) and of their effect on patients and impact on healthcaresystems has markedly increased in recent years. Indepthindividual analysis of the factors contributing to theseevents has allowed strategies to prevent or minimize the impactof AE to be developed. However, an epidemiologic perspectiveis needed to explore possible associations and generalizethe recommendations that can be drawn from thistype of analysis.Some aspects that should been considered while developingfuture strategies are discussed. These aspects include the importanceof patient age and comorbidities on producing AEand the use of highly technological medicine, which is sometimesunnecessary. A culture of trust and confidentiality anda spirit of collaboration among organizations are indispensableto share and learn about the initiatives prompted by thestudy of AE and thereby improve patient safety in the nationalhealth service(AU)

[Why do patients use hospital emergency services on their own initiative?]. / Por qué los pacientes utilizan los servicios de urgencias hospitalarios por iniciativa propia?

INTRODUCTION: The aim of this study was to determine the reasons why patients use hospital emergency services (HES) on their own initiative and the characteristics of these users. METHOD: An ad hoc questionnaire was designed and applied by consecutive selection to patients who could have waited for medical care (level 1 triage) over a 1-week period in November 2002. RESULTS: A total of 348 patients completed the questionnaire; 82.5% attended on their own initiative; of these, 17.7% reported they did not know how Primary Care worked in relation to the Emergency Services; 18.8% consulted a Primary Care physician; 55.0% preferred the HES and 13.5% attended because of a delay in another health care setting. Half the patients (50.5%) were younger than 40 years old and 9.2% were foreigners. CONCLUSIONS: Changes in health services' consumption patterns could jeopardize the public health system unless supply is adapted to the demand expressed and/or interventions are performed to educate the public in rational health services' consumption.

¿Por qué los pacientes utilizan los servicios de urgencias hospitalarios por iniciativa propia? / Why do patients use hospital emergency services on their own initiative?

Introducción: Se pretende describir el perfil de usuario y determinar su motivación para visitar el servicio de urgencias hospitalario (SUH) por iniciativa propia. Método: Se elaboró un cuestionario ad hoc que se aplicó por selección consecutiva a los pacientes que podían esperar asistencia (nivel 1 del triage) durante una semana de noviembre de 2002. Resultados: Respondieron el cuestionario 348 pacientes, acudiendo por iniciativa propia el 82,5%. De éstos, el 17,7% desconocía el funcionamiento de atención primaria respecto a urgencias; el 18,8% consultó con su centro de salud; el 55,0% refirió preferencia por el SUH y el 13,5% acudió por demora en otros niveles asistenciales. El 50,5% era menor de 40 años y el 9,2%, extranjero. Conclusiones: Los cambios en el patrón de consumo de servicios sanitarios pueden comprometer la organización del Sistema Nacional de Salud, si no se adapta la oferta a la necesidad expresada y/o se interviene modulando el uso racional de los recursos sanitarios

Introduction: The aim of this study was to determine the reasons why patients use hospital emergency services (HES) on their own initiative and the characteristics of these users. Method: An ad hoc questionnaire was designed and applied by consecutive selection to patients who could have waited for medical care (level 1 triage) over a 1-week period in November 2002. Results: A total of 348 patients completed the questionnaire; 82.5% attended on their own initiative; of these, 17.7% reported they did not know how Primary Care worked in relation to the Emergency Services; 18.8% consulted a Primary Care physician; 55.0% preferred the HES and 13.5% attended because of a delay in another health care setting. Half the patients (50.5%) were younger than 40 years old and 9.2% were foreigners. Conclusions: Changes in health services' consumption patterns could jeopardize the public health system unless supply is adapted to the demand expressed and/or interventions are performed to educate the public in rational health services' consumption

Brote epidémico por Trichinella Britovi en Granada durante la primavera del 2000 / The spring 2000 outbreak of a Trichinella Britovi in Granada

Fundamento: La triquinelosis continúa presentándose en nuestro medio de forma epidémica. La magnitud de cada epidemia depende del alcance del producto contaminado distribuido. En la primavera del año 2000 se investigó en la capital de Granada un episodio ocasionado por la venta de embutidos sin control sanitario. El objetivo de este trabajo es la descripción epidemiológica del brote causado por Trichinella britovi. Métodos: Estudio descriptivo del brote así como de las medidas de control. El alimento vehículo del parásito se investigó mediante encuesta epidemiológica. Resultados: Entre las semanas epidemiológicas 18-22 se declararon 38 casos. Los síntomas identificados con más frecuencia fueron fiebre, mialgias y edemas palpebrales. El 87 por ciento de las personas afectadas presentó eosinofilia. El 40 por ciento requirieron ingresos hospitalarios. Se encontró T. britovi en la longaniza. Conclusiones: Las epidemias de triquinelosis pueden superar los sistemas de inspección y control actuales, poniendo en riesgo la seguridad alimentaria. La difusión de la alerta sanitaria disminuye la demora diagnóstica. Proponemos la intensificación de la educación sanitaria y continuar con la implantación de programas de autocontrol en industrias y establecimientos, debidamente supervisados y evaluados. Se debe mantener un sistema de vigilancia epidemiológica sensible y de rápida actuación (AU)

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