ABSTRACT
OBJECTIVE: To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability. DESIGN: Prospective cohort study with isolated and non-isolated patients. SETTING: One public university hospital in the Valencian Community (southeast Spain). PARTICIPANTS: We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. EXCLUSION CRITERIA: patients age <18 years old and/or reverse isolation patients. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated. RESULTS: The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients). CONCLUSIONS: AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.
Subject(s)
Medical Errors , Adolescent , Cohort Studies , Humans , Incidence , Prospective Studies , Spain/epidemiologyABSTRACT
Objetivo: Analizar el resultado de la implantación de un Bundle para la prevención de infección de localización quirúrgica (ILQ) en artroplastia de rodilla y cadera. Material y métodos: Estudio de intervención antes-después. Intervención: Bundle. Determinaciones: incidencia acumulada (IA) de ILQ y cumplimiento del Bundle. La medición de la IA de ILQ se realizó mediante un sistema de vigilancia prospectiva y la medición del cumplimiento del Bundle mediante la revisión de historias clínicas. Resultados: En 2012 la IA de ILQ fue del 4,4% frente a 1,6% en 2013. El Bundle se implantó en 2013, para el cumplimiento se revisó una muestra aleatoria del 33% de los pacientes intervenidos de prótesis de rodilla y cadera ese año. El cumplimiento de cada medida fue variable. Conclusiones: Se ha evidenciado una reducción de la ILQ coincidente con la puesta en marcha del Bundle. Se han identificado puntos críticos de incumplimiento y tomado medidas para su mejora
Objetivo: Analyze the result of the implantation of a Bundle for the prevention of surgical site infection (SSI) in knee and hip arthroplasty. Material y métodos: Intervention study before-after. Intervention: Bundle. Determinations: cumulative incidence (CI) of patients with SSI and Bundle compliance. The measurement the CI of SSI was made through a prospective vigilance system and the measurement of the Bundle compliance through a review of the medical histories. Results: In 2012, CI of SSI was 4,4% versus 1,6% in 2013. The Bundle was implanted in 2013, to size the compliance was revised a random sample of 33% of the patients who received knee and hip prosthesis that year. The compliance of each measurement varied.Conclusions: A reduction of the SSI coinciding with the commissioning of the Bundle has been evidenced. Critical points of failure were identified and measures have been implemented
