Vigilancia de infección de herida quirúrgica poscesárea en un hospital general / Surgical site infection surveillance by caesarean section in a general hospital

Las infecciones relacionadas con la asistencia sanitaria suponen un problema de salud pública que justifica su prevención y vigilancia. La reducción de las estancias hospitalarias posquirúrgicas que se ha producido en los últimos años incrementa la posibilidad de que la infección se produzca después del alta hospitalaria. Objetivos: conocer y analizar las tasas de incidencia de infección de localización quirúrgica poscesárea con seguimiento posalta en el periodo 2013-2015. Describir su evolución a lo largo de los tres años. Material y métodos: selección de información quirúrgica en historias clínicas, introducción de datos al sistema de vigilancia de infecciones relacionadas con la asistencia sanitaria (VIRAS-Madrid) y vigilancia posalta los 30 días posintervención mediante consulta al sistema informático hospitalario y atención primaria mediante el visor HORUS. Resultados: se estudiaron 1.353 cesáreas. La incidencia de infección de localización quirúrgica fue 1,55% (1,92% en 2013, 1,52% en 2014 y 1,26% en 2015). La estancia media poscirugía fue de 4,4 días (índice de confianza 95%: 3,6; 5,2). El 95,24% de las infecciones se detectó después del alta hospitalaria y de ellas, el 52,38% a través de las consultas de atención primaria. La tasa de incidencia estratificada por índice de riesgo aumenta a medida que se incrementa este índice, aunque no se encuentran diferencias estadísticamente significativas. Conclusiones: la vigilancia posalta juega un papel fundamental en la detección de las infecciones relacionadas con la asistencia sanitaria puesto que gran parte de ellas se producen tras el alta. La vigilancia en continuidad asistencial mediante el seguimiento posterior al alta permite obtener una tasa de infección más ajustada a la realidad

Healthcare-associated infections are a critical challenge to public health that justifies their prevention and surveillance. The reduction in hospital stay after surgery that has occurred in recent years increases the probability that the infection will occur after hospital discharge. Objectives: The objectives of this analysis were to analyze the incidence rates of post-cesarean surgical site infection with post-discharge surveillance between 2013 and 2015 and to describe their evolution over the three years. Methods: Selection of surgical information in medical records, data record at the surveillance system VIRAS-Madrid and post-discharge surveillance at 30 days after surgery by consulting the hospital electronic medical record and primary care using HORUS. Results: A total of 1353 cesareans were included in the study. The incidence of surgical site infection was 1.55% (1.92% in 2013, 1.52% in 2014 and 1.26% in 2015). The average length of hospital stay after surgery was 4.4 days, (95% CI: 3.6; 5.2). 95.24% of infections were detected after discharge and 52.38% of them through Primary Care consultations. Infection rate increases with increasing risk index score but there are no statistically significant differences. Conclusions: Post-discharge surveillance plays a fundamental role in the detection of healthcare-associated infections occurring after discharge. Post-discharge monitoring is useful to analyze the real trend of surgical site infection (AU)

Uso de dispensadores de solución alcohólica para higiene de manos por los visitantes a un hospital / No disponible

Introducción: La higiene de manos en los visitantes del hospital es un aspecto relevante en la prevención de infecciones pero se sabe poco acerca del uso que estos hacen de las soluciones hidroalcohólicas (SHA). El objetivo de este estudio es examinar las relaciones entre el uso de las SHA y los visitantes del hospital y posibles cambios en el comportamiento tras añadir señales informativas específicas. Métodos: Estudio observacional cuasi-experimental sobre el uso de SHA por los visitantes de un hospital de tercer nivel en Madrid durante los meses de febrero y marzo de 2017. Se observó el comportamiento antes y después de una intervención encaminada a aumentar la visibilidad de las SHA. Se realizó un análisis descriptivo de las variables de interés (grupo edad, sexo, visita en solitario o en grupo) y el cálculo de distribución de frecuencias absolutas y porcentajes para variables categóricas y la probable asociación de variables cualitativas. Resultados: El porcentaje de uso basal de las SHA fue del 2,7%, tras la intervención el porcentaje de uso bajó al 1,2% lo que supone un uso 53% menor (IC95%:0,23-0,93). En el horario de tarde realizaron 2,4 veces más HM que en el turno de mañana (IC95%: 1,22-4,74). Así mismo se encontró que los adultos jóvenes realizan la HM un 77% menos que los niños (IC95%: 0,06-0,85) y los ancianos, realizaban la HM un 78% menos (IC95%: 0,06-0,81). Conclusiones. El estudio demuestra que la HM en las personas que visitan el hospital es muy baja y que las intervenciones realizadas no resultaron efectivas. Es necesario cambiar la estrategia empleada con el objetivo de que los visitantes y pacientes conozcan el importante papel que desempeñan en la prevención de las infecciones relacionadas con el ámbito sanitario

Background: Hand hygiene among visitors is an important aspect in preventing health care associated infections, however, little is known about their use of alcohol based solutions (ABS). The purpose of this study is to examine the relationship between visitors and hand hygiene compliance (HHC) and how it is affected by visual signals. Methods: Observational, quasi- experimental study on the use of ABS by visitors was conducted in a third-level hospital in Madrid during February and March of 2017. The behavior was observed before and after an intervention aimed at increasing the visibility of the ABS. A descriptive analysis of the variables of interest (age group, sex, visit alone or in groups) and the probable association of qualitative variables was performed. Results: An initial 2,7% visitors used the ABS. After the intervention this percentage decreased to 1,2%, which implies 53% less (CI 95%:0,23-0,93) use of ABS. It was observed that hand hygiene was performed 2,4 times more frequently in the afternoon period than in the morning (CI 95%: 1,22-4,74). Young adults used the ABS 77% less than children (CI 95%: 0,06-0,85), and the elder used it 78% less (CI 95%: 0,06-0,81). Conclusions: The results suggest that hand hygiene compliance among visitors is very low and the interventions were not efficient. The strategies to improve hospital visitor’s hand hygiene should be increased/modified because it is an important measure to prevent health care-associated infections

[Influenza vaccination in healthcare workers. Strategies to achieve compliance in a general hospital]. / Vacunación frente a la gripe en trabajadores de un hospital general. Estrategias para incrementar su cobertura.

BACKGROUND AND OBJECTIVE: Since healthcare workers can transmit the influenza virus to high risk patients, they should be vaccinated prior to the influenza season. In this study we describe the influenza vaccination coverage in healthcare workers in a general hospital and study its evolution over the last years. SUBJECTS AND METHOD: Descriptive epidemiological study to determine the anti-influenza vaccination coverage in healthcare workers in a hospital during 2002-2003 and 2003-2004 seasons. The variables studied in each season were sex, age and professional category. RESULTS: During each of the campaigns, 1,215 and 2,287 workers were vaccinated. The vaccination coverage increased significantly (p < 0.01) (20.2% in 2002-2003 and 38% in 2003-2004). Men were vaccinated more than women although the coverage increase was significant in both sexes (p < 0.01). During the 2002-2003 season, workers older than 50 years (24.4%) had the greatest coverage, while during 2003-2004 those older than 31 years (48.7%) were the ones with more coverage. By professional categories, the medical staff (33.8% in 2002-2003 and 59.9% in 2003-2004) had a greater vaccination acceptance. The coverage increase during these two years was significant in all healthcare workers (p < 0.01). CONCLUSIONS: A significant increase in the vaccination coverage has been observed during the two seasons studied. This fact can be related to the changes introduced in the informative strategies and the performance of more active vaccination campaigns which connect vaccination to employment areas.

[Accidents with exposure to biological material contaminated with HIV in workers at a third level hospital in Madrid]. / Accidentes con exposición a material biológico contaminado por VIH en trabajadores de un hospital de tercer nivel de Madrid (1986-2001).

BACKGROUND: Human Immunodeficiency Virus (HIV) is an occupational hazard among healthcare professionals accidentally contaminated with HIV-positive blood. This study is aimed at describing the characteristics of the accidents involving blood of HIV-positive patients recorded over a sixteen-year period at a general hospital. METHODS: Epidemiological study of the accidents reported in 2001 involving biological material from an HIV-positive source by the healthcare personnel of a general hospital throughout the 1986-2001 period entailing the presence of biological material from HIV-positive serology individuals. Individual, time and place-related variables, in addition to the initial serologies and those throughout the protocolized follow-up were studied for those individuals involved in these accidents. RESULTS: A total 550 accidents entailing an HIV-positive source were reported. The average number of accidents was 34.4/year. The accidental exposure rate for the period under study was 7.5/1000 workers/year. The professional group showing the highest accident rate was the nursing staff (54.4%). Percutaneous injuries were the most frequent (80.2%). The mean exposure rate was 2.6/100 beds/year. The anatomical areas involved to the greatest degree were the fingers (75.6%). A total 53.4% of those injured completed the serological follow-up without having shown any seroconversion. CONCLUSIONS: Throughout the sixteen-year period under study, the annual incidence of accidents involving an HIV-positive source increased from the 27 accidents reported in 1986 to the 60 accidents reported in 1990, there having been a downward trend as of that point in time, to the point of 12 accidents having been recorded in 2001.

Mercury, fish oils, and the risk of myocardial infarction.

BACKGROUND: It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids. METHODS: In a case-control study conducted in eight European countries and Israel, we evaluated the joint association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations. RESULTS: The average toenail mercury level in controls was 0.25 microg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend=0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend=0.02). CONCLUSIONS: The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.