Encuesta de las medidas de control de Staphylococcus aureusresistente a meticilina en los hospitales que participan en el programa VINCat / Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program

INTRODUCCIÓN: VINCat es un programa de vigilancia de la infección nosocomial en los hospitales de Cataluña. El objetivo del estudio fue evaluar el cumplimiento de las medidas de control de Staphylococcus aureus resistente a meticilina (SARM) en dichos centros. MÉTODOS: De enero a marzo de 2013 se realizó una encuesta por correo sobre las características de los hospitales y la aplicación de las medidas de control de SARM. RESULTADOS: Respondieron 53 hospitales (>500 camas: 7; 200-500 camas: 14;<200 camas: 32; tenían UCI: 29). Disponían de alerta informática de reingresos el 63%. Realizaban vigilancia activa de los traslados de otro hospital el 46,2%, o centro de larga estancia el 55,8%, siendo ambas medidas significativamente más frecuentes en hospitales con una tasa de SARM≤22% (mediana global). Observaban el cumplimento de higiene de manos el 77,4% de los centros y fue mayor al 50% en el 69,7%. Todos los hospitales aplicaban precauciones de contacto, aunque el 62,3% no disponían de material clínico de uso frecuente exclusivo. La limpieza de la habitación se realizaba más frecuentemente en el 54,7% y tenían programas de adecuación del uso de antibióticos el 67,9%. CONCLUSIONES: Este estudio informa sobre la implementación de medidas preventivas de SARM en hospitales del programa VINCat. Aunque la mayoría de los hospitales disponen de un protocolo específico, el cumplimento de las medidas es mejorable, especialmente la detección activa en pacientes de riesgo, la adherencia a la higiene de manos, la limpieza más frecuente de la habitación y la optimización del uso de antibióticos

INTRODUCTION: VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS: An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS: A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS: This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics

[Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program]. / Encuesta de las medidas de control de Staphylococcus aureus resistente a meticilina en los hospitales que participan en el programa VINCat.

INTRODUCTION: VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS: An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS: A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS: This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.

Factores asociados y análisis descriptivo de la endocarditis infecciosa adquiridaen el entorno hospitalario de un centro terciario de referencia / Associated factors and descriptive analysis of healthcare-related infective endocarditis in a tertiary reference hospital

Introducción y objetivos: Nuestro objetivo primario es evaluar los factores asociados, las manifestaciones clínicas y el pronóstico de la endocarditis infecciosa adquirida en el entorno hospitalario comparándola con la adquirida en la comunidad y en usuarios de drogas por vía parenteral. Como objetivo secundario se analizan cambios ocurridos en el tiempo en la distribución de la endocarditis infecciosa adquirida en el entorno hospitalario. Métodos: Se realizó un estudio prospectivo observacional y comparativo que incluyó los casos de endocarditis desde enero de 2003 a junio de 2010 y se clasiflcaron en 2 grupos; grupo 1: comunidad y usuarios de drogas por vía parenteral, y grupo 2: adquirida en el entorno hospitalario (nosocomial y nosohusial).Los episodios fueron clasiflcados en 2 periodos (periodo I: enero de 2003-junio de 2006, y periodo II: juliode 2006-junio de 2010). Se efectuó un análisis univariado y multivariado. Resultados: Se incluyeron 212 episodios (grupo 1: 138; grupo 2: 74). La edad (OR, 1,026; IC del 95%,1,003-1,049), el índice de Charlson (OR, 1,242; IC del 95%, 1,067-1,445) y la cirugía cardiaca previa (OR,2,522; IC del 95%, 1,353-4,701) fueron variables asociadas a la endocarditis infecciosa adquirida en el entorno hospitalario en el estudio multivariado. Se observó un incremento no signiflcativo de casos de endocarditis infecciosa adquirida en el entorno hospitalario en el periodo II (40/104; 38,4% vs. 34/108;31,4%).Conclusiones: El incremento reciente de la endocarditis infecciosa adquirida en el entorno hospitalario se asocia sin duda al intervencionismo sobre pacientes mayores, portadores de prótesis valvular cardíaca y que además tienen un mayor número de enfermedades de base, entre las que destaca la insuflciencia renal crónica en hemodiálisis (AU)

Introduction and objectives: The primary aim of this study was to evaluate associated factors, clinical features and prognosis of healthcare-related infective endocarditis cases compared with community acquired and intravenous drug user-related episodes. Changes in the distribution of healthcare-related infective endocarditis were also analysed over time in our setting. Methods: A prospective, observational, comparative study was performed. We included all the cases of infective endocarditis from January 2003 to June 2010, which were then classifled into 2 groups: group 1:community-acquired and intravenous drug user origin, and group 2: nosocomial and non-nosocomial healthcare-related cases. The episodes were classifled into 2 periods: period I: January/2003-June/2006and period II: July/2006-June 2010. Univariate and multivariate analyses were performed. Results: A total of 212 cases were included (group 1: 138, group 2: 74). The variables of age (risk ratio1.026; 95% CI, 1.003 to 1.049), Charlson index (risk radio 1.242; 95% CI, 1.067 to 1.445), and previous heartsurgery (risk ratio 2.522; 95% CI, 1.353 to 4.701) were independently associated with healthcare-related infective endocarditis on multivariate analysis. A non-signiflcant increase was observed in health carerelated cases of infective endocarditis in period II (40/104; 38.4% vs. 34/108; 31.4%).Conclusions: The recent increase in healthcare-related infective endocarditis seems to be associated with the use of invasive procedures in elderly patients with prosthetic cardiac valve, and those with a greater number of underlying diseases, especially patients with chronic renal failure on haemodialysis (AU)

[Associated factors and descriptive analysis of healthcare-related infective endocarditis in a tertiary reference hospital]. / Factores asociados y análisis descriptivo de la endocarditis infecciosa adquirida en el entorno hospitalario de un centro terciario de referencia.

INTRODUCTION AND OBJECTIVES: The primary aim of this study was to evaluate associated factors, clinical features and prognosis of healthcare-related infective endocarditis cases compared with community-acquired and intravenous drug user-related episodes. Changes in the distribution of healthcare-related infective endocarditis were also analysed over time in our setting. METHODS: A prospective, observational, comparative study was performed. We included all the cases of infective endocarditis from January 2003 to June 2010, which were then classified into 2 groups: group 1: community-acquired and intravenous drug user origin, and group 2: nosocomial and non-nosocomial healthcare-related cases. The episodes were classified into 2 periods: period I: January/2003-June/2006 and period II: July/2006-June 2010. Univariate and multivariate analyses were performed. RESULTS: A total of 212 cases were included (group 1: 138, group 2: 74). The variables of age (risk ratio 1.026; 95%CI, 1.003 to 1.049), Charlson index (risk radio 1.242; 95%CI, 1.067 to 1.445), and previous heart surgery (risk ratio 2.522; 95%CI, 1.353 to 4.701) were independently associated with healthcare-related infective endocarditis on multivariate analysis. A non-significant increase was observed in healthcare-related cases of infective endocarditis in period II (40/104; 38.4% vs. 34/108; 31.4%). CONCLUSIONS: The recent increase in healthcare-related infective endocarditis seems to be associated with the use of invasive procedures in elderly patients with prosthetic cardiac valve, and those with a greater number of underlying diseases, especially patients with chronic renal failure on haemodialysis.

Higiene de manos para una atención más segura / Hand hygiene for a safer care

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