Evaluación del conocimiento en higiene de manos pre y post capacitación a residentes en un hospital público / Evaluation of hand-hygiene knowledge before and after training of residents in a public hospital

INTRODUCCIÓN: La higiene de las manos se considera la medida más eficaz para reducir las infecciones relacionadas al cuidado de la salud. A partir de enero 2017 se implementó en el Hospital la Estrategia Multimodal de Mejora de la Higiene de Manos (HM), herramienta desarrollada por la OMS. Esta fue adaptada para ser aplicada en nuestra institución, con el objetivo de alcanzar un incremento sostenido de la adherencia a la higiene de manos e implantarla como parte integrante de la cultura de nuestro centro sanitario. El abordaje multimodal incluye acciones a diferentes niveles: sistema (infraestructura), formación y aprendizaje, evaluación y retroalimentación, recordatorios en los lugares de trabajo y clima institucional de mejora en la HM. Dentro de las actividades de formación y aprendizaje se desarrolló una actividad de capacitación a todos los residentes de las áreas médicas y quirúrgicas del HEC. OBJETIVO: El objetivo fue evaluar los conocimientos basales sobre HM entre los residentes del hospital y compararlos luego de recibir un curso de capacitación teórico- práctico específico en la temática. RESULTADOS: Los resultados obtenidos en el examen posterior a la capacitación fueron significativamente superiores a los resultados observados previos a la misma. La intervención realizada y la información recabada permiten reflexionar acerca que el abordaje de una técnica como es la higiene de manos, focalizada en una actividad de capacitación, mejora los conocimientos y formas de llevarlo a la práctica que se tenían previa a esta instancia.

INTRODUCTION: Hand hygiene is considered the most effective measure to reduce healthcarerelated infections. From January 2017, the Multimodal Hand-Hygiene Improvement Strategy, a tool developed by WHO, was implemented in the hospital. This was adapted to be applied in our institution, aiming at achieving a sustained increase of the compliance to hand hygiene and implemented as an integral part of our healthcare center's cultural characteristics. The multimodal approach includes actions at different levels: system (infrastructure), training and learning, evaluation and feedback, reminders at workplaces and institutional climate of HH improvement. A training activity for all residents of the HEC's medical and surgical areas was developed within the training and learning activities. OBJECTIVE: The objective was to evaluate the basal knowledge on HH among hospital residents, and make a comparison after receiving a training theoretical-practical course that was specific on the subject. RESULTS: The results achieved in the post-training examination were significantly superior to the results observed before the training. The intervention made, and the information collected have allowed us to think that the approach to a technique like hand hygiene, on which a training activity was focused, improves the knowledge and implementation that existed before this instance.

Mortalidad en pacientes con neumonía provenientes de geriátrico: estudio caso-control / Mortality in Patients with Pneumonia from Nursing Homes: Case-control Study

Introducción: La neumonía en adultos mayores institucionalizados en geriátricos presenta elevada incidencia y mortalidad. Conocer sus características permite optimizar conductas terapéuticas. Objetivo: Comparar severidad, etiología, regímenes antibióticos utilizados y evolución de una cohorte de pacientes hospitalizados por neumonía provenientes de geriátrico, con un grupo de pacientes de igual edad no residentes en geriátricos. Material y métodos: Estudio multicéntrico, retrospectivo, caso-control, sobre la base de datos internacional CAPO. Se incluyeron 534 pacientes internados en hospitales de Argentina por neumonía, periodo 6/2001-12/2007; 30 pacientes provinieron de geriátrico (casos); por cada caso se seleccionaron 3 controles de edad similar. Análisis estadístico: ?2 y F-ANOVA. Se aplicó análisis univariado y multivariado. Resultados: Edad media 85,7 (DS 6.46) y 84.8 (DS 5.8) años para casos y controles respectivamente, pNS. Los casos presentaron categorías de PSI significativamente mayores (p < 0.0001). La etiología se determinó en 17% de casos y 27% de controles. Los antibióticos utilizados fueron similares en ambos grupos (p = 0.7). No hubo diferencias significativas en tiempo a la estabilidad clínica ni duración de estadía hospitalaria. La mortalidad global en los casos fue 50% vs 26% en controles; (p = 0.02) y la atribuible 43.3% vs 15.5%; (p = 0.002). Análisis multivariado: Accidente cerebro vascular (ACV) (p = 0.05), estado mental alterado (EMA) (p = 0.01) e hipotensión arterial (p = 0.04) fueron las variables significativamente asociadas a mortalidad. Conclusiones: los pacientes provenientes de geriátrico presentaron neumonías más severas y mayor mortalidad. Esta se asoció con la presencia de ACV previo, EMA e hipotensión arterial al ingreso, y no con la condición de provenir de geriátrico.

Introduction: Community-acquired pneumonia (CAP) in institutions for elderly patients presents high incidence and mortality. Defining its characteristics will contribute to optimize therapeutic measures. Objective: To compare severity, etiology, antibiotic regimens used and outcome of a cohort of nursing home residents with CAP with a group of age-matched patients who are not resident at a nursing home. Methods: Multicenter, retrospective, case-control study. Information was taken from the international database CAPO. We included 534 patients hospitalized for CAP in Argentina, from June 2001 to December 2007. Among them, 30 cases were residents in nursing homes (cases). For each case, three controls of similar age were selected. Statistical analysis: ?2 and F-ANOVA. Univariate and multivariate analyses were performed. Results: Mean age was 85.7 (SD 6.46) and 84.8 (SD 5.8) years for cases and controls respectively, p NS. Cases had significantly higher PSI scores (p < 0.0001). The etiology was determined in 17% of cases and 27% of controls. The antibiotics used were similar in both groups (p = 0.7). There was no significant difference in time to reach clinical stability or in length of hospital stay. Overall mortality was 50% in cases vs 26% in controls, (p = 0.02) and attributable mortality was 43.3% and 15.5% respectively (p = 0.002). In the multivariate analysis, stroke (p = 0.05), confusion (p = 0.01) and hypotension (p = 0.04) were associated significantly with mortality. Conclusions: nursing home residents presented more frequently severe pneumonia with increased mortality. This incidence was associated with the presence of previous stroke, confusion and hypotension on admission; it was not associated with residence in a nursing home.

Mortalidad en pacientes con neumonía provenientes de geriátrico: estudio caso-control

Introducción: La neumonía en adultos mayores institucionalizados en geriátricos presenta elevada incidencia y mortalidad. Conocer sus características permite optimizar conductas terapéuticas. Objetivo: Comparar severidad, etiología, regímenes antibióticos utilizados y evolución de una cohorte de pacientes hospitalizados por neumonía provenientes de geriátrico, con un grupo de pacientes de igual edad no residentes en geriátricos. Material y métodos: Estudio multicéntrico, retrospectivo, caso-control, sobre la base de datos internacional CAPO. Se incluyeron 534 pacientes internados en hospitales de Argentina por neumonía, periodo 6/2001-12/2007; 30 pacientes provinieron de geriátrico (casos); por cada caso se seleccionaron 3 controles de edad similar. Análisis estadístico: ?2 y F-ANOVA. Se aplicó análisis univariado y multivariado. Resultados: Edad media 85,7 (DS 6.46) y 84.8 (DS 5.8) años para casos y controles respectivamente, pNS. Los casos presentaron categorías de PSI significativamente mayores (p < 0.0001). La etiología se determinó en 17% de casos y 27% de controles. Los antibióticos utilizados fueron similares en ambos grupos (p = 0.7). No hubo diferencias significativas en tiempo a la estabilidad clínica ni duración de estadía hospitalaria. La mortalidad global en los casos fue 50% vs 26% en controles; (p = 0.02) y la atribuible 43.3% vs 15.5%; (p = 0.002). Análisis multivariado: Accidente cerebro vascular (ACV) (p = 0.05), estado mental alterado (EMA) (p = 0.01) e hipotensión arterial (p = 0.04) fueron las variables significativamente asociadas a mortalidad. Conclusiones: los pacientes provenientes de geriátrico presentaron neumonías más severas y mayor mortalidad. Esta se asoció con la presencia de ACV previo, EMA e hipotensión arterial al ingreso, y no con la condición de provenir de geriátrico.(AU)

Introduction: Community-acquired pneumonia (CAP) in institutions for elderly patients presents high incidence and mortality. Defining its characteristics will contribute to optimize therapeutic measures. Objective: To compare severity, etiology, antibiotic regimens used and outcome of a cohort of nursing home residents with CAP with a group of age-matched patients who are not resident at a nursing home. Methods: Multicenter, retrospective, case-control study. Information was taken from the international database CAPO. We included 534 patients hospitalized for CAP in Argentina, from June 2001 to December 2007. Among them, 30 cases were residents in nursing homes (cases). For each case, three controls of similar age were selected. Statistical analysis: ?2 and F-ANOVA. Univariate and multivariate analyses were performed. Results: Mean age was 85.7 (SD 6.46) and 84.8 (SD 5.8) years for cases and controls respectively, p NS. Cases had significantly higher PSI scores (p < 0.0001). The etiology was determined in 17% of cases and 27% of controls. The antibiotics used were similar in both groups (p = 0.7). There was no significant difference in time to reach clinical stability or in length of hospital stay. Overall mortality was 50% in cases vs 26% in controls, (p = 0.02) and attributable mortality was 43.3% and 15.5% respectively (p = 0.002). In the multivariate analysis, stroke (p = 0.05), confusion (p = 0.01) and hypotension (p = 0.04) were associated significantly with mortality. Conclusions: nursing home residents presented more frequently severe pneumonia with increased mortality. This incidence was associated with the presence of previous stroke, confusion and hypotension on admission; it was not associated with residence in a nursing home.(AU)

Short communication: fasting increases serum concentrations of bilirubin in patients receiving atazanavir: results from a pilot study.

Unconjugated hyperbilirubinemia resulting from therapy with atazanavir is physiologically related to hyperbilirubinemia in Gilbert's syndrome (GS). In patients with GS, changes in diet have a significant impact on bilirubinemia. Our aim was to investigate whether changes in diet affect the level of serum bilirubin in patients receiving atazanavir. Thirty patients on stable therapy with ritonavir-boosted atazanavir without evidence of GS were enrolled. Hemolysis and chronic hepatitis were excluded. After a baseline period of normal intake of calories, the patients were randomized to follow a 24-h 400-calorie diet (fasting), then a 48-h period of normal calorie intake and, afterward, a 24-h period of a high-calorie diet, or the same interventions in inverse order. Serum bilirubin concentrations were measured before and after each intervention. A high adherence to the recommended diet was observed. The mean unconjugated bilirubin concentration before the high-calorie diet was 2.79±1.53 mg/dl and after such intervention it was 2.70±1.40 mg/dl. The mean difference between preintervention and postintervention was -0.08±0.69 mg/dl (p=NS). The mean unconjugated bilirubin concentration before the fasting diet was 2.31±1.23 mg/dl and it was 3.84±1.90 mg/dl after. The mean difference between prefasting and postfasting was 1.53±1.17 mg/dl (p=0.001). According to these results, short periods of fasting seem to increase the unconjugated bilirubin concentration in patients on atazanavir. A high-calorie diet did not have any impact in bilirubin probably because most patients follow similar diets in their everyday life.

Design, development and evaluation of a competitive RT-PCR for quantitation of GBV-C RNA.

Although GB virus C (GBV-C) hepatocyte pathogenicity is still controversial, it appears that at least some strains of this virus are lymphotropic. During the past few years, several reports have documented an apparently beneficial role played by GBV-C in the course of HIV-1 infection. At present, a commercial kit for GBV-C RNA quantitation is not available. In this study, a competitive RT-PCR method for GBV-C in serum samples is described. The sensitivity of the assay proved to be 10(4) and 10(3) genomic equivalents for positive and negative sense RNAs, respectively. This method will discriminate specifically between positive and negative strand RNAs with a discrimination index of at least five log10. Out of 60 samples from different hematological disorders (n = 49), HIV-1 positive patients (n = 7), and blood donors (n = 4), 10 proved to be GBV-C RNA positive. Viral load ranged from 1.1 x 10(7) to 2.34 x 10(8) genomic equivalents/ml. Such values correlated linearly (r = 0.986) with those obtained by a 10-fold serial dilution method. In studies exploring the GBV-C pathogenicity, the measurement of viral load may contribute to understand the possible mechanisms involved.