Training, management, and quality of nursing care of vascular access in adult patients: The INCATIV project.

BACKGROUND: More than one billion of peripheral venous catheters are inserted into hospitalized patients every year. This study sought to identify the status of nursing care in vascular accesses in different hospitals and to evaluate the impact of a series of informative and formative interventions aimed at their care. METHODS: Quasi-experimental, multicenter study. A total of 54 nursing professionals of 19 hospitals participated. The intervention consisted of informative talk and three training sessions related to the care and maintenance of vascular accesses and intravenous therapy in the hospital-admitted adult population. This was delivered in four years, with eight periodic cross-sectional assessments conducted before and after each intervention. To assess quality of nursing care in vascular accesses and intravenous therapy, a quality indicator called Standard Variable (VES), was developed and validated with the Delphi methodology. RESULTS: A total of 21,108 patients, aged 64.0 years (SD 18.3), were assessed, of which 78.3% (16,516) had some type of vascular access inserted. An average of 22.1% (95% CI: 21.4-22.7) were classified as optimal. In total, 3218 nursing care professionals took part in the training activities. The VES indicator grew steadily throughout the study, raising from 7.8% to 37.6%. Changes were statistically significant between those time points in which one of the described interventions was delivered; however, there were no significant changes between time points with no intervention. CONCLUSIONS: This study supports that continuous training interventions can produce improvements in the quality of nursing care and reduce complications in patients with vascular accesses. In addition, the VES indicator was a useful and simple tool to measure quality, but the experience with its use suggests continuous research in the search for standardized indicators that objectify the evaluation and evolution of care.

Conocimientos y aptitudes del personal sanitario frente a sospecha de caso de enfermedad por el virus del Ébola / Knowledge and attitudes of healthcare workers towards a suspect case of Ebola virus disease

Introducción. El último brote de la enfermedad por el virus del Ébola, constituyó un precedente a la hora de evidenciar la necesaria formación del personal sanitario para posibles eventualidades de casos sospechosos de enfermedades contagiosas. Se precisa estudiar el nivel de cualificación del personal sanitario ante dichas situaciones. Material y métodos. Estudio descriptivo mediante encuesta post-taller al personal sanitario de un departamento de salud de la Comunidad Valenciana sobre los conocimientos y aptitudes adquiridos tras la formación. Resultados y conclusiones. El personal sanitario obtuvo una calificación global de aprobado en la encuesta post-taller, pero con diferencias en cuanto a categorías profesionales y distintos bloques de la formación, cuyas calificaciones podrían ser consideradas como deficientes en algunos casos. Se debería revisar la formación del personal sanitario periódicamente y calibrar dicha formación a los recursos de los que se dispone para una correcta actuación (AU)

Introduction. The last outbreak of the Ebola virus disease, was a precedent to demonstrate the necessary training of healthcare personnel for possible eventualities of suspected cases of infectious diseases. It is required to study the level of qualification of healthcare workers in such situations. Methods. Descriptive study using post-workshop survey of healthcare workers in a Valencian Community health department on acquired knowledge and skills after training. Results and conclusions. Healthcare personnel received an overall passing score on the post-workshop survey, but with differences in occupational categories and different blocks of training. The ratings could be considered deficient in some cases. It should be reviewed periodically training health personnel and calibrate such training to the resources available for proper operation (AU)

[Knowledge and attitudes of healthcare workers towards a suspect case of Ebola virus disease]. / Conocimientos y aptitudes del personal sanitario frente a sospecha de caso de enfermedad por el virus del Ébola.

OBJECTIVE: The last outbreak of the Ebola virus disease, was a precedent to demonstrate the necessary training of healthcare personnel for possible eventualities of suspected cases of infectious diseases. It is required to study the level of qualification of healthcare workers in such situations. METHODS: Descriptive study using post-workshop survey of healthcare workers in a Valencian Community health department on acquired knowledge and skills after training. CONCLUSIONS: Healthcare personnel received an overall passing score on the post-workshop survey, but with differences in occupational categories and different blocks of training. The ratings could be considered deficient in some cases. It should be reviewed periodically training health personnel and calibrate such training to the resources available for proper operation.

Exposición cutáneo-mucosa a sangre o material biológico en trabajadores sanitarios / Skin or mucous exposure to blood or biological materials in healthcare workers

Objetivo: analizar las exposiciones cutáneo-mucosas a sangre y material biológico en trabajadores sanitarios de la Comunidad Valenciana recogidas en un período de catorce años (1997-2010).Material y método: estudio descriptivo con componente transversal y longitudinal (1997-2010), en el ámbito que corresponde al Hospital General Universitario de Elche (Comunidad Valenciana). Se utilizó la información generada por el sistema de vigilancia epidemiológica EPINETAC, que recoge las exposiciones accidentales a sangre o material biológico y su seguimiento. También se recogieron variables de identificación, laborales, uso de dispositivos de protección, actuación tras exposición, situación vacunal frente al VHB del expuesto y estado serológico de la fuente. Los datos fueron recogidos mediante entrevista personal, revisión de expediente laboral e historia clínica de la fuente. Resultados: las declaraciones de exposiciones cutáneo-mucosa han ido aumentando con el paso de los años. Las enfermeras declararon el 44%,los médicos de plantilla un 17% y los auxiliares de Enfermería un 14%.El lugar de la exposición más habitual fue la habitación del paciente(34%). La sangre fue el fluido más frecuentemente implicado 76%.Conclusiones: la exposición cutáneo-mucosa en los sanitarios depende de muchas variables: características del paciente y trabajo a realizar, los protocolos y material de seguridad utilizado, la dotación y estructuras que se posean en el lugar de trabajo, pero también son muy importantes factores ligados al comportamiento humano y la organización en el trabajo. Estas exposiciones cutáneo-mucosas, aunque menos numerosas que las percutáneas, deben ser tenidas en cuenta a la hora de la prevención y gestión del riesgo (AU)

Objective: to analyze mucocutaneous exposures to blood and biological material in healthcare workers in the Valencian Community collected over a period of fourteen years (1997-2010).Material and methods: descriptive cross-sectional study with longitudinal component (1997-2010), in the catchment area corresponding to the Hospital General Universitario de Elche (Comunidad Valenciana).The information generated by the surveillance system EPINETAC was used, which includes accidental exposures to blood or biological material, and monitoring. Variables were also collected for identification, employment, use of protective devices, actions taken after exposure, vaccination status of the person exposed against HBV and serological status of the source. Data were collected through personal interview, review of employment records and medical history of the source. Results: confirmations of mucocutaneous exposures have been increasing over the years. Nursing reported 44%, staff physicians 17% and nursing assistants 14%. The place of exposure was most frequently the patient's room (34%). Blood was the most frequently involved fluid 76%.Conclusions: mucocutaneous exposure in health workers depends on many variables: patient characteristics and work to be done, protocols and safety gear used, the equipment and structures in the workplace, but also of outmost importance are factors associated to human behavior and organization at work. These mucocutaneous exposures, though less numerous than the percutaneous, must be taken into account in prevention and risk management planning (AU)

Exposiciones accidentales a sangre y/o material biológico en trabajadores sanitarios / Accidental exposure to blood and/or biological material in healthcare workers

Objetivo: presentar el análisis descriptivo de la información obtenida en un período de doce años (EPINETAC 1997/2008) en el Departamento 20 de Salud de Elche (Alicante). Materiales y métodos: se analizó la información obtenida de 2.023 encuestas sobre exposiciones accidentales realizadas desde 01/01/1997 hasta 31/12/2008 del proyecto EPINETAC. Los datos registrados se analizaron con el programa estadístico SPSS15. Resultados: las enfermeras declaran el 42% de los accidentes percutáneos, los médicos un 14,7% y las auxiliaresde Enfermería un 14,6%. Los médicos sufren el accidente en el quirófano o salas de partos en tres de cada cuatro ocasiones (75,3%) mientras que las enfermeras lo hacen en la habitación de los pacientes (42,3%). Las matronas, médicos y MIR sufren alrededor del 90% de las inoculaciones accidentales durante el uso del material. Conclusiones: aproximadamente la mitad de las exposiciones accidentales declaradas durante este período podían haberse evitado (los accidentes ocurridos durante el uso del material (49,6%) son los únicos que se consideran no evitables).El colectivo profesional con mayor asiduidad de exposiciones accidentales a sangre y fluidos biológicos es elde la Enfermería. Las agujas huecas son el material más frecuentemente implicado en exposiciones ocupacionales, siendo las que se asocian a un mayor riesgo de transmisión (AU)

Objetive: the epidemiological surveillance of exposure tobiological risk in the work place is a fundamental basis for the planning and prioritization of any prevention strategy. The objective is to present the descriptive analysis of the information obtained over a 12 year period (EPINETAC 1997/2008)in the 20th Health Department of Elche (Alicante). Materials and methods: the information obtained from 2.023 surveys on accidental exposures that took place between 01/01/1997 to 31/12/2008 of the EPINETAC project. Recorded data are analysed with the SPSS 15 statistical programme. Results: nurses report 42% of percutaneous accidents; physiciansreport 14,7% and nursing aids 14,6%. Physicians experience accidents in operating or labour and delivery room in three of every four occasions (75,3%), whereas nurses report that accidents happen mainly in patient rooms (42,3%). Midwives, physicians and resident medical students suffer close to 90%of accidental inoculations during the use of materials.Conclusions: approximately half of accidental exposures reported during this period could have been avoided (accidents that occurred during the use of materials (49,6%) arethe only ones that are considered unavoidable). Nurses are the professionals with the highest accidental exposure to blood and biologic fluids. Hollow needles are the most frequently involved material in work-related exposures, and are also associated with a higher transmission risk (AU)