RESUMEN
Introducción: El uso de accesos venosos centrales (AVC) es útil para tratamiento y monitoreo hemodinámico del paciente. Sin embargo, su implementación no está exenta de complicaciones, siendo el principal problema las complicaciones infecciosas asociadas al catéter. Materiales y Métodos. En el servicio de Terapia Intensiva del Hospital Privado del Sur (HPS), se realizó un estudio descriptivo, retrospectivo acerca de la incidencia de infecciones asociadas a catéter (IAC) en la población de pacientes adultos internados durante el período 2006 2011; y se midió el impacto del paquete de medidas propuestas por el Comité de Control de Infecciones diseñadas para reducir la incidencia de las IAC. Resultados: La tasa de uso de AVC fue de 73,76% y la tasa total de IAC fue de 7,16/1000 día catéter. Se observa un descenso de IAC, de 15/1000 día catéter en 2006 a 7,8 en el año 2011. De la flora predominante 53,8% fueron bacilos Gram negativos, cocos Gram positivo el 46,2% restante, y entre ellos sólo 5,13% fue por Staphylococcus aureus meticilinorresistente. Conclusiones: Nuestros datos muestran un importante descenso en las tasas de infección desde la implementación del Programa de Control de Infecciones diseñado por el Comité de Control de Infecciones del HPS, en 2008.
Introduction: The use of central venous accesses (CVA) is useful for the hemodynamic monitoring and treatment of patients. However, its implementation may present some complications being catheter-associated infections the major problem. Materials and Methods: In the Intensive Care Unit of the Hospital Privado del Sur (HPS), we conducted a descriptive study on the incidence of catheter-associated infections (CAI) in an adult patient population admitted during the period 2006-2011, and we measured the impact of the set of measures proposed by the Infection Control Committee designed to reduce the incidence of CAI. Results: The CVA prevalence rate was 73.76% and the overall rate was 7.16 CAI / 1000 catheter days. We observed a decrease in CAI, 15/1000 catheter days in 2006 to 7.8 in the year 2011. Predominant flora were Gram negative bacteria 53.8%, and Gram positive cocci the remaining 46.2%. Among them there was only 5.13% infections caused by methicillin-resistant Staphylococcus aureus. Conclusions: Our data show a significant decrease in infection rates since the implementation of the Infection Control Program designed by the Infection Control Committee of the HPS in 2008.
Asunto(s)
Humanos , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Infección Hospitalaria , Cuidados CríticosRESUMEN
El cuidado e higiene del cordón umbilical (CU) es motivo de preocupación para los padres. Objetivos. Principal: comparar la efectividad del secado natural del CU, con la práctica habitual (alcohol), en la reducción del tiempo de caída del CU y la incidencia de infecciones en el recién nacido (RN). Secundarios: comparar la colonización bacteriana intrahospitalaria del CU, y el grado de satisfacción de los padres en ambos grupos. Población. RN de término asistidos en el Servicio de Neonatología del Hospital Privado del Sur, cuyos padres consintieron participar. Material y métodos. Estudio clínico prospectivo, controlado, abierto, aleatorizado, en dos grupos: Grupo Estudio (secado natural y baño diario con jabón neutro) y Grupo Control (alcohol 70%). Variables principales: tiempo de caída del CU; presencia de infecciones en piel o conjuntivas en el primer mes de vida; colonización del cordón y satisfacción parental. Análisis por intención de tratamiento. Resultados. Se analizaron 362 RN, 181 en cada grupo. La higiene con baño se asoció con una mayor frecuencia de colonización intrahospitalaria del CU (OR 1,92 [1,22 - 3,12], p <0,01) y caída del cordón más temprana (mediana [rango intercuartílico]= 6,00 [3] vs. 7,00 [4] días en el grupo control; p <0,001). No se observó un mayor riesgo de infecciones. El grado de satisfacción parental fue similar y elevado en ambos grupos. Conclusiones. El secado natural y baño redujo el tiempo de caída del CU; aun cuando la frecuencia de colonización fue mayor en el grupo estudio, no se encontró un riesgo mayor de infecciones en el primer mes.
Background. Umbilical cord (UC) care is a cause of concern for parents from birth until its separation. Standard practice in Argentina includes frequent cleansing of the UC with alcohol and body bath only two days after its separation. The effect of different methods of UC care on its separation time and on colonization with microorganisms has been insufficiently explored. Objectives. Main: To compare the effect on time of UC separation when using body bath with neutral soap followed by natural drying of the UC vs. standard care. Secondary: a) colonization rates during hospitalization; b) incidence of skin infection and conjunctivitis and c) parental comfort with both types of care. Population. Normal term newborns (>37 weeks), born at the HPS, and whose parents provided informed consent. Methods. Open prospective controlled clinical trial, with random allocation to two groups: study group -natural drying of the UC and body bath with neutral soap-and control group -UC hygiene with alcohol 70% at each diaper change until its separation and bath two days later-. UC separation time; UC colonization during hospital stay and skin and conjunctive infections in the first 30 days of life were monitored. Analysis was by intention-to-treat. Results. 362 newborns were included, 181 in each group. The groups were well balanced in baseline characteristics. Being in the study group was associated with a shorter time to UC separation (median [interquartile range]= 6.00 [3] vs. 7.00 [4] days; p <0.001) and an increased frequency in nosocomial UC colonization (adjusted OR= 1.92 [1.22- 3.12], p= 0.007). No difference in the rate of infections was observed between both groups. Parental comfort was high and similar in both groups. Conclusions. Compared to standard practice in Argentina, body bath with neutral soap and natural drying of the UC reduced the time to cord separation. This practice increased the colonization rate, but the risk of skin and conjunctive infections was apparently not modified by it. However, the study has insufficient power for secondary outcomes. Health care providers should continue to develop evidence to support or eliminate historical practices.
RESUMEN
BACKGROUND: Umbilical cord (UC) care is a cause of concern for parents right from birth until its separation. Standard practice in Argentina includes frequent cleansing of the UC with alcohol and body bath only two days after its separation. The effect of different methods of UC care on its separation time and on colonization with microorganisms has been insufficiently explored. OBJECTIVES: Main: To compare the effect on time of UC separation when using body bath with neutral soap followed by natural drying of the UC vs. standard care. Secondary: a) colonization rates during hospitalization; b) incidence of skin infection and conjunctivitis and c) parental comfort with both types of care. POPULATION: Normal term newborns (≥37 weeks), born at the HPS, and whose parents provided informed consent. METHODS: Open prospective controlled clinical trial, with random allocation to two groups: study group -natural drying of the UC and body bath with neutral soap- and control group -UC hygiene with alcohol 70% at each diaper change until its separation and bath two days later-. UC separation time; UC colonization during hospital stay and skin and conjunctive infections in the first 30 days of life were monitored. Analysis was by intention-to-treat. RESULTS: 362 newborns were included, 181 in each group. The groups were well balanced in baseline characteristics. Being in the study group was associated with a shorter time to UC separation (median [interquartile range]= 6.00 [3] vs. 7.00 [4] days; p <0.001) and an increased frequency in nosocomial UC colonization (adjusted OR= 1.92 [1.22- 3.12], p= 0.007). No difference in the rate of infections was observed between both groups. Parental comfort was high and similar in both groups. CONCLUSIONS: Compared to standard practice in Argentina, body bath with neutral soap and natural drying of the UC reduced the time to cord separation. This practice increased the colonization rate, but the risk of skin and conjunctive infections was apparently not modified by it. However, the study has insufficient power for secondary outcomes. Health care providers should continue to develop evidence to support or eliminate historical practices.
Asunto(s)
Baños , Etanol/administración & dosificación , Cuidado del Lactante/métodos , Cordón Umbilical , Femenino , Humanos , Recién Nacido , Masculino , Estudios ProspectivosRESUMEN
El cuidado e higiene del cordón umbilical (CU) es motivo de preocupación para los padres. Objetivos. Principal: comparar la efectividad del secado natural del CU, con la práctica habitual (alcohol), en la reducción del tiempo de caída del CU y la incidencia de infecciones en el recién nacido (RN). Secundarios: comparar la colonización bacteriana intrahospitalaria del CU, y el grado de satisfacción de los padres en ambos grupos. Población. RN de término asistidos en el Servicio de Neonatología del Hospital Privado del Sur, cuyos padres consintieron participar. Material y métodos. Estudio clínico prospectivo, controlado, abierto, aleatorizado, en dos grupos: Grupo Estudio (secado natural y baño diario con jabón neutro) y Grupo Control (alcohol 70%). Variables principales: tiempo de caída del CU; presencia de infecciones en piel o conjuntivas en el primer mes de vida; colonización del cordón y satisfacción parental. Análisis por intención de tratamiento. Resultados. Se analizaron 362 RN, 181 en cada grupo. La higiene con baño se asoció con una mayor frecuencia de colonización intrahospitalaria del CU (OR 1,92 [1,22 - 3,12], p <0,01) y caída del cordón más temprana (mediana [rango intercuartílico]= 6,00 [3] vs. 7,00 [4] días en el grupo control; p <0,001). No se observó un mayor riesgo de infecciones. El grado de satisfacción parental fue similar y elevado en ambos grupos. Conclusiones. El secado natural y baño redujo el tiempo de caída del CU; aun cuando la frecuencia de colonización fue mayor en el grupo estudio, no se encontró un riesgo mayor de infecciones en el primer mes.
Background. Umbilical cord (UC) care is a cause of concern for parents right from birth until its separation. Standard practice in Argentina includes frequent cleansing of the UC with alcohol and body bath only two days after its separation. The effect of different methods of UC care on its separation time and on colonization with microorganisms has been insuffciently explored. Objectives. Main: To compare the effect on time of UC separation when using body bath with neutral soap followed by natural drying of the UC vs. standard care. Secondary: a) colonization rates duri ng hospitalization; b) incidence of skin infection and conjunctivitis and c) parental comfort with both types of care. Population. Normal term newborns (≥37 weeks), born at the HPS, and whose parents provided informed consent. Methods. Open prospective controlled clinical trial, with random allocation to two groups: study group -natural drying of the UC and body bath with neutral soap- and control group -UC hygiene with alcohol 70% at each diaper change until its separation and bath two days later-. UC separation time; UC colonization during hospital stay and skin and conjunctive infections in the frst 30 days of life were monitored. Analysis was by intention-to-treat. Results. 362 newborns were included, 181 in each group. The groups were well balanced in baseline characteristics. Being in the study group was associated with a shorter time to UC separation (median [interquartile range]= 6.00 [3] vs. 7.00 [4] days; p <0.001) and an increased frequency in nosocomial UC colonization (adjusted OR= 1.92 [1.22- 3.12], p= 0.007). No difference in the rate of infections was observed between both groups. Parental comfort was high and similar in both groups. Conclusions. Compared to standard practice in Argentina, body bath with neutral soap and natural drying of the UC reduced the time to cord separation. This practice increased the colonization rate, but the risk of skin and conjunctive infections was apparently not modifed by it. However, the study has insuffcient power for secondary outcomes. Health care providers should continue to develop evidence to support or eliminate historical practices.
