Frequency of hand contact with hospital surfaces in hospitalized pediatric patients.

BACKGROUND: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. METHODS: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. RESULTS: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. CONCLUSION: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

INTRODUCCIÓN: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. MÉTODOS: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. RESULTADOS: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. CONCLUSIONES: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

Restructuring of a pediatric hospital in the face of the COVID-19 pandemic.

Overview of the pandemic In December 2019, a new virus named SARS-CoV-2 was reported in Wuhan province, China. The first case of COVID-19 in Mexico was confirmed on February 28, 2020, and the World Health Organization declared the pandemic on March 11.

Identification of asthma risk factors in Mexico City in an International Study of Asthma and Allergy in Childhood survey.

The International Study of Asthma and Allergy in Childhood (ISAAC) has assessed the prevalence of asthma, as well as the factors related to the disease in different countries. The aim of this study was to identify asthma risks factors in Mexico City. Data were obtained from questionnaires of children participating in a phase 3b ISAAC survey. Two thousand ninety-eight boys and 2008 girls were recruited in the 6- to 7-year-old group and 3243 boy and 3333 girls were recruited in the 13- to 14-year-old group. Logistic regression was used to determine the asthma risks factors. In the logistic regression for cumulative and current asthma prevalence, the variables allergic rhinitis and atopic dermatitis were the most important risk factors with the highest odds ratios (OR > 1.5; p < 0.05). The use of antibiotics and paracetamol in the first 12 months of life were related to cumulative asthma in both genders in the 6- to 7-year-old group. Contact of pregnant mother with farm animals was positively related with cumulative asthma in boys in the 6- to 7-year-old group. The main factors associated with the cumulative and current prevalence of asthma in both age groups were atopic dermatitis and allergic rhinitis. Future interventions for the prevention and early diagnosis and treatment could be focused in the natural history of the atopic march.

Tipos y características de los inhaladores para el manejo de asma / Types and characteristics of devices for the treatment of asthma

El tratamiento del asma requiere del uso de medicamentos durante períodos largos para lograr el control de la enfermedad y la vía inhalada es la forma más adecuada para administrarlos. En las últimas 2 décadas se han desarrollado nuevos y mejores dispositivos para la entrega del medicamento, con marcadas diferencias respecto a su diseño, construcción, características de salida y tamaño de las partículas. El médico debe conocer los puntos tecnológicos más destacados de cada aparato para que pueda aprovechar sus ventajas y haga recomendaciones muy precisas. Existen varios dispositivos para administrar medicamentos inhalados: los más viejos y de uso cotidiano en hospitales son los nebulizadores y de manera más reciente se introdujeron los inhaladores de dosis medida presurizados o los inhaladores de polvo seco, que son más usados para el paciente ambulatorio. La condición particular de cada uno de estos dispositivos debe conocerse y aplicarse para ofrecer el máximo beneficio al paciente asmático.

Asthma management requires the use of many drugs for long time with the purpose of achieving control. Inhalator delivery of asthma medications is the best way. In the previous 2 decades, technology has improved delivery devices, changes in design, materials and outsize particles. Physicians should know all the technical points in order to take advantage of these new devises to be able to make appropriate recommendations for their use. There is a large quantity of options for the delivery of asthma medications: nebulizers, metered dose inhaler and dry powder inhalers. Particular characteristics of delivery devices should be known and applied in particular patients.The aim of this review article is assist physicians to choose the best device option.

Cyclophosphamide hypersensitivity in a leukemic child.

Although hypersensitivity reactions to chemotherapeutic drugs have rarely been reported, they may occur with any of these agents. A Mexican native 44-kg 13-year-old boy suffering from acute lymphoblastic leukemia (ALL) received chemotherapy for 7 years. Three years later, a recurrence of ALL was detected in his right testicle. The patient was scheduled to receive 12 weekly cycles of 50 mg/kg of cyclophosphamide (CPM) as a 1-hour intravenous infusion. The patient did not have any history of drug allergies or any other type of ADR. Immediately after the fourth cycle of CPM, the patient developed itchy, maculopapular rash, sweating, respiratory distress, and anxiety. According to the algorithm developed by Naranjo et al, the ADR was classified as probably secondary to CPM. Skin tests were negative to hypersensitivity to CPM, and a new cycle of CPM was administered. However, the patient developed a similar hypersensitivity reaction to CPM. After an analysis of the clinical course of the ADR and the need to continue the chemotherapeutic treatment with CPM, we decided to desensitize the patient to this drug. Total duration of the procedure was 5 hours and was performed on only 1 occasion. The program of 12 cycles of chemotherapy was successfully completed without any sign or symptom of hypersensitivity to CPM. In conclusion, we have reported a case of hypersensitivity to CPM who was successfully desensitized to CPM.

Pruebas de función pulmonar en pediatría / Pulmonary function tests in pediatrics

Las pruebas de función respiratoria son una serie de parámetros para valorar la función broncopulmonar y para su realización se cuenta con instrumentos como el espirómetro y pletismógrafo. Dentro de sus indicaciones están: evaluar la gravedad de los padecimientos pulmonares y/o sus secuelas; evaluar riesgo preoperatorio y pronóstico en cirugía de tórax y abdomen alto; valorar la eficacia del tratamiento; describir la evolución de la enfermedad; monitorear reacciones adversas a medicamentos. Además, permiten realizar pruebas de reto bronquial para diagnóstico de hiperreactividad en vías aéreas. Actualmente se cuenta con flujímetros portátiles con los que se obtienen mediciones cuantitativas de las vías aéreas para monitoreo extrahospitalario, permitiendo detectar la respuesta al tratamiento de acuerdo a un sencillo esquema denominado del semáforo. La compresión de la fisiología pulmonar y el uso de instrumentos para su valoración pueden contribuir de manera importante al cuidado del paciente con enfermedad respiratoria