[Hand hygiene and pandemic. Controversies]. / Higiene de manos y pandemia. Controversias.

During the COVID-19 pandemic, the world's healthcare systems were extremely strained. Intensive care units were stretched to capacity and healthcare facilities were forced to set up spaces to care for critically ill patients. Professionals were required to work in strenuous conditions, completely disrupting their work routines.In this scenario, hand hygiene and the use of gloves by healthcare professionals became a critical point of transmission risk.The results of the ENVIN study in 2020 and 2021, corresponding to the pandemic period, showed worrying data on the increase in infection rates, with rates rising by 250% at the worst moments of the pandemic. This suggested that excessive risk situations were occurring for the patient. Any preventive strategy must place correct hand hygiene and proper use of gloves among its priority objectives. For this reason, the Project Zero Advisory Board made a series of adaptations and recommendations based on available evidence and expert opinion related to hand hygiene and glove use during the pandemic situation to promote best practice in extreme situations. This article reviews the key aspects of hand hygiene as part of the WHO safety strategy, the main barriers to compliance and the main adaptations proposed by the Advisory Board of the Zero projects.

Antisepsia en la manipulación de las conexiones de los accesos vasculares / Antisepsis in the handling of vascular access connections

Los conectores sin aguja proporcionan puntos de acceso fácil al sistema vascular para la administración de fluidos, evitando riesgos de punción accidental y aumentando la seguridad en la manipulación del acceso vascular. Una manipulación no aséptica puede favorecer su contaminación, convirtiéndolos en puerta de entrada de contaminantes endoluminales con capacidad de desencadenar complicaciones infecciosas de graves consecuencias para el paciente. ave y evitable, es necesario incluir en los programas de prevención aquellas medidas que eviten factores predisponentes como serían el aumento de la capacitación del personal, el diseño seguro de los dispositivos, la mejora del procedimiento de desinfección y el uso óptimo del antiséptico. Monitorizar la aplicación de prácticas seguras y difundir los resultados es importante para promover la comprensión de riesgos y beneficios que comporta la descontaminación de las conexiones y mejorar así la seguridad de los pacientes

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety

Antisepsis in the handling of vascular access connections. / Antisepsia en la manipulación de las conexiones de los accesos vasculares.

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety. safety. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.

La descontaminación del entorno ha llegado al paciente / Environmental decontamination has reached the patient

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[Evaluation of pain in a neonatal intensive care unit during endocrine-metabolic tests]. / Valoración del dolor en la unidad de cuidados intensivos neonatales durante la extracción de las pruebas endocrinometabólicas.

OBJECTIVES: To determine whether the pain suffered during the endocrine metabolic test can be lowered by adding skin to skin care to the use of sucrose. To establish factors that may modify the feeling of pain and evaluate the parents opinion during the extraction. PATIENTS AND METHODS: Controlled clinical trial. Two groups: group 1 (n= 27), skin to skin and sucrose, and group 2 (n=27), sucrose. The pain was measured with the Neonatal Infant Pain Scale (NIPS) during the endocrine metabolic test. Patients on mechanical ventilation, with HIV III or IV and those who had been given sedative analgesics in the previous 24 hours were excluded. RESULTS: The average gestational age in group 1 was 35.1 +/- 3.5 weeks and 35.4 +/- 3.2 weeks for group 2. The NIPS in group 1 was 2.51 +/- 1.42 and 2.81 +/- 2.11 (NS) in group 2. On only one occasion was severe pain noticed (group 2). There was a tendency towards a higher NIPS with a higher gestational age (r=0.19) and a lower number of previous capillary (r= -0.06) and venous (r= -0.11) extractions. Group 1 parents thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team. CONCLUSION: By adding skin to skin care to the sucrose during the endocrine metabolic test does not relieve the pain feeling. Parents in the skin to skin group thought that this practice contributed to decreasing their children's irritability and increased their trust in the care team.