Prevención de la infección de localización quirúrgica, según un bundle modificado / Prevention of surgical site infection using a modified bundle

Para controlar la infección de localización quirúrgica (IL) se han descrito, además de otras medidas habituales (esterilización de instrumental, atuendo quirúrgico, limpieza de superficies, filtros HEPA, correcta técnica quirúrgica, etc.), unas medidas sencillas, basadas en evidencia tipo i, que además actúan sinérgicamente (bundle): corte del vello con maquinilla en lugar de rasurado, profilaxis antibiótica, control de la glucemia y la temperatura del enfermo intraquirófano. A estas medidas del bundle habría que añadir otra: antisepsia del campo quirúrgico, en el enfermo, y de las manos-antebrazos, en el equipo quirúrgico. En los últimos años se están introduciendo soluciones alcohólicas en lugar de clorhexidina o povidona iodada para la antisepsia del equipo quirúrgico, con muy buenos resultados, y recientemente (enero, 2010) se ha demostrado con un ensayo clínico multicéntrico que la clorhexidina al 2% en alcohol puede reducir a la mitad la ILQ, respecto de la utilización de povidona yodada. Por todo ello, creo que debemos implementar estos cambios de conducta para lograr reducir, sin apenas coste, la ILQ (AU)

Besides the usual measures to control surgical site infection (SSI) (instrument sterilisation, surgical wear, clean surfaces, HEPA filters, and correct surgical technique, etc), there are some simple measures, based on type I evidence which also work synergically (bundle): hair cutting with a machine instead of a razor, antibiotic prophylaxis, blood glucose monitoring and patient temperature during surgery. To this bundle of measures should be added another: antisepsis of the surgical field, on the patient and on hands and forearms, and surgical equipment. In the last few years alcohol solutions have been introduced in place of chlorhexidine and povidone iodide for antisepsis of surgical equipment, with very good results, and in a recent multicentre clinical trial (January, 2010) it was shown that 2% chlorhexidine in alcohol could reduce SSI by half compared to the use of povidone iodide. For these reasons, I believe that we should introduce these behavioural changes to reduce SSI, with a minimum of cost (AU)

[Impact of the implementation of parenteral nutrition program by the clinical nutrition unit in surgical patients]. / Impacto de la introducción de un programa de nutrición parenteral por la unidad de nutrición clínica en pacientes quirúrgicos.

INTRODUCTION: The creation of a Nutrition Unit (NU), with a specialized professional establishing homogenous criteria and standardized proceedings for the use of parenteral nutrition (PN) may improve the clinical course of the patients and decrease the number of technique-related complications. OBJECTIVES: To describe the clinical characteristics of the patients submitted to PN at our Center. To assess the effect that the implementation of a NU has on the patients clinical course, and to know the frequency of mortality and hospital stay duration after the implementation of the NU at the University Hospital Complex of Albacete. MATERIAL AND METHODS: We reviewed the clinical charts of the patients receiving PN during the two years before and the two years after the creation of the NU by means of a two-period cohort study. RESULTS: Of the 390 patients, 100 belonged to the cohort before the NU and 290 to the following cohort. 61.3% of the patients were admitted at the surgery department. 25% of the patients had a personal history of digestive pathology. Among the reasons for ordering PN to the NU, surgical complications were the most common (66.7%). Oncologic abdominal surgery was the most common category (39.3%) out of the six in which the patients have been categorized. The mortality rate for the first cohort was 29% and for the second cohort 12.8% (p < 0,00). The average of stay days for the first cohort was 29.53 days and 27.67 days for the second one (p = 0.41). CONCLUSIONS: The implementation of a NU has a positive impact on the clinical course of hospitalized patients submitted to PN.

Impacto de la introducción de un programa de nutrición parenteral por la unidad de nutrición clínica en pacientes quirúrgicos / Impact of the implementation of a parenteral nutrition program by the clinical nutrition unit in a surgical patients

Introducción: La creación de una Unidad de Nutrición (UN), con un especialista en la materia que establezca criterios homogéneos y procedimientos estandarizados de uso de la nutrición parenteral (NP) puede mejorar el curso clínico de los pacientes y disminuir las complicaciones relacionadas con la técnica. Objetivos: Describir las características clínicas de los pacientes sometidos a NP en nuestro centro. Evaluar el efecto que la introducción de una UN tiene en el curso clínico de los pacientes y conocer la frecuencia de mortalidad y duración la estancia tras la introducción de una UN en el Complejo Hospitalario Universitario de Albacete. Material y métodos: Se estudiaron las historias clínicas de los pacientes que recibieron NP durante los dos años previos y los dos años posteriores a la creación de la UN mediante un estudio de cohortes con doble temporalidad. Resultados: De 390 pacientes, 100 pertenecen a la cohorte previa a la UN y 290 a la posterior. Un 61,3% de los pacientes estaban ingresados en cirugía. Un 25% de los pacientes presentaba antecedentes de patología digestiva. Respecto a los motivos por los que se solicitó la NP a la UN, las complicaciones quirúrgicas fueron los más frecuentes (66,7%). La cirugía abdominal tumoral fue la categoría más frecuente (39,3%) de las seis en las que se han clasificado a los pacientes. La mortalidad en la primera cohorte fue 29% y en la segunda 12.8% (p < 0,00). 29,53 días fue la media de los días de estancia en la primera cohorte y 27,67 días en la segunda (p = 0,41). Conclusiones: La introducción de una UN tiene un impacto positivo en la evolución de los pacientes hospitalizados sometidos a NP (AU)

Introduction: The creation of a Nutrition Unit (NU), with a specialized professional establishing homogenous criteria and standardized proceedings for the use of parenteral nutrition (PN) may improve the clinical course of the patients and decrease the number of technique-related complications. Objectives: To describe the clinical characteristics of the patients submitted to PN at our Center. To assess the effect that the implementation of a NU has on the patients clinical course, and to know the frequency of mortality and hospital stay duration after the implementation of the NU at the University Hospital Complex of Albacete. Material and methods: We reviewed the clinical charts of the patients receiving PN during the two years before and the two years after the creation of the NU by means of a two-period cohort study. Results: Of the 390 patients, 100 belonged to the cohort before the NU and 290 to the following cohort. 61.3% of the patients were admitted at the surgery department. 25% of the patients had a personal history of digestive pathology. Among the reasons for ordering PN to the NU, surgical complications were the most common (66.7%). Oncologic abdominal surgery was the most common category (39.3%) out of the six in which the patients have been categorized. The mortality rate for the first cohort was 29% and for the second cohort 12.8% (p < 0,00). The average of stay days for the first cohort was 29.53 days and 27.67 days for the second one (p = 0.41). Conclusions: The implementation of a NU has a positive impact on the clinical course of hospitalized patients submitted to PN (AU)

Comparison of the microbicidal efficacy on germ carriers of several tertiary amine compounds with ortho-phthalaldehyde and Perasafe.

Several tertiary amine formulations have been marketed as high-level disinfectants (HLDs). This study compared some of these formulations with two accepted HLDs [ortho-phthalaldehyde (OPA) and Perasafe] by determining the bactericidal effect on 52 micro-organisms using a metallic germ carrier, determining the sporicidal effect using a commercial germ carrier (3M spores), and performing a corrosion test on surgical blades with human blood. OPA and Perasafe were significantly more effective than all the tertiary amines tested, and acted within a contact time of 10 min compared with 20 min for the other products. For Gram-negative micro-organisms, Instrunet FA showed no significant differences at 20 min compared with OPA and Perasafe at 10 min. The amines tested did not differ significantly in global bactericidal efficacy. Unlike the tertiary amines, OPA and Perasafe were effective against mycobacteria (15-min contact period), but were not sporicidal. All agents (except one tertiary amine) passed the corrosion test. In conclusion, OPA and Perasafe can be considered as HLDs. However, 15-20 min of contact is required and both products have disadvantages.

The influence of laboratory adaptation on test strains, such as Pseudomonas aeruginosa, in the evaluation of the antimicrobial efficacy of ortho-phthalaldehyde.

The microbiocidal efficacy of 0.55% ortho-pthalaldehyde (OPA) was evaluated in a rough carrier test, using more than 200 strains of bacteria and yeasts from patients and reference ATCC strains. This test was then compared with the European carrier test (prEN14561) using Pseudomonas aeruginosa. We also sought to determine whether recently isolated P. aeruginosa had the same susceptibility to OPA, after laboratory adaptation. It was shown that P. aeruginosa was less susceptible to OPA (being reduced by a factor of 10(3.8)) than the other strains (reduced by a factor of 10(4)). The surface test used, produced a lesser reduction of P. aeruginosa than the European test. For recently isolated strains (N = 66), the rough model demonstrated that the number of survivors increased both quantitatively and qualitatively from day one to day seven. It was concluded that disinfectant efficacy should be confirmed with recently isolated organisms.

Comparison of the disinfectant efficacy of Perasafe and 2% glutaraldehyde in in vitro tests.

Two percent glutaraldehyde has been the reference disinfectant for high-level disinfection, but its frequent association with adverse effects has stimulated a search for newer disinfectants. We compared the efficacy of 2% glutaraldehyde with that of a new disinfectant formulation, Perasafe (0.2% peracetic acid) in six in vitro tests: germicidal effect in a suspension of micro-organisms; using a microbe-contaminated metallic endodoncy file; an endoscope model; a modified capacity test; a sporicidal test, and corrosiveness on metallic instruments. Both products were effective germicides in 10-20 min, completely destroying microbial inocula except for Mycobacterium and spores. Internal irrigation of endoscopes with 100 mL of either was totally effective. Both substances resisted inactivation after repeated inoculation and did not corrode clean instruments; however, when organic matter was added the 0.2% peracetic acid formulation cleaned without corrosion, while 2% glutaraldehyde fixed the matter to the scalpel, causing corrosion within 2 h. In summary, Perasafe is a good substitute for 2% glutaraldehyde for high-level disinfection.

A new alcohol solution (N-duopropenide) for hygienic (or routine) hand disinfection is more useful than classic handwashing: in vitro and in vivo studies in burn and other intensive care units.

INTRODUCTION: Standard handwashing is a key measure for the prevention of crossed nosocomial infection, but this measure is not always observed. We study whether fast disinfection with an alcohol solution is better than handwashing and whether it can enhance observance. MATERIALS AND METHODS: The effects of several alcohol solutions on native and acquired microbiota are compared with classic handwashing in 'in vitro' and 'in vivo' (health volunteers) quantitative tests. A field assay was subsequently performed in severely ill patient intensive care units (ICUs) (Burn and other ICUs), using a semiquantitative method to compare the effects of disinfection with standard handwashing (n=102) with N-duopropenide alcohol application (n=264). RESULTS AND DISCUSSION: In both designs--health volunteers and hospital ward teams--we found significant differences between handwashing and N-duopropenide application. Handwashing barely modified the native or acquired microbiota (only 0.1 to <2 log10 reduction) and did not eliminate Staphylococcus aureus and Gram-negative bacteria (from 34 to 23%: P>0.05). However, N-duopropenide reduced the acquired microbiota by 5 log (10) and the native hand microbiota by more than 2 log10, as well as significantly reducing S. aureus and Gram-negative bacteria (33-1.3%; P<0.01).

Consumption of alcoholic beverages and subjective health in Spain.

STUDY OBJECTIVE: To examine the relation between alcohol and main alcoholic beverage consumption and subjective health in Spain. DESIGN: Logistic regression analysis using a cross sectional survey based on self reported data on alcohol and alcoholic beverage consumption, subjective health and the principal confounding factors (age, sex, civil status, educational level, job status, social support, region of residence, size of town or city, tobacco consumption, physical activity during leisure time and work hours, and chronic disease). SETTING: The 1993 Spanish National Health Survey. PARTICIPANTS: A 19 573 person sample, representative of the non-institutionalised Spanish population aged 16 years and over. MAIN RESULTS: Among Spaniards, 31.4% reported their health as suboptimal (fair, poor or very poor) and 56.9% consumed alcohol regularly, with the majority having a preference for wine. Light (1-2 drinks per day) or moderate consumption (3-4 drinks per day) was the most frequent pattern. After adjusting for confounding factors, a negative dose-response relation was observed between consumption of total alcohol, wine and beer, and prevalence of suboptimal health (linear trend: p<0.001 for total alcohol, p=0.023 for wine, and p=0.030 for beer). In contrast, for consumption of spirits the prevalence of ill health in moderate drinkers was lower than in non-drinkers, with no clear relation at higher consumption. While persons reporting a preference for wine had a lower frequency of suboptimal health than did abstainers, they showed no difference in frequency of subjective ill health with respect to persons with preference for other types of drink or no preference whatsoever. CONCLUSIONS: The higher the consumption of total alcohol, wine and beer, the lower the prevalence of suboptimal health. These results differ from those obtained in several Nordic countries, where a "J shaped" relation has been observed for total alcohol and wine, and suggest that the relation between alcohol consumption and subjective health may be different in Mediterranean countries.

Clinical assay of N-duopropenide alcohol solution on hand application in newborn and pediatric intensive care units: control of an outbreak of multiresistant Klebsiella pneumoniae in a newborn intensive care unit with this measure.

Outbreaks of gram-negative colonization (generally by antibiotic-resistant enterobacteria) are common in newborn intensive care units (NICUs), and control methods are not always effective. We studied the effectiveness of an alcohol solution of N-duopropenide (NDP) in vivo (germicidal effect on flora of teams in the NICU and the pediatric intensive care unit vs handwashing with nonantiseptic soap) and its effect on the control of a multiresistant (MR) Klebsiella pneumoniae outbreak in our NICU that had persisted for 13 months, despite the use of classic control measures. For educational purposes, we also performed 4 prevalence studies of microbial hand flora in NICU staff (two before and two after introducing NDP). The alcohol solution of NDP was highly germicidal in vivo, destroying microorganisms better than classic handwashing on the hands of 69 health care staff of our NICU and PICU. The flora in both units was reduced from an average of 63% to an average of 95%. Application of this disinfectant to the hands of health care workers after handling newborns helped to eliminate the MR Klebsiella strain in our NICU, (relative risk compared with the period preceding use of the disinfectant: 8.6, with 95% confidence intervals, 4.8-145.5). Four prevalence studies of hand microbial contamination, before and after NDP introduction in the NICU, showed a significant reduction of enterobacteriaceae, mainly MR K pneumoniae, in health care workers. In conclusion, NDP in alcohol was very effective in vivo. It proved to be a useful complementary measure to handwashing and reduced exogenous microorganism transmission in a unit with a heavy patient-care workload.

Urinary infection after orthopedic procedures.

We have investigated prospectively the incidence of urinary tract infection (UTI) in 5320 orthopaedic patients. There were 74 UTIs (1.39%). Enterobacteriaceae was the most frequent etiological agent. Each infection increased the length of stay in hospital by more than 8 days. Statistically independent risk factors for the development of urinary infection were a preoperative stay of more than 4 days, inadequate preoperative preventive measures, central venous catheterization and urinary catheterization. Sex, age, or type of surgery had no statistical influence on the development of infection.

Usefulness of an alcohol solution of N-duopropenide for the surgical antisepsis of the hands compared with handwashing with iodine-povidone and chlorhexidine: clinical essay.

BACKGROUND: The usual surgical antisepsis involves scrubbing the skin with antiseptic solutions. This procedure can damage the skin, with the subsequent risk of infection for the patient. There are several efficient and quick-acting antiseptic alcohol solutions that require no scrubbing. MATERIAL AND METHODS: We compare four alcohol solutions with the classic surgical handwashing products (chlorhexidine and iodine-povidone), in both in vitro (pigskin germ carriers) and in vivo studies. The latter (clinical essays) were done with healthy volunteers (crossed design) as well as with 154 surgical team members (Plastic Surgery or Traumatology), whose hand microbial flora were measured before and after scrubbing up and after surgery. RESULTS AND DISCUSSION: Because of its efficiency in the germ carrier, we chose a solution of N-duopropenide in 60 degrees alcohol with emollients for further comparison with the standard surgical scrub: 4% chlorhexidine and 7.5% iodine-povidone. The quantitative, semiquantitative, and qualitative results obtained with N-duopropenide without scrubbing were better in the healthy volunteers and surgical teams. This product reduced hand microorganisms by more than 2 log, and maintained the reduction for the entire study period. Four percent chlorhexidine initially reduced colonization more than 2 log but lost part of its effect over time during the surgical intervention. Last, 7.5% iodine-povidone reduced the germs by 1 log but at the end of surgery there were even more germs than before washing. CONCLUSION: Because of its efficacy, persistent effect, and skin protection, we advise that scrubbing with classic antiseptic solutions be replaced with gentle washing with an alcohol solution such as N-duopropenide in alcohol.

Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury.

PURPOSE: To our knowledge risk factors for urinary tract infection associated with various drainage methods in patients with spinal cord injury have never been evaluated overall in the acute period. We identified the incidence and risk factors associated with urinary tract infection in spinal cord injured patients. MATERIALS AND METHODS: We prospectively followed 128 patients at our spinal cord injury reference hospital for 38 months and obtained certain data, including demographic characteristics, associated factors, methods of urinary drainage, bladder type, urological complications and predisposing factors of each infection episode. Logistic regression modeling was done to analyze variables and identify risk factors that predicted urinary tract infection. RESULTS: Of 128 patients 100 (78%) were male with a mean age plus or minus standard deviation of 32 +/- 14.52 years. All patients had a nonfatal condition by McCabe and Jackson guidelines, and 47% presented with associated factors. The incidence of urinary tract infection was expressed as number episodes per 100 patients daily or person-days. The overall incidence of urinary tract infection was 0.68, while for male indwelling, clean intermittent, condom and female suprapubic catheterization, and normal voiding the rate was 2.72, 0.41, 0.36, 0. 34 and 0.06, respectively. The risk factors associated with urinary tract infection were invasive procedures without antibiotic prophylaxis, cervical injury and chronic catheterization (odds ratio 2.62, 3 and 4, respectively). Risk factors associated with repeat infection were a functional independence measure score of less than 74 and vesicoureteral reflux (odds ratio 10 and 23, respectively). CONCLUSIONS: Spinal cord injured patients with complete dependence and vesicoureteral reflux are at highest risk for urinary tract infection.

[Spanish disinfectants for the 21st century]. / Desinfectantes Españoles para el siglo XXI.

There are two chemical disinfectants patents from Spain that permit to obtain advantageous products on other disinfectants: Nduopropenide (two iodures of quaternary ammonium) and "Peroxidine" (hydrogen peroxide that active to lactic acid and a surfactant mixture). The first product is used as an antiseptic or disinfectant, but the second, only act as disinfectant. DISINFECTION: It is studied (by germ-carrier methods), the microbicide effect on different microorganisms (Gram positive cocci, Gram negative bacilli, fungus, Mycobacteria and B subtilis spores), comparing these two products with different disinfectants as 2% glutaraldehyde, 1/8 phenate-glutaraldehyde, peracetic acid compounds, 11% oxygen peroxide and 2% sodium hypoclorite. It is obtained that 1/4 Peroxidine in 5 minutes or 1/6 Peroxidine in 10 minutes, are the most effective disinfectant on all microorganisms used (includes the most resistant) since it produces destruction of 4 log-10 of spores and 5 log-10 of Mycobacteria. Moreover, it can destroy, completely, the inoculum of commercial spores, routinely used for sterilization process evaluation, in 20 minutes, when 2% glutaraldehyd needs 3-10 hours. ANTISEPSIE: It is studied the "hygienization" and surgical handwashing with Nduopropenide solution, in comparison with classical washing methods (neutral soap in routinely handwashing and 5% chlorhexidine or 10% iodine-povidone in surgical washing): 1) Nduopropenide and alcohol solution is more effective that routinely handwashing. 2) This product is more effective and persistent, after surgical washing that chlorhexidine or iodine-povidone. Moreover, it does not must be applied with brush. 3) The mixture Nduopropenide and chlorhexidine makes a synergy, then it can be used in hand or skin washing, on heath personnel or patient people, being advantageous on the other products.

Antimicrobial effectiveness of 2% glutaraldehyde versus other disinfectants for hospital equipment, in an in vitro test based on germ-carriers with a high microbial contamination.

2% glutaraldehyde is the reference disinfectant for hospital instruments. However, its high environmental toxicity makes desirable to search for alternatives. We compare the antimicrobial activity of 2% glutaraldehyde with 0.44% N-duopropenide (NDP), 0.66% NDP in 48 degrees alcoholic solution (NDP-alc), 0.13% glutaraldehyde-phenate, 1% or 3% persulphate (Virkon) and 0.1% or 0.5% chlorhexidine, using a model that mimics non-regular surface instruments contaminated with microbial strains (44 bacteria, 6 of which were Mycobacterium). The contaminated carrier is soaked in the disinfectant solution. After 5 or 20 minutes contact the disinfectant is neutralized. The overall results on all microorganisms in 20 minutes, show similar antibacterial activity for 2% glutaraldehyde and 0.66% NDP-alc, followed by 0.44% NDP and after by the two concentrations of Virkon and 0.5% chlorhexidine. The 0.13% glutaraldehyde-phenate and 0.1% chlorhexidine exhibited significantly less effect than any other disinfectant. 0.66% NDP-alc was faster antimicrobial activity than 2% glutaraldehyde, destroying totally the inoculum in 5 minutes. Activity on Mycobacterium showed great differences between 2% glutaraldehyde and the rest of products (> 5 log versus < 3 log reduction in 20 minutes), with an exception: NDP-alc, with similar and faster activity (> 5 log in 5 minutes) than 2% glutaraldehyde. With human blood, the survival microorganisms increase 0.3 log (average) in all the disinfectants used. The aggressiveness on metallic devices was greater in Virkon than in the other disinfectants. We conclude that NDP (alone or in alcoholic solution) may be a good alternative to glutaraldehyde in hospital instruments disinfection.

[Septicemia associated with central venous catheterization in a children's hospital. A multivariate study]. / Septicemias asociadas a la cateterización venosa central en un hospital infantil. Estudio multivariante.

BACKGROUND: The blood stream infections (BSI) are the principal nosocomial infection in the child hospitals. In this study we estimate the incidence of BSI associated with central venous catheterization, and estimate different risk and protective factors, through a multivariate study. MATERIAL AND METHODS: The study have followed in a prospective way during 6 months all the children with central venous catheterization (489 catheters), from the moment of insertion until withdrawal, collecting various data previous to the development of the infection: place of insert, type of catheter, duration, clinic information, microbiology, and the treatments administered through the catheter. In was accomplished an multivariate analysis with logistic regression, for two principal effect variables, the catheter colonization and the catheter related BSI. RESULTS: The incidence of catheter related BSI was 5.5% and for local infection 11.2%. The density of incidence was 3.15 and 6.42 for each 1,000 catheters-day, respectively. The logistic regression model included: colonization of the skin in the insertion point > 15 colonies, days with antibiotics through catheter, use of lipidic parenteral solutions and fever, previous to the infection. The area under the ROC curve was 0.72. CONCLUSIONS: In children with septicemias associated with central catheterization the predictors or sentry criterion for the decision on when to withdraw a catheter are colonization (> 15 colonies) of the insert point, together with the use of lipidic parenteral solutions or extended antibiotic treatment.

Risk infection factors in the total hip replacement.

UNLABELLED: Infection is a complication that occurs in a considerable percentage of hip prostheses replacements, being in many cases necessary to retire them, which generates important health and economical problems. OBJECTIVES: To know the distribution of infection and its risk factors in total hip replacement. MATERIAL AND METHODS: A four year prospective study was developed in the rehabilitation and orthopedic center of 'La Paz' Hospital. A total of 873 patients were included. Patients were controlled by means of active epidemiological surveillance until the day of discharge, listing up their characteristics at admission and risk factors during their stay. A multivariant study was carried out to determine risk factors. RESULTS: Patients' average age was 63 years, 3.4% of them suffered from diabetes and there were no inmunocompromised patients. The percentage of wound infection during the four years was 6%, being reduced to 1.2% in the last year. The risk factors found in the multivariant study were: incorrect prophylaxis (OR: 3.85), wrong scaring (OR: 14.06), suffering more than one intervention (OR: 7.31) and a hospitalization period longer than 30 days (OR: 2.84). CONCLUSION: We think that special attention in the care of the surgical wound, as well as the correct use of prophylaxis, can significantly collaborate to the reduction of infection.

[Nosocomial infection at an intensive care unit: multivariate analysis of risk factors]. / Infección nosocomial en una unidad de cuidados intensivos: análisis multivariante de los factores de riesgo.

BACKGROUND: Nosocomial infections, especially in the intensive care unit, are a very important problem due to their frequency and important consequences (morbility and mortality). On the other hand there are some risk factors and some preventive measures which are involved in the appearance of the nosocomial infections. The purpose of this work was to recognize these risk factors and to identify the preventive measures which are effective, and also to quantify the participation of each risk factors/preventive measures in the development of the nosocomial infections. PATIENTS AND METHODS: Follow-up of a cohort of patients admitted to the intensive care unit of the General Hospital of La Paz (Madrid, Spain) during a year and with a stay of at least 48 hours. RESULTS: We have found a cummulative incidence of patients with nosocomial infection of 32.8%. More than 80% of the patients received antibiotic treatment during their stay in the intensive care unit. The stay of the patients no infected was 4 days while the stay of infected patients was 20 days. We have found a mortality of 29.5%, which was greater in the patients who were infected (42%). In the multivariate analysis we have developed an equation to predict the development of the nosocomial infection. The following variables were identified: six or more instrumentations (OR, 4.75; 95% CI, 2.75-8.19), more of ten days of hospitalization previous to the appearance of the first nosocomial infection (OR, 4.17; 95% CI, 2.60-6.70), administration of muscle relaxing drugs (OR, 2.25; 95% CI, 1.43-3.55), nasogastric tube (OR, 2.19; 95% CI, 1.25-3.84), and altered consciousness (OR, 2.19; 95% CI, 1.25-3.84). Therefore, those patients who present some of these characteristics should be monitored in a special way due to their high risk of development of a nosocomial infection. CONCLUSIONS: Several factors play an important role in the development of a nosocomial infection in the intensive care unit; these are not only intrinsec (especially the altered consciousness) but also extrinsec (instrumentations and drugs), as well as the stay at the hospital previous to the appearance of the first nosocomial infection.

[Nosocomial infection over three years in a neonatal intensive care unit. Multivariate study]. / Infección nosocomial durante tres años en una unidad de vigilancia intensiva neonatal. Estudio multivariante.

BACKGROUND: The Neonate Intensive Care Units (NICU) present high frequencies of hospital infections (HI) as well as patients with high intrinsic and extrinsic infection risks. PATIENTS AND METHODS: A prospective study of 3 years in a NICU was carried out. Six-hundred and five neonates with stays longer than 48 hours were included. A descriptive study and a predictive equation, by non-conditional logistic regression, were performed, including the principal HI risk factors. RESULTS: The HI incidence was 25.8/1,000 patients-day, and it was most frequent in children with weight lower than 2,500 g. The main etiologic agents were Streptococcus epidermis and Pseudomonas aeruginosa. The risk factors for HI in NICU were assisted respiration (odds ratio [OR] = 5.1; 95% CI, 2.3-11.5), low weight at birth (OR = 3.2; 95% CI, 1-1.08), transfusion (OR = 3.8; 95% CI, 1.4-10.1) and central venous catheter. Validation by ROC curve was satisfactory. CONCLUSIONS: The incidence of HI in NICU is high, and depends on both disease features and instrumentation in NICU.

Economical saving due to prophylaxis in the prevention of surgical wound infection.

The objective was to know the principal risk factors that influence in the development of surgical would infection, and the economical saving achieved with the control of a single variable, that is, right prophylaxis. A prospective study was carried out at the Traumatology Department of La Paz Hospital. A total of 5260 patients operated during 1990-1993 are included. Active epidemiological surveillance was used to check patients; logistic regression was used in the multivariant analysis. The principal risk factors found were: immunodeficiency (OR = 8.67), incorrect healing (OR = 14.42), reoperated patient (patients who needed more than one surgical procedure while they are admitted; reoperations) (OR = 3.57), type of surgery (OR = 4.71) and wrong prophylaxis (OR = 6.36). Making constant all the variables except for prophylaxis, we calculated the percentage of infections prevented by a right prophylaxis, and the cost was calculated starting from the number of extra days of infection. The number of infections prevented during the four years was 310, saving a total of 194 million pesetas (1.5 million dollars), due to right prophylaxis. Cost-benefice ratio = 1/17. We consider of special importance to control this manipulable risk factor, in order to avoid the development of infections.