Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel / Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital

Con el objetivo de incrementar la cultura de seguridad en relación con la higiene de manos en el Complejo Hospitalario Universitario Insular Materno-Infantil a través de la presencia de recordatorios y mensajes en todo el centro sobre la importancia de la higiene de manos en la prevención de infecciones, hemos desarrollado nuevo material promocional en el mencionado Complejo Hospitalario, formado por el Hospital Universitario Insular y el Hospital Materno-Infantil, ambos centros de tercer nivel con 450 camas cada uno y acreditados para la docencia MIR. Se contrataron los servicios de un caricaturista profesional, que adaptó el lenguaje a los modismos locales, usando los personajes que habitualmente aparecen en las viñetas del periódico y se siguió trabajando con otros profesionales del diseño gráfico. Se midieron los indicadores de adherencia y consumo de productos de base alcohólica, constatándose un incremento de ambos en los meses posteriores a la implantación de la estrategia. Además se hizo una revisión de infraestructuras relacionadas con la higiene de manos, con lo que comprobamos una clara mejoría en la mayoría de las áreas asistenciales. El material fue muy bien acogido por parte de los profesionales. No se realizó ninguna otra intervención distinta de las habituales, por lo que pensamos que esta estrategia está mejorando la cultura de seguridad en relación con la higiene de manos en nuestros centros (AU)

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting (AU)

[Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital]. / Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel.

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting.

Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico / Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery

Objetivo: Analizar nuestros resultados tras 10 años de adrenalectomías laparoscópicas convencionales (LC) y compararlos con los que obtiene la técnica por puerto único (LESS) recientemente introducida en nuestro medio. Material y método: Hemos revisado retrospectivamente los casos de 75 pacientes intervenidos de suprarrenalectomía por el mismo cirujano, por LC o LESS, en nuestro centro entre agosto de 2005 y junio de 2015. Se describen la edad, el sexo, el tamaño, la lateralidad, el diagnóstico preoperatorio, el tiempo quirúrgico, el sangrado intraoperatorio, la reconversión a cirugía abierta, la estancia media, las complicaciones intra y postoperatorias y el resultado anatomopatológico. Se utilizó el test de Fisher y de Chi cuadrado para comparar datos categóricos, y el test de «t» de Student para la comparación de medias con distribución normal. Se consideró significación estadística cuando p < 0,05. Resultados: La técnica de LC fue realizada en 51 pacientes y la LESS en 24. No se obtuvieron resultados estadísticamente significativos en cuanto al tiempo quirúrgico (LC: 103,9 ± 13,21 min vs LESS: 101,46 ± 13,65 min; p = 0,07), sangrado estimado (LC: 258,82 ± 136,92 cc vs LESS: 131,25 ± 36,74 cc; p = 0,46), complicaciones intraoperatorias (5 casos en LC vs ninguno en LESS; p = 0,47) ni posquirúrgicas (2 en el grupo de la LC vs una en el de LESS; p = 0,69) catalogadas según el Sistema Clavien modificado. La estancia hospitalaria fue menor en el caso del LESS (LC: 3,55 ± 0,69 días vs LESS: 2,21 ± 0,31 días; p = 0,01). Conclusiones: La suprarrenalectomía con LC es el abordaje de elección para el tratamiento quirúrgico de la enfermedad adrenal. La técnica LESS es segura y mejora los resultados cosméticos si se realiza por equipos experimentados sin aumentar la morbilidad

Objective: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. Material and method: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p < 0.05. Results: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9 ± 13.21 min vs. LESS: 101.46 ± 13.65 min; p = 0.07), estimated bleeding (LC: 258.82 ± 136.92cc vs. LESS: 131,25 ± 36,74cc; p = 0.46), intraoperative complications (5 cases in LC, none in LESS; p = 0.47), nor for postoperative complications (two in LC vs. one in LESS; p = 0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55 ± 0.69 days vs. LESS: 2.21 ± 0.31 days; p = 0.01). Conclusions: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams

Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery. / Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico.

OBJECTIVE: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. MATERIAL AND METHOD: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p<0.05. RESULTS: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9±13.21min vs. LESS: 101.46±13.65min; p=0.07), estimated bleeding (LC: 258.82±136.92cc vs. LESS: 131,25±36,74cc; p=0.46), intraoperative complications (5 cases in LC, none in LESS; p=0.47), nor for postoperative complications (two in LC vs. one in LESS; p=0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55±0.69 days vs. LESS: 2.21±0.31 days; p=0.01). CONCLUSIONS: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams.

Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical / Improvement in urinary tract infections rates in a department of internal medicine

Objetivo. Valorar el impacto de una intervención desarrollada en el servicio de Medicina Interna del Hospital Universitario Insular de Gran Canaria para prevenir las infecciones del tracto urinario asociadas a sondaje vesical (ITU-SV). Material y métodos. El proyecto se desarrolló en 3 fases de vigilancia prospectivas de 2 meses de duración cada una entre 2009 y 2011. Durante las fases 1 y 2 se siguieron los criterios diagnósticos de los Centers for Disease Control and Prevention (CDC) de 2004 para la clasificación de las infecciones y se obtuvieron los indicadores de resultado. En la fase 3 se emplearon los criterios de los CDC de 2009 y se obtuvieron tanto indicadores de resultado como de proceso. Se comparó la incidencia acumulada de ITU-SV de las 3 fases mediante el test de tendencia ji-cuadrado. Resultados. El número total de días de sondaje vesical (SV) disminuyó desde la primera a la tercera fase, así como la incidencia acumulada de ITU-SV. Sin embargo, en la segunda fase la media de días de SV aumentó, volviendo a disminuir en la tercera fase. Se realizó una intervención con envío de recordatorios a través de la historia clínica electrónica durante la tercera fase, en la que se logró disminuir las tasas de ITU-SV y reducir la duración media de SV. Conclusiones. Las tasas de ITU-SV podrían ser minimizadas mediante un enfoque multidisciplinar que incluya tanto formación a los sanitarios implicados como vigilancia, retroalimentación y uso específico de recordatorios electrónicos(AU)

Objective. To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. Material and methods. Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)–diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. Results. The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. Conclusions. A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital(AU)

[Improvement in urinary tract infections rates in a department of internal medicine]. / Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical.

OBJECTIVE: To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. MATERIAL AND METHODS: Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)-diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. RESULTS: The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. CONCLUSIONS: A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.

Vigilancia de infecciones y otros eventos adversos en pacientes en diálisis en el área sur de Gran Canaria / Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria

Introducción: Las infecciones bacterianas representan un gran desafío en las estrategias de gestión del riesgo, prevención y seguridad del paciente en hemodiálisis de las cuales las infecciones del acceso vascular (AV) representan la primera causa morbi-mortalidad en estos pacientes. Métodos: Estudio prospectivo de incidencia de eventos adversos e infecciones de 7 meses (marzo-septiembre 2008) en las unidades de Hemodiálisis del Área sanitaria Sur de Gran Canaria (Hospital y Centro periférico) utilizando la metodología del Dialysis Surveillance Network del CDC. Resultados: Se vigilaron 1545 pacientes/mes, 60,5% con fístula (FAV), 35,5% con catéter permanente (CP), 3,0% con prótesis y 1,0% con catéter temporal. La incidencia de eventos en ambos centros fue 8,7 casos por 100 pacientes-mes; la tasa de eventos infecciosos fue de 9,1 para FAV y 20,6 para CP en ámbito hospitalario, mientras las tasas de otras infecciones (respiratorias, herida, orina) fueron similares. Se realizó cultivo antes de empezar tratamiento antibiótico en el 91,0% frente a sospecha de bacteriemia y/o infección AV. El 90,0% de tratamientos se ajustaron con antibiograma. Destaca una baja incidencia de bacterias mutirresistentes mientras que las infecciones relacionadas con el AV fueron causadas en proporción similar por bacterias grampositivas y gramnegativas. Conclusiones: El acceso vascular es el principal factor de riesgo para el desarrollo de infecciones. La vigilancia epidemiológica he permitido detectar oportunidades de mejora en ámbitos asistenciales distintos, integrándose como elemento fundamental en el desarrollo de estrategias multidisciplinarias de seguridad del paciente (AU)

Background: Bacterial infections pose a great challenge to risk management activities in the area of chronic haemodialysis, as vascular access related infections are the main cause of mortality among these patients. Methods: Prospective surveillance study lasting 7 months (March-September, 2008) at the two haemodialysis units in a district health area in Gran Canaria, Spain. We have used methodology proposed by CDC´s Dialysis Surveillance Network. Results: 1545 patientsmonth were enrolled, 60,5% having an arterio-venous fistula (AVF), 35,5% permanent catheter (PC), 3,0% graft and 1,0% temporary catheters. Events incidence rate at both centers was 8,6 cases per 100 patients-month, 9,1 rate for FAV and 2,9 rates for CP, So, the greatest incidence of vascular access related infections was for permanent catheter as compared with AFV. Nevertheless the other type of infections (respiratory, urinary tract, skin and chronic ulcers) showed a similar rate. Microbiological cultures before antibiotic treatment were performed in 82,2 %, but increased up to 91,0% when a vascular related infection was suspected. Empiric treatment was adjusted to antibiogram results in 90,0% of occasions. A low incidence of multirresistant microbes was seen. Gram-positive and gram-negative bacteria appeared in a similar proportion. Conclusions: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, appearing as a key element in the risk management and patient safety areas (AU)

Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria.

BACKGROUND: Bacterial infections pose a major challenge to risk management activities in the area of chronic haemodialysis, as vascular access-related infections are the main cause of mortality among these patients. METHODS: Prospective surveillance study lasting 7 months (March-September, 2008) at two haemodialysis units in a district health area Gran Canaria, Spain. We used the methodology proposed by CDC´s Dialysis Surveillance Network. RESULTS: 1545 patients/month were recorded, 60.5% with an arteriovenous fistula (AVF), 35.5% with a permanent catheter (PC), 3.0% with grafts and 1.0% with temporary catheters. The rate of adverse events was 8.6 cases per 100 patients/month, 9.1 for AVF patients, and 2.9 for PC. Nevertheless, the other types of infections (respiratory, urinary tract, skin and chronic ulcers) showed similar rates. Microbiological cultures were taken in 82.2%, but this rate increased to 91.0% when a vascular access-related infection was suspected. Empirical treatment was adjusted to antibiogram results in 90.0% of occasions. A low incidence of multi-resistant microbes was observed. Gram-positive and gram-negative bacteria appeared in similar proportions. CONCLUSIONS: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, acting as a key element in risk management and patient safety.

Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias / Assessment of a hand hygiene program on healthcare-associated infection control

Objetivo. Evaluar el impacto de una campaña de promoción de la higiene de manos sobre las tasas de infección en un hospital de tercer nivel en Las Palmas de Gran Canaria. Métodos. Estudio descriptivo ecológico, valorando frecuencia de higiene de manos en 3 áreas asistenciales y las tasas de infecciones. Se consideraron 4 momentos temporales: basal (2005), fase 1 de intervención (2006), fase 2 de intervención (2007) y postintervención (2008). La intervención consistió en introducir productos de base alcohólica, feedback sobre resultados de cumplimiento, diseño y colocación de carteles y sesiones de educación sanitaria, con demostraciones prácticas. Se usaron criterios estandarizados para medir variables. Resultados. Se detectó un incremento en la tasa de cumplimiento a lo largo de los 3 periodos, desde el 19,6% en el periodo basal, al 40,0% final (p<0,001). El incremento del cumplimiento fue más acusado entre las oportunidades de riesgo alto (del 12,0–28,4%; p<0,001), aunque solo tras la primera fase de la campaña y entre las de riesgo medio (del 23,6–41,7%; p<0,001). No obstante, los indicadores de infección aumentaron en todas las áreas vigiladas, en especial la prevalencia de pacientes infectados, del 8% en 2005 al 12,2% en el año 2008. Conclusiones. A pesar del incremento en el cumplimiento de la higiene de manos en las áreas vigiladas, no se han conseguido reducir las tasas de infecciones nosocomiales en el hospital. Una estrategia más eficiente debería implicar a responsables clínicos y directivos en todos los aspectos del control de las infecciones(AU)

Aim. to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. Methods. Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. Results. an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19,6% at baseline to 40,0% (p<0,001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12,0% to 28,4%; p<0,001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12,2% in 2008. Conclusions. Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control(AU)