Nosocomial infection surveillance and control: current situation in Spanish hospitals.

We studied healthcare-associated infection (HCAI) surveillance and control programmes in Spanish hospitals in 2006 and the human resources and materials used. A questionnaire on the structure, organisation and resources for HCAI surveillance and control was sent to all hospitals registered in the 2005 National Catalogue of Hospitals. A total of 237 hospitals (29.8%) responded, representing 55.9% of the beds included in the catalogue. Some 92% of hospitals had a surveillance and control programme, although 29.9% had had it for less than five years. Only 17.4% of hospitals had one infection control nurse per 250 beds, and only 36.2% had one infection control doctor per 500 beds. Surveillance is the main activity of those responsible for surveillance and control, and the most widely used systems are reviews of microbiology laboratory test results and studies of outbreaks, prevalence surveys, the incidence of certain procedures and of infection in critical care areas. Collaboration in multicentre studies is variable. EPINE, the prevalence survey of nosocomial infections in Spain, is performed annually in 80.5% of centres; ENVIN-UCI, a study of the incidence of infection in critically ill patients, is carried out in 24.8%, and the European study of the incidence of surgical infection, HELICS, in 22.7%. Priority should be given to improving specialised human resources and establishing common surveillance and control systems.

[Outpatient ENT hospital emergencies: a descriptive study of one year of services]. / Urgencias externas O.R.L. a nivel hospitalario: estudio descriptivo de un año de asistencia.

A descriptive and retrospective scrutiny dealing with 2,638 emergency cases admitted at "Virgen de la Salud" Hospital, Toledo, during 1993. Analysis of a series of parameters as age, sex, hour, day of the week, month, kind of pathology, emergency ward in charge of the exigency and so on, and correlation of these items. Assessment of the gravity of each urgent case and motive of admission. Our results are confronted with those given by other authors.

[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.

[The effect of surgical antibiotic prophylaxis and the timing of its administration on the risk of surgical wound infection]. / Efecto de la profilaxis quirúrgica antibiótica y su tiempo de administración sobre el riesgo de infección de herida quirúrgica.

BACKGROUND: Clinical trials have demonstrated the efficacy of surgical prophylaxis (SP). Nevertheless, how the timing of antibiotic administration influences the risk of infection in clinical praxis has scarcely been studied. In this study an assessment was made of whether the non administration of antibiotic, or its administration longer than 2 hours preoperatively, or only postoperatively, are associated with a higher rate of infection of the surgical wound (SWI) compared with antibiotic administration within the two hours prior to surgery in our setting. METHODS: Observational, longitudinal, pseudoretrospective study. It included 2,483 patients undergoing surgery in 1992, with clean-contaminated, contaminated and clean with prophylaxis indication, and without previous infection surgeries. Information on variables potentially associated with SWI and incidence of infection was monitored. A multivariate analysis was made by means of the logistic regression method to evaluate the association of prophylaxis and time of administration, controlling for the remaining variables. RESULTS: 754 patients received appropriate prophylaxis (within 2 hours prior to surgery); 28 of these patients (3.7%) developed SWI. Twenty-four of the 107 who received prophylaxis longer than 2 hours prior to surgery developed infection (22.4%; p < 0.001 compared with the first group; OD: 7.5, 95% CI: 3.94-14.1); in the group of patients non receiving preintervention doses 94 patients developed infection (7.7%; p = 0.001; OR: 2.16, 95% IC: 1.38-3.41). Among patients who did not receive prophylaxis 24 infections were detected (6%; p = 0.10; OR: 1.66, 95% CI: 0.91-2.99). In the multivariate analysis the administration of prophylaxis longer than 2 hours prior to surgery or postoperatively was confirmed to be associated with a higher SWI rate, as in the non-administration situation, controlling for the remaining variables (OR for longer than 2 hours: 5.82; for postoperative administration: 3.23, and for non-administration: 2.68). CONCLUSIONS: The administration of SP is inappropriate in a high percentage of cases. The administration of SP within the 2 hours prior to surgery reduces the risk of SWI, compared with the administration 2 hours or longer prior to intervention or only postoperatively.

[Myringotomy and transtympanic ventilation tubes in secretory otitis media. A study of 108 children]. / Miringotomía y tubos de ventilación transtimpánicos en otitis media secretora. Estudio en 108 niños.

The aim of this report is to compare the use of tympanostomy tubes (in 190 ears) versus the realization of myringotomy without any posterior placement of tubes (in 19 ears) in the treatment of 108 children with secretory otitis media. Course, sequelae and complications were analyzed over a period of 2 to 9 years. Our results suggest that the use of tympanostomy tubes must follow some specific indications, since they are not free of complications and sequelae.