Effectivity of a Program for the Control and Prevention of COVID-19 Healthcare-Associated Infections in a Spanish Academic Hospital.

BACKGROUND: Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited. OBJECTIVE: The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain. METHODS: We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods. RESULTS: Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009). CONCLUSIONS: A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.

Influencia del sexo del paciente en el manejo del síndrome coronario agudo con elevación del STen los servicios de urgencias / Sex-related differences in emergency department management of acute coronary syndrome

Objetivos: Existen datos en la literatura que demuestran que existen diferencias en cuanto a la mortalidad en el síndrome coronario agudo con elevación del segmento ST(IAMEST) entre los distintos sexos, y ésta es más elevada en las mujeres. Nuestra intenciónes analizar las características específicas y la atención urgente recibida tanto extra como intrahospitalaria en función de sexo. Pacientes y métodos: Estudio longitudinal, observacional donde se incluyeron de forma consecutiva todos los pacientes asistidos en el servicio de urgencias (SU) de un hospital general por IAMEST desde marzo 2001 hasta junio 2007. El estudio es un subanálisisdel registro multicéntrico RESIM. Se analizaron datos demográficos, variables clínicas, horarios y tratamiento administrado a nivel extra e intrahospitalario. Resultados: De los 214 casos recogidos, un 74,8% (160 pacientes) eran hombres. La edad media fue de 64,4 ± 12,6 años. Las mujeres atendidas eran más mayores (71,7años DE ± 10,6) que los hombres (62 años DE ± 12,3). La diabetes mellitus fue más frecuente en las mujeres y la hipertensión arterial y el tabaquismo en los hombres. Hubodiferencias entre los siguientes tiempos: inicio de los síntomas y llegada al hospital(240,3 min en hombres vs 503,3 min en mujeres; p < 0,05), inicio de los síntomas y realización de un electrocardiiograma (ECG) (240,6 min en hombres vs 516,4 min en mujeres; p < 0,01) y llegada al hospital y realización de un ECG (6,4 min en hombres 13 min en mujeres; p < 0,01). No encontramos diferencias en el medio de transporte utilizado ni en el tratamiento administrado tanto a nivel extra como intrahospitalario. Conclusiones: Existen retrasos en la atención de mujeres que acuden al SU con IAMEST. Su consideración puede mejorar la atención prestada a estos pacientes (AU)

Background and objective: Higher mortality rates for women with acute coronary syndrome with ST elevation havebeen reported. Our aim was to analyze patient characteristics and care provided by our emergency department both before and after arrival at the hospital in order to detect sex-related differences in approach to care.Patients and methods: Longitudinal, observational study of consecutive patients with acute coronary syndrome with STelevation attended by a general hospital emergency department between March 2001 and June 2007. The study fell within the scope of work carried out by the Spanish Register of Myocardial Infarction Emergencies (RESIM). Patient characteristics, clinical variables, timing, and treatment administered before and after arrival at the hospital were analyzed. Results: Of the 214 cases registered, 160 (74.8%) were men. The mean (SD) age was 64.4 (12.6) years. The women were older (71.7 [10.6] years) than the men (62 [12.3] years). Diabetes mellitus was more common in women and hypertension and smoking more common in men. Care differed with regard to time elapsed between onset of symptoms to arrival at the hospital (men, 240.3 minutes; women, 503.3 minutes; P<.05), time elapsed between on set of symptoms and an electrocardiogram (ECG) (men, 240.6 minutes; women, 516.4 minutes; P<.01), and time elapsed between arrival at the hospital and an ECG (men, 6.4 minutes; women, 13 minutes; P<.01). There were no differences in type of transport used or in treatment given before or after arrival at the hospital.Conclusions: Care for women with acute coronary syndrome with ST elevation is subject to longer delays. Awareness ofthis may improve emergency care given to women (AU)

Epidemiología de las lesiones deportivas atendidas en urgencias / Emergency treatment of sports injuries: an epidemiologic study

Objetivos: Analizar la epidemiología asistencial en la patología de causa deportiva y su impacto en el servicio de urgencias hospitalario (SUH).Método: Estudio observacional, descriptivo y prospectivo, de 2.000 lesiones deportivas consecutivas atendidas en un SUH durante un periodo de 4 años. Las variables seleccionadas fueron: edad, género, actividad deportiva, tipo de lesión, localización de la lesión, tratamiento y destino tras la atención urgente. Resultados: La mayoría de asistencias por lesiones deportivas se producen en varones(85%), con una edad media de 26 ± 10 años. El deporte que más lesiones aporta es el fútbol (49,5%), seguido del ciclismo (9,5%) y del baloncesto (8,7%). La mayoría de las lesiones se localizan en el miembro inferior (56%), principalmente contusiones (33,8%)y lesiones ligamentosas (30,1%). La mayoría de los pacientes precisó tratamiento ortopédico(79,2%), el 92% de las atenciones fueron resueltas por el propio SUH. Cuando precisaron ingreso, éste se produjo principalmente en traumatología (64%).Conclusiones: El paciente que consulta por lesión deportiva en nuestra área es un varón joven que sufre una contusión en el miembro inferior, recibe tratamiento ortopédico y es resuelto por el SUH sin intervención de otras especialidades. La elevada incidencia de lesiones deportivas, que conllevan tratamiento ortopédico, en personas jóvenes debe ser tenida en cuenta en relación con su repercusión socio-laboral (AU)

Objectives: To analyze epidemiologic patterns related to the treatment of sports-related injuries and the impact these injuries have on a hospital emergency department’s caseload. Methods: We carried out a prospective observational study to describe 2000 sports injuries treated consecutively over a period of 4 years. The variables studied were age, gender, sport, type of injury, location of injury, treatment provided in the hospital emergency department, and destination at discharge from the department. Results: Most sports lesions were in males (85%). The mean (SD) age of all sports-injured patients was 25.99 (10) years. Football (soccer) caused the largest proportion of injuries (49.5%) and was followed by cycling (9.5%) and basketball (8.7%).Most injuries involved a lower limb (56%). Bruises accounted for 33.8% of the caseload and ligament injuries for 30.1%.Orthopedic treatment was applied in 79.2% of the cases. Ninety-two percent of the injuries were treated inside the emergency department. When patients required hospitalization, the admitting department was usually traumatology (64%).Conclusions: The patient who seeks treatment for a sports injury in our practice area is usually male and around 25 years of age. The injury, usually bruising of a lower limb, is generally resolved by emergency department staff without assistance from other departments. The elevated incidence of sports injuries, require orthopedic treatment in young persons should be taken into consideration given the social and employment-related repercussions (AU)