Evaluación de un programa formativo para la prevención de las infecciones relacionadas con la asistencia sanitaria / Assessment of an educational program for the prevention of healthcare-associated infections

Objetivo. Evaluar la efectividad de un programa formativo, para la prevención de las infecciones relacionadas con la asistencia sanitaria (IRAS), basado en la difusión de recomendaciones de eficacia probada en formato Bundles. Material y métodos. Estudio cuasiexperimental desarrollado en un hospital universitario entre mayo de 2011 y febrero de 2012. Se realizó una intervención formativa, donde se impartieron 21 sesiones docentes en los distintos servicios; en ellas se explicaba el contenido de un díptico, que incluía medidas de alta evidencia científica, en formato Bundles, para prevenir las diferentes IRAS; posteriormente, se distribuyó dicho díptico por todo el centro. Se evaluaron los conocimientos de los trabajadores sanitarios (TS) antes y después de cada sesión mediante un cuestionario autocumplimentado; además, se estudió la frecuencia de pacientes con IRAS en el hospital antes y después de la intervención. Resultados. El 41,5% (165/398) de los TS asistieron a las sesiones. Sus conocimientos mejoraron significativamente, principalmente en cuanto a conocer frente a qué microorganismos presentan buena/excelente actividad los preparados de base alcohólica, saber una serie de medidas para prevenir infecciones de orina asociadas a sonda vesical y conocer el lugar preferente para insertar un catéter venoso central, aspectos donde el porcentaje de respuestas correctas aumentó en 53,1, 29,7 y 28,2 puntos, respectivamente. Asimismo, hubo una disminución no significativa en la incidencia de pacientes con IRAS causadas por microorganismos multirresistentes, y un incremento no significativo en la prevalencia de pacientes con IRAS. Conclusiones. El programa formativo mejoró los conocimientos de los TS, mientras que la prevalencia de pacientes con IRAS no mostró cambios significativos en el periodo de estudio(AU)

Objective. To evaluate the effectiveness of an educational program for the prevention of healthcare-associated infections (HCAIs), based on Care Bundles. Material and methods. A quasi-experimental study conducted in a university hospital from May 2011 to February 2012. An educational intervention (21 training sessions) was carried out in all Departments with the support of the contents in a leaflet, which included evidence-based Care Bundles for prevention of different HCAIs. The leaflet was also distributed through all Hospital Departments. We assessed the knowledge of health care workers (HCWs) as regards preventive measures before and after each training session using a self-administered questionnaire, and we studied the frequency of patients with HCAIs before and after the intervention. Results. One-hundred-and-sixty-five out of 398 HCWs (41.5%) attended the training sessions. Their knowledge improved significantly, mainly in terms of: a) antimicrobial activity of alcohol-based solutions, b) preventive measures for cathether-associated urinary tract infections, and c) best place to insert a central venous catheter. These areas increased after training by 53.1, 29.7, and 28.2 points, respectively. There was a non-significant decrease in the incidence of patients with HCAIs by multiresistant microorganisms, and a non-significant increase in the prevalence of patients with HCAIs. Conclusions. The educational program improved the knowledge of the HCWs about preventive measures for HCAIs, whereas the prevalence of patients with HCAIs did not show significant changes in the period of study(AU)

[Assessment of an educational program for the prevention of healthcare-associated infections]. / Evaluación de un programa formativo para la prevención de las infecciones relacionadas con la asistencia sanitaria.

OBJECTIVE: To evaluate the effectiveness of an educational program for the prevention of healthcare-associated infections (HCAIs), based on Care Bundles. MATERIAL AND METHODS: A quasi-experimental study conducted in a university hospital from May 2011 to February 2012. An educational intervention (21 training sessions) was carried out in all Departments with the support of the contents in a leaflet, which included evidence-based Care Bundles for prevention of different HCAIs. The leaflet was also distributed through all Hospital Departments. We assessed the knowledge of health care workers (HCWs) as regards preventive measures before and after each training session using a self-administered questionnaire, and we studied the frequency of patients with HCAIs before and after the intervention. RESULTS: One-hundred-and-sixty-five out of 398 HCWs (41.5%) attended the training sessions. Their knowledge improved significantly, mainly in terms of: a) antimicrobial activity of alcohol-based solutions, b) preventive measures for cathether-associated urinary tract infections, and c) best place to insert a central venous catheter. These areas increased after training by 53.1, 29.7, and 28.2 points, respectively. There was a non-significant decrease in the incidence of patients with HCAIs by multiresistant microorganisms, and a non-significant increase in the prevalence of patients with HCAIs. CONCLUSIONS: The educational program improved the knowledge of the HCWs about preventive measures for HCAIs, whereas the prevalence of patients with HCAIs did not show significant changes in the period of study.

Mortalidad atribuible al consumo de tabaco en España en el año 2006 / Mortality attributable to smoking in Spain in 2006

Fundamento. El consumo de tabaco constituye un importanteproblema de salud pública a nivel mundial.Nuestro objetivo fue estimar la mortalidad atribuible altabaquismo y su impacto sobre la mortalidad prematuraen España en el año 2006.Material y métodos. Estudio descriptivo, transversal,realizado en población española ≥ 35 años en 2006. Elnúmero de defunciones por edad, sexo y causa se obtuvode las estadísticas vitales del Instituto Nacional deEstadística. La prevalencia de tabaquismo por edad ysexo se obtuvo de la encuesta nacional de salud. Losriesgos relativos de muerte utilizados estaban ajustadospor edad, raza, nivel estudios, estado civil, tipotrabajo, consumo frutas/verduras y otros factores deconfusión específicos de ciertas enfermedades. La proporcióny el número de muertes atribuibles al tabaco,por sexo y grupo de edad, fueron estimadas a partir dela fracción etiológica poblacional. Asimismo, se calcularonlos años potenciales de vida perdidos (APVP).Resultados. En 2006, el tabaquismo ocasionó 58.573muertes (45.028 varones; 13.545 mujeres), que constituyeronel 16,15% de todos los fallecimientos (23,94% enhombres; 7,76% en mujeres). Según la causa, las muertesatribuibles se distribuyeron en 25.500 neoplasias malignas,19.117 enfermedades cardiovasculares y 13.956enfermedades respiratorias. El cáncer de tráquea-bronquios-pulmón en hombres y otras cardiopatías en mujeresfueron las que más contribuyeron a dicha mortalidad(33,9% y 30,9% de la misma). Los APVP fueron 211.251,8(176.765,3 en hombres; 34.486,5 en mujeres).Conclusiones. El consumo de tabaco contribuye muynotoriamente a la mortalidad en España. El impacto queeste hábito tiene en nuestra sociedad representa unacarga inaceptable(AU)

Background. Tobacco consumption is a worldwide publichealth problem. Our aim was to estimate the mortalityattributable to smoking and its impact on prematuremortality in Spain in the year 2006.Methods. Descriptive, cross-sectional study, carried outon the Spanish population aged ≥ 35 years in 2006. Thenumber of deaths by age, sex and cause was obtainedfrom the vital statistics of the National Institute of Statistics.The prevalence of smoking by age and sex wasobtained from the national health survey. The relativerisks of death employed were adjusted by age, sex, educationallevel, civil status, type of work, consumption offruit/vegetables and other confounding factors specificto certain diseases. The proportion and number of deathsattributable to tobacco, by sex and age group, wereestimated on the basis of the etiological fraction of thestudy population. Similarly, potential years of life lost(PYLL) were calculated.Results. In 2006, smoking caused 58,573 deaths (45,028men; 13,545 women), which accounted for 16.15% of alldeaths (23.94% in men; 7.76% in women). By cause, theattributable deaths were distributed in 25,500 maligntumours, 19,117 cardiovascular diseases and 13,956 respiratorydiseases. Trachea-bronchial-lung cancer in menand other cardiopathies in women were those that mostcontributed to that mortality (33.9% and 30.9%). The PYLLwere 211,251.8 (176,765.3 in men; 34,486.5 in women).Conclusions. Tobacco consumption makes a very notablecontribution to mortality in Spain. The impact thatthis habit has on our society is an unacceptable burden(AU)

Molecular epidemiology of drug-resistant Salmonella Typhimurium in Spain.

One hundred and forty-seven Salmonella serotype Typhimurium strains isolated in three provinces in the midwest of Spain were studied. Of these, 93.6% were drug resistant. There were two predominant resistance phenotypes: 43 isolates (29.3%) were resistant to amoxicillin, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole and 27 isolates (18.4%) to amoxicillin, amoxicillin/clavulanic acid, tetracyclines, chloramphenicol, streptomycin and sulphamethoxazole. Randomly amplified polymorphic DNA (RAPD) analysis and pulsed field gel electrophoresis (PFGE) were performed for molecular typing. Thirty-six DNA band profiles were differentiated by RAPD, and 38 by PFGE. We found a high level of clonality; 27% of strains were identical by both methods. There were additional smaller clonal lines within every area. The highest discriminatory power was obtained with PFGE, but the greatest degree of genetic diversity was observed among Salmonella Typhimurium using both RAPD and PFGE.

Molecular epidemiology of drug-resistant Salmonella Typhimurium in Spain

One hundred and forty-seven Salmonella serotype Typhimurium strains isolated in three provinces in the midwest of Spain were studied. Ofthese, 93.6% were drug resistant. There were two predominant resistance phenotypes: 43 isolates (29.3%) were resistant to amoxicillin, tetracyclines,chloramphenicol, streptomycin and sulphamethoxazole and 27 isolates (18.4%) to amoxicillin, amoxicillin/clavulanic acid, tetracyclines,chloramphenicol, streptomycin and sulphamethoxazole. Randomly amplified polymorphic DNA (RAPD) analysis and pulsed field gelelectrophoresis (PFGE) were performed for molecular typing. Thirty-six DNA band profiles were differentiated by RAPD, and 38 by PFGE. Wefound a high level of clonality; 27% of strains were identical by both methods. There were additional smaller clonal lines within every area.The highest discriminatory power was obtained with PFGE, but the greatest degree of genetic diversity was observed among SalmonellaTyphimurium using both RAPD and PFGE

Se estudiaron 147 de cepas de Salmonella serotipificadas como Typhimurium procedentes de tres provincias españolas del medio-oeste. El93,6% de ellas eran resistentes a los antimicrobianos. Hubo dos fenotipos de resistencia predominantes: 43 cepas (29,3%) fueron resistentesa amoxicilina, tetraciclinas, cloranfenicaol, estreptomicina y sulfametoxazol, y 27 (18,4%) a amoxicilina, amoxicilina-ácido clavulánico, tetraciclinas,cloranfenicol, estreptomicina y sulfametoxazol. Los distintos patrones de resistencia se determinaron por técnicas de biología molecular:RAPD (Randomly Amplified Polymorphic DNA) y PFGE (Pulsed Field Gel Electrophoresis). Por RAPD se diferenciaron 36 patrones debandas, y por PFGE 38. Se encontró una proporción alta de clones: el 27% de las cepas fueron idénticas por ambos métodos. Además, encada área se encontraron algunos clones diferentes adicionales. Con PFGE se obtuvo el mayor poder discriminatorio, pero el mayor gradode diversidad genética se observó usando ambas técnicas conjuntamente

[Health-related quality of life in Spanish women with osteoporosis]. / Qualidade de vida relacionada à saúde em espanholas com osteoporose.

OBJECTIVE: To analyze the health-related quality of life in patients with osteoporosis and to compare it with the overall population. METHODS: A cross-sectional descriptive study was carried out with 60 female patients of the rheumatology service at a university hospital, in Spain, from April to October 2003. The Short Form-36 (SF-36) questionnaire was applied in order to obtain demographic data, clinical characteristics and data about lifestyles related to health. Patients were classified in age groups. The statistics tests performed were Chi-square, general linear model, Student's t-test. RESULTS: The interviewees' average age was 65.57 years old (SD: +/- 9.7 years), and average time interval for diagnosis was 3.4 +/- 2.84 years. The best scores were in social functioning (89), emotional aspects (72.2), mental health (63), and vitality (53.7). The lowest scores were in general health (45.1), physical capacity (47.7), pain (52.3) and physical aspects (59.9). The patients' average scores were lower than the general Spanish population's scores in the following dimensions: functional capacity, physical aspects, pain and overall health status. The greatest differences between the average SF-36 scores for patients and for the overall Spanish population were in the age group ranging from 55 to 64 years old. Scores were lower or similar to the general Spanish population in all other dimensions of the questionnaire. No significant associations were found between the dimensions of the SF-36 contemplated in this study and the clinical, demographic and lifestyle data. CONCLUSIONS: The patients presented bad quality of life, particularly with respect to those dimensions that are most relevant with respect to osteoporosis, when compared with the overall Spanish population. The physical dimensions were the ones most affected.

Qualidade de vida relacionada à saúde em espanholas com osteoporose / Health-related quality of life in Spanish women with osteoporosis

OBJETIVO: Analisar a qualidade de vida relacionada à saúde de pacientes com osteoporose e compará-la com a população geral. MÉTODOS: Foi realizado um estudo descritivo transversal com 60 pacientes do sexo feminino no serviço de reumatologia de um hospital universitário na Espanha, de abril a outubro de 2003. Foi aplicado o questionário Short Form-36, abordando dados demográficos, características clínicas e dados sobre estilos de vida relacionados à saúde. As pacientes foram classificadas em grupos etários. Foram utilizados os seguintes testes estatísticos: qui-quadrado, modelo linear geral, t de Student. RESULTADOS: As entrevistadas tinham idade média de 65,57 (DP: ±9,7 anos), e tempo de diagnóstico médio de 3,4±2,84 anos. As melhores pontuações foram obtidas nas dimensões aspectos sociais (89), aspectos emocionais (72,2) e saúde mental (63). As mais baixas foram em estado geral de saúde (45,1), capacidade funcional (47,7), dor (52,3) e aspectos físicos (59,9). As pontuações médias dos pacientes resultaram inferiores às pontuações conhecidas da população geral espanhola nas dimensões capacidade funcional, aspectos físicos, dor e estado geral de saúde. As máximas diferenças entre as pontuações médias do SF-36 dos pacientes e os valores populacionais espanhóis correspondem ao grupo de idade de 55 a 64 anos. Nas demais dimensões do SF-36, as pontuações foram inferiores ou similares aos valores populacionais espanhóis. Não se encontraram associações significativas entre as dimensões do SF-36 estudadas e os dados clínicos, demográficos e de estilos de vida analisados. CONCLUSÕES: Os pacientes apresentaram baixa qualidade de vida, sobretudo nas dimensões mais relevantes da enfermidade, quando comparada com valores da população espanhola em geral. As áreas físicas foram as mais afetadas.

[Epidemiological study and effect on antimicrobial use in the genus Acinetobacter in a university hospital]. / Estudio epidemiológico y efecto sobre la utilización de antimicrobianos en el genero Acinetobacter en un hospital universitario.

In recent years, bacteria of the genus Acinetobacter have gradually been gaining epidemiological importance. This is due to the fact that they have been emerging as opportunistic pathogens causing a great number of nosocomial infections, and due to their multiresistance to antimicrobial agents, which limits treatment options. This study aimed to determine the epidemiological importance of isolates of the genus Acinetobacter at the Clinical University Hospital of Salamanca, Spain. The identification and susceptibility of Acinetobacter was determined using the Pasco automated system for Gram-negative bacteria MIC/ID 6J. Clinical and epidemiological data were obtained from the clinical history. During the study period it was found that A. anitratus was the most frequently isolated species (56%). The origin of the bacteria was mainly nosocomial (70%), and it was most prevalent in the ICU.

Estudio epidemiológico y efecto sobre la utilización de antimicrobianos en el género Acinetobacter en un hospital universitario / Epidemiological study and effect on antimicrobial use in the genus Acinetobacter in a university hospital

En los últimos años, las bacterias del género Acinetobacter han ido adquiriendo importancia epidemiológica de forma gradual y ascendente, debido a su emergencia como patógeno oportunista causante de gran número de infecciones nosocomiales, y por su multirresistencia a los antimicrobianos, que constituye un factor limitante para el tratamiento. Con este estudio se pretende conocer y valorar la importancia epidemiológica de los aislamientos del género Acinetobacter en el Hospital Clínico Universitario de Salamanca. La identificación y sensibilidad de Acinetobacter se determinó mediante el sistema automatizado Pasco para gramnegativos CMI/ID 6J. Los datos clínicos y epidemiológicos se obtuvieron a partir de las historias clínicas. Durante el periodo de estudio se comprobó que A. anitratus era la especie aislada con mayor frecuencia (56 por ciento). La procedencia fue fundamentalmente hospitalaria (70 por ciento), siendo la UCI el servicio donde más prevalencia tiene esta bacteria. (AU)

[Epidemiological situation of tuberculosis in the province of Salamanca and the influence of HIV/AIDS infection]. / Situación epidemiológica de la tuberculosis en la provincia de Salamanca e influencia de la infección VIH/sida.

This study aimed to determine the real prevalence of tuberculosis and the influence of HIV/AIDS infection from January 1992 to January 2001 in the health area of Salamanca. Data on tuberculosis were obtained from the EDO system of the Medical Records Service and the Microbiology Department of the University Hospital of Salamanca. Data on HIV/AIDS infection were obtained from the records on seropositive patients from the Preventive Medical Service. It was found that during the study period, 769 cases of tuberculosis were diagnosed and 606 cases were reported, 12.7% of which were in HIV/AIDS patients. There was 8.7% resistance to isoniazid and 8.3% to rifampin. Multidrug resistance was found in 4.17%. It was concluded that there is a close relationship between tuberculosis and HIV/AIDS infection, which may constitute a risk factor for the disease as well as for the appearance of multidrug resistance. The low reporting of tuberculosis cases shows the need for active surveillance systems.

[Mortality attributable to smoking in Castilla and Leon]. / Mortalidad atribuible al consumo de tabaco en Castilla y León.

OBJECTIVE: To calculate the contribution of tobacco consumption to mortality in Castilla y León, and its effect on premature mortality in this community. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: Population of Castilla y León. MEASUREMENTS AND MAIN RESULTS: The source of information used were the life statistics from the National Institute of Statistics for 1995. The proportion and number of deaths attributed to tobacco were calculated by working out aetiological population fractions. 9.37% of the total deaths occurring were attributed to tobacco consumption. Mortality was higher in men (7.22%) than in women (2.27%). The diagnostic categories contributing most to these figures were tracheal-bronchial-lung cancer (36.9%) and ischaemic heart disease (22%). CONCLUSIONS: The study shows the importance of tobacco dependency as a public health problem in Castilla y León, and its major contribution to premature death.

[Admissions estimate and inadequate stays in a regional hospital]. / Estimación de ingresos y estancias inadecuadas en un hospital comarcal.

UNLABELLED: An inappropriate hospital use, defined as hospital utilization that could have been occurred at a lower attending level or in less time, increases costs, creates inefficient management and influences on attending quality. The objective of this work was to evaluate the appropriateness and inappropriateness of hospital admissions and stays in a district hospital for acute patients as well as causes of such inappropriateness. MATERIAL AND METHODS: Retrospective, descriptive study based on the review of clinical records of patients who required hospital admission. A sample of 378 patients representative of hospitalization for a 18-month period was selected. As measurement instrument the AEP (Appropriateness Evaluation Protocol) was used. This simple method has proved to be of high validity and reliability for the identification of inappropriate hospital use. RESULTS: The percentage of inappropriate hospital admissions detected was 13.8%, whereas the inappropriateness of hospital stays was 33.9%. As for clinical departments, the higher percentage of inappropriateness corresponded to the Traumatology Department (43%). The causes accounting for the inappropriateness of admissions related to the "necessity of admission"; but at a lower level, "diagnostic tests and/or therapy can be made on an outpatient basis" and "premature admission". As for hospital stays, the most common causes were "not rapid discharge", "diagnostic tests pending" and/or "any diagnostic and/or therapeutic procedure can be performed on an outpatient basis". CONCLUSION: The inappropriateness degree of hospital admissions and stays is similar to that observed in other more complex hospitals in our country. The causes underlying this phenomenon are dependent upon physician's decisions and social and public health conditions of the Area.

[Demand of microbiological diagnosis by pediatricians from the Salamanca area]. / Demanda de diagnóstico microbiológico por los pediatras del área de Salamanca.

OBJECTIVE: The purpose of this study was to assess the referrals made by pediatricians for microbiological diagnoses and to evaluate the process by determining the index of contaminated urine samples. PATIENTS AND METHODS: A transverse retrospective study was carried out on the referrals made to the microbiology laboratory of the University Hospital in Salamanca during 1997. The study was limited to the health area of Salamanca, which covers a population of 358,408 inhabitants. The data are distributed according to care levels and referral indicators (proportions and indices) are elaborated. RESULTS: The referrals and results of the 65,462 samples that were processed during this period were analyzed. Of the total, 10,120 (28%) were positive. The overall rate of pediatric referrals was 533 per 1,000 inhabitants. The highest demand was for serology, urinary and fecal studies. The rate of positive results in the different pediatric samples was 156/1000. The rate of results in urine was 154/1000. The rate of contaminated urine samples was 92/1000. CONCLUSIONS: The types of microbiological analyses in greatest demand are serology and urine cultures. The relationship between referrals and positive results is 4:1. The quality of the process can be improved through patient instruction and by means of suitable sample collection and transport.

[The effectiveness of an informational seminar on occupational health]. / Efectividad de un seminario informativo en salud laboral.

OBJECTIVE: The aim of this research was to evaluate the effectiveness of an information seminar concerning health at work, as an in-work training procedure. DESIGN: A quasi-experimental before-and-after study was conducted through a 20-question survey on health at work. This questionnaire was administered before and after the seminar. Quantitative changes were evaluated through frequency indicators and the statistical significance of the changes was established through the chi-squared and Student's t tests and one-way two-tailed ANOVA. SETTING: Primary care in Castilla y León. PARTICIPANTS: A three-and-a-half hour long information seminar, with 102 primary care professionals--doctors, pharmacists, vets and nurses--was held. RESULTS: Results showed an improvement in the complex of training-information areas used as criteria to evaluate the acquisition of knowledge on health at work. The greatest positive change (36%) was found for matters relating to general principles of health at work for risk factors, and for work-connected pathologies. CONCLUSIONS: The information seminar is proposed as a procedure to use in on-going training of primary care health professionals.

[Mortality due to HIV/AIDS infection in the Community of Castile and León]. / Mortalidad por infección VIH/sida en la comunidad de Castilla y León.

OBJECTIVE: To find the effect of HIV/AIDS infection on mortality and its evolution between 1989 and 1993. DESIGN: Descriptive epidemiological study. SETTING: Mortality study in the Community of Castilla y León. PATIENTS AND OTHER PARTICIPANTS: The source of information used were the vital statistics published by the National Institute of Statistics. Mortality was analysed for the principal causes of death in people aged between 15 and 54. Specific and standardised mortality rates were calculated in function of the variables, year of death, age and sex. MEASUREMENTS AND MAIN RESULTS: Mortality due to HIV/AIDS infection increased progressively over time in both sexes, reaching in 1993 a rate of 13.56 per 10(5) in males and 3.52 per 10(5) in women. In 25 to 34-year old women the main causes of death were HIV/AIDS infection (9.36 per 10(5)) and traffic accidents (3.94 per 10(5)), whereas in men they were traffic accidents (38.67 per 10(5)) and HIV/AIDS infection (26.88 per 10(5)). CONCLUSIONS: Mortality due to HIV/AIDS has increased in recent years and at present is the main cause of death in 25 to 34-year old women, and the second in men of this age-group.