Autotransfusión postoperatoria en la cirugía protésica primaria de rodilla. Comentarios / Comments on "Postoperative autotransfusion in primary knee replacement surgery"

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Autotransfusión postoperatoria en la cirugía protésica primaria de rodilla. Comentarios / Comments on "postoperative autotransfusion in primary knee replacement surgery"

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[Accidents with biological material in health care workers in 2 primary health care areas (1990-1999)]. / Accidentes con material biológico en trabajadores sanitarios de 2 áreas de atención primaria (1990-1999).

OBJECTIVE: To find out the exposures with biological material in health care workers in primary health care, registered in the biological accidents database from Preventive Medicine Service in Miguel Servet Universitary Hospital of Zaragoza. DESIGN: Descriptive study of a retrospective cohort. SITE: Primary health care, Areas II and V of Zaragoza.Participants. Workers in this areas, distributed by: physician, nursing staff, auxiliary, orderly, housekeeping staff, others. MEASUREMENTS AND MAIN RESULTS: Data of: workers, accident, serologic source, worker protection and vaccinal status of hepatitis B. The incidence of accidents was 26 (period 1997-1999). Most proportion of accidents were declared by nursing (78%). The highest occupational incidence was in auxiliary (63 ). In 90,1% of the cases, the accident was needlestick injury. The source was known in 67,7% of cases. The accidents occurred in hands in 96,8% of cases, and only one third of workers carried gloves. CONCLUSIONS: Results obtained are similar with previous studies about this event. We must insist on the need to declare these accidents, providing more information and accessibility for the declaration to worker. Moreover, we must insist on the correct application in the health care field of the standard precautions, because almost 50% of accidents are evitable, and to increase hepatitis B vaccination covertures.

[Transfusion and pre-deposit autotransfusion in orthopedic and traumatologic surgery]. / Transfusión y autotransfusión predepósito en cirugía ortopédica y traumatológica.

PURPOSE: We present a retrospective study about the transfusional needs and the results of the preoperative autologous donation programme in our centre during 1996, in the Orthopaedic and Traumatologic Surgery Service's patients (SOT). PATIENTS AND METHODS: During 1996 the SOT Service carried out 592 major programmed surgical procedures with implants: hip prostheses (HP), knee prostheses (KP) and spinal column fixings (SCF). We've reviewed transfusion forms of the Blood Bank and the preoperative autologous donation forms of the patients sent to us. We've analysed the data with the EpiInfo 6.04 of CDC. Atlanta and SSPS programmes, using the chi 2 of Pearson's Test for qualitative variables and T-Student's test for 2 quantitative variables. RESULTS: The put 387 HP, 118 KP and 87 SCF. 1399 units of blood were administered to 437 patients: 310 HP, 64 KP and 63 SCF. The units/patient (U/P) mean was: 3.3 in HP, 2.3 in PTR and 3.5 in SCF. They sent 99 patients to be programmed for autotransfusion, of which 15 were excluded. The patients' number and the surgical procedures were: 39 HP, 7 KP and 38 SCF. They solicited 247 units (2.9 U/P) and we took out 91.4% of these and the programme was finished in the 73.8% of patients. They transfused 311 U, autologous 176, to 91.6% of programmed patients. Only autologous blood was received by 48% of transfused patients without any statistically significant differences (SSD) (p > 0.05) between the different prostheses. The difference among the transfusion needs of HP and SCF and over KP is SSD (p < 0.001), being non significant between HP and SCF. The probability of getting an autotransfusion programme is bigger in SCF, with a SSD (p < 0.001) of SCF over the HP and the KP and non significant between the last two. The probability of being transfused is greater in the programmed autotransfusion group, this being SSD (p < 0.001), as much of global form as comparing separately each type of prostheses. In the programmed autotranfusion group there are no SSD (p > 0.05) between the type of prostheses and the probability of being transfused, finding the same SSD when we compare the U/P mean and each type of prostheses. The opposite occurred to the patients programmed, it is SSD (p < 0.001) as much of global form as comparing the U/P means in each type of prostheses. Finally, between the global U/P transfused global in the patients that we did an autotransfusion on and those we didn't the difference is SSD (p < 0.001), seeing the same SSD comparing the U/P means in each type of prostheses between both groups. CONCLUSIONS: Given that the autotransfusion is safer than the homologous transfusion and the high percentage of this type of patients that need transfusion, 80% of HP, 54% of KP and 73% of SCF 72%, it would be desirable to enlarge the autotransfusion preoperative programme because it is only carried out on 14.18% of this type of procedures.

[Costs of accidental punctures in hospital health personnel]. / Costes de las inoculaciones accidentales en personal sanitario de un hospital.

OBJECTIVES: The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme. RESULTS: The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%). CONCLUSIONS: High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care]. / Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria.

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.