¿Cuál es el nivel de contaminación del cepillo de dientes almacenado en diferentes entornos sanitarios? / What is the level of toothbrush contamination stored in different sanitary settings?

Introducción: Los cepillos pueden albergar una amplia variedad de microorganismos, incluyendo bacterias hongos y virus, pudiendo así facilitar la translocación de especies en un mismo individuo y la transmisión de especies entre individuos. Métodos: Estudio de la contaminación bacteriana de los cepillos de dientes de cien voluntarios con la cumplimentación de un cuestionario (lugar de almacenamiento, tipo de cepillo, utilización de estuche de almacenamiento y meses de uso). Resultados: Se estudiaron un total de 100 muestras. El 33% guardaba el cepillo fuera del baño, un 20% lo guardaba en el cajón del baño y un 47% sobre el lavabo del baño. El 92% de las muestras estaban contaminadas como mínimo con un grupo de microorganismos Conclusión: El lugar de almacenamiento del cepillo de dientes es fundamental en la reducción de la contaminación. Se debe guardar en un lugar seco, lejos del inodoro y sin estuche

Introduction: Brushes can house a wide variety of microorganisms, including fungal bacteria and viruses, which can facilitate the translocation of species in the same individual and the transmission of species between individuals. Methods: Study of the bacterial contamination of toothbrushes of one hundred volunteers with the completion of a questionnaire (place of storage, type of brush, use of storage case and months of use). Results: A total of 100 samples were studied. 33% kept the brush outside the bathroom, 20% kept it in the bathroom drawer and 47% on the bathroom sink. 92% of the samples were contaminated with at least one group of microorganisms. Conclusion: The storage place of the toothbrush is fundamental in the reduction of contamination. It should be stored in a dry place, away from the toilet and without a box

[Epidemiology of Q fever in Spain (2018)]. / Epidemiología de la fiebre Q en España (2018).

Q fever is an anthropozoonosis whose causative agent is Coxiella burnetii, which has an important impact from the human and animal health point of view. In this review, a brief historical reference of the infection by C. burnetii and Q fever has been made initially. In a second section the basic epidemiological aspects of this infection are described (reservoirs/ sources of infection, form of transmission and epidemiological forms). Subsequently, the data of the infection by C. burnetii in Spain will be are indicated, particularly the clinical series, the seroepidemiological studies in humans, the affectation of different types of mammals and the participation of the ticks in the biological cycle. In addition, basic data on C. burnetii infection/ disease in other regions of the world will be are also included. Finally, and taking into account the previous data will indicate the main epidemiological characteristics of Q fever at present.

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)

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

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.

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. MAIN RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente a 1,6% ; p = 0,04); la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedad pulmonar obstructiva crónica (EPOC) (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones postquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso (AU)

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. Main results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial (AU)

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente al 1,6%; p = 0,04), la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedades pulmonares obstructivas crónicas (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones posquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. Results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial.

Outbreak of Streptococcus equi subsp. zooepidemicus infections on the island of Gran Canaria associated with the consumption of inadequately pasteurized cheese.

Streptococcus equi subsp. zooepidemicus infections are infrequent in humans. A clinical and epidemiological study of a milk-borne outbreak caused by this organism is described. Fifteen patients (5 females, 10 males) with a median age of 70 years (range 47-86) were infected. Twelve (80%) had underlying diseases. Infection with S. equi subsp. zooepidemicus presented as primary bacteremia in six cases, as bacteremia associated with aortic aneurism in four cases, as septic arthritis in two cases, as pneumonia in two cases, and as meningitis in one case. Five (33.3%) patients died. A case-control study proved that consumption of inadequately pasteurized cheese of a specific brand was associated with S. equi subsp. zooepidemicus disease (OR=4.5; 95% CI 1.57-19.27; p<0.001). This outbreak serves as a reminder that S. equi subsp. zooepidemicus causes serious infections that are usually zoonoses. Identification of beta-hemolytic streptococci to the species level to detect contaminated foods of animal origin is important for preventing new food-borne outbreaks. For a precise characterization of the isolates, the application of molecular markers is recommended.

Etiología y consideraciones terapéuticas en otitis media crónica. Análisis de un período de 5 años / Aetiology and therapeutic considerations in chronic otitis media. Analysis of a 5 year period

Fundamento: El objetivo de este estudio es revisary actualizar la etiología bacteriana de la otitis media crónica y la sensibilidad antibiótica de los microorganismos implicados. Método: Se ha realizado un estudio retrospectivo en el que se incluyen 127 pacientes adultos con otitis media crónica, entre los años 2000 y 2004. A las bacterias aisladas se les realizaron pruebas de sensibilidad antibiótica a: quinolonas, aminoglucósidos, colistina, oxacilina, amoxicilinaclavulánico y cefalosporinas. Resultados: Los aislamientos más frecuentes fueron bacilos gram-negativos, principalmente Pseudomonas aeruginosa en el 47,6%, Staphylococcus aureus en el 21%. Entre los resultados destaca la resistencia del 18% de las cepas de P. aeruginosa a ciprofloxacino y del 21,6% de resistencia de S. aureus a levofloxacino. Además el 10,8% de las cepas de S. aureus fue resistente a betalactámicos. Conclusión: El principal patógeno encontrado es P. aeruginosa, seguido de S. aureus. Existe un incremento del desarrollo de las resistencias bacterianas a los antibióticos, por lo que es necesario realizar antibiograma sistemáticamente

Background: This study provides an update on thebacterial aetiology of chronic otitis media in our area and the antibiotic sensivity of the bacteria involved in this pathology. Methods: A retrospective study from 2000 to 2004, is carried out in a total of 127 adults diagnosed of chronic otitis media. Isolated bacteria were tested in vitro regarding sensitivity to fluoroquinolones, aminoglyosides, colistin, oxacilin, amoxicillin-clavulanic acid and cephalosporins. Results:The most common pathogens we found were gramnegativeorganisms, especially Pseudomonas aeruginosa (47,7%), but among gram positive organisms, Staphylococcus aureus, was involved in a significant number of infections (21%). The main findings that we found were as follows: 18% of P. aeruginosa strains were resistant to ciprofloxacinand 21,8% S. aureus strains were resistant to levofloxacin. 10,8% of S. aureus strains showed resistance to â-lactams. Conclusion: The most important pathogen in our study was P. aeruginosa along with a variety of other gram-negative organisms and S. aureus. There is growing concern over the use of antibiotics and the development of resistance. We need to evaluate the antimicrobial activity by determining the susceptibility of a particular antibiotic against a specific bacterial strain

[Aetiology and therapeutic considerations in chronic otitis media. Analysis of a 5 year period]. / Etiología y consideraciones terapéuticas en otitis media crónica. Análisis de un período de 5 años.

BACKGROUND: This study provides an update on the bacterial aetiology of chronic otitis media in our area and the antibiotic sensivity of the bacteria involved in this pathology. METHODS: A retrospective study from 2000 to 2004, is carried out in a total of 127 adults diagnosed of chronic otitis media. Isolated bacteria were tested in vitro regarding sensitivity to fluoroquinolones, aminoglyosides, colistin, oxacilin, amoxicillin-clavulanic acid and cephalosporins. RESULTS: The most common pathogens we found were gram-negative organisms, especially Pseudomonas aeruginosa (47.7%), but among gram positive organisms, Staplhylococcus aureus, was involved in a significant number of infections (21%). The main findings that we found were as follows: 18% of P. aeruginosa strains were resistant to ciprofloxacin and 21.8% S. aureus strains were resistant to levofloxacin. 10.8% of S. aureus strains showed resistance to beta-lactams. CONCLUSION: The most important pathogen in our study was P. aeruginosa along with a variety of other gram-negative organisms and S. aureus. There is growing concern over the use of antibiotics and the development of resistance. We need to evaluate the antimicrobial activity by determining the susceptibility of a particular antibiotic against a specific bacterial strain.