Reestructuración del funcionamiento de la Unidad de Hospitalización a Domicilio del Hospital Universitario Germans Trias I Pujol para el manejo de pacientes COVID y no COVID ingresados durante la pandemia del COVID-19 en España / Restructuring the Operation of the Home Care Unit of the Germans Trias I Pujol University Hospital for the management of patients COVID and no COVID Admitted during the COVID-19 Pandemic in Spain

INTRODUCCIÓN: La Unidad de Hospitalización a Domicilio del Hospital Universitari Germans Trias I Pujol, ante la grave situación sanitaria generada por el COVID-19 optó por varias estrategias para la atención de los pacientes ingresados con o sin diagnóstico de COVID optimizando los recursos de atención sanitaria. MÉTODO: Estudio descriptivo sobre la reorganización de la Unidad de Hospitalización a Domicilio (UHAD) durante la pandemia del COVID-19 en el período comprendido entre el 14 de Marzo y 31 de Mayo del 2020. Una ampliación del número de camas virtuales, así como de los turnos e incorporación de personal sanitario (médico/enfermeros) fue necesario, activándose paralelamente 2 plataformas de telemedicina para monitorización y contacto con los pacientes (COVIDApp para los pacientes COVID y Revita para los pacientes no COVID). RESULTADOS: Un total de 781 pacientes referidos del área de hospitalización, urgencias y atención primaria fueron incluidos, 584 (74,8%) ingresados con diagnóstico de COVID-19 (por PCR = polymerase chain reaction) y 197 (25,2%) pacientes ingresados por otras patologías (no-COVID) provenientes de la zona Metropolitana Nord de Barcelona y Maresme. Un 24,6% de los pacientes no-COVID y un 2,5% de los pacientes COVID eran pacientes crónicos complejos. El porcentaje de reingreso hospitalario fue mayor en los pacientes no-COVID (11.6%) que en los pacientes COVID (4,28%). El porcentaje de altas de la UHAD aumentó hasta un 35,34%. Ambas plataformas permitieron realizar seguimiento estrecho de los pacientes. CONCLUSIONES: La pandemia del COVID-19 ha remarcado la necesidad de optimizar y reestructurar los recursos del sistema sanitario, siendo las plataformas de Telemedicina COVIDApp y Revita de ayuda como herramientas innovadoras

INTRODUCTION: The COVID-19 pandemic made that the Home Care Unit of the Germans Trias I Pujol University Hospital implement strategies for the management of patients admitted with or without COVID-19, optimizing health care resources. METHOD: A descriptive study of patients with and without COVID-19 was conducted between March 14th and May 31th, 2020. An increase in the number of virtual beds, as well as extension of working hour and incorporation of personnel health (doctor/nurses) was necessary, activating 2 telemedicine platforms for monitoring of patients (COVIDApp for COVID patients and Revita for non-COVID patients). RESULTS: A total of 781 patients referred from the hospitalization, emergency and primary care were included, 584 (74.8%) admitted with a diagnosis of COVID-19 (by PCR) and 197 (25.2%) patients admitted by other pathologies (non-COVID) from the Nord Metropolitan area of Barcelona and Maresme. 24.6% of non-COVID patients and 2.5% of COVID patients were complex chronic patients. The percentage of hospital readmission was higher in non-COVID patients (11.6%) than in COVID patients (4.28%). The percentage of discharges from the UHAD increased to 35.34%. Both platforms allowed for close monitoring of patients. CONCLUSIONS: The COVID-19 pandemic has highlighted the need to optimize and restructure the resources of the health system, with the Telemedicine platforms COVIDApp and Revita as innovative tools

Incidence of catheter-related bloodstream infection in a general hospital using two different detection methods

Introduction: The aim of this study was to determine the incidence of central venous catheter-related bloodstream infection (CRBSI) in a general hospital, using two different assessment methods. Methods Method A: One observer prospectively followed up all patients with central venous catheters (CVCs) placed in our hospital over a period of 1 year, recording all CRBSI episodes. Incidence was calculated in two ways, in relation to the total number of catheter days, and in relation to the total number of hospital days of all patients hospitalized during this period. Method B: Another observer recorded all CRBSI episodes diagnosed during the same time period using microbiology data in which blood culture and catheter culture were positive for the same microorganism. Incidence was calculated in relation to the total number of hospital days of all hospitalized patients. The patient's demographic characteristics and the catheter-related variables were recorded and analysed. Based on clinical and microbiological criteria, catheters were classified as uninfected, colonized, or CRBSI. Results Over the study period, 878 central venous catheters were placed in 704 patients. The total number of catheter days was 7357, and the mean duration of catheter use was 8.15 days (1-86). The total number of hospital stays in this period was 92,167.Method A: 15 episodes of CRBSI were detected, yielding an overall incidence of 2.03 episodes/1000 catheter days or 0.16 episodes/1000 hospital days. Method B: 11 episodes of CRBSI, with an incidence of 0.12 episodes/1000 hospital days. Conclusion The two methods studied yielded different CRBSI rates, with a higher incidence reported by prospective follow-up (Method A). In addition, this method enabled a better assessment to be made of CRBSI risk as the calculation could be performed in relation to the days patients were catheterized (AU)

Introducción: El objetivo de nuestro estudio es medir la incidencia de bacteriemia por catéter venoso central (BRC) en un hospital general mediante dos métodos de valoración diferentes. Métodos: Método A: seguimiento prospectivo de todos los pacientes con catéteres venosos centrales(CVC) insertados en nuestro hospital durante 1 año, registrando los episodios de BRC. Datos referidos al total de días de catéter y al total de estancias hospitalarias en este período. Método B: registro de los episodios de BRC por otro observador a partir de hemocultivos y de cultivo de catéter positivos al mismo microorganismo durante el mismo periodo de tiempo, datos proporcionados por microbiología y referidos al total de estancias hospitalarias. Se registraron las características (..) (AU)

[Peripheral venous catheter-related bacteremia in a general hospital]. / Características de la bacteriemia relacionada con catéter venoso periférico en un hospital general.

INTRODUCTION: Catheter sepsis is a constant and serious problem in our hospitals for the cost it generates, both in terms of morbidity and economics. It's becoming more frequent also in peripherally inserted catheters. Our study aims to know the importance and characteristics of peripheral venous catheter bacteremia in a general hospital. MATERIAL AND METHODS: Prospective and comparative analysis of all episodes of central and peripheral venous catheter-related bacteraemia, in 2009. RESULTS: Twenty-eight episodes of catheter-related bacteraemia in a total of 25 patients. Sixteen episodes originated in central catheter (57.2%), 11 in peripheral (39.3%) and 1 in peripherally inserted central catheter (3.5%). Two cases of exitus directly related to the peripheral catheter infection. ETIOLOGY: 13 episodes of S. aureus (3 MRSA), including 8 in peripheral catheter (8/13, 61.5%), 12 episodes of plasma coagulase negative staphylococcus, including 2 in peripheral catheter (2/12, 16.6%). CONCLUSIONS: Peripheral catheter-related bacteraemia is an emerging health problem with important clinical and prognostic connotations for patients. It is necessary continuous training on correct handling measures to prevent intravascular catheters infections including peripheral catheters in every hospital ward.

Características de la bacteriemia relacionada con catéter venoso periférico en un hospital general / Peripheral venous catheter-related bacteremia in a general hospital

Introducción. La bacteriemia por catéter es un problema constante y grave en nuestros hospitales, por el coste que genera, tanto en términos de morbilidad como económico. Cada vez es más frecuente la bacteriemia originada en catéteres de inserción periférica. Nuestro trabajo pretende conocer la importancia y características de la bacteriemia de catéter venoso periférico en un hospital general. Material y métodos. Análisis prospectivo y comparativo de todos los episodios de infección de catéter venoso central y periférico, durante el año 2009. Resultados. 28 episodios de bacteriemia por catéter en 25 pacientes. Dieciséis episodios se originaron en catéter central (57,2%), 11 en periférico (39,3%) y 1 en catéter central de inserción periférica (3,5%). Hubo dos casos de fallecimiento relacionados directamente con la infección del catéter periférico. Etiología. 13 episodios por Staphylococcus aureus (3 S. aureus resistente a meticilina, SARM), de ellos 8 en catéter periférico (8/13; 61,5%), 12 episodios por estafilococo coagulasa negativo (ECN), de ellos 2 en periférico (2/12; 16,6%). Conclusiones. La bacteriemia relacionada con catéter periférico es un problema sanitario emergente con importantes connotaciones clínicas y pronósticas para los pacientes. Es necesaria una formación continuada sobre normas de actuación consensuadas para prevenir las infecciones de catéteres intravasculares incluidos los periféricos, en todos los dispositivos asistenciales hospitalarios(AU)

Introduction. Catheter sepsis is a constant and serious problem in our hospitals for the cost it generates, both in terms of morbidity and economics. It’s becoming more frequent also in peripherally inserted catheters. Our study aims to know the importance and characteristics of peripheral venous catheter bacteremia in a general hospital. Material and methods. Prospective and comparative analysis of all episodes of central and peripheral venous catheter- related bacteraemia, in 2009. Results. Twenty-eight episodes of catheter-related bacteraemia in a total of 25 patients. Sixteen episodes originated in central catheter (57.2%), 11 in peripheral (39.3%) and 1 in peripherally inserted central catheter (3.5%). Two cases of exitus directly related to the peripheral catheter infection. Etiology: 13 episodes of S. aureus (3 MRSA), including 8 in peripheral catheter (8/13, 61.5%), 12 episodes of plasma coagulase negative staphylococcus, including 2 in peripheral catheter (2/12, 16.6%). Conclusions. Peripheral catheter-related bacteraemia is an emerging health problem with important clinical and prognostic connotations for patients. It is necessary continuous training on correct handling measures to prevent intravascular catheters infections including peripheral catheters in every hospital ward(AU)

Uveítis anterior y endocarditis / Anterior uveitis and endocarditis

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Incidence of catheter-related bloodstream infection in a general hospital using two different detection methods.

INTRODUCTION: The aim of this study was to determine the incidence of central venous catheter-related bloodstream infection (CRBSI) in a general hospital, using two different assessment methods. METHODS: Method A: One observer prospectively followed up all patients with central venous catheters (CVCs) placed in our hospital over a period of 1 year, recording all CRBSI episodes. Incidence was calculated in two ways, in relation to the total number of catheter days, and in relation to the total number of hospital days of all patients hospitalized during this period. Method B: Another observer recorded all CRBSI episodes diagnosed during the same time period using microbiology data in which blood culture and catheter culture were positive for the same microorganism. Incidence was calculated in relation to the total number of hospital days of all hospitalized patients. The patient's demographic characteristics and the catheter-related variables were recorded and analysed. Based on clinical and microbiological criteria, catheters were classified as uninfected, colonized, or CRBSI. RESULTS: Over the study period, 878 central venous catheters were placed in 704 patients. The total number of catheter days was 7357, and the mean duration of catheter use was 8.15 days (1-86). The total number of hospital stays in this period was 92,167. Method A: 15 episodes of CRBSI were detected, yielding an overall incidence of 2.03 episodes/1000 catheter days or 0.16 episodes/1000 hospital days. Method B: 11 episodes of CRBSI, with an incidence of 0.12 episodes/1000 hospital days. CONCLUSION: The two methods studied yielded different CRBSI rates, with a higher incidence reported by prospective follow-up (Method A). In addition, this method enabled a better assessment to be made of CRBSI risk as the calculation could be performed in relation to the days patients were catheterized.