Una intervención educativa en pacientes diagnosticados de hipertensión y con tratamiento farmacológico / No disponible

Introducción: El objetivo del presente estudio es evaluar la efectividad de las intervenciones de educación para la salud en pacientes hipertensos para mejorar la adherencia al cumplimiento del tratamiento. Método: Estudio experimental, aleatorizado, en pacientes con hipertensión arterial en la consulta externa del Hospital Clínico San Carlos. Se realizó una intervención educativa en el grupo experimental (n=10) y tratamiento habitual en el grupo control (n=10). Se tomaron medidas antropométricas y se valoró la adherencia al tratamiento al inicio y al primer mes de seguimiento. Resultados: el grupo experimenta presentó una disminución media significativa de 8,2 y 2,4 puntos en la puntuación total cuestionario de adherencia (p=0,041) y en la subescala de autopercepción (p=0,06), respectivamente. No hay diferencias de la puntuación entre los grupos, ni cambios en las cifras de tensión arterial o medidas antropométricas. Conclusiones: Las intervenciones de educación para la salud en la hipertensión arterial, favorecer la adherencia al tratamiento y la práctica de hábitos de vida saludables, mejorando el control de la enfermedad (AU)

Introduction: The aim of this study is to evaluate the effectiveness of health education in hypertense patients and in that way improve their treatment adherence. Methods: Randomized controlled trial, in hypertense patients who be treated at Clinic San Carlos Hospital. Health education program were done in the experimental group (n=10) while normal treatment followed in control group. Anthropometric measures, blood pressure, and adherence tests were performed at baseline and 1 month. Results: There were no differences between groups in anthropometric measures, blood pressure and adherence test punctuation. However experimental group show a significant decrease in the adherence test of 8,2 and 2,4 points of the total punctuation (p=0.041) and self perception subscale (p=0.06). conclusions: Health educations programs promote treatment adherence and encourage practicing health live stile, in hypertense patients, as a consequence improving the disease outcome (AU)

Consumo y actitudes hacia el tabaco de los profesionales de la medicina y enfermería del Hospital Clínico San Carlos de Madrid / No disponible

Objetivo Valorar la prevalencia de consumo de tabaco de Licenciados en Medicina (LM) y Diplomados Universitarios en Enfermería (DUE), y sus opiniones, actitudes y hábitos (personales y profesionales) en relación con el consumo de tabaco en un centro hospitalario. Métodos Estudio transversal, muestreo estratificado con asignación proporcional. Realización de 426 entrevistas directas, con encuesta validada, entre abril-mayo de 2004 a profesionales adscritos mayoritariamente al Hospital Clínico San Carlos (HCSC). Resultados Se obtuvieron 377 encuestas válidas. La prevalencia de tabaquismo es de un 38,5%. Mujeres (42,7%), menores de 35 años (51,2%) y DUE (44,5%) son los subgrupos con mayor prevalencia de fumadores. Ser fumador se asocia significativamente con menor preocupación por los efectos del consumo de tabaco y del humo ambiental sobre la salud; también están menos convencidos de que el hospital ha de ser un espacio sin humo. Un 45,3% fuman en zonas no permitidas. Los fumadores promueven menos el cumplimiento de la normativa y dan consejo antitabaco con menor frecuencia. Más del 50% del total no piensa que los profesionales sanitarios desempeñen un papel de modelo social; alrededor del 20% cree que los fumadores no tienen en cuenta sus recomendaciones y un 85% considera necesaria una formación específica. Conclusiones El hecho de fumar condiciona opiniones y comportamientos relacionados con el tabaco, influyendo en el desempeño profesional. Existe una necesidad sentida y objetiva de formación sobre el abordaje del paciente y del compañero fumador, y un clima de escepticismo en la efectividad de las acciones de los profesionales para reducir el consumo de tabaco y conseguir el cumplimiento de las restricciones dentro de los centros sanitarios. Aunque tras los años de actividades preventivas existe un estado de opinión que apoya la transformación del hospital en un centro sin humo, sigue siendo necesario intervenir con los profesionales, hasta conseguir la resolución de este problema de salud pública

Objectives To assess smoking prevalence among Medicine and Nursery graduates at the Clinical Hospital San Carlos (HCSC), and to get some information about their opinions, personal and professional attitudes, as well as their habits related to the tobacco consumption within the Hospital. Methods A prevalence study was performed within a 426 representative sample of health professionals (doctors and nurses from secondary and third health assistance levels), who were interviewed with a Spanish validated questionnaire. Period: April to May 2004. Spss 12.0 was used to analyse results. Results Smoking prevalence among HCSC health professionals, was 38,5%. The most affected groups were nurses (44,5% smokers), < 35 years and women (42,7%). The smoker condition is significantly associated to less concern about both the fact of smoking and the enviromental smoke effects against health. 45,3% of them smoke in not allowed places, and they have a more tolerant attitude in general regarding this issue. Only 57,3% of professionals usually pro mote the fulfilment of tobacco control rules amid patients and relatives, and smokers do it even less often. Near 20% of total sample think that the smokers do not consider their recommendations and 85% think that specific formation is required. Conclusions The smoker condition is a determinant factor for opinions, attitudes and behaviour related to smoking matters, and it has a c1ear influence on the professional activities. There is a lack of training about professional health promotion approach to smokers (both patients and colleagues). There is also a sceptic view of the environmental tobacco regulation effectiveness. Despite of the advances produced in these past years, it is still necessary to take part and dedicate resources to this public health problem

Epidemiology of biological-exposure incidents among Spanish healthcare workers.

OBJECTIVE: To determine the frequency and the epidemiological characteristics of biological-exposure incidents occurring among healthcare personnel. DESIGN: Prospective surveillance study. SETTING: Participating Spanish primary-care and specialty centers from January 1994 to December 1997. PARTICIPANTS: 70 centers in 1994, 87 in 1995, 97 in 1996, and 104 in 1997. METHODS: Absolute and relative frequencies were calculated for several variables (position held, area of care, type of injuring object, activity, etc) and for the different categories of each variable. RESULTS: There were 20,235 registered incidents. Annual incidence rates were as follows: 1994, 51 per 1,000; 1995, 58 per 1,000, 1996, 54 per 1,000; and 1997, 59 per 1,000. Mean age of accident victims was as follows: 1994, 35.68 (standard deviation [SD], 16.26); 1995, 33.6 (SD, 11.9); 1996,38.2 (SD, 17.27); and 1997, 36.7 (SD, 16.33) years. Of the 20,235 incidents, 15,860 (80.7%) occurred to women; 50% (9,833) accidents were among nursing staff. The type of incident most frequently reported was percutaneous injury (81.1%). The highest frequency of accidents was seen in medical and surgical areas (28% and 25.6%, respectively). Blood and blood products were the most commonly involved material (87.6%). Administration of intramuscular or intravenous medication was the activity associated with the highest accident rate (20.3%). The most frequent immediate action in response was rinsing and disinfecting (65.6%). CONCLUSIONS: The incident registry was highly stable in terms of incidence rates over the observation period and served to highlight the large number of incidents recorded each year. The potential implications of the results are the need to explore reasons for increased exposures in certain areas, with the aim of focusing prevention efforts, and, similarly, to establish the factors associated with diminished incidence rates to model successful measures.

Influenza virus immunization effectivity in kidney transplant patients subjected to two different triple-drug therapy immunosuppression protocols: mycophenolate versus azathioprine.

BACKGROUND: Due to possible complications and treatment limitations, the prevention of influenza in renal transplant (RT) patients is highly indicated. METHODS: Forty-nine patients with a 1-year functioning RT subjected to two different immunosuppressive regimens and 37 healthy relatives (HR) were administered the anti-influenza vaccine as recommended for 1996 to 1997. Anti-influenza antibody, creatinine, and immunological markers were estimated at 1 and 3 months after vaccination. RESULTS: Three months after vaccination, 46.2% of the RT patients and 69% of the HR (P=0.06) showed protective antibody titers to influenza A (relative risk [RR]; 0.67; 95% confidence interval: 0.44-1.02). A total of 20.5% of the RT patients and 44.8% of the HR showed antibodies to influenza B (P=0.03). Despite these differences, the incidence of illness was similar. The immunosuppressive regimen had no effect on the antibody response. CONCLUSIONS: Although the RT patients showed a reduced antibody response, no negative effects on graft outcome were observed.

[Levels of evidence in the prevention and control of nosocomial infection]. / Niveles de evidencia en la prevención y control de la infección nosocomial.

BACKGROUND: Sanitary, economic and social importance of nosocomial infections justifies the introduction and development of control and surveillance systems in hospitals. The practice of a rational medicine needs the scientific evidence evaluation of the control measures employed, in terms of efficacy, efficiency and effectivity. METHODS: Critical appraisal of medical literature with special emphasis in recommendations provided by Centers for Disease Control and Prevention (CDC). RESULTS: A minimum proportion of prevention and control recommendations provided by Centers for Disease Control and Prevention (CDC) are included in the Category IA (demonstrated evidence in well-designed epidemiological or experimental studies), while sanitary impact (reduction of the nosocomial infection incidence or prevalence) or economic impact (the benefit derived of this nosocomial infection frequency reduction) of numerous interventions keeps being a motive for study and discussion because its evidence level is not demonstrated due to internal or external validity problems. CONCLUSIONS: An appropriate strategy to be adopted by sanitary professionals in charge of nosocomial infection control is the application of the evidence-based medicine methodology and principles.

[outbreak of invasive pulmonary mycosis in neutropenic hematologic patients in relation to remodelling construction work]. / Brote de micosis pulmonar invasiva en pacientes hematológicos neutropénicos en relación con obras de remodelación.

BACKGROUND: An increase was observed in the number of cases of invasive pulmonary mycosis in neutropenic hematologic patients coinciding with construction work being carried out in the Hospital Clínico San Carlos (Madrid, Spain). The aim of this study was to confirm the existence of an outbreak, identify the factors related and adopt adequate control measures. METHODS: A descriptive, epidemiologic, environmental microbiologic study was performed. The incidence of cases in the study period and a control period was compared. Air samples were collected in the affected area and other areas of hospitalization not related to the construction work. The ventilation system of the Hemalotogy Isolation Unit (HIU) was also sampled. The control measures undertaken included: hermetic sealing of the construction work adjacent to hematology followed by transfer of the patients to another floor of the hospital. RESULTS: The existence of an outbreak was confirmed (significant increase in the incidence, p = 0.017). Eleven cases and one death by massive hemoptisis were reported. The mean total fungal count and to Aspergillus spp were 120 and 35 UFC/m3, respectively in the hematologic hospitalization area adjacent to the construction work and 37 and 5 UFC/m3 in other areas (p < 0.001). Contamination was detected in the ventilation system of the HIU by A. fumigatus (125 UFC/m3 of air from the interior of the conduct). CONCLUSIONS: An elevated number of fungal spores found in samples from the hematologic hospitalization area as well as no further new cases being reported following the transfer of the patients suggest that the outbreak was related to the adjacent construction work being carried out.

Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA.

In hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) many patients are initially colonized without infection. The reasons why some progress to infection while others do not are not known. A cohort of 479 hospital patients, initially only colonized with MRSA, was followed prospectively for the development of MRSA infection. Risk factors for progression to infection were assessed using Cox proportional hazards survival analysis. Fifty-three patients (11.1%) developed 68 MRSA infections. Intensive care setting, administration of three or more antibiotics, ulcers, surgical wounds, nasogastric or endotracheal tubes, drains, and urinary or intravenous catheterization were all associated with increased rates of MRSA infection. Multivariate analysis showed that intensive care patients, compared with medical patients, had a higher rate of developing MRSA infection within the first four days of admission, with a hazard ratio of 26.9 (95% CI 5.7-126). Surgical wounds, pressure ulcers and intravenous catheterization were also independent risk factors, with hazard ratios (and 95% CI) of 2.9 (1.3-6.3); 3.0 (1.6-5.7) and 4.7 (1.4-15.6), respectively. These findings suggest that, during an MRSA outbreak, clinical infection would be reduced if surgical and intensive care patients received priority for the prevention of initial colonization with MRSA. Prevention of pressure ulcers, and strict aseptic care of intravenous catheters and surgical wounds would also reduce the development of MRSA infection. Since early treatment with vancomycin is known to reduce the mortality, patients colonized with MRSA who also have one or more of these risk factors may warrant empirical vancomycin therapy at the earliest suggestion of infection.

[Air microbiology monitoring in plenum-ventilated operating rooms. Proposed standards]. / Control microbiológico aéreo de quirófanos de ventilación plena. Sugerencia de estándares.

BACKGROUND: Microbiological standard for air in plenum ventilated operating theatres are not defined. The aim of this study was to analyze the microbiological contamination of air in HUSC theatres and to establish standards of reference. METHODS: 408 air samples (80 l/sample) were taken from air intake and center of the theatres in three surgical areas, throughout five consecutive years (1991-1995). RCS air sampler was used. Media of microbiological counts were compared using the ANOVA and the Kruskall-Wallis tests. Microbiological standards were established based on upper limit of confidence interval of counts, when the degree of contamination was similar in two consecutive years. RESULTS: A falling trend of microbiological counts was observed, with statistical significance between counts found in 1992 and those found in 1994 and 1995 (p < 0.01). There was no difference between results of the three surgical areas, but there was a significant difference between counts from air intake and center of theatres, regardless the year or the surgical area (p < 0.01). During this time a significant decrease in the percentage of samples with presence of fungi (p = 0.001) was produced. The results of years 1994 and 1995 were taken for establish the microbiological standards. CONCLUSIONS: This control program allowed to evaluate and improve the hygienic conditions in the operating theatres and to establish a microbiological standards of reference for plenum ventilated theatres.

Nosocomial outbreak of Burkholderia pickettii infection due to a manufactured intravenous product used in three hospitals.

Forty-six cases of nosocomial infection caused by Burkholderia pickettii were reported between June and November 1993 in three metropolitan hospitals in Madrid. A case-control study of the outbreak was conducted to identify its cause. Seventy-four percent of the patients were males; the mean age +/- SD of the patients was 54 +/- 20 years. Sixty-five percent of the patients presented with some gastrointestinal disorder, and 80% had a peripheral catheter; 98% were treated with intravenous fluids, and 96% were treated with intravenous ranitidine. On the basis of results of a descriptive study and knowledge of the epidemiologic features of B. pickettii, a provisional causal hypothesis was formulated: intravenous ranitidine was the source of the outbreak. As a control measure, it was advised to stop treatment with this drug. On the basis of results of logistic regression and the microbiological isolation of B. pickettii in an ampule of the drug, we concluded that intravenous ranitidine was the cause of the outbreak.

The cost of infection in surgical patients: a case-control study.

To determine the excess hospital cost attributable to hospital acquired infection in a UK hospital 67 surgical patients with hospital acquired infection (HAI) were matched with uninfected controls on the primary features of the first operative procedure and primary diagnosis, and on the secondary features of sex, age and surgical service. Costs were calculated from the hospital's unit costs for pathology, radiology and for the cost of one day's extra stay. The mean cost of one day of antibiotic therapy was also measured. In infected patients there was a significant increase in the length of hospital stay of 8.2 days with a mean extra cost per patient of 1041 pounds (P < 0.001). Microbiology, haematology, chemical pathology and radiology requests were all significantly increased with a mean extra cost per infected patient of 10.4 pounds, 7.8 pounds, 96. pounds, and 3.3 pounds, respectively. Antibiotic therapy contributed significantly to the extra costs (44 pounds per infected patient). The mean extra cost per patient was highest in orthopaedic patients (2646 pounds) and least in gynaecology patients (404 pounds). For the infections with significantly increased cost, multiple infections carried the greatest (3362 pounds), and urinary tract infections the least (467 pounds) cost. Hospital length of stay was the greatest contributor to the cost and accounted for 95% of the extra cost in orthopaedics, 94% in gynaecology and 92% in general surgery and urology. Antibiotic therapy was the second most significant contributor to cost and, with the exception of urinary tract infection and infections in gynaecology, was at least five times more per patient than requests for microbiology, haematology, chemical pathology or radiology.

Nosocomial infection by Rhizomucor pusillus in a clinical haematology unit.

Three patients suffering from acute leukaemia were treated with cytotoxic agents and broad-spectrum antibiotics and received blood transfusion and nasal packing for severe epistaxis. All developed necrosis of nasal and facial tissues, with facial swelling an oedema; two biopsies showed typical phycomycete mycelium, and Rhizomucor pusillus was grown from one biopsy. Air and surfaces in the unit and the air intake and ducting were all heavily colonized by Rh. pusillus and other phycomycetes. It is suggested that Rh. pusillus spores from the air invaded the tissues in the conditions promoted by the nasal packing in these patients with impaired defences.