Impact of the “Zero Resistance” program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study / Impacto del Proyecto “Resistencia Zero” en la adquisición de bacterias multirresistentes en pacientes ingresados en Unidades de Cuidados Intensivos en España. Estudio de intervención, multimodal y multicéntrico

Objective To assess the impact of a multimodal interventional project (“Zero Resistance”) on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient’s ICU stay. Design Prospective, open-label, interventional, multicenter study. Setting 103 ICUs. Patients Critically ill patients admitted to the ICUs over a 27-month period. Interventions Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU. Main variable of interest Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection. Results A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31–1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83–1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52–1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57–0.80, p<0.0001). Conclusions The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient’s ICU stay (AU)

Objetivo Evaluar el impacto de un proyecto de intervención multimodal (“Resistencia Zero”, RZ) en la adquisición de bacterias multirresistentes (BMR) durante la estancia en UCI. Diseño Estudio prospectivo, abierto, intervencionista, multicéntrico. Ámbito 103 UCI. Pacientes Pacientes críticos ingresados en UCI, durante un período de 27 meses. Intervenciones Implementación de un paquete de 10 recomendaciones para prevenir la aparición y propagación de BMR en UCI. Principal variable de interés Tasa de pacientes que adquieren BMR durante su estancia en UCI, diferenciando entre colonización e infección. Resultados Se incluyeron 139.505 pacientes. En 5.409(3,9%), se identificaron 6.020 BMR al ingreso y en 3.648(2,6%), se aislaron 4.269 nuevas BMR durante la estancia en UCI. La tasa de pacientes con BMR detectadas al ingreso aumentó significativamente (IRR 1,43, IC 95% 1,31–1,56) (p<0,001) durante el periodo de estudio, con un incremento del 32,2% entre las tasas mensuales inicial y final. Por el contrario, la tasa de pacientes con BMR detectadas durante la estancia en UCI disminuyó, no significativamente (IRR 0,93, IC 95% 0,83–1,03) (p=0,174), con una disminución del 24,9% entre las tasas mensuales iniciales y finales. Según la clasificación en colonización o infección, hubo un aumento significativo de colonizaciones por BMR detectadas al ingreso (IR 1,69, IC 95% 1,52–1,83; p<0,0001) y una disminución significativa de infecciones producidas por BMR adquiridas durante la estancia en UCI (IR 0,67, IC 95% 0,57–0,80, p<0,0001). Conclusiones La implementación de las recomendaciones del proyecto RZ se asoció con una reducción significativa de pacientes con infecciones por BMR adquiridas en UCI (AU)

Impact of the "Zero Resistance" program on acquisition of multidrug-resistant bacteria in patients admitted to Intensive Care Units in Spain. A prospective, intervention, multimodal, multicenter study.

OBJECTIVE: To assess the impact of a multimodal interventional project ("Zero Resistance") on the acquisition of multidrug-resistant bacteria (MDR-B) during the patient's ICU stay. DESIGN: Prospective, open-label, interventional, multicenter study. SETTING: 103 ICUs. PATIENTS: Critically ill patients admitted to the ICUs over a 27-month period. INTERVENTIONS: Implementation of a bundle of 10 recommendations to prevent emergence and spread of MDR-B in the ICU. MAIN VARIABLE OF INTEREST: Rate of patients acquiring MDR-B during their ICU stay, with differentiation between colonization and infection. RESULTS: A total of 139,505 patients were included. In 5409 (3.9%) patients, 6020 MDR-B on ICU admission were identified, and in 3648 (2.6%) patients, 4269 new MDR-B during ICU stay were isolated. The rate of patients with MDR-B detected on admission increased significantly (IRR 1.43, 95% CI 1.31-1.56) (p<0.001) during the study period, with an increase of 32.2% between the initial and final monthly rates. On the contrary, the rate of patients with MDR-B during ICU stay decreased non-significantly (IRR 0.93, 95% CI 0.83-1.03) (p=0.174), with a 24.9% decrease between initial and final monthly rates. According to the classification into colonization or infection, there was a highly significant increase of MDR-B colonizations detected on admission (IRR 1.69, 95% CI 1.52-1.83; p<0.0001) and a very significant decrease of MDR-B-infections during ICU stay (IRR 0.67, 95% CI 0.57-0.80, p<0.0001). CONCLUSIONS: The implementation of ZR project-recommendations was associated with a significantly reduction an infection produced by MDR-B acquired during the patient's ICU stay.

Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

BACKGROUND: Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a "Train-the-Trainers" (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. METHODS: We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. RESULTS: Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. CONCLUSIONS: The TTT in hand hygiene model proved to be effective in enhancing participant's knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

Los cuidados con clorhexidina bucal en la prevención de la neumonía asociada a ventilación mecánica a debate / Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study

Propósito: La clorhexidina oral es un antiséptico ampliamente utilizada en pacientes hospitalizados y ambulatorios para mantener la salud oral. El objetivo del estudio es analizar el efecto de los cuidados orales con clorhexidina sobre la mortalidad en la población general hospitalizada de un centro sanitario. Método: Es un estudio de cohortes, observacional de un único centro, retrospectivo, que incluye pacientes adultos entre 2012 y 2014. La mortalidad asociada a los cuidados orales con clorhexidina se evaluó mediante análisis de regresión logística. Se consideró una dosis acumulativa de clorhexidina de 300mg como proxy dicotómico para la exposición al antiséptico. Se ajustan los resultados según datos demográficos, categorías de diagnóstico y riesgo de mortalidad expresados en cuatro categorías (menor, moderado, mayor y extremo). Resultados: La cohorte de estudio incluyó a 82.274 pacientes, de los cuales un 14% recibieron cuidados orales con clorhexidina. Un nivel bajo de exposición a la clorhexidina (≤300mg) se asoció a un mayor riesgo de muerte [odds ratio (OR) 2.61; IC del 95% 2,32-2,92]. Esta asociación fue más fuerte en pacientes con un menor riesgo de muerte: [odds ratio (OR) 5.50; IC del 95% 4.51-6.71] para riesgo menor/moderado, [odds ratio (OR) 2.33; IC del 95% 1.96-2.78] para riesgo mayor y [odds ratio (OR) 1.13;IC del 95% 0.90-1.41] no significativo para riesgo extremo. El estudio analiza también el riesgo alto para la exposición a clorhexidina (≤300mg) y no se observan diferencias en la mortalidad entre pacientes críticos ventilados y no ventilados pero sí se observa un incremento del riesgo de muerte en aquellos pacientes que no habían estado ventilados mecánicamente y que no habían estado ingresados en UCI. El número de pacientes que debían estar expuestos para tener un caso de letalidad adicional fue de 47.1 (IC del 95%; 45.2-49,1). Discusión/Conclusión: Los datos obtenidos argumentan la necesidad de replantear el uso indiscriminado y generalizado de los cuidados orales con clorhexidina en los pacientes hospitalizados en ausencia de beneficios comprobados en poblaciones específicas

No disponible

Competencias de la enfermera de prevención y control de infecciones (EPyCI) / No disponible

No disponible

Assessment of a training programme for the prevention of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. AIM: To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. METHOD: A prospective, quasiexperimental, pre- and post-study of the nursing team in a 16-bed medical/surgical ICU. Pre-intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post-intervention phase mirrored the pre-intervention phase. FINDINGS: Nurses answered more questions correctly on the post-intervention questionnaire than on the pre-intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post-intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). CONCLUSION: The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance.

Impacto de acciones de mejora en la prevención de infección urinaria nosocomial (IUN) en pacientes con sondaje vesical (1991-2010) / No disponible

Aproximadamente el 19% (EPINE 2010) (1) de los pacientes ingresados en un centro sanitario está sometido de forma temporal a la cateterización de las vías urinarias (CV). En el caso de los pacientes ingresados en una unidad de cuidados intensivos esta cifra puede alcanzar el 71,10% (ENVIN-UCI 2010) (2). Aunque los efectos adversos asociados a este procedimiento son relativamente benignos, en ocasiones pueden derivar en complicaciones más graves con aumento de la morbilidad, de los costes asociados y que generan un importante disconfort para el paciente (3). En mayo de 1991, en el marco de nuestra participación en un estudio multicéntrico sobre uso de CV en los hospitales (4), detectamos que en nuestro centro el 9% de los pacientes ingresados era portador de CV y de ellos un 27,5% presentaba IUN (3). Aunque nuestros resultados no discrepaban de los obtenidos en el conjunto de hospitales, consideramos que estos valores ofrecían una clara oportunidad de mejora. Un dato relevante fue la evidencia de que (..) (AU)

Approximately 19% (EPINE 2010) (1) of the patients admitted to a health care center are submitted in a temporary way to the catheterization of the urinary ways (CV). In the case of the patients admitted to an intensive care unit this number can reach 71.10% (ENVIN-UCI 2010) (2). Although the adverse effects associated to this procedure are relatively benign, on occasions, they can derive, in more severe complications with increase of the morbidity, from the associated costs and that generate an important discomfort for the patient (3). In May 1991, within the framework of our participation in a multicentre study on use of CV in the hospitals (4), we detect that in our health care center 9% of new patients were wearing CV and of them 27.5% had IUN (3). Although our results did not (..) (AU)

[The VAMP device. Benefits for the critical patient]. / Dispositivo VAMP. Beneficios para el paciente crítico.

Taking blood samples by means of conventional intravascular devices requires throwing away an initial volume of mixed blood and serum which comprises between 24-26% of the volume of blood extracted from the patient admitted into an intensive care ward. At present time there exists a device with a reservoir, VAMP, which permits one to obtain blood samples without having to waste this initial volume. The working hypothesis poses that the use of the VAMP device decreases the risk of transfusion. This study has a random prospective design. This study subjects are 58 patients admitted in the intensive care ward at the Parc Taulí Corporation distributed in a control group which made use of a conventional device and a VAMP group which made use of the device having a reservoir. The study used a data recordsheet. Statistical calculations were carried out on the SPSS program.

Dispositivo vamp / Vamp device

La obtención de muestras de sangre a través de dispositivos intravasculares convencionales, requiere desechar un volumen inicial de mezcla de sangre y suero, que representa entre un 24-26 por ciento del volumen de sangre extraído al paciente ingresado en U.C.I. Actualmente existe un dispositivo con reservorio (VAMP) que permite obtener la muestra sin desechar este volumen inicial.La hipótesis de trabajo plantea que el uso del dispositivo VAMP disminuye el riesgo de transfusión. El diseño del estudio es prospectivo randomizado. Los sujetos de estudio son 58 pacientes ingresados en la U.C.I. de la Corporació Parc Taulí (C.P.T.), distribuidos en grupo control (portador de dispositivo convencional) y grupo VAMP (portador de dispositivo con reservorio). Se ha utilizado como instrumento una hoja de recogida de datos. Los cálculos estadísticos se han realizado con el programa SPSS (AU)