Recommendations for the prevention of healthcare-associated infections in nursing homes.

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

The PHH-1V HIPRA vaccine: a new tool in the vaccination strategy against COVID-19.

OBJECTIVE: Vaccination against SARS-CoV-2 is essential to mitigate the personal, social and global impact of the coronavirus disease (COVID-19) as we move from a pandemic to an endemic phase. Vaccines are now required that offer broad, long-lasting immunological protection from infection in addition to protection from severe illness and hospitalisation. Here we present a review of the evidence base for a new COVID-19 vaccine, PHH-1V (Bimervax®; HIPRA HUMAN HEALTH S.L.U), and the results of an expert consensus. METHODS: The expert committee consisted of Spanish experts in medicine, family medicine, paediatrics, immunology, microbiology, nursing, and veterinary medicine. Consensus was achieved using a 4-phase process consisting of a face-to-face meeting during which the scientific evidence base was reviewed, an online questionnaire to elicit opinions on the value of PHH-1V, a second face-to-face update meeting to discuss the evolution of the epidemiological situation, vaccine programmes and the scientific evidence for PHH-1V and a final face-to-face meeting at which consensus was achieved. RESULTS: The experts agreed that PHH-1V constitutes a valuable novel vaccine for the development of vaccination programmes aimed towards protecting the population from SARS-CoV-2 infection and disease. Consensus was based on evidence of broad-spectrum efficacy against established and emerging SARS-CoV-2 variants, a potent immunological response, and a good safety profile. The physicochemical properties of the PHH-1V formulation facilitate handling and storage appropriate for global uptake. CONCLUSIONS: The physicochemical properties, formulation, immunogenicity and low reactogenic profile of PHH-1V confirm the appropriateness of this new COVID-19 vaccine.

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España / Consensus statement on the use of alemtuzumab in daily clinical practice in Spain

Introducción: Alemtuzumab es un fármaco de alta eficacia aprobado por la Agencia Europea de Medicamentos como tratamiento modificador de la enfermedad en pacientes con esclerosis múltiple remitente recurrente.ObjetivoElaborar un documento de consenso sobre el manejo de alemtuzumab en la práctica clínica habitual, que sea de aplicación en el ámbito español.DesarrolloUn grupo de expertos en esclerosis múltiple revisó las publicaciones disponibles hasta diciembre de 2017, de tratamiento con alemtuzumab y esclerosis múltiple. Se incluyeron trabajos sobre eficacia, efectividad y seguridad, despistaje de infecciones y vacunación, administración y monitorización. La propuesta inicial de recomendaciones fue desarrollada por un grupo coordinador con base en la evidencia disponible y en su experiencia clínica. El proceso de consenso se llevó a cabo en 2 etapas; se estableció como porcentaje inicial de acuerdo grupal el 80%. El documento final con todas las recomendaciones acordadas por el grupo de trabajo se sometió a revisión externa y los comentarios recibidos fueron considerados por el grupo coordinador.ConclusionesEl documento aportado pretende ser una herramienta útil para facilitar el manejo del fármaco en condiciones de práctica clínica habitual. (AU)

Introduction: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis.ObjectiveA consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain.DevelopmentA group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group.ConclusionThe present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice. (AU)

Consensus statement on the use of alemtuzumab in daily clinical practice in Spain. / Consenso de expertos sobre el uso de alemtuzumab en la práctica clínica diaria en España.

INTRODUCTION: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis. OBJECTIVE: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain. DEVELOPMENT: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group. CONCLUSION: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2021 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

[Recovering lost vaccine coverage due to COVID-19 pandemic]. / Recuperando las coberturas vacunales perdidas en la pandemia de COVID-19.

The 2019 coronavirus disease pandemic can have an alarming impact on vaccination coverage. WHO, UNICEF and Gavi warn that at least 80 million children under the age of 1 are at risk of contracting diseases such as diphtheria, measles and polio due to the interruption of routine immunization and the temporary suspension of 93 campaigns of large-scale vaccination.In Spain, a new healthcare scenario, which prioritizes telematics over in person, fear of contagion by going to health centers, and recommendations for physical distance and restricted mobility, reduce attendance at primary care centers. Despite recommendations established by the health authorities, vaccination coverage has decreased in all Autonomous Communities between 5% and 60%, depending on the age and type of vaccine. School vaccinations have been suspended and only vaccination of pregnant women against tetanus, diphtheria and pertussis has been maintained. The decrease has been more evident for non gratuity vaccines: the first dose of meningococcal vaccine B has decreased by 68.4% in the Valencian Community, and Andalusia has observed a 39% decrease in the total doses of this vaccine and of 18% for that of rotavirus.The recovering of vaccinations should be planned, organized and carried out in the shortest possible time.This article discusses some aspects of the recovery of vaccination coverage for different groups: children, adolescents and adults, and patients at risk and in special situations.

Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students.

INTRODUCTION: Hand hygiene is crucial to prevent cross infection. Healthcare students are in a prime position to learn hand hygiene skills. The aim of this study was to analyze hand hygiene behavioral intentions of healthcare students before and after contact with the patient and to compare the knowledge of and attitude towards hand hygiene between medical and nursing students. METHODS: In a descriptive survey research design, convenience selection of a sample of medical students (n=657) and nursing students (n=303) was done from modules taught by the Department of Preventive Medicine and Public Health in both Medicine and Nursing undergraduate degrees in four Spanish universities. The hand hygiene Questionnaire, a validated instrument to evaluate behavior, knowledge, and attitudes, was used. RESULTS: A significantly lower percentage of students reported always or almost always carrying out hand hygiene before contact with the patient or invasive procedures in comparison to the percentage complying after contact with secretions or with the patient. Although hand hygiene knowledge appears acceptable, its importance is not sufficiently valued. CONCLUSIONS: There are deficiencies in behavioral intention, knowledge, and attitudes related to hand hygiene in medical and nursing students. Better results are observed among nursing students, especially those who have received specific training.

[Vaccine-related adverse reactions in immunocompromised patients and in special situations of a hospital Vaccine Unit]. / Reacciones adversas asociadas a la vacunación en pacientes inmunodeprimidos y en situaciones especiales de una Unidad de Vacunas hospitalaria.

OBJECTIVE: The aim of the study was to describe the type of vaccines administered in the Vaccine Unit at a reference hospital. Calculate the overall and specific reporting rate of adverse reactions. METHODS: Retrospective observational study for the period between November 2014 and November 2017, on patients who developed an adverse drug reaction (ADR) after the administration of a vaccine and who were notified to the Spanish Pharmacovigilance System. The variables analyzed were age, sex, risk group, vaccine class, co-administration and type of ADR. A univariate and bivariate analysis was performed. The global and vaccine specific rate of ADR notification was calculated. RESULTS: A total of 18,123 vaccines were administered, of which 20.7% corresponded to hepatitis B virus vaccine. Fifty-three RAM suspects were reported. In 64.2% of cases only one vaccine was administered. Inactivated vaccines accounted for 88.7% of notifications. The highest number of notifications was generated by the 23 serotypes pneumococcal polysaccharide vaccine. The overall reporting rate was 0.42%. The hexavalent vaccine had the highest reporting rate (2.81%). 49.1% of the ADR were systemic. CONCLUSIONS: The overall reporting rate was low but higher than that of other authors. Proper reporting of possible adverse post-vaccine reactions is essential to contribute to vaccine safety and to increase public confidence in vaccines.

[Bronchospasm and flushing after vaccination with 23 serotype pneumococcal polysaccharide in chronic patients]. / Broncoespasmo y flushing tras la vacunación con neumococo polisacárida de 23 serotipos en pacientes crónicos.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a series of suspected systemic adverse reactions registered with the 23 serotype pneumococcal polysaccharide vaccine (PNEUMOVAX23®). Calculate the cumulative incidence of the reaction and know if similar and/or compatible cases have been described in the scientific literature or in pharmacovigilance. METHODS: Observational and retrospective study realized between 01/12/2015 and 30/09/2017 in the Vaccines Unit of an autonomic reference hospital. We calculated the cumulative incidence of the adverse reaction for that vaccine. The common pharmacovigilance database (FEDRA) was consulted. RESULTS: Nine systemic adverse reactions were recorded (flushing + bronchospasm + SatO2<95%). The cumulative incidence was 1.036%. The outcome was recovered/resolved for everyone. No similar and/or compatible cases were found. CONCLUSIONS: The reactions described do not appear in the PNEUMOVAX23® data sheet. Epidemiologically, no causal relationship can be established between the symptoms and the variables studied. This study could be the basis for more detailed research that could modify the vaccine data sheet.

Actitudes de los profesionales sanitarios en la implementación de las recomendaciones oficiales de vacunación antigripal / No disponible

Se ha realizado un estudio para conocer las actitudes de los profesionales sanitarios hacia la recomendación de la vacunación oficial de vacunación antigripal. Para llevar a cabo este estudio se utilizó el cuestionario validado y publicado en la Revista Española de Salud Pública; (CAPSVA) y se pasó a los profesionales sanitarios de las CCAA de Asturias y Canarias. El muestro realizado no fue probabilístico sino de tipo incidental y se recogió cuestionario de 288 profesionales de Asturias y 192 de Canarias. El cuestionario contiene variables socio-demográficas y también variables relacionadas con las indicaciones oficiales de vacunación frente a gripe y características de las vacunas, datos sobre eficacia, efectividad y seguridad y por últimos da-tos sobre la formación que profesionales tienen sobre vacunación. La participación en el estudio fue voluntaria y anónima, y no se proporcionó ningún incentivo por la participación, y contó con la autorización de todos los participantes y con la autorización previa del programa de vacunaciones de cada Consejería, así como con la aprobación del Comité de Ética de la Investigación del Principado de Asturias (ref 34/19). Dentro los principales resultados del estudio el 62,7% dicen haber recibido formación al respecto en vacuna, el 90% de los encuesta-dos considera que la estrategia vacunal seguida en su CCAA mejora el espectro de protección frente a la gripe. Y como aspecto a mejorar manifestaron la necesidad de mantener la formación en este campo tanto en médicos/as como enfermeras/os y farmacéuticos/as. En cuanto a las recomendaciones específicas de la vacunación antigripal, cabe destacar que las más valoradas han sido aquellas que recomiendan la vacunación antigripal a sus propios pacientes con un valor de 2,992 sobre 5, y que la recomendación va ligada al interés del paciente en este caso con un valor de 2,923 sobre 5. En conclusión, las mejoras en las vacunas antigripales, como las vacunas cuadrivalentes, son un factor más a tener en cuenta a la hora de mejorar las coberturas de vacunación antigripal, ya que se percibe como un valor añadido clave tanto en la población general como entre los profesionales sanitarios

A study has been carried out to know the attitudes of health professionals towards the recommendation of the official vaccination of influenza vaccination. To carry out this study, the questionnaire validated and published in the Revista Española de Salud Pública was used; (CAPSVA) and passed to the health professionals of the Autonomous Communities of Asturias and the Canary Islands. The sampling was not probabilistic but of an incidental type and a questionnaire was collected from 288 professionals from Asturias and 192 from the Canary Islands. The questionnaire contains sociodemographic variables and also variables related to the official indications of vaccination against influenza and characteristics of vaccines, data on efficacy, effectiveness and safety and for the latest data on the training that professionals have on vaccination. Participation in the study was voluntary and anonymous, and no incentive for participation was provided, and had the authorization of all participants and prior authorization of the vaccination program of each Ministry, as well as the approval of the Committee on Research Ethics of the Principality of Asturias (ref 34/19). Among the main results of the study, 62.7% say they have received training in this regard in a vaccine, 90% of respondents believe that the vaccine strategy followed in their Autonomous Community improves the spectrum of protection against influenza. And as an aspect to improve, they expressed the need to maintain training in this field in both doctors and nurses and pharmacists. Regarding the specific recommendations of influenza vaccination, it should be noted that the most valued have been those that recommend influenza vaccination to their own patients with a value of 2,992 out of 5, and that the recommendation is linked to the patient's interest in this case with a value of 2,923 out of 5. In conclusion, improvements in influenza vaccines, such as quadrivalent vaccines, are another factor to consider when improving influenza vaccination coverage, as it is perceived as an added value key both in the general population and among health professionals

[Use of hepatitis B AS04C adjuvanted vaccine in HIV patients]. / Uso de vacuna frente a hepatitis B adyuvada con AS04C en pacientes VIH.

OBJECTIVE: Co-infection with hepatitis B virus (HBV) in patients with human immunodeficiency virus (HIV) increases associated morbidity and mortality. Vaccination against HBV has been shown to be the most effective method to prevent this situation. Standard vaccination schemes used in this population do not appear to be effective enough. The objective is to identify the response rate following the use of AS04C-adjuvanted hepatitis B vaccine in HIV patients as well as the possible associated adverse reactions. METHODS: An observational, analytical study with a retrospective cohort of HIV positive patients discharged in 2016 from the Vaccines Unit of a Preventive Medicine and Public Health Service. Patients with antiHBs (-), antiHBcActot (-) and HBsAg (-) at baseline were included, none of them had received prior HBV vaccination. HBV adjuvanted vaccine was used in a 4-dose regimen (0-1-2-6 months). When antiHBs was <10 IU/mL after primovaccination, two additional doses of the same vaccine were applied with an interval of 30 days. RESULTS: A total of 39 patients were included. Of them, 74.4% were men. The mean age was 47.26 years. The response rate after primary vaccination was higher than 92% and up to 100% with the two subsequent doses. No adverse reactions were reported. CONCLUSIONS: The administration of AS04C-adjuvanted hepatitis B vaccine in HIV patients showed a 100% response rate, showing an excellent safety profile.

Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel / Compliance with contact isolation precautions of multidrug-resistant microorganisms in a tertiary hospital

Introducción. El aislamiento preventivo del paciente con microorganismos multirresistentes se considera una medida eficaz para evitar situaciones de brote epidémico en el ámbito hospitalario. El objetivo es evaluar el cumplimiento por parte de profesionales sanitarios y familiares de las precauciones de aislamiento de contacto en pacientes colonizados/infectados con microorganismos multirresistentes. Material y métodos. Estudio observacional desde octubre de 2014 a marzo de 2015. Se diseñó una lista de verificación de monitorización con variables de estructura (dotación material), conocimiento de la situación y cumplimiento de las precauciones por pacientes, familias y profesionales. Se realizó análisis univariante y bivariante. Se utilizaron las pruebas no paramétricas U de Mann-Whitney y KruskalWallis. Resultados. Se realizaron 467 monitorizaciones. El carro se encontraba correctamente ubicado en 453 ocasiones (97%). El tensiómetro individual estaba presente en 421 observaciones (90%), mientras que el fonendoscopio y el termómetro no superaban el 44% (43,9% de 205 y 16,5% de 77, respectivamente). El contenedor de residuos y el producto de base alcohólica se observaron bien ubicados en 461 (98,7%) de los casos. El jabón antiséptico para higiene del paciente se registró correctamente colocado en 348 ocasiones (74%). El 84,9% (305) de los pacientes y el 91,4% (234) de los familiares conocían la situación. El cumplimiento en los profesionales de colocación/retirada de bata desechable y guantes se situó próximo al 50% para la entrada a la habitación (49,5% de 56 y 53,0% de 60, respectivamente) y fue del 40% (28) para la salida. La higiene de manos se registró como realizada en 30 ocasiones (26,5%) a la entrada y 25 (35,2%) a la salida. Conclusiones. Existe un importante margen de mejora en el cumplimiento de las precauciones de aislamiento. El incumplimiento actual no puede ser imputado al déficit de materiales, sino a conductas individuales. Urge implementar y evaluar programas de intervención basados en modelos psicosociales, capaces de modificar la actitud y las conductas relacionadas con las precauciones de aislamiento de contacto por microorganismos multirresistentes (AU)

Introduction. Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. Methods. An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. Results. Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. Conclusions. There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms (AU)

[Compliance with contact isolation precautions of multidrug-resistant microorganisms in a tertiary hospital]. / Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel.

INTRODUCTION: Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. METHODS: An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. RESULTS: Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. CONCLUSIONS: There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms.