Definition and clinical management of haemodialysis central venous catheter local infections (exit site and tunnel infection): An international consensus assessment.

AIM: To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD-CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections. BACKGROUND: A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD-CVC). DESIGN: A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries. METHODS: Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4-point Likert-type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study. RESULTS: A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon. CONCLUSION: This Delphi study provides international expert consensus definitions of ESI and TI in HD-CVC, laying the groundwork for the validation of an HD-CVC ES clinical assessment scale for early identification of ESI. RELEVANCE TO CLINICAL PRACTICE: In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD-CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.

Early identification of local infections in central venous catheters for hemodialysis: A systematic review.

BACKGROUND: The use of central venous catheters (CVC) is associated with higher morbidity and mortality, related to infectious complications, contributing to poorer clinical outcomes and increased healthcare costs. According to the literature, the incidence of local infections related to CVC for hemodialysis is highly variable. This variability is related to differences in definitions of catheter-related infections. OBJECTIVE: To identify signs and symptoms for determining local infections (exit site and tunnel tract infections) used in the literature in tunnelled and nontunnelled CVC for hemodialysis. DESIGN: Systematic review METHODS: Structured electronic searches were conducted in five electronic databases, from 1 January 2000-31 August 2022, using key words and specific vocabulary, as well as manual searches in several journals. Additionally, vascular access clinical guidelines and infection control clinical guidelines were reviewed. RESULTS: After validity analysis, we selected 40 studies and seven clinical guidelines. The definitions of exit site infection and tunnel infection used in the different studies were heterogeneous. Among the studies, seven (17,5 %) used the definitions of exit site and tunnel infection based on a clinical practice guideline. Three of the studies (7.5 %) used the Twardowski scale definition of exit site infection or a modification. The remaining 30 studies (75 %) used different combinations of signs and symptoms. CONCLUSIONS: Definitions of local CVC infections are highly heterogeneous in the revised literature. It is necessary to establish a consensus regarding the definitions of hemodialysis CVC exit site and tunnel infections. REGISTRATION: PROSPERO (CRD42022351097).

¿Cómo se muestra la actividad de las enfermeras por las Consejerías de Salud? / How is the nursing activity shown by the Spanish regional health ministries?

Objetivo: Analizar los indicadores de enfermería y los resultados de su actividad publicados por las Consejerías de Salud de las comunidades autónomas. Método: Estudio observacional descriptivo por 2 observadores con buscadores web localizando las memorias de actividad de las organizaciones sanitarias autonómicas. Para cada página web institucional se evaluó la existencia de información de actividad relacionada con «enfermería/enfermera/matrona». Se analizaron los indicadores de resultados asistenciales, de calidad y seguridad clínica y su presentación. Resultados: Configuración de listado de 19 entradas de servicios públicos de salud con los indicadores específicos de actividad enfermera de cada uno, partiendo de 56 webs institucionales analizadas. El perfil de indicadores más frecuentes resultante es: actividad mostrada desagregada por áreas de salud, de 2019, en «PDF», sin visión de género ni de edad, centrados en el número de consultas, frecuentación y presión asistencial en atención primaria. Conclusiones: La oferta de indicadores sanitarios presenta una gran variabilidad estatal. Se puede valorar los aportes cualitativos y cuantitativos autonómicos, centrados más en la estructura, en medir la actividad para la gestión y en el nivel de la atención primaria, pero con un escaso enfoque en la medición de buenas prácticas. Se confirma que la información publicada no refleja la realidad de la actividad enfermera, siendo llamativa la deficiencia de indicadores a nivel hospitalario.(AU)

Objective: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. Method: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to «nursing/nurse/midwife» was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. Results: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in «PDF» format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. Conclusions: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.(AU)

How is the nursing activity shown by the Spanish regional health ministries?

OBJECTIVE: To analyse the nursing records and the results of their activity published by the Spanish regional health ministries. METHOD: Descriptive observational study by two observers with web search engines locating the activity reports of the regional health organizations. The existence of activity information related to "nursing/nurse/midwife" was evaluated for each institutional web page. The indicators of care results, quality and clinical safety and their presentation were analysed. RESULTS: Preparation of a table including 19 public health services entries with specific indicators/records of nursing activity for each one, based on 56 institutional websites. The most frequently resulting profile of indicators is activity shown disaggregated by health areas, from 2019, in "PDF" format, without gender or age vision, focused on the number of consultations, frequentation and healthcare pressure in primary care. CONCLUSIONS: The supply of health indicators presents a great state variability. Regional qualitative and quantitative contributions can be valued, focused more on structure, on measuring activity for management and at the level of primary care but with little focus on measuring good practices. It is confirmed that the published information does not reflect the reality of nursing activity. Being striking the deficiency of hospital activity indicators.

Vacuna contra el SARS-CoV-2 (COVID-19) y enfermedad renal crónica / SARS-CoV-2 vaccine (COVID-19) and chronic kidney disease

La literatura más reciente indica que la enfermedad renal crónica constituye la comorbilidad con mayor riesgo de desarrollar enfermedad grave por SARS-CoV-2, coronavirus 2019 (COVID-19). Muchas sociedades científicas se han posicionado a favor de la vacunación de los pacientes con enfermedad renal crónica como prioritaria, debido a esta alta vulnerabilidad. En España, la quinta actualización de la Estrategia de vacunación frente a COVID-19 del Consejo Interterritorial de Salud, incluyó a los pacientes con ERC dentro del grupo 7 (personas con condiciones de muy alto riesgo). A lo largo del artículo se describen los tipos de vacunas según mecanismo de acción, las vacunas actualmente aprobadas por la Agencia Europea del Medicamento (EMA) y todo lo relacionado con el proceso de vacunación (preparación, administración y seguimiento), además de los aspectos a tener en cuenta en los pacientes con enfermedad renal crónica. (AU)

The most recent evidence indicates that chronic kidney disease is the comorbidity with the highest risk of developing severe disease due to SARS-CoV-2, coronavirus 2019 (COVID-19). Many scientific societies have advocated for vaccination of patients with chronic kidney disease as a priority, due to this high vulnerability. In Spain, the fifth update of the COVID-19 vaccination strategy published by the Interterritorial Health Council included CKD patients in group 7 (people with very high-risk conditions). This manuscript describes the types of vaccines according to mechanism of action, the vaccines currently approved by the European Medicines Agency (EMA) and information related to the vaccination process (preparation, administration and follow-up), as well as aspects to be taken into account in patients with CKD. (AU)

Nursing now: una campaña de todos para todos / Nursing now: a campaign from all for all

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