[Prospective study of the incidence density of multi-resistant microorganisms and Clostridioides difficile during the period 2012- 2019 in the Canary Islands]. / Estudio prospectivo de la densidad de incidencia de microorganismos multirresistentes y Clostridioides difficile durante el periodo 2012-2019 en la Comunidad Autónoma de Canarias.

OBJECTIVE: In 2012, the Canary Islands Health Service implemented a new surveillance system for nosocomial infections caused by multi-resistant microorganisms and Clostridioides difficile. This system will make it possible to know the incidence rates of these pathogens, periodically contrast them to monitor their trend and compare them with those of other national and European health institutions. METHODS: Observational, prospective study of the density of incidence of multi-resistant pathogens and Clostridioides difficile in the healthcare centers of the Canary Islands Health Service from 2012 to 2019. RESULTS: The incidence density of methicillin-resistant Staphylococcus aureus infections for 2012 was 1.96 cases per 10,000 stays and decreased to 0.80 in 2019, reaching the lowest figure in the surveillance period. Infections due to carbapenemase-producing Enterobacterales (CPE) showed an upward trend, 0.47 (2014) and 2.35 (2019). The slight upward trend in imipenem-resistant Acinetobacter baumannii infections in observed bacteraemias 0.17 (2012) and 0.09 (2019) has been corrected. No cases of infection with vancomycin-resistant enterococci were observed. With regard to C. difficile, an upward trend that began in 2012 has consolidated, producing an increase of 216% in the number of cases detected at the end of the study period. CONCLUSIONS: The most relevant problem detected today is the CPE. The data analyzed in this period showed an evident change in the trend of the multi-resistant pathogens studied. This fact must be confirmed in the future.

Estudio prospectivo de infección quirúrgica en cirugía cardiaca y adecuación de la profilaxis antibiótica / Prospective study of surgical infection in cardiac surgery and adequacy of antibiotic prophylaxis

Introducción. Las infecciones de localización quirúrgica son un importante problema que limitan los potenciales beneficios de las intervenciones quirúrgicas. Nuestro estudio pretende evaluar si la adecuación de las pautas de profilaxis quirúrgica en cirugía cardiaca disminuye la incidencia de la infección de la localización quirúrgica. Material y método. Estudio prospectivo de la incidencia de infección relacionada con los procedimientos quirúrgicos de cirugía cardíaca en los centros sanitarios del sistema canario de la salud entre los años 2012 y 2019 mediante un sistema de vigilancia epidemiológica. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y las causas de incumplimiento en cirugía cardiaca: indicación, duración, inicio y no repetición. Resultados. En el año 2019 la incidencia acumulada de infección del sitio quirúrgico fue del 3,28% (n = 13), lo que supone mantener la tendencia descendente desde el año 2012 (p<0,05). La aparición de la infección fue más frecuente durante el ingreso (61,5%). La profilaxis quirúrgica fue adecuada en el (95,8%), siendo las principales causas de inadecuación la administración fuera del tiempo estipulado (29%) y la no repetición del antimicrobiano en cirugías de larga duración (29%). No se encontró relación entre la adecuación de la profilaxis y la infección del sitio quirúrgico (p>0,05). Conclusión. Los datos analizados mostraron un cambio evidente en la tendencia de infección. No se encontró asociación significativa entre adecuación de la profilaxis e incidencia de infección de localización quirúrgica. Los sistemas de vigilancia y control de infección permiten evaluar y comparar las tasas de infección en cirugía cardiaca. (AU)

Introduction. Surgically site infections are a major problem that limits the potential benefits of surgical interventions. Our study aims to assess whether the adequacy of surgical prophylaxis guidelines in cardiac surgery reduces the incidence of infection at the surgical site. Material and method. Prospective study of the incidence of infection related to cardiac surgery surgical procedures in the health centers of the Canary Islands health system between 2012 and 2019 using an epidemiological surveillance system. The degree of compliance with antibiotic prophylaxis and the causes of non-compliance in cardiac surgery were evaluated: indication, duration, initiation and non-repetition. Results. In 2019, the cumulative incidence of surgical site infection was 3.28% (n = 13), which implies maintaining the downward trend since 2012 (p <0.05). The appearance of the infection was more frequent during admission (61.5%). Surgical prophylaxis was adequate in (95.8%), the main causes of inappropriateness being administration outside the stipulated time (29%) and non-repetition of the antimicrobial in long-term surgeries (29%). No relationship was found between the adequacy of prophylaxis and surgical site infection (p> 0.05). Conclution. The analyzed data showed an evident change in the infection trend. No significant association was found between adequacy of prophylaxis and incidence of surgical site infection. Surveillance and infection control systems allow the evaluation and comparison of infection rates in cardiac surgery. (AU)

Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel / Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital

Con el objetivo de incrementar la cultura de seguridad en relación con la higiene de manos en el Complejo Hospitalario Universitario Insular Materno-Infantil a través de la presencia de recordatorios y mensajes en todo el centro sobre la importancia de la higiene de manos en la prevención de infecciones, hemos desarrollado nuevo material promocional en el mencionado Complejo Hospitalario, formado por el Hospital Universitario Insular y el Hospital Materno-Infantil, ambos centros de tercer nivel con 450 camas cada uno y acreditados para la docencia MIR. Se contrataron los servicios de un caricaturista profesional, que adaptó el lenguaje a los modismos locales, usando los personajes que habitualmente aparecen en las viñetas del periódico y se siguió trabajando con otros profesionales del diseño gráfico. Se midieron los indicadores de adherencia y consumo de productos de base alcohólica, constatándose un incremento de ambos en los meses posteriores a la implantación de la estrategia. Además se hizo una revisión de infraestructuras relacionadas con la higiene de manos, con lo que comprobamos una clara mejoría en la mayoría de las áreas asistenciales. El material fue muy bien acogido por parte de los profesionales. No se realizó ninguna otra intervención distinta de las habituales, por lo que pensamos que esta estrategia está mejorando la cultura de seguridad en relación con la higiene de manos en nuestros centros (AU)

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting (AU)

[Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital]. / Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel.

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting.

Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias / Assessment of a hand hygiene program on healthcare-associated infection control

Objetivo. Evaluar el impacto de una campaña de promoción de la higiene de manos sobre las tasas de infección en un hospital de tercer nivel en Las Palmas de Gran Canaria. Métodos. Estudio descriptivo ecológico, valorando frecuencia de higiene de manos en 3 áreas asistenciales y las tasas de infecciones. Se consideraron 4 momentos temporales: basal (2005), fase 1 de intervención (2006), fase 2 de intervención (2007) y postintervención (2008). La intervención consistió en introducir productos de base alcohólica, feedback sobre resultados de cumplimiento, diseño y colocación de carteles y sesiones de educación sanitaria, con demostraciones prácticas. Se usaron criterios estandarizados para medir variables. Resultados. Se detectó un incremento en la tasa de cumplimiento a lo largo de los 3 periodos, desde el 19,6% en el periodo basal, al 40,0% final (p<0,001). El incremento del cumplimiento fue más acusado entre las oportunidades de riesgo alto (del 12,0–28,4%; p<0,001), aunque solo tras la primera fase de la campaña y entre las de riesgo medio (del 23,6–41,7%; p<0,001). No obstante, los indicadores de infección aumentaron en todas las áreas vigiladas, en especial la prevalencia de pacientes infectados, del 8% en 2005 al 12,2% en el año 2008. Conclusiones. A pesar del incremento en el cumplimiento de la higiene de manos en las áreas vigiladas, no se han conseguido reducir las tasas de infecciones nosocomiales en el hospital. Una estrategia más eficiente debería implicar a responsables clínicos y directivos en todos los aspectos del control de las infecciones(AU)

Aim. to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. Methods. Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. Results. an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19,6% at baseline to 40,0% (p<0,001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12,0% to 28,4%; p<0,001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12,2% in 2008. Conclusions. Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control(AU)

[Assessment of a hand hygiene program on healthcare-associated infection control]. / Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias.

AIM: to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. METHODS: Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. RESULTS: an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p<0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p<0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008. CONCLUSIONS: Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control.