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.

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain.

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Los GRD y la atención geriátrica hospitalaria / Diagnosis-related groups and geriatric hospital care

No disponible

Disposiciones previas: experiencia piloto en una residencia de ancianos / Advanced dispositions: pilot experience in a nursing home

OBJETIVOS: 1. Facilitar a los residentes con actual autonomía psíquica la realización de sus disposiciones previas. 2. Conocer los valores de los residentes respecto a aspectos asistenciales, organizativos y sus últimas disposiciones. 3. Divulgar las opciones existentes en aspectos asistenciales y legales. MÉTODOS: En noviembre de 2000 se realizaron reuniones informativas con 41 residentes de la Residencia de nuestro centro, seleccionados por no presentar ninguna enfermedad potencialmente mortal ni deterioro cognoscitivo. En el primer trimestre de 2001 se realizó una entrevista individual a los 20 residentes que participaron voluntariamente. El protocolo recoge datos epidemiológicos, puntuaciones en diversas escalas, aspectos organizativos, confesionales, disposiciones de desenlace y actitudes hacia la enfermedad. El resumen fue firmado por residente, médico, trabajadora social y representante elegido. RESULTADOS: 20 participantes: 30 per cent solteros, 45 per cent viudos. 80 per cent saben leer y escribir o tienen estudios primarios. Índice Barthel: media de 73, Mini Mental de Lobo: 25, Escala de Philadelphia: 7,7. Testamento realizado: 35 per cent. Implicación familiar en 60 per cent. Representante elegido: 60 per cent familiar de primer grado. Restricción de visitas o/y llamadas: 10 per cent. El 85 per cent solicitan asistencia religiosa católica. El 80 per cent tiene alguna disposición de desenlace manifestada. El mayor miedo es al dolor (35 per cent) y a la limitación funcional (20 per cent), deseando tratamiento paliativo el 75 per cent de los casos. El 60 per cent quieren recibir información en caso de enfermedad terminal oncológica o degenerativa.El 65 per cent estarían de acuerdo con recibir maniobras de RCP. El 85 per cent no quiere recibir nutrición enteral en caso de demencia. El 5 per cent es donante de córnea previamente, y el 35 per cent tiene deseo de serlo tras la charla. CONCLUSIONES: 1. La realización de disposiciones previas ofrece al residente la posibilidad de discutir con el equipo interdisciplinar aspectos referentes a su atención médica y asistencial que de otra manera no serían tratados. 2. El documento es un instrumento útil para conocer los valores del residente ante una enfermedad grave y ayuda a orientar su manejo en el caso de pérdida del poder de decisión por causa médica. 3. Pese a las actitudes paternalistas, más de la mitad de residentes quieren información en caso de enfermedad terminal y mayoritariamente rechazan medidas artificiales para la nutrición (AU)

Analysis of bed usage and occupancy following the introduction of geriatric rehabilitative care in a hospital in Huesca, Spain.

The decision support system BOMPS (Bed Occupancy Management and Planning Software) is used to document the effects on bed usage and occupancy of policy changes in the role of the provincial hospital of Huesca, Spain. A preliminary analysis of data for 1,834 hospital discharges during the period 1987 to 1996 showed that there was an increase in hospital activity. Estimates of bed usage and occupancy during a calendar year were calculated from aggregated weekly census data. Bed usage by short-stay patients increased following the introduction of rehabilitative care. Bed usage by long-stay patients decreased immediately following the introduction of rehabilitative care, however, the time between admission and census for long-stay patients decreased only after a number of years.