Evaluating hazardous waste generation in for-profit outpatient haemodialysis centres.

BACKGROUND: "Green" haemodialysis management to reduce the environmental impact of haemodialysis is growing. OBJECTIVES: Dealing with hazardous waste production could heighten healthcare professionals' awareness of this problem, and improve their healthcare involvement in environmental sustainability and environmental-friendliness. DESIGN AND MEASUREMENTS: A list of for-profit outpatient haemodialysis centres in the Valencian Community (E Spain) was compiled. Data on their hazardous waste production from 2008 to 2012 through the annual waste reports issued by official organisations competent in environmental issues were collected. RESULTS: There are 22 for-profit dialysis centres, that managed the treatment for 69.1% of all dialysis patients in the region. Data were collected from 16 centres that collectively offer 350 dialysis places (33.8% of all the places in this region). Mean annual hazardous waste production per dialysis session increased by 14% during the study period: 0.640 kg per session in 2008 vs. 0.740 kg in 2012. DISCUSSION AND CONCLUSIONS: As hazardous waste production is high, we must examine the reasons why it is growing. Information about haemodialysis waste production and management is scarce and difficult to access. Having an evaluation of its production would motivate further research, especially as end-stage kidney disease is increasing, and whose main long-term treatment, haemodialysis, produces hazardous waste and employs substantial natural resources. Minimising its environmental impact is not mission impossible.

Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario / Adverse events and associated factors in patients who died in a University Hospital

Fundamento y objetivo. El presente trabajo de investigación pretende relacionar los eventos adversos (EA) asociados a la asistencia sanitaria con otro indicador de calidad asistencial como es la mortalidad hospitalaria, determinando la proporción de fallecidos en los que está presente algún EA y qué factores se asocian a una mayor proporción de EA en personas fallecidas. Material y métodos. Inicialmente se realizó un estudio descriptivo de mortalidad de base hospitalaria, seguido de un estudio de casos y controles en pacientes fallecidos. Se estudió la presencia de EA, la probabilidad con la que se hubieran podido prevenir y predecir y su asociación con diversos factores. Resultados. La proporción de EA encontrada fue del 19,8% (82/414), siendo la proporción de pacientes fallecidos que padeció algún EA del 15,5% (64/414). La razón de EA por persona era de 1,28. El EA más frecuente fue la infección nosocomial. El 48,8% de los EA eran prevenibles. No se ha encontrado una diferencia en la presencia de EA por edad ni por sexo. Entre los factores que se asociaron a la presencia de EA destacan la intervención quirúrgica, la estancia y el tipo de servicio en el que estaban ingresados los pacientes. Discusión. La proporción de pacientes fallecidos con EA, el porcentaje de EA prevenibles, el tipo más frecuente (la infección nosocomial) y la relación de la estancia y la intervención quirúrgica con su presencia, nos hacen centrar la atención en el desarrollo de medidas que reduzcan la estancia hospitalaria y en la difusión de las medidas de prevención y control de la infección nosocomial(AU)

Objective. This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. Methods. First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. Results. The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. Discussion. The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection(AU)

[Adverse events and associated factors in patients who died in a university hospital]. / Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario.

OBJECTIVE: This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. METHODS: First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. RESULTS: The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. DISCUSSION: The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection.

Prevalence of Trypanosoma cruzi infection in pregnant Latin American women and congenital transmission rate in a non-endemic area: the experience of the Valencian Health Programme (Spain).

This study describes the results of the health programme implemented in the Valencian Community (Spain) to achieve an early diagnosis of Chagas disease in pregnant Latin American women and their newborns. During 2009 and 2010, 1975 women living in the health districts of three university hospitals were enrolled via midwives or at the time of delivery. Diagnosis of disease was performed using two serological tests with different antigens. Congenital infection was diagnosed by parasitological, molecular or serological methods from blood samples obtained at birth or in subsequent controls. The overall seroprevalence of Chagas infection in pregnant women from 16 different endemic countries was 11·4%. Infection was higher in those from countries in the Gran Chaco Region (Bolivia, 34·1%; Paraguay, 7·4%; Argentina, 5·3%). Eight newborn infants from Bolivian mothers had congenital Chagas which represents a vertical transmission rate of 3·7%. In conclusion, this work supports the benefits of offering an early diagnosis to pregnant women and newborns during routine prenatal healthcare.

Factores predisponentes, facilitadores y reforzantes respecto al tabaquismo en trabajadores sanitarios / Predisposing, enabling and reinforcing factors regarding smoking in healthcare workers

Objetivos: Ante la elevada prevalencia de tabaquismo que continúa existiendo entre el personal sanitario, se ha llevado a cabo este estudio a fi n de identifi car y analizar los Factores Predisponentes, Facilitadores y Reforzantes (PRECEDE) respecto al tabaquismo en trabajadores de un Hospital Universitario Valenciano. Métodos: Se ha realizado un estudio cualitativo transversal, basado en un cuestionario no estructurado sobre los factores que motivan el consumo de tabaco en una muestra aleatoria de 120 trabajadores del Hospital Universitario Dr. Peset, diferenciándose cuatro categorías (n=30): Nunca fumadores, Fumadores habituales, Ex Fumadores sin recaída y Fumadores tras recaída. Resultados: Los principales factores PRECEDE identifi - cados en cada grupo fueron: Nunca Fumadores: Predisponentes (Conocimiento, “sé que es perjudicial”), Facilitadores (entorno familiar no fumador) y Reforzantes (Experiencia, “lo probé y no me gustó”). Fumadores: Predisponentes (“fumar es mi vicio”), Facilitadores (situaciones de estrés) y Reforzantes (“me hace sentir bien”). Ex Fumadores sin Recaídas: Predisponentes (problemas de salud), Facilitadores (deporte, presión familiar y social) y Reforzantes (ahorro económico). Fumadores tras Recaída: Predisponentes (creencia “por uno no pasa nada”), Facilitadores (entorno de fumadores) y Reforzantes (sensación de calma). Conclusiones: Según el estudio realizado, es recomendable que los programas de educación sanitaria contra el tabaquismo en el ámbito hospitalario presten especial atención a los factores relacionados con falsas creencias todavía existentes en el personal sanitario, así como a los entornos de los fumadores (AU)

Objectives: Since a high prevalence of tobacco addiction continues existing among healthcare workers, this study has been carried out in order to identify and to analyze Predisposing, Enabling and Reinforcing factors (PRECEDE) regarding smoking habits in healthcare workers at a Valencian University Hospital. Methods: We performed a qualitative cross-sectional study based on a non-structured questionnaire about factors that motivate smoking habit. A random sample of 120 health-care workers from Dr Peset University Hospital were interviewed and distributed among four categories (n=30): Non-smokers, Smokers, Ex- Smokers without relapses and Smokers with relapse. Results: The most important PRECEDE factor for each group was: Never-smokers: Predisposing (Knowledge, “I know that smoking is detrimental to health”), Enabling (non-smoker’s family environments) and Reinforcing (Experience, “I tried it and I did not like it”). Smokers: Predisposing (“smoking is my vice”) Enabling (stressful situations) and Reinforcing (“it makes me feel good”). Ex-Smokers without Relapses: Predisposing (Health problems), Enabling (Sport, family Pressure and social Perception) and Reinforcing (Cost). Smokers after Relapse: Predisposing (Belief It’s just one cigarette), Enabling (smoker’s environment) and Reinforcing (sensation of calm). Conclusions: According to this study, health promotion programs against smoking in hospitals should pay special attention to factors related to false beliefs among healthcare workers and smoker’s settings (AU)