Evaluación de la infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio multicéntrico de incidencia / Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: A multi-center incidence study

Introducción: Las infecciones de localización quirúrgica (ILQ) son un importante problema que limita los beneficios de las intervenciones quirúrgicas. Se evaluó la incidencia acumulada de ILQ en cirugía de colon y el cumplimiento de la profilaxis antibiótica, así como las causas de su incumplimiento. Métodos: Estudio prospectivo observacional multicéntrico entre los años 2012 y 2019 en 7 hospitales del Servicio Canario de Salud mediante un sistema de vigilancia epidemiológica activa. Se definió ILQ de acuerdo con los criterios de los Centers for Disease Control and Prevention. Resultados: En el año 2019 la incidencia acumulada de ILQ fue del 10,6% (n=80), lo que supone mantener la tendencia descendente desde el año 2012. La aparición de ILQ fue más frecuente durante el ingreso (76%). La profilaxis quirúrgica fue adecuada en el 81,2%, siendo las principales causas de inadecuación la duración excesiva de la prescripción del antimicrobiano (49%) y los fallos en la indicación (33%). La incidencia ha sido superior en el grupo de ILQ órgano-espacio (53,75% del total) en comparación con las superficiales o profundas. Conclusión: La incidencia acumulada de ILQ obtenida es similar a la calculada en otros estudios realizados en condiciones semejantes. La quimioprofilaxis preoperatoria fue adecuada en la mayoría de intervenciones. (AU)

Introduction: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. Methods: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. Results: In 2019, the cumulative incidence of SSIs was 10.6% (n=80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. Conclusion: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions. (AU)

Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: a multi-center incidence study.

INTRODUCTION: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. METHODS: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. RESULTS: In 2019, the cumulative incidence of SSIs was 10.6% (n = 80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. CONCLUTION: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions.

[Application of the self-evaluation questionnaire of the WHO multimodal strategy to improve the practice of hand hygiene in a tertiary hospital]. / Aplicación del cuestionario de autoevaluación de la estrategia multimodal de la OMS para mejorar la práctica de higiene de manos en un hospital de tercer nivel.

OBJECTIVE: Hand hygiene (HH) is the single most important and effective measure to reduce the risk of healthcare-related infections. However, low compliance with HH indications among healthcare professionals is often low. The objective of this study was to evaluate the implementation of a multimodal strategy to promote HH among healthcare professionals. METHODS: We used the "Application guide of the multimodal strategy of the World Health Organization for the improvement of hand hygiene", which consists of: changes to the system, education and training, evaluation and feedback, workplace reminders, organizational safety climate and monitoring of compliance with HH. The strategy was designed as an intervention study to promote HH in the Maternal and Child Insular University Hospital Complex in the period 2012-2020. RESULTS: Overall compliance with the HH indications at the end of the study period was 59.2%. The use of alcoholic-based products increased with respect to previous years (p <0.05), reaching 70 liters/1000 hospital admissions in the final year. Healthcare professionals perceived training and accessibility to an alcohol-based preparation at each point of care as the most effective measures for promoting good HH practice. CONCLUSIONS: The implementation of a multimodal intervention significantly improved compliance with handwashing and the use of alcohol-based products among healthcare professionals. Despite having previous training on hand hygiene, HH knowledge among professionals remains incomplete. Prior training followed by time worked are the most important determinants of knowledge and perceptions about hand hygiene.

Objetivo. El objetivo de este trabajo es evaluar la implementación de la aplicación de una estrategia multimodal para impulsar la promoción de la Higiene de Manos (HM). Métodos. Se utilizó la «Guía de aplicación de la estrategia multimodal de la Organización Mundial de la Salud para la mejora de la higiene de manos¼. La estrategia se planteó como un estudio de intervención para promover la HM en el Complejo Hospitalario Universitario Insular Materno Infantil en el período 2012-2020. Resultados. El cumplimiento global de las indicaciones de HM al final del periodo de estudio fue del 59,2%. El consumo de productos de base alcohólica aumentó con respecto a los años anteriores (p<0,05), siendo en el último año de 70 litros por cada 1000 estancias. La encuesta reveló que la formación y la existencia de preparado de base alcohólica en cada punto de atención eran percibidas por parte de los profesionales sanitarios como los principales aspectos facilitadores de la práctica de HM. Conclusiones. La implementación de una intervención multimodal mejoró significativamente la adhesión al lavado de manos y el uso de productos de base alcohólica entre los profesionales sanitarios. A pesar de tener formación previa sobre higiene de manos, los conocimientos de los profesionales son incompletos. La formación previa seguido del tiempo trabajado son los determinantes más importantes de las conocimientos y percepciones sobre higiene de manos.

Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: A multi-center incidence study. / Evaluación de la infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio multicéntrico de incidencia.

INTRODUCTION: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. METHODS: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. RESULTS: In 2019, the cumulative incidence of SSIs was 10.6% (n=80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. CONCLUSION: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions.

Reprocesado en endoscopia flexible: Elementos esenciales y controversias / No disponible

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Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel / Staphylococcus aureus resistant to methicillin and usual decolonizers with a reservoir in a health worker in a tertiary hospital

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Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria / Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)

Introducción. Los microorganismos multirresistentes (MMR) son causa importante de infección nosocomial, su manejo clínico-terapéutico es complicado y producen elevada morbimortalidad, con aumento de costes sanitarios asociados. En centros sanitarios de larga estancia (CSLE), la colonización/infección de sus residentes por MMR es cada vez mayor, pudiendo estos actuar como reservorios y vehículos para brotes de cepas resistentes en los hospitales de agudos. Los objetivos del estudio fueron determinar la prevalencia de portadores de MMR y detectar factores asociados al estado de portador. Material y métodos. Estudio de prevalencia de corte en 235 residentes de 2 CSLE en Las Palmas de Gran Canaria (Islas Canarias, España) entre octubre y noviembre del 2012. Se investigó la presencia de MMR en frotis nasal, faríngeo y rectal utilizando medios de cultivo selectivos. Se estudiaron los factores de riesgo asociados al estado de portador mediante análisis univariante y multivariante. Resultados. El 36,2% de residentes fueron portadores de al menos un MMR. El 26,6% fueron portadores de enterobacterias productoras de betalactamasa de espectro extendido y el 10,2% portadores de SARM. Los factores asociados significativamente con la colonización por MMR fueron: colonización-infección previa por MMR, ingreso hospitalario en los últimos 3 meses, infecciones de repetición del tracto urinario y enfermedad arterial periférica. Conclusiones. La prevalencia de MMR en estos CSLE es mayor que la encontrada en la bibliografía, especialmente la de enterobacterias BLEE. Debido a la alta prevalencia de infección/colonización por MMR y los factores de riesgo asociados al estado de portador, es posible que los CSLE actúen de reservorio de MMR y además su diseminación se facilite con el traslado de estos pacientes a hospitales en episodios agudos (AU)

Introduction. Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state. Material and methods. A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis. Results. More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease. Conclusions. The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting (AU)

[Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)]. / Prevalencia y factores asociados a la colonización de microorganismos multirresistentes en centros de larga estancia de Gran Canaria.

INTRODUCTION: Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state. MATERIAL AND METHODS: A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis. RESULTS: More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease. CONCLUSIONS: The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting.

Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure.

BACKGROUND: The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery. OBJECTIVES: The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI). METHODS: Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation. RESULTS: Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients. CONCLUSION: FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.

Outbreak of Pseudomonas aeruginosa infections in a neonatal care unit associated with feeding bottles heaters.

This report describes an outbreak caused by Pseudomonas aeruginosa in a neonatal care unit possibly linked to feeding bottles heaters. Infection control measures were undertaken such as reinforcement of contact isolation precautions, environmental microbiologic sampling, educational sessions on hand hygiene, and use of sterilized water to refill feeding bottles heaters. The sustained eradication of P aeruginosa isolates after implementing control measures on feeding bottles heaters strongly suggests those as the source of the outbreak.

[Antibiotic ointments and methicillin-resistant Staphylococcus aureus with a reservoir in a healthcare worker in a tertiary hospital]. / Staphylococcus aureus resistente a la meticilina y a descolonizadores habituales con reservorio en un trabajador sanitario en un hospital de tercer nivel.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission. METHODS: Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources. RESULTS: From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012). CONCLUSION: This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers.

Malaria in paradise: characterization of imported cases in Gran Canaria Island (1993-2006).

BACKGROUND: Spain obtained the official certificate of malaria eradication in 1964. However, imported malaria cases have been increasing during the last few decades in this country. This study aims to describe the clinical and epidemiological features of patients diagnosed with malaria on Gran Canaria Island. METHODS: A retrospective study was conducted based on case review of all patients diagnosed with malaria microbiologically confirmed from 1993 to 2006, at the three referral teaching hospitals on Gran Canaria Island. RESULTS: One hundred eighty-four episodes in 181 patients were diagnosed, 170 of them were analyzed. Most of them (82%) were travelers. Nearly 15% (14.7%) declared having had some chemoprophylaxis, but only half of them completed the treatment. Twenty cases (10.9%) were diagnosed who had just arrived as immigrants, mainly children. Malaria was acquired in Africa by 94.7% of the cases and Plasmodium falciparum was responsible for the majority of the cases (84.1%). Clinical and epidemiological differences were observed among different groups of patients formed by their origin and travel purposes. At least one indicator of severe malaria was established in 22.9% of the cases. However, global mortality was 3.8%. CONCLUSIONS: Malaria in Gran Canaria Island is imported from endemic areas, mainly from African countries, observed mostly among young adult males, but clinical and epidemiological features may change among different groups of patients. The number of immigrants diagnosed with malaria is increasing in this area nowadays.

Screening for tuberculosis infection in spanish healthcare workers: Comparison of the QuantiFERON-TB gold in-tube test with the tuberculin skin test.

OBJECTIVE: The risk of latent tuberculosis (LTBI) in healthcare workers (HCWs) is high. Until recently, the tuberculin skin test (TST) was the only diagnostic test available for Mycobacterium tuberculosis infection. A new enzyme-linked immunosorbent assay test, the QuantiFERON-TB Gold (QFT-G) test, was recommended by the US Centers for Disease Control and Prevention as an alternative test for the diagnosis of LTBI in HCWs. The purpose of our study was to compare the TST and the QFT-G test in Spanish HCWs in order to improve procedures for the detection of LTBI. METHODS: A cross-sectional study with blinded comparison of TST and QFT-G test results was carried out among 134 HCWs at an 800-bed Spanish university hospital. The level of interferon-gamma production stimulated by the QFT-G test was measured. A concentration of at least 0.35 IU/mL was considered a positive result. An induration of at least 5 mm in non-BCG-vaccinated or at least 15 mm in BCG-vaccinated HCWs for the TST was considered positive. RESULTS: Of the 134 HCWs included (mean age, 33.4 years; 101 [75.4%] women; 47 [35.1%] BCG vaccinated), the LTBI prevalence diagnosed with any test was 11.2% (95% confidence interval, 6.6%-18.1%), with the TST was 8.96%, and with the QFT-G test was 5.97% (nonsignificant differences). The QFT-G test value was higher in subjects with TST induration of at least 15 mm than in subjects with TST induration of less than 15 mm (P < .001). Overall agreement between the results of the two tests was found in 94% of HCWs (kappa = 0.56), but agreement was only 59% in HCWs who had a positive result for both tests. Disagreement was present in the results found for 5% of HCWs. CONCLUSIONS: Few studies have compared both tests in populations with high M. tuberculosis exposure but low BCG vaccination prevalence. Agreement between both tests is high, especially among negative results. Studies are needed to clarify the reasons for disagreement and to establish the best TST and QFT-G test cutoff point.

[Surveillance and control of methicillin-resistant Staphylococcus aureus in Spanish hospitals. A GEIH-SEIMC and SEMPSPH consensus document]. / Vigilancia y control de Staphylococcus aureus resistente a meticilina en hospitales españoles. Documento de consenso GEIH-SEIMC y SEMPSPH.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen, both in-hospital and in the community. Although there are several guidelines with recommendations for the control of this microorganism, the measures proposed are not uniformly implemented in Spanish hospitals. The objective of this document is to provide evidence-based recommendations that are applicable to Spanish hospitals, with the aim of reducing transmission of MRSA in our health care centers. The recommendations are divided into the following groups: surveillance, active detection of colonization in patients and health care workers, control measures for colonized or infected patients, decolonization therapy, environmental cleaning and disinfection, antimicrobial consumption, measures for non-hospitalized patients, and others. The main measures recommended include appropriate surveillance, hand hygiene, and implementation of active surveillance, contact precautions, and environmental cleaning.

Vigilancia y control de Staphylococcus aureus resistente a meticilina en hospitales españoles. Documento de consenso GEIH-SEIMC y SEMPSPH / Surveillance and control of methicillin-resistant Staphylococcus aureus in Spanish hospitals A GEIH-SEIMC and SEMPSPH consensus document

Staphylococcus aureus resistente a meticilina (SARM)es un patógeno de gran trascendencia. Aunque existen numerosas guías para el control de este microorganismo, la aplicación de las medidas de control es heterogénea en los hospitales españoles. Este documento pretende ofrecer recomendaciones basadas en la evidencia aplicables a nuestros centros, con el objetivo de reducir la transmisión de SARM en los centros sanitarios. Las recomendaciones se distribuyen en aspectos relacionados con la vigilancia, la detección activa de la colonización en pacientes y sanitarios, las medidas de control con los pacientes colonizados o infectados, el tratamiento de descolonización, la limpieza y desinfección ambiental, el consumo de antimicrobianos, las actuaciones en pacientes no hospitalizados y otros. Las medidas principales se refieren a una adecuada vigilancia, la higiene de manos, la detección activa de pacientes colonizados, el uso de precauciones de contacto y la limpieza ambiental (AU)

Methicillin-resistant Staphylococcus aureus (MRSA)is an important pathogen, both in-hospital and in the community. Although there are several guidelines with recommendations for the control of this microorganism, the measures proposed are not uniformly implemented in Spanish hospitals. The objective of this document is to provide evidence-based recommendations that are applicable to Spanish hospitals, with the aim of reducing transmission of MRSA in our health care centers. The recommendations are divided into the following groups: surveillance, active detection of colonization inpatients and health care workers, control measures for colonized or infected patients, decolonization therapy, environmental cleaning and disinfection, antimicrobial consumption, measures for non-hospitalized patients, and others. The main measures recommended include appropriate surveillance, hand hygiene, and implementation of active surveillance, contact precautions, and environmental cleaning (AU)

Incrementar la adherencia a la higiene de manos en el hospital es posible / Greater hand hygiene adherence in hospitals is possible

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Surveillance and risk factors on hysterectomy wound infection rate in Gran Canaria, Spain.

OBJECTIVES: Surveillance programs for nosocomial infection control may find out opportunities for improvement. The aim of this study was to determine the incidence of surgical site infection and their potential risk factors after hysterectomy in a tertiary hospital in Gran Canaria, Spain. STUDY DESIGN: Prospective study on patients undergoing abdominal or vaginal hysterectomy between 1st June 2000 and 31st December 2004. Surgical site infection incidence rates were calculated according to procedure, and National Nosocomial Infection Surveillance (NNIS) system risk categories. We also reviewed antimicrobial prophylaxis use and morbidity. To determine associate risk factors a multivariate analysis was performed. RESULTS: A total of 1540 women were surveyed; neoplasm (30.5%), obesity (24.3%), and diabetes (16.2%) grouped the main morbidity. About 81 cases (5.2%) met criteria for postoperative surgical site infection (6.0% for abdominal procedure and 3.1% for vaginal procedure). Most patients (86.4%) had adequate antimicrobial prophylaxis, but inadequacy was more frequent by vaginal (17.6%) than abdominal procedure (12.0%) (p=0.005). NNIS high-risk patients had significantly higher infection rates than did low-risk patients (p=0.01). The most common causative organism isolated was Escherichia coli (17.5%). Multivariate analysis showed obesity, inadequate antimicrobial prophylaxis, and abdominal procedure as the main risk factors. CONCLUSION: Rate of surgical site infection is high. Enhanced and multidisciplinary efforts are needed.