Effectiveness of the BNT162b2 mRNA Covid-19 vaccine in Spanish healthcare workers.

INTRODUCTION: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. MATERIAL AND METHODS: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. RESULTS: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. CONCLUSIONS: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.

Effectiveness of the BNT162b2 mRNA Covid-19 vaccine in Spanish healthcare workers / Impacto de la vacuna BNT162b2 de mRNA frente a COVID-19 en personal sanitario español

Introduction: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. Material and methods: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. Results: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. Conclusions: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.(AU)

Introducción: Los trabajadores sanitarios (TS) de primera línea tienen mayor riesgo de infectarse de SARS-CoV-2 que la población general, por lo que han sido un grupo prioritario para la vacunación frente a COVID-19. Comparamos la incidencia y prevalencia de TS infectados antes y después de la vacunación con BNT162b2 mRNA frente a COVID-19. Material y métodos: Estudio prospectivo observacional realizado entre 01 de diciembre de 2021 en el Hospital Universitario La Paz, Madrid, España. Se registraron los casos positivos para SARS-CoV-2 en TS y se compararon con los hospitalizados por COVID-19. Resultados: Dos semanas tras la primera ronda de vacunación las nuevas infecciones en TS (sintomáticas y asintomáticos) disminuyeron sustancialmente y los casos acumulados de TS infectados y pacientes hospitalizados por COVID-19 empezaron a divergir. No hubo nuevas infecciones en TS vacunados a los siete días de la segunda dosis de la vacuna. Conclusión: La vacuna BNT162b2 mRNA frente a SARS-CoV-2 es altamente eficaz en TS españoles.(AU)

Effectiveness of the BNT162b2 mRNA Covid-19 vaccine in Spanish healthcare workers.

Introduction: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. Material and methods: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. Results: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. Conclusions: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.

Introducción: Los trabajadores sanitarios (TS) de primera línea tienen mayor riesgo de infectarse de SARS-CoV-2 que la población general, por lo que han sido un grupo prioritario para la vacunación frente a COVID-19. Comparamos la incidencia y prevalencia de TS infectados antes y después de la vacunación con BNT162b2 mRNA frente a COVID-19. Material y métodos: Estudio prospectivo observacional realizado entre 01 de diciembre de 2021 en el Hospital Universitario La Paz, Madrid, España. Se registraron los casos positivos para SARS-CoV-2 en TS y se compararon con los hospitalizados por COVID-19. Resultados: Dos semanas tras la primera ronda de vacunación las nuevas infecciones en TS (sintomáticas y asintomáticos) disminuyeron sustancialmente y los casos acumulados de TS infectados y pacientes hospitalizados por COVID-19 empezaron a divergir. No hubo nuevas infecciones en TS vacunados a los siete días de la segunda dosis de la vacuna. Conclusión: La vacuna BNT162b2 mRNA frente a SARS-CoV-2 es altamente eficaz en TS españoles.

First wave of the COVID-19 pandemic in Madrid: handling the unexpected in a tertiary hospital.

Introduction: The COVID-19 pandemic was declared on March 11th, 2020. By the end of January, the first imported cases were detected in Spain and, by March, the number of cases was growing exponentially, causing the implementation of a national lockdown. Madrid has been one of the most affected regions in terms of both cases and deaths. The aim of this study is to describe the epidemic curve and the epidemiological features and outcomes of COVID-19 patients hospitalized in La Paz University Hospital, a tertiary hospital located in Madrid. Methods: We included confirmed and probable COVID-19 cases admitted to our centre from February 26th to June 1st, 2020. We studied trends in hospitalization and ICU admissions using joinpoint regression analysis. Results: A sample of 2970 patients was obtained. Median age was 70 years old (IQR 55-82) and 54.8% of them were male. ICU admission rate was 8.7% with a mortality rate of 45.7%. Global CFR was 21.8%. Median time from symptom onset to death was 14 days (IQR 9-22). Conclusions: We detected an admissions peak on March 21st followed by a descending trend, matching national and regional data. Age and sex distribution were comparable to further series nationally and in western countries.

Effectiveness of the BNT162b2 mRNA Covid-19 vaccine in Spanish healthcare workers.

INTRODUCTION: Frontline health care workers (HCW) have higher risk than the general population to become infected by SARS.CoV.2, so they were a priority group for Covid-19 vaccine administration. We compared the incidence and prevalence of HCW infected pre-and post-vaccination with the BNT162b2 mRNA COVID-19 vaccine. MATERIAL AND METHODS: Prospective observational study carried out between 01/12/20 and 07/03/21 in La Paz University Hospital, Madrid (Spain). SARS.CoV.2 positive cases in HCW after vaccination were collected and compared to those hospitalized COVID-19 patients at the same hospital. RESULTS: Two weeks after finishing the first round of vaccinations daily new cases of HCW infections (symptomatic and asymptomatic) decreased substantially and cumulative cases of infected HCW and hospitalized COVID-19 patients started to diverge. No new positive cases of HCW infection were registered seven days after the second dose of BNT162b2 mRNA COVID-19 vaccine. CONCLUSIONS: BNT162b2 mRNA COVID-19 vaccine is highly effective in Spanish HCW.

Population structure of OXA-48-producing Klebsiella pneumoniae ST405 isolates during a hospital outbreak characterised by genomic typing.

OBJECTIVES: The aim of this study was to investigate the structure of a broad and sustained hospital outbreak of OXA-48-producing Klebsiella pneumoniae (KpO48) belonging to sequence type 405 (ST405). METHODS: Whole-genome sequencing and comparison of ten ST405 KpO48 isolates obtained from clinical samples in our hospital was performed. Using stringent criteria, 36 single nucleotide polymorphisms (SNPs) were detected (range 0-21 in pairwise comparisons), and allele-specific PCR was used to call the SNPs among a larger set of isolates. RESULTS: Several haplotypes were identified within the population. The haplotypes did not show a spatial structure, but a temporal evolution of sequential haplotype replacements was observed. CONCLUSIONS: The dispersed spatial distribution suggests a reservoir formed by a large pool of colonised patients, and the temporal replacement pattern suggests that the sustained outbreak was composed of several small outbreaks that appeared and rapidly dispersed to several units.

Bla-OXA48 gene microorganisms outbreak, in a tertiary Children's Hospital, Over 3 years (2012-2014): Case Report.

RATIONALE: Carbapenem-resistant Enterobacteriaceae are an emerging problem in children. Nosocomial spread remains the principal risk factor for acquisition of these microorganisms. PATIENTS CONCERNS: We describe an outbreak of Klebsiella pneumoniae OXA48 (KOXA48) in a tertiary children's hospital during the years 2012 to 2014, as well as the preventive measures put in place in colonized and infected cases. DIAGNOSES: We studied, "in vitro," the KOXA48 susceptibility to antiseptics and surface disinfectants. Moreover, an epidemiological surveillance of infection or colonization by these microorganisms, with molecular typing of the KOXA48, was performed, and carbapenemase genes were confirmed by polymerase chain reaction (PCR). INTERVENTIONS: The bundles recommended (early detection, cohorting of children and health care workers [HCW], contact precautions, etc.) to control the KOXA48 outbreak were taken from those described in the centers for disease control (CDC) 2012 guide, and adapted according to our experience in controlling other outbreaks. OUTCOMES: All the KOXA48 microorganisms isolated from children belonged to the same strain (ST11) and were susceptible to alcohol solutions but not the surface disinfectant previously employed in our hospital (tensoactive). We reinforced the surface disinfection using a double application (tensoactive + alcohol). The outbreak of KOXA48 begun in 2012 (16 cases in neonatal intensive care unit [NICU] and 1 in pediatric intensive care unit [PICU]) ended before the end of the same year and was not transmitted to new patients in 2013 to 2014, despite readmission of some colonized cases, in intensive care units (ICUs) and other units, of our children hospital. LESSONS: Infected children are the tip of the iceberg (3/17) of KOXA48 prevalence making it necessary to identify the cases colonized by these bacteria. At the beginning of the outbreak, the susceptibility of the epidemic strain to antiseptics and surface disinfectants should be studied. Moreover, the measures taken (cohorts, contact precautions, etc.) must be thorough in both colonized and infected cases, immediately, after microbiological diagnosis.

Infección de localización quirúrgica como factor de riesgo de mortalidad en cirugía colorrectal / No disponible

Objetivo: Determinar los factores de riesgo para la mortalidad postquirúrgica en una cohorte de pacientes sometidos a cirugía mayor de colon y recto. Material y método: Fueron estudiados de forma prospectiva 342 pacientes (256 intervenidos de colon y 86 de recto). Los datos se obtuvieron a partir del sistema de vigilancia epidemiológica semestral realizada durante cuatro años. El ámbito del estudio es un hospital público de alta complejidad. Para analizar factores de riesgo asociados con la variable de resultado mortalidad postquirúrgica, se crea un modelo multivariable logístico y se calcula el punto de corte óptimo con su sensibilidad y especificidad, y el área bajo la curva, con su intervalo de confianza al 95% (curva ROC). Resultados: La mortalidad postquirúrgica global fue del 7% (8,2% en cirugía de colon y del 3,5% en cirugía de recto). En el estudio multivariante se determinaron como factores de riesgo independientes para la mortalidad postquirúrgica: diagnóstico de ILQ de cualquier tipo (OR, 2,80; IC95%,1,02-7,63;p=0,04); ILQ de órga- no/espacio (OR, 9,4; IC95%, 2,85-31,15;p=0,001); transfusión peri-quirúrgica (OR, 7,15; IC95%, 2,35- 21,73; p=0,001); edad (incremento anual) (OR, 1,09; IC95%, 1,03-1,16 ; p=0,002); y ASA> 2 (OR, 2,80; IC95%,1,02-7,63; p=0,04). Conclusiones: La ILQ en cirugía colorrectal es un factor predictivo de mortalidad postquirúrgica con un riesgo 2,8 veces superior a pacientes que no la padecen. Este riesgo se multiplica por 9,4 en caso de infección de órgano/espacio

Objective: To identify postoperative mortality risk factors in a cohort of patients undergoing major colorectal surgery. Methodology: We prospectively studied 342 patients (256 underwent colon resection and 86 underwent rectum resection). Data were obtained from semi-annual surveillance conducted during four years. The scope of the study is a tertiary public hos- pital. To analyze risk factors associated with the outcome postoperative mortality (30 days after surgery), a multivariable logistic model is created and the opti- mal cutoff with its sensitivity and specificity and area under the curve with confidence intervals at 95% (ROC curve) is calculated. Results: The overall postoperative mortality was 7% (8.2% in colon surgery and 3.5% in rectal surgery). In the multivariate analysis we determined as independent risk factors for postoperative mortality: diagnosis of any type of SSI (OR, 2.80, 95%,1,02-7, 63, p = 0.04), SSI organ / space (OR 9.4, 95% CI 2.85 to 31.15, p = 0.001), perioperative transfusion (OR, 7.15, 95% CI 2.35 to 21.73, p = 0.001), age (annual increase) (OR, 1.09, 95% CI 1.03 to 1.16, p = 0.002) and ASA index > 2 (OR, 2.80, 95%,1,02-7, 63, p = 0.04). Conclusion: SSI in colorectal surgery is a predictive factor for postoperative mortality with a risk 2.8 times higher than patients without it. This risk is multiplied by 9.4 on organ / space SSI

Interhospital spread of NDM-7-producing Klebsiella pneumoniae belonging to ST437 in Spain.

This study describes an interhospital spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) producing NDM-7 carbapenemase that started in December 2013 in Madrid, Spain. NDM-7-producing CRKP were isolated from urine, rectal swabs or blood samples from seven patients admitted to three different hospitals (Hospital Universitario La Paz, Hospital de Cantoblanco and Hospital Central de la Cruz Roja). The isolates were resistant to all antimicrobials tested except colistin and fosfomycin. One blood isolate was susceptible to minocycline and tigecycline but was resistant to fosfomycin. All isolates were closely related by pulsed-field gel electrophoresis (PFGE) and DiversiLab(®) analysis and belonged to multilocus sequence typing (MLST) sequence type 437. In addition, blaNDM-7, blaTEM-1, blaCTX-M-15 and aac(3)-IIa were identified. Family contacts of the index case were negative for NDM-producing bacteria. The outbreak occurred in two separate waves and the cases associated with Hospital de Cantoblanco had been admitted to the same room. Environmental samples from the trap of a sink and a shower in this room were positive for NDM-7-producing CRKP. To our knowledge, this is the first reported worldwide outbreak of NDM-7-producing CRKP. No relationship with the Indian continent, the Balkans or the Middle East could be established. Frequent transfer of aged or chronically ill patients between the facilities involved may have favoured the spread of NDM-7-producing CRKP. The spread of the second wave in Hospital de Cantoblanco probably occurred as a result of transmission from an environmental reservoir.

Evaluación de un paquete de medidas para la prevención de la infección de localización quirúrgica en cirugía colorrectal / Evaluation of a preventive surgical site infection bundle in colorectal surgery

OBJETIVO: Evaluar la efectividad de un protocolo para la prevención de la infección de localización quirúrgica (ILQ) en cirugía colorrectal. PACIENTES Y MÉTODOS: Evaluación de 2 cohortes de pacientes intervenidos de colon y recto en un hospital público de tercer nivel: una cohorte histórica (2008-2011) y otra prospectiva (posterior a la implementación del programa en 2012). Las principales medidas establecidas fueron: adecuación de la profilaxis antimicrobiana prequirúrgica, mantenimiento de la normotermia del paciente en el quirófano y adecuación del cambio de guante durante la intervención. Se determinó la comparabilidad de ambas cohortes mediante un análisis bivariable de la edad, sexo, factores e índices de riesgo (índice NNIS, índice ASA, tiempos quirúrgicos, transfusión periquirúrgica, diagnóstico, diabetes, insuficiencia renal). RESULTADOS: Se evaluó a 342 pacientes (256 intervenidos de colon y 86 de recto), distribuidos en 2 cohortes: periodo previo (218) y periodo postimplementación del programa (124). La incidencia acumulada de ILQ de la primera cohorte fue del 27,5% (IC 95% = 21,6-33,4), y de la cohorte postintervención 16,9% (IC 95% = 10,3-23,5; p = 0,03). La mortalidad postoperatoria fue del 9,2% (IC 95% = 5,4-13) en la primera cohorte y del 3,2% (IC 95% = 0,1-6,3) en la cohorte postintervención (p = 0,04). La administración inadecuada de la profilaxis disminuyó del 37,4% (IC 95% = 30,4-44,6) al 18,9% (IC 95% = 11,9-26,1; p = 0,001). CONCLUSIONES: Tras la implementación de un protocolo para la prevención de la infección quirúrgica en cirugía colorrectal se verifica una disminución significativa de la frecuencia de ILQ, de la mortalidad posquirúrgica y de la profilaxis antimicrobiana inadecuada

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P = .03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P = .04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P = .001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery

Evaluation of a preventive surgical site infection bundle in colorectal surgery.

OBJECTIVE: To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery. PATIENTS AND METHODS: Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure. RESULTS: We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P=.03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P=.04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P=.001). CONCLUSION: A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery.

Infections caused by OXA-48-producing Klebsiella pneumoniae in a tertiary hospital in Spain in the setting of a prolonged, hospital-wide outbreak.

OBJECTIVES: We describe clinical and microbiological features of infections caused by OXA-48-producing Klebsiella pneumoniae (O48KP) in the setting of a prolonged, hospital-wide outbreak detected in January 2011. METHODS: Clinical, demographic and microbiological data of patients with growth of O48KP in clinical specimens were collected until December 2011. PCR was used to detect carbapenemase and ß-lactamase genes. The genetic relationships were determined by automated repetitive-sequence-based PCR. RESULTS: Seventy-one patients with clinically guided cultures showing growth of O48KP were identified. Nine were considered to be colonizing rather than causing infection. The most frequent source of infection was the urinary tract (22/62), followed by surgical site infections (17/62). Blood cultures were positive in 23/62 patients. Many patients had significant comorbidity and prolonged hospital stays. In-hospital mortality among patients with O48KP infections was 43.5%. The MIC(90)s of ertapenem, imipenem and meropenem were >32, 16 and 16 mg/L, respectively. No single antimicrobial was active against all the isolates. The antibiotics most active against O48KP were amikacin (97.2% susceptible), colistin (90.1%), tigecycline (73%) and fosfomycin (66.2%). Although eight clones were identified, a predominant clone caused 73.2% of the infections. Multilocus sequence typing (MLST) of the predominant clone gave sequence type (ST) 405 and bla(TEM-1), bla(SHV-76), bla(CTX-M-15) and bla(OXA-1) genes and the insertion sequence IS1999 of the Tn1999 transposon were associated with bla(OXA-48) in this clone. CONCLUSIONS: To our knowledge, this is the largest reported series of infections caused by O48KP in the setting of a single-centre outbreak and provides further input on the clinical relevance of infections caused by O48KP and the difficulties associated with its detection and control.

[Implementation of a form for adverse effect notification: results for the 1st year]. / Implementación de un formulario para la notificación de eventos adversos: resultados del primer año.

OBJECTIVES: To describe the introduction of an incident monitoring system by electronic reporting in the Complejo Hospitalario de Toledo (CHT) and to analyse the initial results. MATERIALS AND METHOD: CHT is a public hospital with 750 beds, 59 for critical patients, an ambulatory surgery unit and three outpatient clinics. Access to the electronic reporting system is on the main screen of the hospital intranet. The reporting system is voluntary and confidential. It was introduced at the same time as setting up website on clinical safety and the provision of specific training on the subject. RESULTS: A total of 62 reports were received on the electronic system over a period of 12 months (December 2006 to December 2007), of which 74.5% were reported by nursing staff. The service from where it was reported most often was Geriatrics (43.1%). Most of the incidents were classified by the notifiers themselves as "no injury" (64.7%) and as "avoidable" 92.2%. A total of 56.9% were related to care. Some reports led to the issuing of three documents of recommendations by the Quality Unit and the Pharmacy Department. CONCLUSIONS: Most of the notifications were incidents related to care and were reported by nurses. The reporting system can complement other tools in promoting a clinical safety culture and defining the risk profile of a health organisation.

Implementación de un formulario para la notificación de eventos adversos: resultados del primer año / Introduction of a form for reporting adverse events: results from the first year

Objetivos: Describir la implementación de un programa de notificación de incidentes mediante un formulario electrónico en el Complejo Hospitalario de Toledo (CHT) y analizar los resultados iniciales.Material y método: El CHT es un hopital público que cuenta con 750 camas, 59 de ellas de cuidados críticos, una unidad de cirugía mayor ambulatoria y tres centros de especialidades. El icono para acceder al formulario electrónico de notificación de efectos adversos(FENEA) se encuentra en la pantalla inicial de la intranet, accesible a todos los profesionales. La notificación es voluntaria y anónima. La implementación fue simultánea a la de una web interna sobre seguridad clínica y a la impartición de formación específica sobre el tema.Resultados: Durante los primeros 12 meses (diciembre de 2006 a diciembre de 2007) se recibieron 62 notificaciones a través del FENEA. El personal de enfermería fue el que más notificó (74,5%). El servicio desde donde se notificó con mayor frecuencia fue geriatría (43,1% del total). La mayoría de los incidentes fueron clasificados por los propios notificadores como “sin lesión” (64,7%) y como “evitables” el 92,2%. El 56,9% estuvo relacionado con los cuidados en la atención. A partir de algunas notificaciones la unidad de calidad y el servicio de farmacia realizaron y difundieron tres documentosde recomendaciones.Conclusiones: La mayoría de las notificaciones fueron incidentes relacionados con los cuidados y fueron realizadas por enfermeras. La implementación de un FENEA puede ser una herramienta complementaria a otras para promocionar una cultura de seguridad clínica y definir el perfil de riesgos de una organización sanitaria

Objectives: To describe the introduction of an incident monitoring system by electronic reporting in the Complejo Hospitalario de Toledo (CHT) and to analyse the initial results.Materials and method: CHT is a public hospital with 750 beds, 59 for critical patients, an ambulatory surgery unit and three outpatient clinics. Access to the electronic reporting system is on the main screen of the hospital intranet. The reporting system is voluntary and confidential. It was introduced at the same time as setting up website on clinical safety and the provision of specific training on the subject.Results: A total of 62 reports were received on the electronic system over a period of 12 months (December 2006 to December 2007), of which 74.5% were reported by nursing staff. The service from where it was reported most often was Geriatrics (43.1%). Most of the incidents were classified by the notifiers themselves as “no injury” (64.7%) and as “avoidable” 92.2%. A total of 56.9% were related to care. Some reports led to the issuing of three documents of recommendations by the Quality Unit and the Pharmacy Department.Conclusions: Most of the notifications were incidents related to care and were reported by nurses. The reporting system can complement other tools in promoting a clinical safety culture and defining the risk profile of a health organisation (AU)

Evaluación de una vía clínica para la apendicitis infantil tras dos años de implantación / Evaluation of a clinical pathway for childhood appendicitis two years after its introduction

Objetivo: Evaluación del impacto asistencial de una vía clínica (VC) para la apendicitis aguda en el Hospital Infantil La Paz, tras 2 años de implantación. Material y método: Estudio semiexperimental con controles históricos. Monitorización de la satisfacción del paciente mediante realización de encuestas. Resultados: Se incluye a 125 pacientes de entre 1 y 13 años; 71 varones y 54 mujeres. El grupo control (GC) está formado por 67 niños (53,6%), y el grupo vía clínica (VC), por 58 (46,4%). La estancia media ± DE (desviación estándar) en apendicitis flemonosas es de 4,22 ± 2,1 días en GC y de 3,2 ± 0,7 en VC (p = 0,041). El porcentaje de pacientes con adecuación de la profilaxis antimicrobiana perioperatoria fue del 67,2% (45/67) en el GC y del 94,8% (55/58) en VC (p = 0,001). La media de dosis de analgésico administradas por paciente fue de 11,58 en GC y de 5,49 en VC (p = 0,001). Durante el segundo año de implantación de la VC, el 59% de los encuestados afirmaron estar "muy satisfechos" con la atención recibida y el 63,4% de ellos opinaron lo mismo respecto a la atención del dolor. Conclusiones: La implantación de la vía ha facilitado la estandarización del tratamiento antimicrobiano y la adecuación en la profilaxis perioperatoria. La estancia ha disminuido en 1 día en apendicitis no complicadas sin un mayor número de reingresos ni complicaciones. La mayoría de los pacientes afirmaron estar "satisfechos" o "muy satisfechos" con la atención recibida

Objective: To assess the clinical impact of a clinical pathway (CP) for acute appendicitis in children at La Paz Children's Hospital after 2 years of implementation. Material and method: We performed a quasi-experimental study with historical controls. Patient satisfaction was monitored through surveys. Results: A total of 125 patients were recruited, aged 1-13 years; there were 71 boys and 54 girls. The control group (CG) included 67 children (53.6%) and the clinical pathway (CP) group included 58 (46.4%). The mean length of hospital stay ± standard deviation (SD) for uncomplicated appendicitis was 4.22 ± 2.1 days for the CG and 3.2 ± 0.7 for the CP group (p = 0.041). The percentage of patients with adequate prophylactic antimicrobial therapy was 67.2% (45/67) for the CG and 94.8% (55/58) for the CP group (p = 0.001). The mean number analgesic doses per patient was 11.58 in the CG and 5.49 in the CP group (p = 0.001). During the second year of the implementation of the CP, 59% of the patients surveyed reported they were "very satisfied" with the care received and 63.4% were "very satisfied" with pain management. Conclusions: The implantation of the CP has helped to standardize antibiotic therapy and appropriate preoperative prophylaxis. The length of hospital stay decreased by 1 day for uncomplicated appendicitis with no increase in readmissions or complications. Most patients were "satisfied" or "very satisfied" with the care received

Diseño y validación de una vía clínica para la apendicitis aguda infantil / Design and validation of a clinical pathway for acute appendicitis in children

Objetivo: Elaboración, implantación y evaluación de una vía clínica (VC) para la apendicitis aguda en el Hospital Infantil La Paz de Madrid. Material y método: Coordinación del equipo de trabajo por la unidad de calidad del hospital. Revisión bibliográfica buscando la mejor evidencia científica. Diseño de los documentos de la VC. Implantación de la vía en junio de 2003. Realización del estudio piloto descriptivo. Resultados: Diseño de los documentos de la VC mediante el consenso de todos los profesionales implicados en el proceso. Para ello se realizaron 5 reuniones durante los meses de abril y mayo de 2003. Los documentos son los siguientes: matriz temporal, hoja de información para el paciente durante su estancia hospitalaria, recomendaciones al alta, hoja de registro para tratamientos y cuidados de enfermería, hoja de variaciones, encuesta de satisfacción, indicadores para la evaluación. Realización del estudio piloto descriptivo previo a la implantación definitiva: la estancia media se ajusta a la estipulada en la VC (6,8 días en apendicitis complicadas y 3,0 en no complicadas), las variaciones se produjeron por causa del paciente (13,5%) y por los profesionales (29,7%), ninguna por la institución. El tipo de antibioterapia fue el estipulado en la mayoría de los casos (94,6%). Conclusiones: La implantación de la vía clínica ha facilitado el consenso entre los profesionales. La estandarización del tratamiento antimicrobiano ha facilitado el control de la variabilidad clínica no justificada. El cumplimiento de las estancias establecidas se produjo en la mayoría de los pacientes

Objective: To design, introduce and evaluate a clinical pathway (CP) for acute appendicitis in children at La Paz Children's Hospital in Madrid (Spain). Material and method: A multidisciplinary team was coordinated by the quality assurance unit at the hospital. A search was conducted for the best scientific evidence published and the CP documents were designed. The CP was implemented in June 2003, the starting point for the descriptive pilot study. Results: Following five meetings held in April and May 2003, the professionals involved agreed on the design of the CP documents. The documents are as follows: framework, patient information sheet, postoperative recommendations, records of medical care and treatment, record of changes, patient evaluation sheet, evaluation instructions. A descriptive pilot study was performed prior to definitive implantation of the CP. The mean length of stay matched that stipulated by the CP (6.8 days for complicated appendicitis and 3.0 for uncomplicated appendicitis). Variations were related to the patient's condition (13.5%) and to the medical staff (29.7%). No variations were due to the center. In most patients (94.6%) the type of antibiotic therapy stipulated was administered. Conclusions: The implantation of the CP has made consensus among professionals easier. The standardization of antibiotic treatment has helped to control unjustified clinical variations. In most patients, the length of stay coincided with that established in the CP