Hospital readmission within 30 days of older adults hospitalized in a public hospital

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score - RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days

Sleep quality of nurses in the emergency department of public hospitals in China and its influencing factors: a cross-sectional study.

BACKGROUND: Studies have shown that poor sleep could result in many unpleasant consequences and is prevalent in nurses. Considering the fact of high stress, overwhelming workload and many night shifts in the emergency department in China, this study aimed to evaluate the current status of emergency nurses' sleep quality in public hospitals in Shandong, China and explored its influencing factors. METHODS: A self-administered questionnaire incorporating the Job Content Questionnaire and Pittsburgh Sleep Quality Index (PSQI) was conducted among 4856 emergency nurses in five randomly selected city emergency command systems in Shandong, China. The association of potential influencing factors, including occupational, psychosocial and individual factors, with poor sleep (PSQI> 5) was quantified by multivariate logistic regression analysis. RESULTS: The average PSQI score of 4730 emergency nurses in public hospitals was 8.2 ± 3.9, including 3114 (65.8%) subjects with PSQI > 5 and 2905 (61.4%) > 8; these figures were found highest for 337 emergency nurses in 14 tertiary hospitals with 11.8 ± 4.3, 257 (76.3%) and 232 (68.8%), followed by 1044 emergency nurses in 43 secondary hospitals with 9.5 ± 3.9, 725 (69.4%) and 675 (64.7%) and 3349 emergency nurses in 167 primary hospitals with 7.4 ± 3.5, 2132 (63.7%) and 1998 (59.7%). The following factors were associated with poor sleep: hospital level (tertiary vs. primary, secondary vs. primary), female sex, less of exercise, long work hours per week, many patients in the charge of at night, high monthly night shift frequency (4-6 vs. never, ≥7 vs. never) and high occupational stress. CONCLUSIONS: The sleep quality of emergency nurses in public hospitals in China was poor, especially in tertiary hospitals. Many factors as listed above, especially occupational stress, night shift taking and workload at night, should be considered when improving emergency nurses' sleep quality.

Qualitative analysis of direction of public hospital reforms in China.

Reforms in public hospitals are among the most important improvements in China's health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.

More than a name: Heterogeneity in characteristics of models of maternity care reported from the Australian Maternity Care Classification System validation study.

BACKGROUND: Without a standard terminology to classify models of maternity care, it is problematic to compare and evaluate clinical outcomes across different models. The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics and an overarching broad model descriptor (Major Model Category). AIM: This study aimed to assess the extent of variability in the defining characteristics of models of care grouped to the same Major Model Category, using the Maternity Care Classification System. METHOD: All public hospital maternity services in New South Wales, Australia, were invited to complete a web-based survey classifying two local models of care using the Maternity Care Classification System. A descriptive analysis of the variation in 15 attributes of models of care was conducted to evaluate the level of heterogeneity within and across Major Model Categories. RESULTS: Sixty-nine out of seventy hospitals responded, classifying 129 models of care. There was wide variation in a number of important attributes of models classified to the same Major Model Category. The category of 'Public hospital maternity care' contained the most variation across all characteristics. CONCLUSION: This study demonstrated that although models of care can be grouped into a distinct set of Major Model Categories, there are significant variations in models of the same type. This could result in seemingly 'like' models of care being incorrectly compared if grouped only by the Major Model Category.

Resultados iniciales del Registro Español de Hernia Incisional / Initial results of the National Registry of Incisional Hernia

INTRODUCCIÓN: El objetivo de este estudio fue analizar los datos recopilados en el Registro Nacional de Hernia Incisional (EVEREG) para conocer la situación actual del tratamiento de esta dolencia en España. MÉTODOS: EVEREG es una base de datos prospectiva online en la que, desde julio de 2012, se registraron de forma anónima los datos de las hernias incisionales intervenidas en España. RESULTADOS: Hasta marzo de 2015, se han registrado 4.501 hernias en 95 de los 113 hospitales inscritos. La edad media de los casos fue de 62,7 años, un 56,5% mujeres, con un IMC medio de 30,2 kg/m2 y un 29,8% de ellos con riesgo quirúrgico elevado (ASA III-V). Un 93,7% de las intervenciones fueron electivas, el 88,3% por cirugía abierta y el 22,2% fueron hernias recurrentes. El 66,9% correspondían a una hernia tras laparotomía media, en el 81,4% el diámetro transversal fue menor de 10 cm. Se empleó una prótesis en el 96,2% de los casos. La estancia postoperatoria fue de 5,3 días, con complicaciones en el 29,1% y con una mortalidad del 0,8%. Tras una mediana de seguimiento de 7,7 meses se ha detectado un elevado índice de recurrencias (20,7% al año), sobre todo en hernias intervenidas tras una reparación previa (18,1% primarias vs. 30,6% recidivadas; p = 0,004). CONCLUSIÓN: El registro EVEREG es una herramienta útil para conocer la situación actual del tratamiento de la hernia incisional. El análisis de los datos señala como principales elementos susceptibles de mejora el bajo índice de seguimiento y la elevada tasa de recurrencias

INTRODUCTION: The aim of this study was to the data from the National Registry of Incisional Hernia (EVEREG) to determine the reality of the treatment of this condition in Spain. METHODS: EVEREG is an online prospective database which has been functioning since July 2012; operations for incisional hernia are anonymously recorded. RESULTS: Up to March 2015, 4501 hernias from 95 of the 113 participating hospitals were registered. The mean age of the patients was 62.7, and 56.5% were women, with a mean BMI of 30.2 kg/m2; 29.8% presented a high surgical risk (ASA III-V). A total of 93.7% were scheduled surgeries, 88.3% open surgery and 22.2% were recurrent incisional hernias. There were 66.9% hernias after a midline laparotomy, and 81.4% of a transverse diameter of less than 10 cm. A mesh was used in 96.2% of cases. Postoperative stay was 5.3 days and 29.1% presented a complication, with a mortality of 0.8%. After a median follow-up of 7.7 months a high rate of recurrence was detected (20.7% per year), especially in hernias that were operated on after a previous repair (18.1% primary vs. 30.6% recurrent; P=.004). CONCLUSION: the EVEREG registry is a useful tool to know the current situation of incisional hernia treatment. Analysis of the data shows several points that could be improved: a low rate of follow-up and high recurrence rate

[Technical efficiency of traditional hospitals and public enterprises in Andalusia (Spain)]. / Eficiencia técnica de los hospitales públicos y de las empresas públicas hospitalarias de Andalucía.

OBJECTIVE: To assess the technical efficiency of traditional public hospitals without their own legal identity and subject to administrative law, and that of public enterprise hospitals, with their own legal identities and partly governed by private law, all of them belonging to the taxypayer-funded health system of Andalusia during the period 2005 -2008. METHODS: The study included the 32 publicly-owned hospitals in Andalusia during the period 2005-2008. The method consisted of two stages. In the first stage, the indices of technical efficiency of the hospitals were calculated using Data Envelopment Analysis, and the change in total factor productivity was estimated using the Malmquist index. The results were compared according to perceived quality, and a sensitivity analysis was conducted through an auxiliary model and bootstrapping. In the second stage, a bivariate analysis was performed between hospital efficiency and organization type. RESULTS: Public enterprises were more efficient than traditional hospitals (on average by over 10%) in each of the study years. Nevertheless, a process of convergence was observed between the two types of organizations because, while the efficiency of traditional hospitals increased slightly (by 0.50%) over the study period, the performance of public enterprises declined by over 2%. DISCUSSION: The possible reasons for the greater efficiency of public enterprises include their greater budgetary and employment flexibility. However, the convergence process observed points to a process of mutual learning that is not necessarily efficient.

Hospital performance in China: do location and hospital level matter?

In this study, the operational and financial differences of hospitals were assessed by geographical area and by various levels of government ownership. Hospital geographic location (east, middle, and west) had a significant impact on hospital financial performance, but no significant influence on operational performance. Hospital government ownership level (province, city, and county) had a significant influence on both operational and financial performance. China's current public policy of not fully subsidizing its public hospital systems and limiting their ability to set prices for certain health care services may have negative and unintended consequences in its ability to provide needed health care services to its population. The government should revisit its policies to eliminate the differences regarding hospital performance related to location and government ownership levels.

Relative efficiency and productivity: a preliminary exploration of public hospitals in Beijing, China.

BACKGROUND: Third-grade hospitals in Beijing have been rapidly developing in capacity and scale for many years. These hospitals receive a large number of patients, and ensuring their efficient operation is crucial in meeting people's healthcare needs. In this context, a study of their relative efficiency and productivity would be helpful to identify the driving factors and further improve their performance. METHODS: After a review of literature, the current numbers of open beds and employees were selected as input variables. The number of outpatient and emergency visits and the number of discharged patients were selected as output variables. A total of 12 third-grade Class A general public hospitals in Beijing were selected for a preliminary study. The panel data from 2006-2009 were collected by the National Institute of Hospital Administration, Ministry of Health of P.R. China. Descriptive analysis and data envelopment analysis were used to analyze the data using Stata 10.0 and DEAP(V2.1) software. RESULTS: In the 2006-2009 period, descriptive results show that sample hospitals continuously expanded their capacity and scale, with growth rate of total revenue being the highest among all variables. The DEA results show that the average annual growth rate of productivity was 26.7%, and the rates were 47.3%, 21.3% and 13.8% respectively for two consecutive years. The average annual growth rate of technological change was 28.3%, and the rates were 49.4%, 21.5% and 16.4% respectively for two consecutive years. The average annual growth rate of technical efficiency change was -1.3%, and the rates were -1.4%, -0.02% and -2.2% respectively for two consecutive years. CONCLUSIONS: The sample hospitals in Beijing experienced substantial productivity growth, but annual growth rates were declining. Substantial technological change was the main contributor to the growth. Although some hospitals exhibited improvements in technical efficiency, there was a slight decline in general. To improve overall efficiency and productivity, both government and hospitals need to further drive positive technological change, technical change, and allocative efficiency of public hospitals. More empirical studies are needed to include more hospitals of all three grades at a larger scale.

Desordens no comportamento alimentar antes e após a cirurgia de bypass gástrico em um hospital público / Disorders in eating behavior before and after gastric bypass surgery in a public hospital

A cohort study with 25 patients was carried out in a public hospital unit aiming to identify the prevalence of eating disorders before bariatric surgery; verify their persistence at 6 months postoperatively; and analyze how such disorders influenced the ponderal weight loss in bariatric patients. Through anthropometric comparative analysis and the applica-tion of questionnaires regarding eating behavior, patients were classified as ?presenting? or ?free from? eating disorders before and 6 months after surgery. Significant reduction was observed in the prevalence of nocturnal eating and binge eating among patients at 6 months postoperatively. Lower loss of excess weight was verified among patients classified as ?presenting? eating disorders in the preoperative phase. Patients affected by eating disorders require monitoring by expert staff, which contributes to achieve satisfactory results.

Con el objetivo de determinar la prevalencia de trastornos alimentarios antes de la cirugía bariátrica, de comprobar si éstos persistieron 6 meses después de la intervención y de analizar cómo tales trastornos influyeron en la pérdida de peso de los pacientes bariátricos, se realizó un estudio de cohorte con 25 pacientes en unidad de hospital público, con medición antropométrica y aplicación de un cuestionario relacionado con el comportamiento alimentario, siendo clasificados, los pacientes, como portadores o libres de trastornos alimentarios, antes de la cirugía y 6 meses después. Se encontró una reducción significativa en la prevalencia de comedores compulsivos y nocturnos entre aquellos pacientes evaluados 6 meses después de la intervención. Se evidenció una menor pérdida del exceso de peso entre los pacientes clasificados como portadores de trastornos alimentarios en la fase preoperatoria. Pacientes que sufren de trastornos alimentarios requieren un seguimiento con personal especializado, contribuyendo, así, al logro de resultados satisfactorios.

Objetivando identificar a prevalência de desordens alimentares antes da cirurgia bariátrica, verificar se persistiram aos 6 meses do pós-operatório e analisar como tais desordens influenciaram na perda ponderal de pacientes bariátricos, realizou-se um estudo de coorte com 25 pacientes em unidade pública hospitalar, com aferição antropométrica e aplicação de questionário referente ao comportamento alimentar, sendo classificados como portadores ou livres de desordens alimentares antes e 6 meses após a realização da cirurgia. Foi verificada uma redução significativa na prevalência de comedores compulsivos e comedores noturnos entre os pacientes aos 6 meses do pós-operatório. Foi evidenciada menor perda do excesso de peso entre os pacientes classificados como portadores de desordens alimentares na fase pré-operatória. Pacientes acometidos por desordens alimentares necessitam de acompanhamento com equipe especializada, contribuindo para o alcance de resultados satisfatórios.

Perfil dos pacientes portadores de síndrome coronariana aguda submetidos à intervenção coronariana percutânea / Profile of patients with acute coronary syndrome undergoing percutaneous coronary intervention

Mais de 12 milhões de pessoas têm doença arterial coronariana e maisde 1 milhão apresenta um infarto do miocárdio a cada ano nos EstadosUnidos, resultando em cerca de 466.000 mortes atribuídas à doença arterialcoronariana. No Brasil, o infarto agudo do miocárdio representa a maiorcausa de morte e incapacidade. O atendimento rápido a estes pacientes,bem como a realização de angioplastia transluminal coronariana, podemdiminuir o risco de morbimortalidade destes pacientes. Objetivo: Descrevero perfil dos pacientes portadores de síndrome coronariana aguda submetidosà intervenção coronariana percutânea. Métodos: Trata-se de um estudoseccional, exploratório, descritivo, retrospectivo, com abordagemquantitativa. A amostra foi composta por 39 pacientes, internados naUTI Hemodinâmica de um hospital escola, na cidade de Recife - PE, noperíodo de julho de 2010 a julho de 2011. Foi realizada análise de banco dedados COREHEMO do serviço de cardiologia intervencionista da referidainstituição no período de fevereiro a março de 2012. Resultados: Dos 39pacientes estudados, 56,4% são do sexo masculino, a faixa etária maisacometida foi a de 50-79 anos, com 76,9% dos casos. A hipertensão arterialsistêmica aparece em 97,4% dos casos. A apresentação clínica da doença é,em sua maioria, angina estável, representando 82% da amostra. 87,2% dospacientes fazia uso de antiagregantes plaquetários. Conclusão: A maioriados resultados mostra-se semelhante aos dados nacionais, porém, deve-sedar mais atenção ao correto preenchimento dos formulários dos pacientes,bem como à importância do acompanhamento de exames laboratoriais quesão preconizados por diretrizes vigentes...

More than 12 million people have coronary artery disease and more than1 million has a myocardial infarction each year in the United States,resulting in about 466,000 deaths attributed to coronary artery disease.In Brazil, acute myocardial infarction is the major cause of death anddisability. The quick service to these patients, as well as the performanceof percutaneous transluminal coronary angioplasty may decrease the riskof morbidity and mortality of these patients. Objective: To describe theprofile of patients with acute coronary syndrome undergoing percutaneouscoronary intervention. Methods: This is a cross-sectional study,exploratory, descriptive, retrospective, with a quantitative approach.The sample consisted of 39 patients admitted to the ICU Hemodynamicsof a teaching hospital, in Recife - PE, in the period July 2010 to July2011. Analysis was performed database COREHEMO interventionalcardiology service of that institution in the period February to March2012. Results: Of 39 patients 56.4% were males, the age group mostaffected was between 50-79 years, with 76.9% of cases. Systemic arterialhypertension appears in 97.4% of cases. The clinical presentation ofdisease is mostly stable angina, representing 82% of the sample. 87.2%of patients used antiplatelet. Conclusion: Most of the results were similarto national data, however, more attention should be given to the correctcompletion of patient forms, as well as the importance of monitoringlaboratory tests that are recommended by current guidelines...

High genetic diversity among Pseudomonas aeruginosa and Acinetobacter spp. isolated in a public hospital in Brazil

In Brazil and other regions of the world, Pseudomonas aeruginosa and Acinetobacter spp. have emerged as important agents of nosocomial infection and are commonly involved in outbreaks. The main objective of the present study was to evaluate the genetic relationship among P. aeruginosa and Acinetobacter spp. isolated from patients in a public university hospital in northwestern Paraná, Brazil, and report their antimicrobial resistance profile. A total of 75 P. aeruginosa and 94 Acinetobacter spp. isolates were phenotypically identified and tested for antibiotic susceptibility using automated methodology. Polymyxin B was tested by disk diffusion for P. aeruginosa. Metallo-β-lactamase (MBL) was detected using a disk approximation test. Genotyping was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Approximately 55% of the P. aeruginosa isolates and 92% of the Acinetobacter spp. isolates were multiresistant, but none were MBL-producers. ERIC-PCR revealed the presence of small clusters of carbapenem-resistant Acinetobacter spp., most likely OXA-type carbapenemase producers. Furthermore, high genetic diversity in P. aeruginosa and Acinetobacter spp. clinical isolates was observed, suggesting that cross-transmission is not very frequent in the studied hospital.

No Brasil, bem como em outras regiões do mundo, Pseudomonas aeruginosa e Acinetobacter spp. surgiram como importantes agentes de infecção nosocomial e são comumente envolvidos em surtos. O objetivo principal deste estudo foi descrever a relação genética de P. aeruginosa e Acinetobacter spp. isoladas de pacientes internados em hospital universitário público do noroeste do Paraná - Brasil e reportar o perfil de resistência dessas bactérias. Um total de 75 P. aeruginosa e 94 Acinetobacter spp. isolados foi fenotipicamente identificado e testado para a suscetibilidade aos antibióticos por metodologia automatizada. A polimixina B foi testada por difusão em disco para P. aeruginosa. Metalo-β-lactamase (MBL) foi detectada por disco-aproximação. Análise genotípica foi realizada por enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Aproximadamente 55% dos isolados de P. aeruginosa e 92% de Acinetobacter spp. isolados foram multirresistentes, mas nenhum foi produtor de MBL. Os resultados de ERIC-PCR revelaram pequenos grupamentos de Acinetobacter spp. resistentes aos carbapenêmicos, provavelmente pela produção de carbapenemases do tipo OXA. Além disso, alta diversidade genética entre os isolados de P. aeruginosa e Acinetobacter spp. foi observada, sugerindo que a transmissão cruzada destas espécies bacterianas não é muito frequente em nosso hospital.

Prevalence of nosocomial infections in acute care hospitals in Catalonia (VINCat Program).

The first objective of the Catalonian Nosocomial Infection Surveillance Program (VINCat) is to monitor the prevalence (%) of patients with nosocomial infections (NI), patients undergoing urinary catheterization with closed circuit drainage (%) and patients undergoing antibiotic treatment (%). We present the results for the period 2008-2010. Comprehensive and point annual prevalence surveys were conducted that included conventionally hospitalized patients in acute care hospitals belonging to the VINCat Program. The number of participating hospitals was 46 (2008), 48 (2009) and 61 (2010), most belonging to the Network of Public Use Hospitals of Servei Català de la Salut. The results are presented globally and by hospital size (<200 beds, 200-500 beds, >500 beds). The prevalence of patients with active NI acquired during the current or the previous hospitalization (global NI/P%) was 7.6 (2008), 6.2 (2009) and 6.3 (2010). The prevalence of patients with active NI acquired during the current (actual NI/P%) was 6.2 (2008), 4.7 (2009) and 4.6 (2010).The results by hospital size shows that the variation occurred mainly in <200 beds hospitals. The proportion of closed circuit urinary catheterization use was 90.2%. The use of antibiotics varied between 34.6% and 37.6%, with no differences due to hospital size. The global prevalence of NI provides information on the burden of NI at the institutional and regional level. Between 17.3% and 26.9% of patients with NI at the time of the study had acquired it in a previous hospitalization at the same institution.

Surveillance of surgical site infections in elective colorectal surgery. Results of the VINCat Program (2007-2010).

The VINCat Program is a standardized surveillance program of healthcare infections in Catalonia, Spain. This program includes monitoring of surgical site infections (SSI) of elective colorectal surgery. The aim of this study was to define SSI rates in colorectal surgery among VINCat hospitals over a period of 4 years. We included consecutive elective colorectal interventions performed in VINCat hospitals from 2007 to 2010. Follow-up visits were performed 30 days after surgery. Prospective monitoring of SSI in colorectal surgery was performed according to standardized VINCat methodology. SSI was defined according to the Centers for Disease Control (CDC) and surgical risk factors according to the National Healthcare Safety Network (NHSN) classification. From 2007 to 2010, 49 centers performed 10,104 surgical procedures. The cumulative incidence of SSI was 20.8% (95% CI: 20.03-21.63). The annual cumulative SSI incidence rate did not vary significantly over the study period; however, there were significant differences among hospital infection rates. The relative frequency of organ-space infection increased from 25% in 2007 to 40% in 2010 (p<0.001). Laparoscopic surgery also increased (28% in 2007 to 42% in 2010, p<0.001). However, no changes were observed in mean surgery duration, ASA score and degree of surgical contamination. The VINCat Program incorporated a large number of Catalan hospitals that participated in standardized monitoring of colorectal surgery. The cumulative incidence rate of SSI for colorectal surgery was 20.8%, although there were large variations between hospitals.

Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the VINCat Program (2007-2010).

The VINCat Program is an institutional surveillance program for hospital-acquired infections developed in the healthcare institutions of Catalonia, Spain. The program includes the monitoring of various components of hospital-acquired infection, among which is catheter-related bloodstream infection (CRBSI). The aim of this study was to describe the frequency of CRBSI in hospitals participating in the VINCat Program over a period of 4 years (2007-2010). The monitoring of the CRBSI component is carried out continuously in all inpatient units by performing a daily assessment of all blood culture results issued by the Microbiology Laboratories. Precise definitions are used for CRBSI, and adjusted rates are expressed per 1,000 days of hospitalization, hospital size and type of catheter. The rates of CRBSI in catheters used for parenteral nutrition are adjusted and expressed per 1,000 days of device use. The aggregate data of the total period are shown in percentiles (10%, 25%, 50% or median, 75%, and 90%). From 2007 to 2010, a total of 2977 episodes of CRBSI were reported in 40 hospitals participating in the VINCat Program. The cumulative incidence of CRBSI has been 0.26 episodes per 1,000 days of hospitalization (CI95% 0.2 to 0.3). The overall incidence varied depending on hospital size: 0.36 ‰ for hospitals in Group I (>500 beds), 0.17 ‰ for Group II (200-500 beds), and 0.09 ‰ for Group III (<200 beds). 76% of the episodes were associated with central venous catheters (CVC), 19% of the episodes with peripheral venous catheters (PVC), and the remaining 5% with peripherally inserted CVCs (PICC). The most common organisms causing CRBSI were staphylococci, the group Klebsiella, Serratia and Enterobacter, Candida spp., and Pseudomonas aeruginosa. There are important differences in the etiology of CRBSI in relation to these variables. During the reporting period, a significant reduction (38.1%, CI95%, 29.0-46.0%) of CRBSI rates have been observed in Group I hospitals. CRBSI surveillance is an important element of the VINCat Program, offering to us the possibility of establishing standard values for this component and implementing intervention strategies for its reduction.

Epidemiology of surgical site infections after total hip and knee joint replacement during 2007-2009: a report from the VINCat Program.

The VINCat Program is a system for epidemiological surveillance of healthcare-related infections in which the majority of Catalan hospitals participate. It has a specific module for surgical site infections (SSI) surveillance. Primary hip and knee arthroplasties are basic indicators of the program due to their high frequency and the important morbidity of SSI of these sites. Results are presented for surgical site infection (SSI) surveillance of primary hip and knee arthroplasties for the first three years of the VINCat Program. The program requires SSI surveillance to be performed in a standardized, prospective and continuous manner by an infection control team from the centers. With primary arthroplasties, as with all procedures involving implants, the surveillance is maintained for 1 year after the intervention. The VINCat Program uses the SSI definitions of the Centers for Disease Control (CDC) and patients are stratified by surgical risk, following the classification of the National Healthcare Safety Network (NHSN). During the period 2007-2009, 51 Catalan hospitals participated in the SSI surveillance of prosthetic orthopedic surgery. The overall SSI rate in the interventions for total primary hip prosthesis (7,804 procedures) was 3.0% (IC 95%: 2.6-3.4) and for total primary knee prosthesis (16,781 procedures) was 3.3% (IC95%: 3.0-3.6). During the period 2007-2009, the overall SSI rates for total primary hip and knee arthroplasty were higher than those published by some surveillance systems in our environment. There were significant differences in the infection rates by procedure and in those adjusted by risk among the different hospitals.

Device-associated infection rates in Adult Intensive Care Units in Catalonia: VINCat Program findings.

Hospital-acquired infections are a leading cause of morbidity and mortality, especially in the intensive care unit (ICU). Surveillance of device-associated infections plays a major role in infection control programs. In 2006, the Surveillance Program of Nosocomial Infections in Catalonia (VINCat Program) was started, with the major aim of reducing infection rates through a process of active monitoring. The study period comprised calendar years 2008 (with 21 ICUs participating), 2009 (with 21 ICUs participating), and 2010 (with 28 ICUs participating). Each participating hospital was required to have an infection control team made up of at least one physician, an infection surveillance nurse, and a microbiology laboratory. Hospitals were classified into three groups according to their size. Central venous catheter-associated bloodstream infection (CVC-BSI) and ventilator-associated pneumonia (VAP) were chosen as the device-associated infections to analyze. Incidence rates of device-associated infections were calculated by dividing the total number of device-associated infection (VAP or CVC-BSI) days by the total number of days use for the relevant device. Mechanical ventilation use ranged from 0.10 to 0.85 days (overall, 0.35), and central venous catheter use ranged from 0.18 to 0.98 days (overall, 0.65). Incidence rates of VAP ranged from 7.2 ± 3.7 to 10.7 ± 9.6 episodes of VAP/1000 ventilator days. Incidence rates of CVC-BSl ranged from 1.9 ± 1.6 to 2.7 ± 2.0 episodes of CVC-associated bloodstream infection/1000 central venous catheter days. The implementation of the VINCat Program allowed monitoring of nosocomial device-associated infections in ICUs in Catalonia and enabled corrective measures in ICUs with increased incidences of device-associated infections.