Low pre-transplant levels of mannose-binding lectin are associated with viral infections and mortality after haematopoietic allogeneic stem cell transplantation.

BACKGROUND: Mannose-binding lectin (MBL) is a key component of innate immunity. Low serum MBL levels, related to promoter polymorphism and structural variants, have been associated with an increased risk of infection. The aim of this work was to analyse the incidence and severity of infections and mortality in relation to the MBL2 genotype and MBL levels in patients underwent allogeneic haematopoietic stem cell transplantation (Allo-HSCT). RESULTS: This was a prospective cohort study of 72 consecutive patients underwent Allo-HSCT between January 2007 and June 2009 in a tertiary referral centre. Three periods were considered in the patients' follow-up: the early period (0-30 days after Allo-HSCT), the intermediate period (30-100 days after Allo-HSCT) and the late period (> 100 days after Allo-HSCT). A commercial line probe assay for MBL2 genotyping and an ELISA Kit were used to measure MBL levels. A total of 220 episodes of infection were collected in the 72 patients. No association between donor or recipient MBL2 genotype and infection was found. The first episode of infection presented earlier in patients with pre-transplant MBL levels of < 1000 ng/ml (median 6d vs 8d, p = 0.036). MBL levels < 1000 ng/ml in the pre-transplant period (risk ratio (RR) 2.48, 95% CI 1.00-6.13), neutropenic period (0-30 days, RR 3.28, 95% CI 1.53-7.06) and intermediate period (30-100 days, RR 2.37, 95% CI 1.15-4.90) were associated with increased risk of virus infection. No association with bacterial or fungal disease was found. Mortality was associated with pre-transplant MBL levels < 1000 ng/ml (hazard ratio 5.55, 95% CI 1.17-26.30, p = 0.03) but not with MBL2 genotype. CONCLUSIONS: Patients who underwent Allo-HSCT with low pre-transplant MBL levels presented the first episode of infection earlier and had an increased risk of viral infections and mortality in the first 6 months post-transplant. Thus, pre-transplant MBL levels would be important in predicting susceptibility to viral infections and mortality and might be considered a biomarker to be included in the pre-transplantation risk assessment.

Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection.

BACKGROUND: A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI. METHODS: A prospective study of patients undergoing hip or knee arthroplasty from February 2009 to February 2014 was performed in a Spanish tertiary health care hospital. The diagnostic accuracy of the different methods was evaluated constructing receiver-operating-characteristic (ROC) curve areas. RESULTS: One hundred thirty consecutive patients were included: 18 (13.8%) early PJI, 35 (27%) delayed PJI and 77 (59.2%) late PJI. For individual parameters, the area under the ROC curve for peri-implant tissue culture was larger for early (0.917) than for delayed (0.829) and late PJI (0.778), p = 0.033. There was a significantly larger difference for ROC area in the synovial fluid culture for delayed (0.803) than for early (0.781) and late infections (0.679), p = 0.039. The comparison of the areas under the ROC curves for the two microbiological tests showed that sonicate fluid was significantly different from peri-implant tissue in delayed (0.951 vs 0.829, p = 0.005) and late PJI (0.901 vs 0.778, p = 0.000). The conjunction of preoperative parameters, synovial fluid culture and CRP, improved the accuracy for late PJI (p = 0.01). The conjunction of histopathology and sonicate fluid culture increased the area under ROC curve of sonication in early (0.917 vs 1.000); p = 0.06 and late cases (0.901 vs 0.999); p < 0.001. CONCLUSION: For early PJI, sonicate fluid and peri-implant tissue cultures achieve the same best sensitivity. For delayed and late PJI, sonicate fluid culture is the most sensitive individual diagnostic method. By combining histopathology and peri-implant tissue, all early, 97% of delayed and 94.8% of late cases are diagnosed. The conjunction of histopathology and sonicate fluid culture yields a sensitivity of 100% for all types of infection.

Progression of subclinical cardiovascular disease in patients with HIV.

OBJECTIVE: Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. METHODS: Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. RESULTS: Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). CONCLUSIONS: After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.

H1N1 virus infection: chest radiographic findings.

OBJECTIVE: To show the plain chest film findings in patients with confirmed infection with the new variant of the influenza A (H1N1) virus and to correlate these findings with the clinical history and evolution. MATERIAL AND METHODS: We reviewed the clinical histories and radiological studies in 99 patients infected with the new variant of H1N1 influenza who were admitted in two Hospitals in Cantabria, Spain. Plain chest film findings were classified according to their parenchymal pattern and the distribution of the lesions. RESULTS: Of the 99 patients evaluated, 28 had changes on the plain chest film acquired at admission. In these 28 patients, the findings were: condensation in 19, condensation and ground-glass opacities in 7, and ground-glass opacities in 2; the distribution of the lesions was diffuse in 17 patients and bilateral in 17, with the lower and middle lobes being the most frequently affected. The lesions progressed in 13 patients, and the 7 patients who required mechanical ventilation had a higher frequency of diffuse lesion distribution and more lung fields affected on the plain chest field acquired at admission. Pathological findings on plain chest films were more common in males, in smokers, and in patients who presented with shortness of breath, pleuritic pain, and diarrhea (P<0.05). CONCLUSION: Most patients infected with the new variant of the H1N1 virus had no alterations on the plain chest film acquired on admission; when findings were present, the predominant pattern was diffuse, bilateral condensation mainly involving the bases of the lungs. Pleural effusion and hilar or mediastinal lymph node enlargement were uncommon.

Evaluation of endothelial function and subclinical atherosclerosis in patients with HIV infection.

The aim of this study was to analyse the association between human immunodeficiency virus (HIV) related clinical and analytical parameters and the presence of subclinical atherosclerosis as well as endothelial dysfunction. This was a prospective cohort study of HIV-positive patients who underwent intima media thickness (IMT) determination and coronary artery calcium scoring to determine subclinical atherosclerosis. To detect endothelial dysfunction, the breath holding index, flow-mediated dilation and the concentration of endothelial progenitor cells (EPCs) were measured. Patients with an IMT ≥ 0.9 mm had an average of 559.3 ± 283.34 CD4/µl, and those with an IMT < 0.9 mm had an average of 715.4 ± 389.92 CD4/µl (p = 0.04). Patients with a low calcium score had a significantly higher average CD4 cell value and lower zenith viral load (VL) than those with a higher score (707.7 ± 377.5 CD4/µl vs 477.23 ± 235.7 CD4/µl (p = 0.01) and 7 × 104 ± 5 × 104 copies/ml vs 23.4 × 104 ± 19 × 104 copies/ml (p = 0.02)). The number of early EPCs in patients with a CD4 nadir < 350/µl was lower than that in those with a CD4 nadir ≥ 350 (p = 0.03). In HIV-positive patients, low CD4 cell levels and high VL were associated with risk of developing subclinical atherosclerosis. HIV patients with CD4 cell nadir < 350/µl may have fewer early EPCs.

Graded contrast echocardiography in pulmonary arteriovenous malformations.

To compare the results of transthoracic contrast echocardiography (TTCE) adding a grading scale with the results of thoracic computed tomography (CT) in order to optimise the use of both techniques. 95 patients with hereditary haemorrhagic telangiectasia (HHT) were examined with TTCE and thoracic CT to detect pulmonary arteriovenous malformations (PAVMs). According to previous studies, TTCE was divided into a four grade scale depending on the degree of opacification of the left ventricle after the administration of a contrast agent. Of the 95 patients (50.5% female; mean age 46 yrs), none with normal or grade 1 TTCE had detectable PAVMs on thoracic CT. Shunts of grades 2, 3 and 4 were associated with PAVMs according to thoracic CT in 25, 80, and 100% of the cases. There was a statistically significant association between the TTCE grade and the detection of a PAVM by thoracic CT. There were also statistically significant associations between TTCE grade and the cardiac cycle when the contrast was first visible in the left atrium, and size of the feeding artery. Graded TTCE and timing of left atrium opacification may be useful techniques in selecting HHT patients for PAVM screening with thoracic CT scans.

[Brain abscess in a third-level hospital: epidemiology and prognostic factors related to mortality]. / Abscesos cerebrales en un hospital de tercer nivel: epidemiología y factores que influyen en la mortalidad.

OBJECTIVE: To document the epidemiology, causes, treatment and prognostic factors associated with mortality of patients with brain abscess in a tertiary medical center. METHODS: Observational retrospective cohort study of patients with cerebral abscess admitted at a tertiary hospital during 13 years. RESULTS: The case records of 71 patients admitted to a tertiary hospital between January 1992 and December 2005 and diagnosed of brain abscess were review. Brain abscess occurred at all ages, more frequently in men than in women. Fever, headache and altered mental status were common presenting symptoms. The most common site of infection was the frontal lobe (28 patients). Seventeen patients had multiple abscesses. Staphylococcal infection was seen most commonly. Computed tomography provided sufficient diagnostic information in all cases. Twenty six patients had early surgical drainage. Thirty four patients were admitted to the intensive care Unit (ICU). The overall mortality was 21% (15 patients), all of that related to the infection. Six patients died in ICU. More than 65 years of age (OR, 1.0; CI 95%, 1.0-1.1), medical treatment without surgery (OR, 8.9; CI 95%, 1.1-73.8), presence of multiple abscesses, (OR, 6.0; CI 95%, 1.0-34.9), immunosuppression (OR, 21.5; CI 95%, 2.9-157.2) and delay in starting antibiotherapy (OR, 1.5 per day of delay; CI 95%, 1.0-2.1) were independent predictors of in-hospital death. CONCLUSIONS: In spite of improvement in diagnosis and treatment of patients with cerebral abscess, mortality is still high. Factors related to patient underlying diseases and the delay in the start an antibiotic treatment were associated with increased mortality (50% increase of mortality risk per day in the delay of starting antibiotherapy).

Surgical site infections in cardiac surgery after a hospital catastrophe.

On 2 November 1999, one of the main hospital façades adjoining cardiovascular surgery collapsed in a 900-bed teaching hospital in Santander, Spain. The purpose of this study was to determine whether the accident affected the safety of patients by increasing the risk for nosocomial and surgical site infections (SSI). Measures for the prevention of nosocomial infections were immediately reinforced. A total of 217 consecutive patients were operated on before 2 November 1999, with another 296 after this date. Patients in both study periods showed similar severity of illness, complexity of surgical procedure and length of hospital stay. The overall rate of nosocomial infection before and after the accident was 28.1% and 24.7%, respectively (P=0.381). The rates of respiratory infection, urinary infection and bacteraemia were also similar. A statistically significant reduction in the SSI rate in the second period was observed (14.8% vs 4.4%, P=0.008). The collapse of the façade was not associated with any increase in nosocomial infection rates, but there was a significant reduction of SSI rates in relation to intensive infection control measures implemented after the collapse.

[A multimodal strategy to improve adherence to hand hygiene in a university hospital]. / Estrategia multimodal para la mejora de la adherencia a la higiene de manos en un hospital universitario.

OBJECTIVE: Within the framework of the PaSQ (Patient Safety and Quality care) Project, this hospital decided to implement a multifaceted hospital-wide Hand Hygiene (HH) intervention based on a multimodal WHO approach over one year, focusing on achieving a sustained change in HH cultural change in this hospital. MATERIAL AND METHODS: Setting: University Hospital Marqués de Valdecilla, Santander (Spain), a tertiary hospital with 900 beds. Intervention period: 2014. An action plan was developed that included the implementation of activities in each component of the 5-step multimodal intervention. An observation/feedback methodology was used that included the provision of performance and results feedback to the staff. A 3/3 strategy (non-blinded direct observation audits performed during 3 randomised days every 3 weeks with pro-active corrective actions at the end of each observation period). HH compliance, alcohol-based hand-rub (ABHR) consumption, and rate of MRSA infection, were monitored during the intervention. RESULTS: Hospital ABHR consumption increased during the study period: from 17.5 to 19.7mL/patient-days. In the intervention units, this consumption was 24.8mL pre-intervention, 42.5mL during the intervention, and 30.4mL two months post-intervention. There were 137 evaluation periods in 30 different days, in which a total of 737 health-care workers were observed and 1,870 HH opportunities. HH compliance was 54.5%, ranging between 44.8% and 69.9%. The incidence of MRSA infection decreased during the intervention in the selected units, from 13.2 infections per 10,000 patient-days pre-intervention to 5.7 three months post-intervention. CONCLUSIONS: Our HH strategy, supported by a 3/3 strategy increased alcohol-based hand-rub consumption and compliance. A reduction in MRSA infections was observed.

Comparison of three diagnostic tests in detecting vestibular deficit in patients with peripheral vestibulopathy.

OBJECTIVES: This study aimed to evaluate the results of the video head impulse test and of the caloric and rotatory chair tests in patients with dizziness. Agreement between test results was assessed and the best protocol for detecting peripheral vestibulopathy was identified. METHODS: Participants comprised 116 patients, 75 with a peripheral vestibulopathy and 41 with non-peripheral vestibulopathy. The main outcome measures were classified as normal or abnormal according to our laboratory data. RESULTS: Agreement between tests was low. Vestibulopathy testing that required all three results to be abnormal had a sensitivity of 0.547, a specificity of 0.878, and positive and negative predictive values of 0.891 and 0.514, respectively. Vestibulopathy testing that required just one result to be abnormal had a sensitivity of 0.933, a specificity of 0.292, and positive and negative predictive values of 0.701 and 0.705, respectively. CONCLUSION: In peripheral vestibulopathy, there was weak concordance in the assessment of horizontal semicircular canal function among the different tests. However, the video head impulse test had sufficient statistical power to be recommended as the first-line test.

Applicability of two surgical-site infection risk indices to risk of sepsis in surgical patients.

OBJECTIVE: To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery. DESIGN: 1-year prospective case-control study. SETTING: A tertiary-care center in Spain. PATIENTS: Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance. METHODS: Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient. RESULTS: 99 cases and 97 controls were included. After controlling for confounders, both the SENIC index (P<.001) and the NNIS index (P=.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41). CONCLUSIONS: Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.

Epidemiological differences between sepsis syndrome with bacteremia and culture-negative sepsis.

OBJECTIVE: To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome. DESIGN: Prospective case-control study matched for gender, age, and length of preinfection hospital stay. SETTING: 1,200-bed tertiary-care center in Spain. PATIENTS: Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis. RESULTS: Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis. CONCLUSION: Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.

[Risk factors for nosocomial sepsis: a case-control study]. / Factores de riesgo de sepsis nosocomial: un estudio de casos y controles.

BACKGROUND: The objective of this study was to identify the risk factors associated with the nosocomial sepsis syndrome according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. PATIENTS AND METHOD: A 1-year prospective case-control study matched for sex, age (+/- 5 years), and pre-infection hospital stay (+/- 1 day) was performed in a 1,200-bed university hospital. Cases were selected according to the above criteria. Controls were randomly selected from the daily list of hospitalized patients. Crude and adjusted odds ratios (OR) were determined. RESULTS: 346 cases and 346 controls were included. Multivariate analysis identified the following intrinsic risk factors: coma in the 48 hours before sepsis (OR: 15.1; CI 95%, 5.6-41.2), renal failure (OR: 3.4; CI 95%; 1.5-10.8), neoplasm (OR: 2.4; CI 95%, 1.1-5.1), prosthesis material (OR: 2.7; CI 95%, 1.0-7.8), and serum albumin concentration at admission lower than 3.1 g/dl (OR: 5.3; CI 95%, 2.3-12.4). Main extrinsic risk factors were: previous nosocomial infection (OR: 12.5; CI 95%, 1.61-96.3), intensive care unit (ICU) stay (OR: 10.6; CI 95%, 3.1-36.2), naso-gastric tube (OR: 8.4; CI 95%, 2.3-31.3), indwelling urinary catheter (OR: 5.0; CI 95%, 1.4-18.9), H2 blockers treatment (OR: 5.0; CI 95%, 1.6-15.2), and IV central line (OR: 4.1; CI 95%, 1.2-14.0). CONCLUSION: In our study, main risk factors for development of nosocomial sepsis were presence of coma in the 48 hours before sepsis, ICU stay, and prior cross infection during hospitalization.

[Incidence of nosocomial infection surveillance in general surgery]. / Frecuencia de la vigilancia de la infección nosocomial en cirugía general.

BACKGROUND: We have not found any study assessing the sensitivity of different frequencies of nosocomial infection surveillance (NIS). The objective of this study is to contribute to the ascertainment of the frequency of the NIS surveillance in surgical patients, where NIS has shown to be most efficient. METHODS: A prospective cohort study on 1,483 patients undergoing general surgery in a reference hospital was performed between November 1992 and July 1994. A daily NIS, plus review of clinical chart after hospital discharge, performed by two trained clinicians was taken as gold standard. The expected number of infections detected according to different schedules of NIS (from a minimum of weekly examination to a NIS performed every other day) was estimated taking into account the duration of infection and the hospital stay after infection healing. This number was corrected multiplying it by 0.9 (sensitivity of NIS without reviewing clinical chart after discharge). Confidence intervals (CI) were estimated using the binomial's exact method. RESULTS: 235 nosocomial infections were detected by the gold standard. The sensitivity of the weekly NIS for all infections was 78.3% (95% CI = 72.5-83.4); it varied from 63.6% (95% CI = 45.1-79.6) for urinary tract infections (UTI) to 85% (95% CI = 62.1-96.8) for respiratory tract infections; for surgical wound infections, it was 80.1% (95% CI = 72.4-86.5). As expected sensitivity increased with the frequency of NIS. A frequency of NIS every four days yielded a sensitivity for all infections of 86.4% (IC 95% = 81.3-90.5), 78.8% (CI 95% = 61.1-91.0) for UTI and 86.8% (CI 95% = 79.9-92.0) for SWI. CONCLUSIONS: Most nosocomial infections were detected by one visit a week. Twice visits a week improved the sensitivity of NIS in about 10%. It is important to emphasize that results change according to duration of infection and post-discharge hospital stay.

Laparoscopic cholecystectomy: analysis of risk factors for predicting conversion to open cholecystectomy.

AIM: to assess the usefulness of different clinical and ultrasound parameters to identify patients at high risk of conversion from laparoscopic to open cholecystectomy. METHODS: we retrospectively reviewed the clinical records and preoperative ultrasonographic images of 80 patients who underwent laparoscopic cholecystectomy. RESULTS: eight clinical and nine ultrasound parameters were assessed. Our statistical analysis showed that ultrasound imaging indicated two risk factors for conversion from laparoscopic to open cholecystectomy: a scleroatrophic gallbladder and dilation of the intrahepatic biliary ducts. A gallbladder wall thicker than 6 mm was also considered a risk factor, although this difference was not statistically significant. CONCLUSIONS: our results suggest that preoperative ultrasonography is useful in selecting patients who are highly likely to require conversion from laparoscopic to open surgery.

[Clinical trials on glaucoma: differences according to the medical or surgical nature of the treatment being evaluated]. / Ensayos clínicos sobre glaucoma: diferencias en función de que evalúen tratamientos médicos o quirúrgicos.

PURPOSE: To compare the quality of clinical trials on glaucoma between those evaluating the effectiveness of medical treatments and those evaluating surgical treatments. METHOD: Clinical trials on glaucoma published in seven international journals between January 1980 and December 1999 were selected. The papers were revised by researchers with a background in epidemiology using a standard qualitative questionnaire. Proportions were compared using Fisher's exact test. RESULTS: Sample size was pre-estimated in 19% of medical treatment trials and 2% of surgical trials (p=0.005); masking (72% vs. 9%; p<0.001) and intention-to-treat analysis (17 vs. 0 papers; p<0.001) were also more frequent in medical trials. Only 50% of the trials correctly described the patient flow. CONCLUSIONS: Quality in clinical trials on glaucoma medical treatment was higher than in surgical trials regarding sample size pre-estimation, masking and intention-to-treat analysis. However, both medical and surgical trials should improve in these aspects and in the patient flow description

Estrategia multimodal para la mejora de la adherencia a la higiene de manos en un hospital universitario / A multimodal strategy to improve adherence to hand hygiene in a university hospital

Objetivo. Enmarcado en el Proyecto PaSQ, el Hospital Universitario Marqués de Valdecilla implementa una estrategia multimodal de mejora de la higiene de manos (HM) para fomentar su cumplimiento de forma mantenida en el tiempo y mejorar la seguridad de los pacientes. Material y métodos. Durante 2014 se desarrollaron diferentes actividades siguiendo los 5 puntos de la estrategia multimodal de la OMS. En 4 unidades seleccionadas (135 camas) se implementó la estrategia 3/3, una metodología de evaluación y retroalimentación que proporciona resultados inmediatos a los profesionales, contribuyendo a su formación, y que consiste en una evaluación directa de profesionales, no enmascarada y realizada durante 3 días a la semana cada 3 semanas. Se monitorizaron los indicadores de HM del Ministerio de Sanidad, Servicios Sociales e Igualdad. Resultados. El consumo de preparados de base alcohólica aumentó en 2014 con relación a 2013: 17,5 a 19,7ml/pacientes-día. En las unidades de intervención el consumo fue 24,8 pre-intervención, 42,5 durante la intervención y 30,4 2 meses-postintervención. Se realizaron 137 sesiones de observación: 737 profesionales observados y 1.870 oportunidades de HM. La adherencia a la HM fue 54,5%, variando a lo largo del periodo desde 44,8% en mayo a 69,9% y 69,4% al inicio y fin del proyecto. La incidencia de infecciones por S. aureus meticilín-resistente disminuyó en las unidades piloto durante 2014: de 13,2 a 5,7 infecciones por 10.000 pacientes-día. Conclusiones. La estrategia de mejora implementada, apoyada en la estrategia 3/3, aumentó el consumo de preparados de base alcohólica, al mismo tiempo que se observó una reducción de las infecciones por S. aureus meticilín-resistente (AU)

Objective. Within the framework of the PaSQ (Patient Safety and Quality care) Project, this hospital decided to implement a multifaceted hospital-wide Hand Hygiene (HH) intervention based on a multimodal WHO approach over one year, focusing on achieving a sustained change in HH cultural change in this hospital. Material and methods. Setting: University Hospital Marqués de Valdecilla, Santander (Spain), a tertiary hospital with 900 beds. Intervention period: 2014. An action plan was developed that included the implementation of activities in each component of the 5-step multimodal intervention. An observation/feedback methodology was used that included the provision of performance and results feedback to the staff. A 3/3 strategy (non-blinded direct observation audits performed during 3 randomised days every 3 weeks with pro-active corrective actions at the end of each observation period). HH compliance, alcohol-based hand-rub (ABHR) consumption, and rate of MRSA infection, were monitored during the intervention. Results. Hospital ABHR consumption increased during the study period: from 17.5 to 19.7mL/patient-days. In the intervention units, this consumption was 24.8mL pre-intervention, 42.5mL during the intervention, and 30.4mL two months post-intervention. There were 137 evaluation periods in 30 different days, in which a total of 737 health-care workers were observed and 1,870 HH opportunities. HH compliance was 54.5%, ranging between 44.8% and 69.9%. The incidence of MRSA infection decreased during the intervention in the selected units, from 13.2 infections per 10,000 patient-days pre-intervention to 5.7 three months post-intervention. Conclusions. Our HH strategy, supported by a 3/3 strategy increased alcohol-based hand-rub consumption and compliance. A reduction in MRSA infections was observed (AU)

[Benchmarking in the emergency unit process in 7 hospitals from different autonomous communities]. / Benchmarking en el proceso de urgencias entre siete hospitales de diferentes comunidades autónomas.

OBJECTIVE: To identify and to share the results among hospitals regarding the process of attention at the Emergency Unit, and to detect the practices that explain the differences. SETTING: 7 hospitals of different regions in Spain. PERIOD OF STUDY: 2005-2007. Firstly the comparability criteria were defined assuring the homotecia in the «emergency process¼. In order to fulfil the study objectives, 11 criteria were selected and every center sent the information of each one. 7 indicators were identified to compare hospitals processes'. Data regarding all the attentions provided during the study period was analyzed, establishing the benchmark among the centers. Finally, a questionnaire was elaborated for the process analysis, considering all the stages of the process, the resources and the procedures used in every stage, to be fulfilled in each hospital. RESULTS: The homotecia has been verified in the 7 hospitals, with some differences between centers. 7 indicators have been analyzed in the different hospitals, corresponding to 1,526,890 patients attended in the study period. A benchmark has been identified, with the best results in four of seven indicators: % of admissions from urgencies: 8.3%, emergency pressure: 56.14%, emergency length of stay: 2 hs 20min, and % of patients with length stay > 24h: 0.05%. Differences between the stages of the process, resources and procedures used in every stage in the benchmark center have been analyzed. CONCLUSIONS: A set of indicators to compare Emergency Departments has been identified, letting us establish the benchmark.