[Impact of covid-19 vaccination on hospitalization in a third-level hospital.] / Impacto de la vacunación frente a la covid-19 sobre la hospitalización en un hospital de tercer nivel.

OBJECTIVE: This study presents information on the evolution of severe cases of SARS-CoV-2 infection that required hospitalization since the beginning of vaccination in Spain. The objective was to know the impact of vaccination against COVID-19 on the hospitalization of patients with SARS-CoV-2 infection, hospital mortality and readmissions for this cause, and to describe the characteristics of vaccinated patients who required admission. METHODS: A retrospective, observational epidemiological study was conducted of all patients admitted with SARS-CoV-2 infection confirmed by a diagnostic test for active infection (PDIA) in a tertiary hospital, from January 2021 to June 2021. The incidence of admissions was calculated based on the vaccination status of the patients and age groups at different times according to the progress of the strategy of vaccination COVID-19. RESULTS: Between December 27, 2020 and June 30, 2021, 1,308 patients with positive PDIA were admitted to the University Hospital of Salamanca, of which 1,167 (89.2%) were not vaccinated, 129 (9.9%) had received one dose of vaccine and 12 (0.9%) were fully vaccinated. Of the latter, none were admitted to the ICU and 2 died. CONCLUSIONS: Vaccination against COVID-19 has contributed to the decrease in hospitalizations, since February 2021, of older and institutionalized people. Fully vaccinated people have a lower risk of admission to the ICU and death. These data, together with the information available on recent cases of new SARS-CoV-2 infections in unvaccinated young people, are in favor of achieving high vaccination coverage of the entire population in the shortest possible time.

OBJETIVO: Este estudio presenta información sobre la evolución de los casos graves de infección SARS-CoV-2 que requirieron hospitalización desde el inicio de la vacunación en España. El objetivo fue conocer el impacto de la vacunación frente a COVID-19 sobre la hospitalización de pacientes con infección SARS-CoV-2, la mortalidad intrahospitalaria y los reingresos por esta causa, y describir las características de los pacientes vacunados que precisaron ingreso. METODOS: Se realizó un estudio epidemiológico observacional retrospectivo, de todos los pacientes ingresados con infección por SARS-CoV-2 confirmada mediante una prueba de diagnóstico de infección activa (PDIA) en un hospital de tercer nivel, de enero de 2021 a junio de 2021. Se calculó la incidencia de ingresos en función del estado vacunal de los pacientes y grupos de edad en diferentes momentos según el avance de la campaña de vacunación. RESULTADOS: Entre el 27 de diciembre de 2020 y el 30 de junio de 2021 ingresaron en el Hospital Universitario de Salamanca 1.308 pacientes con PDIA positiva, de los cuales 1.167 (89,2%) no estaban vacunados, 129 (9,9%) habían recibido una dosis de vacuna y 12 (0,9%) estaban completamente vacunados. De estos últimos, ninguno ingresó en UCI y 2 fallecieron. CONCLUSIONES: La vacunación frente a COVID-19 ha contribuido al descenso de las hospitalizaciones desde el mes de febrero de 2021, sobre todo en personas mayores e institucionalizadas. Las personas completamente vacunadas parecen tener menor riesgo de ingreso en UCI y fallecimiento. Estos datos, junto con la información disponible de los casos recientes de nuevas infecciones por SARS-CoV-2 en personas jóvenes no vacunadas, están a favor de conseguir una cobertura vacunal elevada de toda la población en el menor tiempo posible.

[Impact of nosocomial transmission of influenza virus in an acute hospital]. / Impacto de la transmisión nosocomial del virus de la gripe en un hospital de agudos.

OBJECTIVE: The increase in morbidity and mortality associated the influenza virus infections represents an important global challenge, with particular relevance within health institutions.The aim of the study was to highlight the impact, repercussions and characteristics of the nosocomial transmission of influenza virus. METHODS: A sample of 286 hospitalized patients in a third-level hospital with confirmed influenza (virus RNA in respiratory specimens) is included. The study design was observational, through the collection of positive microbiological results from the 2016-2017 season. A comparative statistical analysis was carried out between cases of community-acquired influenza and hospital-acquired cases. RESULTS: 14.3% of the total sample (41 cases) was considered of nosocomial origin. Significant differences were observed in the percentage of vaccinated between hospital-acquired (34.1%) and community-acquired (50.2%); and in the number of days of hospitalization after diagnosis between both groups. The attack rate was 0.66%. CONCLUSIONS: The nosocomial acquisition of the influenza virus resulted in a greater severity of the process and in the increase of days of hospital stay. Strict adherence to control measures and epidemiological surveillance of influenza cases has allowed to reduce the attack rate.

OBJETIVO: El incremento de la morbimortalidad asociado a la infección por el virus de la gripe supone un importante reto a nivel mundial, con especial relevancia dentro de las instituciones sanitarias. El objetivo del estudio fue analizar el impacto, repercusiones y características de la transmisión nosocomial del virus de la gripe. METODOS: Se incluyó una muestra de 286 pacientes hospitalizados en un centro de tercer nivel con gripe confirmada (ARN del virus en muestras respiratorias). El diseño del estudio fue observacional, mediante recogida de los resultados microbiológicos positivos de la temporada de gripe 2016-2017. Se realizó un análisis estadístico comparativo entre los casos de gripe comunitaria y los casos nosocomiales. RESULTADOS: El 14.3% del total de la muestra (41 casos) se consideró de origen nosocomial. Se observaron diferencias significativas en el porcentaje de vacunados entre los casos de infección nosocomial (34,1%) y comunitaria (50,2%), y en el número de días de ingreso tras diagnóstico (12 ±22 días para los casos nosocomiales y 6 ±8 días para los comunitarios). La tasa de ataque fue del 0,66%. CONCLUSIONES: La adquisición nosocomial del virus de la gripe se tradujo en una mayor gravedad del cuadro y en el incremento de los días de estancia hospitalaria. El estricto cumplimiento de las medidas de control y vigilancia epidemiológica de los casos de gripe ha permitido lograr una tasa de ataque reducida.

[Implementation of a clinical pathway for transurethral resection in benign prostatic hyperplasia]. / Implantación de una vía clínica para la resección transuretral por hiperplasia benigna de próstata.

OBJECTIVE: Clinical pathways constitute a powerful tool for reducing the variability that occurs in clinical practice. The results obtained with the use of a clinical pathway for patients undergoing transurethral resection for benign hyperplasia of the prostate (BPH) are presented. METHODS: A prospective study was carried out on a cohort of 80 consecutive patients that had undergone transurethral resection for BPH after the application of a clinical pathway (5 days hospitalization) and compared with the results of a historical cohort of 80 consecutive patients that had been treated before the application of the clinical pathway. The exclusion criteria were diabetes mellitus, anticoagulation therapy with dicoumarin and other pathologies that changed the length of the preoperative stay established in the clinical pathway. For the evaluation of the degree of satisfaction, patients were asked to fill out a questionnaire included in the pathway documents. RESULTS: 73 patients met the inclusion criteria of the clinical pathway. 67 of the 80 patients that underwent surgery before the application of the clinical pathway were valid for comparative analysis. No statistically significant differences were found between both groups for age, prostate volume measured by DRE and US, previous treatment for prostatism, anesthetic risk and weight of the resected specimen. With the application of the pathway, the mean duration of hospital stay was reduced from 6 (SD 1.7; range 4-15) to 4.9 (SD 1.4; range 3-13) days (p < 0.0001) and the duration of urethral catheterization from 4.5 (SD 1.4; range 3-13) to 3.8 (SD 1.3; range 2-11) days (p < 0.01). Statistically significant differences were found before and after the application of the clinical pathway for degree of compliance of the preestablished antimicrobial prophylaxis guidelines during hospitalisation and after discharge, and thromboembolic prophylaxis. The relative risk of complications after discharge was less after the application of the clinical pathway (RR = 0.66), although it was not statistically significant (CI: 0.41-1.05). 63 of the 73 patients included in the clinical pathway submitted the questionnaire without identifying themselves. Duration of hospitalization was considered adequate by 89%, and coincided with the programmed and actual duration according to 82.5%. CONCLUSIONS: The application of a clinical pathway for patients undergoing transurethral resection for BPH has reduced costs by reducing the length of hospital stay and adverse effects. Furthermore, reducing the variability of medical care has improved its quality.