OBJECTIVE
To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.


DESIGN
Case-control and cohort studies of surgical intensive care unit (SICU) patients.


SETTING
A university-affiliated Veterans Affairs medical center.


PATIENTS
Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).


MEASUREMENTS
CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.


RESULTS
When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence interval, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the outbreak period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.


CONCLUSIONS
Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (i.e., nosocomial infection) needs to be critically assessed.

The role of understaffing in central venous catheter-associated bloodstream infections [see comments]

Objetivo: Determinar la prevalencia de portadores asintomaticos y sensibilidad antimicrobiana de Staphylococcus aureus  en trabajadores del Hospital Regional de Ica.  Material y metodos:  Estudio de tipo descriptivo transversal realizado en noviembre del 2011. Segun muestreo aleatorio simple sin reposicion, la muestra fue de 131 trabajadores. Se obtuvieron los datos con la aplicacion de una ficha y la extraccion de las muestras mediante hisopado, obteniendo 262 cepas de manos y fosas nasales. El aislamiento, identificacion y pruebas de sensibilidad se efectuaron segun los criterios del  Clinical and Laboratory Standars Institute  (CLSI). Los datos se procesaron en el programa SPSS, realizando analisis univariado y pruebas de significacion estadistica.  Resultados:  La prevalencia de portadores asintomaticos fue de 12,98% en total, 10,7% en manos y 5,3% en fosas nasales. Todos los germenes fueron sensibles a: meticilina, cefaclor, ceftazidima, ancomicina y rifampicina. Solo fueron resistentes algunas cepas de fosas nasales (7,1%) a: oxacilina, dicloxacilina, claritromicina y cloranfenicol.  Conclusiones:  La prevalencia de portadores asintomaticos de  Staphylococcus aureus  fue baja. Se observo menor frecuencia de portadores cuando se utilizaban algunas medidas de proteccion. La resistencia antimicrobiana tambien fue baja. Se debe realizar un estudio caso-control para identificar los factores de proteccion.

/pdf/portadores-asintomaticos-de-staphylococcus-aureus-en-26yjiscnv8.pdf

PORTADORES ASINTOMÁTICOS DE Staphylococcus aureus EN TRABAJADORES DEL HOSPITAL REGIONAL DE ICA, PERÚ 2011

Objetivos: conocer los patrones locales de resistencia a antibioticos de las bacterias aisladas de secreciones bronquiales en una unidad de cuidados intensivos, y evaluar los casos de neumonia asociada a ventilador. Material y metodos: analisis retrospectivo de los patrones de resistencia a antibioticos, durante 2004 y 2005. Para calcular el numero de casos de neumonia asociada a ventilador se establecio diagnostico consensuado entre un equipo de vigilancia local comparandolo con el informe del area de epidemiologia hospitalaria. Resultados: las bacterias mas aisladas fueron Pseudomonas aeruginosa con 134 aislamientos (26 %), 71 multidrogorresistentes (53 %); seguida por Staphylococcus con 122 aislamientos (24 %), de los cuales 88 correspondieron a S. aureus, con 62 aislados (70 %) resistentes a meticilina. Las enterobacterias, Eschericha coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, asi como Acinetobacter sp. y Stenotrophomonas maltophilia se aislaron ocasionalmente. Candida represento 17 %. Se identificaron tres periodos en los que el aislamiento de Staphylococcus aureus fue mayor y tres para P. aeruginosa. Hubo diferencias entre los casos de neumonia asociada a ventilador informados por epidemiologia hospitalaria y el equipo de vigilancia local. Conclusiones: destaca la alta frecuencia de resistencia en P. aeruginosa y S. aureus. Las enterobacterias, Acinetobacter o S. maltophilia no representaron un problema. Por la divergencia en los casos informados de neumonia asociada a ventilador deben establecerse definiciones claras de caso

/pdf/respiratory-tract-fluid-microbiology-in-an-intensive-care-2j7puxq412.pdf

Respiratory tract fluid microbiology in an intensive care unit

An evaluative investigation of health systems and services was carried out in "Dr. Joaquin Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba from January, 2011 to October, 2012, in order to evaluate the quality of nursing care in the surgical rooms of this institution, for which the patients admitted to these services during that period (97), and the nursing staff working at the moment of carrying out the study were considered. Among the results difficulties were evidenced in the disposable material resources (clinical thermometers and alternative illumination sources), the evaluation of performance revealed difficulty in the procedures and the delay in the patient's admission constituted one of the aspects impacting the non satisfaction of those investigated in relation to the nursing staff. Likewise, dissatisfaction of the care giver with the stimulation was identified, and it could be concluded that in the general process of care to the patient in the surgical rooms the main deficiencies which constitute immediate work projections to improve for an excellence care were identified.

Calidad de la atención de enfermería en los servicios quirúrgicos del Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" Quality of the nursing care in the surgical services of "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital

Introduction: The effectiveness of alcohol-based handrub containing 80% ethanol or isopropyl alcohol 75%, as an alternative to handwashing with plain soap and water is the objective of global challenge for the safety of the patient, “Clean Care is Safer Care”. Objective: To measure effectiveness on removing germs of Alcohol-based handrub proposed by the World Health Organization. Materials and methods: We included 103 health workers, 17.5% physicians and 82.5% nurses who worked in a hospital. 332 samples were taken before and after each technique Results: 28.3% samples were identified coloni forming units before handwashing and 15.3% in the posterior (p=0.234), with alcohol-based handrub in the sample previous 25.6% and after the hygiene 2.4% (p= 0.000). Coagulase-negative staphylococci were identified in 25.9% and 2.1% gram negative samples, in 4 cases was isolated Enterobacter sp. The alcohol-based handrub was effective when calculated before and handrubbing (RR 0.10 CI 0.02-0.39) when compared with the technique handwashing with soap and water (RR 0.12 CI 0.030.5). The technique of handwashing was not effective (RR 0.71 CI 0.43-1.18) Eficacia de la higiene de manos con un preparado de base alcohólica vs lavado de manos con agua y jabón Effectiveness of alcohol-based handrub vs handwashing with soap and water Ángela liliana londoño, Marta lucia Murillas • arMenia (coloMbia) Dra. Ángela Liliana Londoño F.: Especialista en Epidemiología. PhD en Medicina Preventiva y Salud Pública. Docente Facultad de Ciencias de la Salud, Universidad del Quindío; Lic. Marta Lucía Murillas B. Licenciada en Enfermería. Docente Facultad de Ciencias de la Salud, Universidad del Quindío. Armenia (Colombia) Institución Financiadora: La investigación fue financiada por la Universidad del Quindío a través de proyecto aprobado en convocatoria interna. Correspondencia. Ángela Liliana Londoño F. Armenia, Quindío (Colombia). E-mail: angelalilianal@uniquindio.edu.co Recibido: 01/VI/2011 Aceptado: 27/X/2011

Effectiveness of alcohol-based handrub vs handwashing with soap and water

SUMMARY Hand washing represents the easiest way to prevent nosocomial infection. Despite this fact, poor medical adherence to this practice has been the rule, never reaching more than 50 % of the evaluated personnel. It is mandatory to find ways to improve this inadequate health-personnel practice. In that sense, medical journals are the major channels to communicate and share experiences. A search in Latin American indexes with the words “hand washing” or “lavado de manos” yielded only four references, none devoted particularly to this issue. Many medical recommendations that come from the developed world are not applicable to our environment. However, hand-washing recommendations are among the few that are applicable worldwide. Hand-washing practice should be encouraged in all areas where patients are treated. RESUMEN El lavado de manos desempena un importante papel en la disminucion de las infecciones nosocomiales. Despues de revisar algunos indices se destaca la carencia de informacion en espanol sobre el tema, cuando que por su sencillez y aplicabilidad debiera ser motivo frecuente de publicacion para comunicar y compartir experiencias. En forma similar a lo encontrado en investigaciones internacionales, los escasos trabajos latinoamericanos al respecto demuestran que existe resistencia del personal de salud para llevar a cabo el lavado de manos, que debiera ser rutinario. Al evaluar esta practica, personal de salud de paises desarrollados no alcanzo 50 % de cumplimiento. En un servicio de urgencias del Sector Salud nacional, solo 12.1 % del personal de salud cumplio con ella. Por su facilidad, bajo costo y potencialidad para disminuir las infecciones nosocomiales, las recomendaciones acerca del lavado de manos formuladas en paises desarrollados son de las pocas practicas medicas que pueden ser emuladas en los paises en desarrollo.

/pdf/reflexiones-acerca-del-lavado-de-manos-2dhmhkndde.pdf

Luis Javier Casanova Cardiel

Papers

Reflexiones acerca del lavado de manos