Seguridad De La Endoscopia Ambulatoria Sin Test De Cribado Para Sars-Cov-2. Desde La Reanudacion De La Actividad Endoscopica Hasta La Vacunacion

Introduccion: Durante la pandemia del COVID-19 las sociedades endoscopicas recomendaron el uso de equipos de proteccion personal (EPP) y la realizacion de cuestionarios de cribado (CC) dirigidos a la deteccion de sintomas;sin quedar clara la necesidad de realizar test diagnosticos de SARS-Cov-2 (SCV-2). La seguridad de esta actitud no ha sido valorada adecuadamente. Metodos y objetivos: Nuestro objetivo primario es evaluar si para prevenir la infeccion por SCV-2 en los trabajadores de nuestra unidad (t-UE) es seguro hacer un CC a los pacientes con endoscopias programadas, sin realizarse test diagnosticos. Nuestro objetivo secundario es comparar la incidencia de SCV-2 en la poblacion de referencia (PR), los pacientes programados (SPs) y en t-UE. Se analizaron retrospectivamente los pacientes con endoscopias programadas de forma ambulatoria previamente a la vacunacion (junio/2020- diciembre/2020). Se realizo un CC en las 72h previas a la prueba y en el dia de la misma. Todos los trabajadores disponian de EPP. Resultados: Se programaron 7.089 endoscopias. Un 9,5% fueron canceladas: un 0,35% por sospecha de SCV-2 y un 0,1% por SCV-2 confirmado antes del procedimiento. 638 pruebas se suspendieron por motivos no relacionados con SCV-2. Se realizaron 6,419 endoscopias. Se diagnostico SCV-2 en 15 pacientes en los 15 dias siguientes a la endoscopia. De los 106 profesionales trabajaron en nuestra unidad se diagnostico SCV-2 en tres casos durante este periodo. En ninguno de ellos se demostro relacion con la exposicion laboral. En la tabla se muestra la densidad de incidencia (DI, x 100,000 habitantes) y la razon de tasas (RR) de la infeccion por SCV-2 en la PR, SPs y t-UE. [Table presented] Conclusiones: En ninguno de los trabajadores con diagnostico de SCV-2 se pudo atribuir la infeccion al medio laboral. La implementacion de CC de SVC-2 resulto seguro para los t-UE, incluso en ausencia de vacunacion global de la poblacion. La incidencia de SCV-2 fue menor en SPs y en los t-UE que en la PR.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.

Outpatient Endoscopy without Sars-Cov-2 Testing: From the Resumption of Endoscopic Activity to Vaccination Was It Safe to Do That?

Introduction: Recommendations made by scientific societies regarding the need of pre-procedural testing for SARS-CoV-2 infection have been inconsistent throughout the pandemic. Several society guidelines advocated the use of personal protective equipment (PPE) and screening questionnaires for active COVID-19 disease without testing patients before endoscopy. The safety of this approach before the start of widespread vaccinations has not been properly assessed. Aims & Methods: Primary: To evaluate the safety of a screening questionnaire for active COVID-19 disease in the scheduled patients (SPs) for endoscopic procedures, without testing SARS-CoV-2, to prevent the infection in health-care workers of our endoscopy unit (EU-HCWs). Secondary: To compare the incidence of COVID-19 disease between the reference population (RP), SPs and EU-HCWs. Outpatient endoscopies scheduled from June 2020 to December 2020 were retrospectively analysed. Patients were screened by a questionnaire within 72 hours of their planned procedure and on the day of attendance. Healthcare professionals received appropriate training in infection control practices and handling of PPE. Patients were not tested for SARS-CoV-2 infection before endoscopy. Result(s): Seven thousand and eighty-nine outpatient endoscopies were scheduled. In 670 cases (9.5%) the procedures were cancelled. In 25 patients (0.35%) active COVID-19 disease was suspected before endoscopy. Two of the suspected cases had positive confirmatory tests (PT). Besides, 7 patients had a PT prior to endoscopy. Thus, 9 endoscopies (0.12%) were deferred because of confirmed COVID- 19 disease. The remaining 638 procedures were cancelled because the patient did not attend to the endoscopy unit (346) or due to a cancellation request other than COVID-19 disease from the physician or patient (292). A total of 6.419 endoscopies were performed. In 48 patients (0.75%) compatible symptoms with infection were present during the following 15 days after the procedure. COVID-19 disease was confirmed in 11 of these symptomatic patients. Besides, 4 asymptomatic patients had PT: two of them had close contact with a family member. There is no information about the reason for testing SARS-CoV-2 in the other 2 asymptomatic positive patients. In total 15 patients (0.2%) were positive within 15 days after endoscopy. One hundred and six professionals were working in our endoscopy unit (EU) during this period. Three EU-HCWs were diagnosed of COVID-19 disease. They were all physicians. None of these cases could be linked to occupational exposure. Table 1 shows the incidence rate (IR,) and rate ratio (RR, 95% confidence interval) of SARS-CoV-2 in our SPs, the RP and in our EU-HCWs. Conclusion(s): During the pre-vaccination period, 3 EU-HCWs were diagnosed of COVID-19 disease. None of them could be attributed to occupational exposure.The implementation of a COVID-19 infection screening questionnaire before the procedures without performing SARS-CoV-2 testing was safe enough for the EU-HCWs even in the absence of global vaccination of the population.The incidence of confirmed infections was lower in the SPs and EU-HCWs when compared to our RP.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19

Introduction Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System» published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing», with 27.57% of positive responses) and 10 (“Support of the hospital management in safety”, with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service») with 85.29% of positive responses, and 5 («Teamwork») with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave.

INTRODUCTION: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. METHODS: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ2 and ANOVA tests were used. RESULTS: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 ("Staffing", with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 ("Expectation of actions by management/supervision of the service") with 85.29% of positive responses, and 5 ("Teamwork") with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. CONCLUSIONS: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

[Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave]. / Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19.

Introduction: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing¼, with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service¼) with 85.29% of positive responses, and 5 («Teamwork¼) with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Simulation Model of a Spare Parts Distribution Network in the Airline Industry for Reducing Delays and Improving Service Levels: A Design of Experiments Study

Currently, delays are the most common cause of airline disputes. One of the factors leading to these situations is the distribution of spare parts. The efficient management of the spare parts distribution can reduce the volume of delays and the number of problems encountered and therefore maximize the consumer satisfaction levels. Moreover, airlines are under pressure due to their tight competition, a problem that is expected to grow worse due to the COVID-19 pandemic. By carrying out efficient maintenance and distribution management along the supply chain, authorities, airlines, aircraft manufacturers, and consumers can obtain various benefits. Thus, the aim of this research is to perform a design of experiments study on a spare parts distribution network simulation model for the aviation industry. Based on this model, the effect of the input parameters and their interactions can be derived. Moreover, the findings are converted to a combined methodology based on simulation and design of experiments for the design and optimization of distribution networks. This research study thereby provides an approach to identify significant factors that could lead to a better system performance. In conclusion, this proposed approach enables aircraft maintenance systems to improve their service by minimizing delays and claims, reducing processing costs, and reducing the impact of maintenance on customer unsatisfaction. © 2022, Springer Nature Switzerland AG.

Social communication analysis in Homeschooling: a scoping review

In the 21st century, transformations to the social system have made way for educational alternatives in which the speech-language pathologist, as a promoter of communicative skills, adopts a significant role. Homeschooling is one of those options, however, there are controversies around its impact on the development of children's social skills. This article is a scoping review that explores the relationship between Homeschooling and the development of social communication. Studies published in Spanish or English between the years 2000 and 2020 available with and full text were included, and those that included participants with cognitive disabilities or learning disorders were excluded. Of 328 studies found, only 9 met the inclusion criteria. The selected documents were analyzed according to the components of social communication: interaction, social cognition, and pragmatics in verbal and nonverbal communication. There are discrepancies between the results. Some authors claim that the social communication skills of homeschooled children are better than those of children going to school, but others state that they merely meet expected standards for their age. The role of parents or educators was identified as decisive. No studies were found addressing pragmatic skills. In conclusion, the limitations regarding the number of articles and heterogeneity of the methodologies do not allow the results to be generalized to the population. The need for further studies in this area is evident, especially at this time of confinement due to the COVID-19 pandemic. © 2021, Universidad de Chile, Departamento de Fonoaudiologia. All rights reserved.

Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19 Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave

Introducción El ambiente sanitario actual y, especialmente, las UCI, sen un medio complejo, altamente tecnificado y multidisciplinar, con interacciones entre los profesionales sanitarios y los usuarios, en los que puede haber errores a distinto nivel. Nuestro objetivo fue valorar la percepción de seguridad del paciente en nuestra unidad al terminar la tercera ola de la pandemia de COVID-19, con la intención de llevar a cabo acciones de mejora posteriores. Métodos Estudio observacional, transversal y descriptivo. La percepción sobre la cultura de seguridad se estimó mediante el cuestionario HSOPS traducido al castellano. Algunas preguntas se plantearon en sentido positivo y otras en sentido negativo. También se calificó la respuesta como positiva, negativa o neutra. Se compararon visualmente, no de forma matemática, nuestros hallazgos con los encontrados en el estudio nacional previo «Análisis de la cultura sobre seguridad del paciente en el ámbito hospitalario del Sistema Nacional de Salud español» publicado en 2009. Se realizó un análisis de subgrupos en función del grupo profesional y de la antigüedad como sanitario. Se emplearon las pruebas t de Student, χ? y ANOVA. Resultados Respondieron al cuestionario 62 profesionales, el 73,90% del total. La mediana del tiempo de trabajo en UCI fue 2 años (rango intercuartil 2-4,5 años). La calificación del grado de seguridad fue 8,06 (DE 1,16). La mayoría (91,20%) no había notificado ningún evento adverso en el último año. Un 30,90% había recibido formación en seguridad de paciente recientemente. Las dimensiones consideradas como debilidad fueron la 9 («Dotación del personal», con 27,57% de respuestas positivas) y la 10 («Apoyo de la gerencia del hospital en la seguridad», con 17,64% de respuestas positivas). Las dimensiones consideradas como fortalezas fueron 3 («Expectativa de acciones por parte de dirección o supervisión del servicio») con un 85,29% de respuestas positivas y 5 («Trabajo en equipo») con el 95,58% de respuestas positivas. Los valores del índice α de Cronbach indican una consistencia interna adecuada del cuestionario. En general, nuestros datos son más positivos que los recogidos en la encuesta nacional de 2011, aunque las 2 dimensiones consideradas debilidades ya lo eran en el trabajo previo. Conclusiones La percepción de seguridad del paciente en la UCI de nuestro hospital tras finalizar la tercera oleada de la pandemia de COVID-19 era adecuada, con estimaciones más positivas que las del estudio nacional sobre cultura de seguridad hospitalaria realizado en 2009. La búsqueda constante de la seguridad del paciente debería priorizar su actividad en las 2 dimensiones consideradas debilidades: la Dotación de personal y el Apoyo de la gerencia del hospital en todo lo relacionado con la seguridad del paciente.

Evaluation of an UVC robot for terminal disinfection of hospital rooms

Introduction: The dramatic spread of COVID-19 has disrupted lives, communities and businesses worldwide. A new autonomous robot, equipped with UVC light to perform fast and reliable disinfections while it is on movement, has been developed to contribute to the reduction of the impact on public health. Objectives: In this work, we have scientifically evaluated the ability of this robot to disinfect hospital rooms. Methods: We selected empty rooms just after patient discharge and before terminal cleaning. We took 94 microbiological samples of highly touched surfaces inside the hospital patient's rooms using Rodac plates, before introducing the robot in the room. After the robot operation, samples were taken in the same places. The plates were incubated and read after 5 days. We performed descriptive statistics, and non-parametric Wilcoxon test for repeated measures, using IBM SPSS and OPENEPI. Results are presented in colony-forming units per plate (cfu/p) per plate. Patients are considered to be at risk when the bacterial count on hospital surfaces exceeds 120 FCU/plate (5 fcu/cm2). Results: The initial situation was that in 4% of the locations there was a risk for the patients (more than 120 cfu per plaque). After applying this robot there were no locations with risk for the patients. The table shows that the mean colony reduction is 81.96% and the median experiments a reduction of 94.8%. In any case, both levels mean and median are below the threshold for disinfection that is 10 fcu/plate. The Wilcoxon test for related samples indicates that the differences are statistically significant (P < 0.0001). The normal procedure is to clean the room using a Chloramine-based disinfectant after the UVC, so the cumulated effect will be even higher. Conclusion: The use of this robot allowed to reduce the colony-forming units below the risk threshold. Therefore it is a valid technique for terminal disinfection of hospital rooms. (Figure Presented).

Complications and causes of death of patients with COVID-19 requiring extracorporeal respiratory support. A subanalysis of the ECMOVIBER study

Objective: To describe the most frequent complications and causes of death of COVID-19 patients requiring extracorporeal respiratory support. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult (>18 years old) COVID-19 patients requiring veno-venous ECMO between 1st March and 1st December 2020 were included. The follow up period ended 1st December 2020. Demographic data, comorbidities and complications during ECMO [acute kidney injury, ventilator associated pneumonia (VAP), hemorrhage and thrombosis] were recorded. Results are described using median (interquartile range) or frequency (percentage). Results: A total of 316 patients [age 55 (47-60), 253 (80%) male] were included. Only 21 (7%) patients had prior respiratory disease and 12 (4%) chronic kidney disease. One hundred and thirty-one (41%) patients received anticoagulation prior to cannulation and 94 (30%) suffered concomitant bacterial coinfection prior to ECMO initiation. Eighty-two (26%) patients developed acute kidney injury of which 73 (89%) required continuous renal replacement therapy;50 (16%) suffered at least one thrombotic episode during the extracorporeal support (47 deep venous thrombosis, 3 pulmonary embolism) and 41 (13%) presented haemorrhagic shock. In 109 (34%) patients clots in the circuit were identified and 20 of them (18%) required at least one circuit change. The most frequent infectious complication was VAP [154 patients (49%)]. One hundred and twenty (38%) patients died on ECMO and 9 (3%) after decannulation. The most frequently reported causes of death were multiorgan dysfunction [37 (29%)], persistent respiratory failure due to COVID- 19 [23 (18%)] and septic shock [20 (15%)]. Death during cannulation occurred in 11 cases (3% of the total population). Conclusions: Complications during extracorporeal respiratory support in COVID-19 patients are frequent. VAP may complicate up to half of the cases. Persistent COVID-19 was the cause of death of almost one fifth of the population.