Impact of squalene-based adjuvanted influenza vaccination on graft outcome in kidney transplant recipients.

BACKGROUND: Safety concerns have been raised about the use of adjuvanted vaccines after kidney transplantation. METHODS: We retrospectively analyzed 65 kidney transplant (KT) recipients who received ≥1 dose of influenza vaccine (pandemic or seasonal) during the 2009-2010 campaign. Participants were classified into 2 groups: those who received a squalene-based AS03- or MF59-adjuvanted vaccine ("adjuvanted vaccination" [AV] group, n = 37) and those who exclusively received non-adjuvanted vaccines ("non-adjuvanted vaccination" [NAV] group, n = 28). Primary outcomes included occurrence of biopsy-proven acute graft rejection (BPAR) and graft function at months 6 and 12 after vaccination. Patients were followed up until graft loss, death, or October 2010. RESULTS: Four episodes of BPAR occurred during post-vaccination follow-up, with no differences between the AV and NAV groups, in terms of cumulative incidence (5.4% vs. 7.1%, respectively; P = 0.581), incidence rate (0.22 vs. 0.18 episodes per 1000 transplant-days; P = 0.950), or occurrence of severe episodes (T-cell-mediated BPAR of grade ≥2a) (2.7% vs. 3.6%; P = 0.680). No between-group differences were seen in graft function after vaccination. CONCLUSION: Adjuvanted influenza vaccination in KT recipients seems to be safe regarding graft outcome.

[Multicentre study of infection incidence in knee prosthesis]. / Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla.

OBJECTIVE: To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. MATERIAL AND METHOD: A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. RESULTS: 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. DISCUSSION: In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures.

Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla / Multicentre study of infection incidence in knee prosthesis

Objetivo. Determinar la incidencia de infección de localización quirúrgica en el procedimiento prótesis de rodilla, durante un año de seguimiento en 12 hospitales madrileños. Material y método. Estudio prospectivo de enero a diciembre de 2009, utilizando el programa Indicadores Clínicos de Mejora Continua de Calidad. Se incluyeron prótesis de rodilla primarias y de revisión intervenidas el año previo. Se utilizaron criterios de infección de localización quirúrgica y categorías por índice de riesgo de los Centros para el Control y Prevención de Enfermedades y del National Nosocomial Infections Surveillance. Se calcularon tasas crudas y ajustadas por índice de riesgo. Resultados. Se analizaron 2.088 procedimientos quirúrgicos de prótesis de rodilla. La tasa global de infección de localización quirúrgica fue del 2,1%. El 65% de las infecciones fueron de órgano/espacio. El 60% de las infecciones se identificaron precozmente. Se obtuvo confirmación microbiológica en el 41,9% de los casos. La profilaxis quirúrgica fue adecuada en el 63,3%, siendo la principal causa de inadecuación su duración en el 85,7%. La preparación prequirúrgica fue correcta en el 50,3% de los pacientes. La tasa de infección en artroplastias de rodilla fue dos veces superior a la esperada según el National Healthcare Safety Network y similares a las tasas nacionales. Discusión. La tasa de infección de nuestro estudio se encuentra dentro del rango de las tasas de infección descritas en otros estudios europeos ya publicados. Las estrategias de vigilancia y control de las infecciones asociadas a la asistencia sanitaria permiten evaluar tendencias y el impacto de las medidas de prevención (AU)

Objective. To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. Material and method. A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. Results. 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. Discussion. In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures (AU)

Influenza vaccination coverage among hospital personnel over three consecutive vaccination campaigns (2001-2002 to 2003-2004).

This study was carried out to assess influenza vaccination coverage among hospital personnel and the impact of health promotion campaigns, within the hospital, designed to increase vaccination coverage over three consecutive vaccination campaigns (2001-2002 to 2003-2004). The health promotion tool used in the 2001-2002 and 2002-2003 were informative posters distributed throughout the hospital. In the 2003-2004 season, the recommendation was also published in the internal bulletin and Web site of the hospital. In addition, a physician and a nurse from the Department of Preventive Medicine visited all departments offering vaccination in the work place. The overall vaccination coverage in the 2001-2002 campaign was 16% with coverage of 11.5% in nurses and 15% in physicians. In the 2002-2003 and 2003-2004 campaigns the overall vaccination coverage was 21% and 40%, respectively (p<0.01). Staff physicians and resident physicians reached 60 and 42% coverage rates in the 2003-2004 campaign, but coverage in nurses and nursing assistant remained around 30% (p<0.01). In summary, influenza vaccination coverage among hospital based healthcare personnel increased significantly during the last three seasons, however, it still remains low despite active attempts at promoting influenza vaccination.

Gestión de residuos biosanitarios y citotóxicos en un centro hospitalario / Management of bio-sanitary and cytotoxic wastes at a hospital centre

Los residuos sanitarios generados diariamente, van en aumento y la innovación en las actividades hospitalarias han traído consigo un gran incremento del volumen de desechos clínicos. A una pequeña fracción de éstos, se le atribuyen riesgos asociados a la salud pública y precisarán una gestión diferenciada. El interés por la correcta gestión de estos residuos es creciente y, sin embargo, hay dificultad en la aplicación del sistema de gestión y en el cumplimiento del marco legal. El plan de gestión de residuos es una herramienta para promover una adecuada gestión de residuos en los centros sanitarios. Los profesionales sanitarios y no sanitarios deben ser partícipes, del mismo modo que la información y formación es clave en nuestro trabajo diario, para garantizar un entorno seguro y en mejores condiciones técnicas e higiénicas (AU)

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Cost analysis of two strategies for hepatitis A vaccination of hospital health-care personnel in an intermediate endemicity area.

The aim of the study was to carry out a cost analysis to allow the comparison of the cost of two vaccination strategies against Hepatitis A in health-care personnel. A total of 423 health-care workers were recruited at one General Hospital of Madrid, Spain. Blood specimens were obtained for anti-HAV antibody determination. The prevalence of anti-HAV antibody was 40% (95% CI: 35-45) and it was directly correlated with age. Cost analysis determined that the critical value of prevalence for vaccination with HAV vaccine was 23%. In hospital health-care workers < or =30 years in age, vaccination with HAV vaccine (without screening) would be the less costly strategy. In those >30 years in age, it would be less costly to screen for anti-HAV antibody first and vaccinate those who are antibody-negative.

Hepatitis B vaccination in infants of mothers infected with human immunodeficiency virus.

A study was conducted to investigate the immunogenicity of a recombinant DNA hepatitis B vaccine in neonates and children of HIV-infected women. Immunization against hepatitis B consisted of three 10 micrograms doses of the vaccine administered on a 0-, 1- and 6-month schedule. The children were followed up for an average of 11 months. Of the 118 HIV-positive neonates who participated in the study, 95 lost their HIV antibodies during the follow-up period. Most (94.2%) of the latter who completed the study responded to the vaccine. Of the 23 who remained HIV-positive, 17 completed the study and 7 produced hepatitis B antibodies.