Impact of COVID-19 on the degree of compliance with hand hygiene: a repeated cross-sectional study.

Hand hygiene (HH) is the paramount measure used to prevent healthcare-associated infections. A repeated cross-sectional study was undertaken with direct observation of the degree of compliance on HH of healthcare personnel during the SARS-CoV-2 pandemic. Between, 2018-2019, 9,083 HH opportunities were considered, and 5,821 in 2020-2022. Chi squared tests were used to identify associations. The crude and adjusted odds ratios were used along with a logistic regression model for statistical analyses. Compliance on HH increased significantly (p < 0.001) from 54.5% (95% CI: 53.5, 55.5) to 70.1% (95% CI: 68.9, 71.2) during the COVID-19 pandemic. This increase was observed in four of the five key moments of HH established by the World Health Organization (WHO) (p < 0.05), except at moment 4. The factors that were significantly and independently associated with compliance were the time period considered, type of healthcare-personnel, attendance at training sessions, knowledge of HH and WHO guidelines, and availability of hand disinfectant alcoholic solution in pocket format. Highest HH compliance occurred during the COVID-19 pandemic, reflecting a positive change in healthcare-personnel's behaviour regarding HH recommendations.

Effectiveness of the systematic use of antimicrobial filters in the water taps of critical care units for the prevention of healthcare-associated infections with Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa (PA) is the third leading aetiological agent in healthcare-associated infections (HAIs) and the one most frequently found in patients with pneumonia associated with mechanical ventilation. In intensive care units (ICU), its appearance is associated with higher mortality, an increase in the days spent on ventilation, and hospital stay length and costs. Thus, evaluating strategies for preventing these infections is essential for their control. Therefore, our objective was to evaluate the effectiveness of the systematic use of antimicrobial filters in preventing PA infections in critical care units. METHODS: This was an open experimental crossover study. A total of 2,156 patients admitted for more than 24 hours in critical care units were included, 1,129 of them in units with filters, and 1,027 in units without filters. The study groups were followed-up for 24 months and HAIs were checked for the presence of PA. Chi-squared test were used to compare the rate of HAIs between groups and we calculated 95% confidence intervals adjusted by Poisson regression for the rate ratio (RR) of the association magnitude. RESULTS: Both groups were homogeneous in terms of intrinsic and extrinsic patient factors. The incidence of PA infections in the units with filters was 5.5 cases/1,000 hospitalized days and 5.4/1,000 hospitalized days for the units without water filters (RR = 1.09 [0.67-1.79]). CONCLUSIONS: Routine placing antimicrobial filters in the water taps in critical care units was not an effective means of preventing the emergence of HAIs caused by PA.

Estimated Costs Associated with Surgical Site Infections in Patients Undergoing Cholecystectomy.

Among healthcare-associated infections, surgical site infections (SSIs) are the most frequent in Spain. The aim of this work was to estimate the costs of SSIs in patients who underwent a cholecystectomy at the Hospital General Universitario de Alicante (Spain) between 2012-2017. This was a prospective observational cohort study. The Active Epidemiological Surveillance Program at our hospital recorded all the cholecystectomies performed. Risk factors associated with the development of SSIs were determined by multivariate analysis and two homogeneous comparison groups were obtained by using the propensity score. The number of extra days of hospital stay were recorded for patients with an SSI and with the cost per hospitalised day data, the additional cost attributed to SSIs was calculated. A total of 2200 cholecystectomies were considered; 110 patients (5.0%) developed an SSI. The average length of hospital stay was 5.6 days longer among patients with an SSI. The cost per SSI was EUR 1890.60 per patient, with the total cost for this period being EUR 207,961.60. SSIs after cholecystectomy lead to a prolongation of hospital stay and an increase in economic costs. It is essential to implement infection surveillance and control programs to reduce SSIs, improve patient safety, and reduce economic burden.

Effectivity of a Program for the Control and Prevention of COVID-19 Healthcare-Associated Infections in a Spanish Academic Hospital.

BACKGROUND: Although recommendations to prevent COVID-19 healthcare-associated infections (HAIs) have been proposed, data on their effectivity are currently limited. OBJECTIVE: The aim was to evaluate the effectivity of a program of control and prevention of COVID-19 in an academic general hospital in Spain. METHODS: We captured the number of COVID-19 cases and the type of contact that occurred in hospitalized patients and healthcare personnel (HCP). To evaluate the impact of the continuous use of a surgical mask among HCP, the number of patients with COVID-19 HAIs and accumulated incidence of HCP with COVID-19 was compared between the preintervention and intervention periods. RESULTS: Two hundred fifty-two patients with COVID-19 have been admitted to the hospital. Seven of them had an HAI origin (6 in the preintervention period and 1 in the intervention period). One hundred forty-two HCP were infected with SARS-CoV-2. Of them, 22 (15.5%) were attributed to healthcare (2 in the emergency department and none in the critical care departments), and 120 (84.5%) were attributed to social relations in the workplace or during their non-work-related personal interactions. The accumulated incidence during the preintervention period was 22.3 for every 1000 HCP and 8.2 for every 1000 HCP during the intervention period. The relative risk was 0.37 (95% confidence interval, 0.25 to 0.55) and the attributable risk was -0.014 (95% confidence interval, -0.020 to -0.009). CONCLUSIONS: A program of control and prevention of HAIs complemented with the recommendation for the continuous use of a surgical mask in the workplace and social environments of HCP effectively decreased the risk of COVID-19 HAIs in admitted patients and HCP.

[Effectiveness of the first dose of BNT162b2 vaccine to preventing covid-19 in healthcare personnel.] / Efectividad de la primera dosis de vacuna BNT162b2 para prevenir la COVID-19 en personal sanitario.

OBJECTIVE: A first protective dose of vaccine may allow delaying the second dose in a context of low supply. The objective is to assess the effectiveness of a single dose of vaccine against SARS-CoV-2 (BNT162b2) after twelve days of its administration in healthcare personnel (HCP) of a Health Department. METHODS: A case-control study was made. HCP with suspected COVID-19 and HCP close contacts of COVID-19 cases were included between January 27 and February 7, 2021. They were PCR tested for SARS-CoV-2; those with positive PCR were considered cases and those with negative PCR were considered controls. The crude (VE) and adjusted (VEa) vaccine effectiveness to prevent COVID-19 cases and their 95% confidence interval were calculated using the formula VE = (1-Odds ratio) x 100. RESULTS: 268 HCP were included, of which 70 (26.1%) were considered cases and 198 (73.9%) controls. The frequency of vaccine exposure in cases was 55.7% vs. 69.7% in controls (p=0.035). The VEa of the first vaccine dose was 52.6% (95%CI: 1.1-77.3). The VEa in the subgroup of HCP studied for suspected disease was 74.6% (CI95%: 38.4-89.5). CONCLUSIONS: One dose of BNT162b2 vaccine against SARS-CoV-2 offers early protection after twelve days of administration. These data could be considered to adapt strategies and consider postponing the second dose in situations of limited vaccine supply in order to achieve the maximum number of people covered with a first dose.

OBJETIVO: Una primera dosis de vacuna protectora permitiría aplazar la segunda dosis en un contexto de suministro escaso. El objetivo de este trabajo fue conocer la efectividad de una dosis de vacuna frente a SARS-CoV-2 (BNT162b2) tras doce días de su administración en personal sanitario (PS) de un Departamento de Salud. METODOS: Se realizó un estudio de casos y controles. Se incluyó a PS con sospecha de COVID-19 y PS que tuvo contactos estrechos con casos de COVID-19 entre el 27 de enero y el 7 de febrero de 2021. Se les realizó una PCR para determinar SARS-CoV-2; aquellos con PCR positiva fueron considerados casos y aquellos con PCR negativa fueron considerados controles. Se calculó la efectividad vacunal cruda (EV) y ajustada (EVa) para prevenir casos de COVID-19 y su intervalo de confianza al 95%, mediante la fórmula EV = (1-Odds ratio) x 100. RESULTADOS: Fueron incluidos 268 PS, de los cuales 70 (26,1%) fueron considerados casos y 198 (73,9%) controles. La frecuencia de exposición a la vacuna en los casos fue del 55,7% frente al 69,7% en los controles (p=0,035). La EVa de la primera dosis de vacuna fue del 52,6% (IC95%: 1,1-77,3). La EVa en el subgrupo de PS estudiados por sospecha de enfermedad fue del 74,6% (IC95%: 38,4-89,5). CONCLUSIONES: Una dosis de vacuna BNT162b2 frente a SARS-CoV-2 ofrece protección temprana tras doce días de su administración. Estos datos podrían considerarse para adaptar estrategias y valorar aplazar la segunda dosis en situaciones de limitación de suministro de vacuna, con el fin de conseguir el máximo número de personas cubiertas con una primera dosis.

Frequency, Associated Risk Factors, and Characteristics of COVID-19 Among Healthcare Personnel in a Spanish Health Department.

INTRODUCTION: This study examines the frequency, associated factors, and characteristics of healthcare personnel coronavirus disease 2019 cases in a healthcare department that comprises a tertiary hospital and its associated 12 primary healthcare centers. METHODS: This study included healthcare personnel that showed symptoms or were in contact with a coronavirus disease 2019 case patient from March 2, 2020 to April 19, 2020. Their evolution and characteristics (age, sex, professional category, type of contact) were recorded. Correlations between the different characteristics and risk of developing coronavirus disease 2019 and severe coronavirus disease 2019 were analyzed using chi-square tests. Their magnitudes were quantified with ORs, AORs, and their 95% CIs using a logistic regression model. RESULTS: Of the 3,900 healthcare professionals in the department, 1,791 (45.9%) showed symptoms or were part of a contact tracing study. The prevalence of those with symptoms was 20.1% (784/3,900; 95% CI=18.8, 21.4), with coronavirus disease 2019 was 4.0% (156/3,900; 95% CI=3.4, 4.6), and with severe coronavirus disease 2019 was 0.5% (18/3,900; 95% CI=0.2, 0.7). The frequency of coronavirus disease 2019 in symptomatic healthcare personnel with a nonprotected exposure was 22.8% (112/491) and 13.7% (40/293) in those with a protected exposure (AOR=2.2, 95% CI=1.2, 3.9). The service in which the healthcare personnel performed their activity was not significantly associated with being diagnosed with coronavirus disease 2019. A total of 26.3% (10/38) of male healthcare personnel with coronavirus disease 2019 required hospitalization, compared with 6.8% (8/118) among female healthcare personnel (OR=4.9, 95% CI=1.8, 13.6). CONCLUSIONS: A surveillance and monitoring program centred on healthcare personnel enables an understanding of the risk factors that lead to coronavirus disease 2019 among this population. This knowledge allows the refinement of the strategies for disease control and prevention in healthcare personnel during the coronavirus disease 2019 pandemic.

[Compliance with hand hygiene guidelines and determinants of compliance]. / Grado de cumplimiento y determinantes de las recomendaciones sobre la higiene de manos.

INTRODUCTION: A basic indicator for assessing a program aimed at improving hand hygiene (HH) is the degree of compliance with the recommendations established for this purpose. The aim of this study is to investigate this indicator and related determinant factors in a general hospital. METHODS: We performed 166 observation periods of one hour's duration, distributed over three work shifts and covering all the hospitalization units; 3957 HH opportunities were recorded. Variables associated with the observation period, the professionals involved and the medical activity taking place were also recorded. The Chi-square test, and calculation of the raw OR and the adjusted OR with a logistic regression model were used to study associations between the variables studied and failure to perform HH. RESULTS: The overall frequency of HH activity was 30%, ranging from 8.9% to 60.5% depending on the professional tasks involved. The most important independent risk factors for failure to perform HH were the following: no availability of alcohol in a pocket size bottle (OR: 2.3 [1.7-3.3]); medical activities carried out in the surgical unit (OR: 2.6 [2.0-3.3]); activities taking place before entering into contact with patients (OR: 3.2 [2.4-4.2]); and use of gloves during the activity (OR: 2.2 [1.6-3.2]). CONCLUSION: The frequency of HH is low, but there are several potentially modifiable factors involved, which could improve with interventions. One example might be better education of hospital personnel on the importance of HH.

Grado de cumplimiento y determinantes de las recomendaciones sobre la higiene de manos / Compliance with hand hygiene guidelines and determinants of compliance

Introducción. Un indicador básico para evaluar un programa de mejora de la higiene de manos (HM) es el grado de cumplimiento de las recomendaciones dadas para su realización, el objetivo del trabajo es conocer éste y sus factores determinantes en un hospital general. Métodos. Se han realizado 166 períodos de observación de una hora de duración distribuidos en los tres turnos de trabajo y en todas las unidades de hospitalización, registrándose 3.957 oportunidades de realización de la HM. Se han recogido variables asociadas al período de observación, al profesional y a la propia actividad. Para estudiar la asociación entre las variables explicativas y la no realización de la HM se ha utilizado la chi cuadrado y se ha calculado la odds ratio (OR) cruda y la OR ajustada con un modelo de regresión logística. Resultados. La frecuencia de realización de la HM es de un 30% y varía según el tipo de actividad de un 8,9 a un 60,5%. Los factores de riesgo de no realización de la HM que tienen un efecto independiente mayor son: la no disposición de solución alcohólica en formato de bolsillo (OR: 2,3 [1,7-3,3]); la realización de las actividades en unidades quirúrgicas (OR: 2,6 [2,0-3,3]); las actividades de antes de entrar en contacto con el paciente (OR: 3,2 [2,4-4,2]), y la utilización de guantes durante la actividad (OR: 2,2 [1,6-3,2]). Conclusión. La frecuencia de realización de la HM es baja pero existen factores que son potencialmente modificables si se interviene sobre ellos, como por ejemplo, el nivel de conocimientos del personal sanitario sobre la HM (AU)

Introduction. A basic indicator for assessing a program aimed at improving hand hygiene (HH) is the degree of compliance with the recommendations established for this purpose. The aim of this study is to investigate this indicator and related determinant factors in a general hospital. Methods. We performed 166 observation periods of one hour's duration, distributed over three work shifts and covering all the hospitalization units; 3957 HH opportunities were recorded. Variables associated with the observation period, the professionals involved and the medical activity taking place were also recorded. The Chi-square test, and calculation of the raw OR and the adjusted OR with a logistic regression model were used to study associations between the variables studied and failure to perform HH. Results. The overall frequency of HH activity was 30%, ranging from 8.9% to 60.5% depending on the professional tasks involved. The most important independent risk factors for failure to perform HH were the following: no availability of alcohol in a pocket size bottle (OR: 2.3 [1.7-3.3]); medical activities carried out in the surgical unit (OR: 2.6 [2.0-3.3]); activities taking place before entering into contact with patients (OR: 3.2 [2.4-4.2]); and use of gloves during the activity (OR: 2.2 [1.6-3.2]). Conclusion. The frequency of HH is low, but there are several potentially modifiable factors involved, which could improve with interventions. One example might be better education of hospital personnel on the importance of HH (AU)

[Influenza vaccination in healthcare workers. Why are some vaccinated whereas others are not]. / Vacunación de gripe en trabajadores sanitarios. Por qué se vacunan y por qué no se vacunan.

BACKGROUND AND OBJECTIVE: Influenza vaccination is indicated in health professionals. Nevertheless, vaccination coverage in healthcare workers tends to be low. This paper determines the reasons why some workers are vaccinated whereas others are not and investigates what type of intervention can modify the latter attitude. METHOD: This was a cross-sectional descriptive study using a questionnaire survey. SETTING: workers at Hospital General Universitario de Alicante (Alicante, Spain). Absolute frequencies and relative frequencies expressed in percentages were calculated for each of the variables studied. Results were analyzed considering the professional categories of the persons involved and the departments where they worked. RESULTS: The reasons for influenza vaccination stated by hospital workers were to protect their health (65.6%), the belief that vaccination is beneficial (45.7%), and to avoid transmitting influenza to their patients (42.5%), and to their own families (39.8%). The main reasons for not undergoing vaccination were to avoid medication (17.9%), confidence in their own defenses (17%), or fear of the secondary effects of the vaccine (16.8%). CONCLUSION: The main reason given by hospital personnel for undergoing vaccination was to protect their own health and that of their family and patients. The reasons most frequently given for not undergoing vaccination were based on possible side effects of the vaccine, the conviction of not being part of a high-risk group, and doubts about the effectiveness of the vaccine as a protective agent. Many of the reasons given for not undergoing vaccination were based on erroneous beliefs and should be taken into account when designing strategies to increase influenza vaccination coverage among health personnel.

Vacunación de gripe en trabajadores sanitarios. Por qué se vacunan y por qué no se vacunan / Influenza vaccination in healthcare workers. Why are some vaccinated whereas others are not?

Antecedentes y objetivo. En el personal sanitario está indicada la vacuna antigripal. Sin embargo, la cobertura antigripal en sanitarios suele ser baja. Este trabajo pretende conocer las razones de los trabajadores para vacunarse de gripe, los motivos para no vacunarse y si éstos serían modificables mediante algún tipo de intervención. Método. Estudio descriptivo transversal mediante un cuestionario para conocer los motivos para vacunarse y otro cuestionario para conocer los motivos de no vacunación. Ámbito de estudio. Trabajadores del Hospital General Universitario de Alicante. Se estudian las variables categoría profesional y tipo de servicio donde trabaja. Se calculan frecuencias absolutas y relativas en porcentaje para cada uno de los valores de las variables. Resultados. Los motivos de vacunación más frecuentes fueron proteger su salud (65,6%), creer que es conveniente vacunarse (45,7%), evitar contagiar a los pacientes (42,5%) y a los familiares (39,8%). Los principales motivos para no vacunarse fueron: evitar medicación (17,9%), confiar en las propias defensas del organismo (17%) y temor a efectos secundarios (16,8%). Conclusión. Los motivos más frecuentes del personal del hospital para vacunarse de gripe son proteger su salud, la de su familia y la de los pacientes. Los motivos más frecuentes para no vacunarse se basan en los posibles efectos derivados de su administración, la percepción de bajo riesgo y dudas sobre su efectividad. Muchos de los motivos se basan en creencias erróneas y deben ser considerados para el diseño de estrategias que incrementen las coberturas vacunales de gripe en personal sanitario (AU)

Background and objective. Influenza vaccination is indicated in health professionals. Nevertheless, vaccination coverage in healthcare workers tends to be low. This paper determines the reasons why some workers are vaccinated whereas others are not and investigates what type of intervention can modify the latter attitude. Method. This was a cross-sectional descriptive study using a questionnaire survey. Setting. workers at Hospital General Universitario de Alicante (Alicante, Spain). Absolute frequencies and relative frequencies expressed in percentages were calculated for each of the variables studied. Results were analyzed considering the professional categories of the persons involved and the departments where they worked. Results. The reasons for influenza vaccination stated by hospital workers were to protect their health (65.6%), the belief that vaccination is beneficial (45.7%), and to avoid transmitting influenza to their patients (42.5%), and to their own families (39.8%). The main reasons for not undergoing vaccination were to avoid medication (17.9%), confidence in their own defenses (17%), or fear of the secondary effects of the vaccine (16.8%). Conclusion. The main reason given by hospital personnel for undergoing vaccination was to protect their own health and that of their family and patients. The reasons most frequently given for not undergoing vaccination were based on possible side effects of the vaccine, the conviction of not being part of a high-risk group, and doubts about the effectiveness of the vaccine as a protective agent. Many of the reasons given for not undergoing vaccination were based on erroneous beliefs and should be taken into account when designing strategies to increase influenza vaccination coverage among health personnel (AU)