[Update of the recommendations of the Bacteraemia Zero Project]. / Actualización de las recomendaciones del Proyecto Bacteriemia Zero.

The Bacteraemia Zero (BZ) Project was the first of the Zero Projects to be implemented in Intensive Care Unit (ICU), achieving a decrease in catheter-related infection rates below those recommended by the quality standards of scientific societies. Following the SARS-CoV-2 pandemic in ICU, a significant increase in these infection rates has been observed. Increase in infection rates and the need to incorporate the best available evidence into clinical practice justifies the need to update the recommendations of the BZ project. A working group formed by members of the different scientific societies considered that the mandatory measures of the project should not be modified due to its proven efficacy. In addition, this group decided to incorporate the following optional measures: use of catheters impregnated with antimicrobials, use of dressings impregnated with chlorhexidine, use of caps with an antiseptic solution in connectors, and daily body hygiene with chlorhexidine.

Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study.

BACKGROUND: Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor. OBJECTIVE: The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. METHODS: A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay. RESULTS: The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]). CONCLUSIONS: The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.

Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España / Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain

Objetivo: Evaluar el nivel de implementación de los protocolos asociados a la prevención de la debilidad muscular adquirida en la unidad de cuidados intensivos (UCI), así como la presencia del fisioterapeuta en distintas UCI de España. Método: Estudio descriptivo, transversal realizado en 86 UCI de adultos de España entre los meses de marzo a junio de 2017. Se excluyeron UCI neuroquirúrgicas y de grandes quemados. Se utilizó encuesta multirrespuesta que incluía preguntas sobre los protocolos de: control de glucemia, sedación, valoración del dolor, prevención del delirium, manejo del delirium y movilización precoz. La encuesta fue rellenada a través de un aplicativo protegido por usuario y contraseña. Análisis inferencial con t de Student o U de Mann-Whitney y de correlación con Pearson o Rho de Spearman. Resultados: El 89,5% de las UCI tenían protocolo de control de glucemia, con rango predominante de 110-140 mg/dl. El 74,4% evaluaban el nivel de sedación, si bien solo tenían protocolos de sedación el 36% de ellas. Con relación a la valoración del dolor se realizaba en el 73,7% de los pacientes comunicativos, mientras que en los no comunicativos solo era del 47,5%. Solo el 37,2% realizaban screening diario para detectar el delirium, y disponían de protocolos de prevención del delirium el 31,4% de las UCI, del manejo del delirium el 26,7% y de movilización precoz el 14% de las UCI. En el 34,9% de los casos se solicita interconsulta al servicio de rehabilitación. Conclusiones: La implementación de los diferentes protocolos asociados a la prevención de la debilidad muscular adquirida ha sido elevada en relación con los protocolos de control de glucemia, valoración del nivel de sedación y del dolor de pacientes comunicativos, mientras que baja en los de movilización precoz y screening y prevención del delirio. Asimismo, es poco frecuente la presencia del fisioterapeuta en la UCI

Aim: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. Method: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. Results: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140 mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. Conclusions: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU

Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain. / Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España.

AIM: To evaluate the degree of implementation of protocols associated with the prevention of intensive-care-unit (ICU) acquired muscle weakness, and the presence of the physiotherapist in various ICU in Spain. METHOD: A descriptive, cross-sectional study performed in 86 adult ICU in Spain between March and June 2017. Neurosurgical and major burns ICU were excluded. A multiple-choice survey was used that included questions on protocols for glycaemia control, sedation, pain assessment, delirium prevention, delirium management and early mobilisation. The survey was completed using a user-protected application and password. The Student's t-test or Mann-Whitney U test and Pearson's correlation or Spearman's Rho test were used for the inferential analysis. RESULTS: Eighty-nine point five percent of the ICU had a glycaemia control protocol, with a predominating range of 110-140mg/dl. Seventy-four point four percent evaluated sedation levels, although only 36% had sedation protocols. Pain assessment was carried out on communicative patients in 73.7%, and on uncommunicative patients in only 47.5%. Only 37.2% performed daily screening to detect delirium and 31.4% of the ICU had delirium prevention protocols, 26.7% had delirium management protocols and 14% had protocols for early mobilisation. Thirty-four point nine percent requested cross consultation with the rehabilitation department. CONCLUSIONS: The implementation of the different protocols associated with the prevention of ICU-acquired muscle weakness was high in relation to glycaemia control protocols, sedation level and pain assessment in communicative patients, and was low for early mobilisation and delirium screening and prevention. Similarly, the physiotherapist was seldom present in the ICU.

Grado de conocimiento de las guías de prevención de la neumonía asociada a ventilación mecánica de las enfermeras de cuidados intensivos del sur de Europa / Southern European Intensive Care Nurses’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

Objetivos Determinar el grado de conocimiento de las enfermeras de cuidados intensivos del sur de Europa de las guías de prevención de la neumonía asociada a ventilación mecánica y compararlo con los resultados globales de Europa. Diseño Subanálisis de un estudio observacional realizado mediante un cuestionario de nueve preguntas con respuesta cerrada llevado a cabo entre octubre de 2006 y marzo de 2007.Ámbito Seis países del sur de Europa, de los 22 países europeos participantes. Participantes Enfermeras voluntarias de cuidados intensivos. Resultados Se recibieron 3.329 cuestionarios, de los cuales 1.182 fueron del sur de Europa donde hubo una tasa de respuesta del 75,8%. La puntuación media global fue de 45,1% y la de el Sur de Europa 46,6% donde fue significativamente mejor (p<0,001). El análisis de regresión lineal mostró que los años de experiencia (por aumento de categoría) está independientemente relacionado con mejores puntuaciones (B=0,154±(ES) 0,045) (95% IC (0,066-0,242))(p=0,001) y trabajar en una unidad de cuidados intensivos con menor número de camas está independientemente relacionado con mejores puntuaciones (B=−0,210±(ES) 0,059)((95% IC) −0,326- −0,094)(p<0,001).Conclusiones El conocimiento de las enfermeras de las unidades de cuidados intensivos de los países del sur de Europa sobre las guías de prevención de la neumonía asociada a ventilación mecánica es bajo aunque mejor que en la muestra global de Europa (AU)

Objectives To assess Southern European intensive care unit nurses’ knowledge about evidence-based guidelines for the prevention of ventilator-associated pneumonia and to compare these findings with a pan-European perspective. Design A sub-analysis from an observational study performed using a 9-questions, multiple-choice questionnaire performed during the period October 2006 - March 2007.SettingSix Southern European countries, selected from 22 participant European countries. Participants Volunteer nurses from intensive care units. Results 3329 questionnaires were obtained, 1182 of them belonging to Southern European countries with a 75.8% response rate. Global average score was 45.1%, being it significantly better in the South of Europe (46.6%, P<.001). A linear multiple regression analysis showed that years of working experience (per class of increase) (B=0.154±(SD) 0.045) (95% CI (0.066-0.242))(p=0.001) and working in a smaller intensive care unit (B=−0.210±(SD) 0.059)((95% CI) −0.326-0.094)(P<.001) was independently associated with better test scores. Conclusions Southern European critical care nurses’ knowledge about ventilator-associated pneumonia prevention is poor, but significantly better than in the pan-European countries (AU)

[Southern European intensive care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia]. / Grado de conocimiento de las guías de prevención de la neumonía asociada a ventilación mecánica de las enfermeras de cuidados intensivos del sur de Europa.

OBJECTIVES: To assess Southern European intensive care unit nurses' knowledge about evidence-based guidelines for the prevention of ventilator-associated pneumonia and to compare these findings with a pan-European perspective. DESIGN: A sub-analysis from an observational study performed using a 9-questions, multiple-choice questionnaire performed during the period October 2006 - March 2007. SETTING: Six Southern European countries, selected from 22 participant European countries. PARTICIPANTS: Volunteer nurses from intensive care units. RESULTS: 3329 questionnaires were obtained, 1182 of them belonging to Southern European countries with a 75.8% response rate. Global average score was 45.1%, being it significantly better in the South of Europe (46.6%, P<.001). A linear multiple regression analysis showed that years of working experience (per class of increase) (B=0.154 ± (SD) 0.045) (95% CI (0.066-0.242))(p=0.001) and working in a smaller intensive care unit (B=-0.210 ± (SD) 0.059)((95% CI) -0.326-0.094)(P<.001) was independently associated with better test scores. CONCLUSIONS: Southern European critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor, but significantly better than in the pan-European countries.

[Consumption of psychodrugs. Influence of family dysfunction]. / Consumo de psicofármacos. Influencia de la disfunción familiar.

INTRODUCTION: The objective of this study is to know the prevalence of psychodrug consumption in Primary Health Care, related factors and influence of the family factor on this consumption. METHODS: Observational cross sectional study carried out in an urban Health Care Center. A total of 434 patients older than 14 years old, who are health care consumers, were included. They were selected by systematic sampling for 6 consecutives weeks. Psychodrugs consumption and related factors were measured by a questionnaire designed for this purpose. The questionnaire was filled out by personal interview and case history revision. Existence of family dysfunction was determined by self-applied Apgar-family questionnaire. RESULTS: Prevalence of psychodrugs consumption was 26% (95 % CI: 22-30). A total of 53% were benzodiazepines and 27% were antidepressants (73 % are SSRI). There was family dysfunction in 20 % of consumers and 12 % of non-consumers, which is a statistically significant difference (p<0.01). By logistic regression, being between 45-64 years old (OR: 3.18), or more than 65 years old (OR: 3.29), being female (OR: 2.2), being a housewife (OR: 3.07), having psychiatric background (OR: 15.2) and having important family dysfunction in the Apgar-family questionnaire (OR: 7.19) were the variables which appeared as associated with this consumption. CONCLUSIONS: Consumption of psychodrugs in Primary Health Care consumers is 26 %. Being 45 years old or more, female and housewife are possible factors which predict psychodrugs consumption. Psychiatric disease antecedents and having important family dysfunction are also associated independently. These should be kept in mind to improve medical prescription of these drugs in Primary Health Care.

Consumo de psicofármacos. Influencia de la disfunción familiar / Consumption of psycbodrugs Influence of family dysfunction

Introducción. El objetivo de este estudio es conocer la prevalencia del consumo de psicofármacos en Atención Primaria, los factores relacionados y la influencia del factor familiar en dicho consumo. Métodos. Estudio observacional y transversal realizado en un centro de salud urbano. Incluimos 434 pacientes, mayores de 14 años demandantes de consulta, seleccionados durante 6 semanas consecutivas mediante muestreo sistemático. Medimos el consumo de psicofármacos y los factores relacionados mediante cuestionario diseñado al efecto y cumplimentado con entrevista personal y revisión de historias clínicas. La presencia de disfunción familiar se determina con el autocumplimentado del test de Apgar familiar Resultados. Prevalencia del consumo de psicofármacos del 26 por ciento (IC 95 por ciento: 22-30). El 53 por ciento fueron benzodiacepinas y el 27 por ciento antidepresivos (73 por ciento son ISRS). Encontramos disfunción familiar en el 20 por ciento de los consumidores y en el 12 por ciento de los que no consumen, diferencia estadísticamente significativa (p < 0, 01 ). Mediante regresión logística, tener entre 45-64 años (OR. 3,18) o más de 65 años (OR:3,29), ser mujer (OR. 2,2), ser ama de casa (OR: 3,07), tener antecedentes psiquiátricos (OR. 15,2) y presentar un Apgar familiar con disfunción familiar grave (OR: 7,19) son las variables que aparecen asociadas al citado consumo. Conclusiones. El consumo de psicofármacos en población demandante de asistencia en Atención Primaria es del 26 por ciento. Tener 45 o más años, ser mujer y ama de casa constituyen posibles factores predictores del consumo de psicofármacos. Los antecedentes de patología psiquiátrica y presentar disfunción familiar grave se asocian también de forma independiente y deberían ser tenidos en cuenta en la mejora de la calidad y pertinencia de la prescripción de estos fármacos en Atención Primaria (AU)

Estudio experimental para comprobar la efectividad de los ácidos grasos hiperoxigenados en la prevención de las úlceras por presión en pacientes ingresados / Experimental study to test the effectiveness of hyperoxygenated fatty acids in the prevention of pressure sores in hospitalized patients

Objetivo: Identificar si hay diferencias en la incidencia de úlceras por presión en los enfermos a los que se realiza prevención con aplicación de ácidos grasos hiperoxigenados y a los que no se les aplica. Diseño: Estudio experimental, aleatorizado, controlado, con grupo control y grupo experimental. Ámbito de estudio: Hospital General Vall d'Hebron, entre diciembre de 1999 y mayo de 2000.Sujetos de estudio: Tras calcular el tamaño de la muestra necesario, se estudiaron a 192 pacientes que ingresaron en el centro sin úlceras por presión y que tenían la movilidad y la actividad alteradas (según la escala de riesgo EMINA©). La técnica de muestreo utilizada ha sido accidental, a medida que iban ingresando los pacientes en el hospital. Intervención: Al grupo control se le realizó la prevención habitual para las úlceras por presión que se lleva a cabo en el hospital. Al grupo experimental, además de esta prevención, se le aplicaron ácidos grasos hiperoxigenados según el protocolo establecido para el estudio. La asignación de los pacientes a los 2 grupos se realizó de manera aleatoria. Resultados y conclusiones: Se estudiaron a 192 pacientes (96 por grupo). La incidencia de úlceras por presión en el grupo control fue del 35 por ciento (intervalo de confianza [IC] del 95 por ciento, 27-47 por ciento) y en el grupo experimental del 19 por ciento (IC del 95 por ciento, 12-29 por ciento), siendo esta diferencia estadísticamente significativa (*2 = 6,8; gl = 1; p = 0,007).La incidencia de úlceras por presión es menor en el grupo experimental, lo que indica que los ácidos grasos hiperoxigenados son útiles para prevenir el desarrollo de este tipo de úlceras (AU)