[Patient safety: Patients perception at primary care level at an urban healthcare district]. / Seguridad del paciente: percepción de los pacientes en atención primaria de un distrito sanitario urbano.

OBJECTIVES: Patient safety is a quality objective and a priority in healthcare. Most of the research has focused on the hospital setting and from the professional perspective. The objective of our study is to know the opinion of the patient who attends primary care regarding its safety in this area. MATERIAL AND METHODS: Cross-sectional observational study. A survey carried out with patients chosen through four health centres representing different socioeconomic levels of the same Basic Health Zone. Fifty patients per centre were surveyed. RESULTS: Two hundred patients surveyed of whom more than 90% reported no negative experiences in terms of errors in medication, identification, diagnosis or clinical management, highlighting the good care received and the good resolution of their problem. However, only around half claimed to understand the explanations of the healthcare professionals or to have had the opportunity to give an opinion or have shared decision-making on their management. These factors were closely related to the perceived lack of time in consultation and constant change of physician. CONCLUSIONS: The vast majority of our patients report no adverse effects or safety issues during their primary care attendance. However, there is evidence of the need to strengthen aspects related to consultation time and increase the number and stability of human resources in health centres to improve patient satisfaction with the health system.

[Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]. / Grupos de discusión como abordaje para valorar conocimiento, actitudes y prácticas de higiene de manos en profesionales de la unidad de cuidados intensivos de adultos de un hospital de referencia.

OBJECTIVES: The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. METHODS: Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. RESULTS: Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. CONCLUSIONS: The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.

The national web-based outbreak rapid alert system in Norway: eight years of experience, 2006-2013.

In 2005, the Norwegian Institute of Public Health established a web-based outbreak rapid alert system called Vesuv. The system is used for mandatory outbreak alerts from municipal medical officers, healthcare institutions, and food safety authorities. As of 2013, 1426 outbreaks have been reported, involving 32913 cases. More than half of the outbreaks occurred in healthcare institutions (759 outbreaks, 53·2%). A total of 474 (33·2%) outbreaks were associated with food or drinking water. The web-based rapid alert system has proved to be a helpful tool by enhancing reporting and enabling rapid and efficient information sharing between different authorities at both the local and national levels. It is also an important tool for event-based reporting, as required by the International Health Regulations (IHR) 2005. Collecting information from all the outbreak alerts and reports in a national database is also useful for analysing trends, such as occurrence of certain microorganisms, places or sources of infection, or route of transmission. This can facilitate the identification of specific areas where more general preventive measures are needed.

Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014.

In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.

Waterborne outbreaks in the Nordic countries, 1998 to 2012.

A total of 175 waterborne outbreaks affecting 85,995 individuals were notified to the national outbreak surveillance systems in Denmark, Finland and Norway from 1998 to 2012, and in Sweden from 1998 to 2011. Between 4 and 18 outbreaks were reported each year during this period. Outbreaks occurred throughout the countries in all seasons, but were most common (n = 75/169, 44%) between June and August. Viruses belonging to the Caliciviridae family and Campylobacter were the pathogens most frequently involved, comprising n = 51 (41%) and n = 36 (29%) of all 123 outbreaks with known aetiology respectively. Although only a few outbreaks were caused by parasites (Giardia and/or Cryptosporidium), they accounted for the largest outbreaks reported during the study period, affecting up to 53,000 persons. Most outbreaks, 124 (76%) of those with a known water source (n = 163) were linked to groundwater. A large proportion of the outbreaks (n = 130/170, 76%) affected a small number of people (less than 100 per outbreak) and were linked to single-household water supplies. However, in 11 (6%) of the outbreaks, more than 1,000 people became ill. Although outbreaks of this size are rare, they highlight the need for increased awareness, particularly of parasites, correct water treatment regimens, and vigilant management and maintenance of the water supply and distribution systems.

Ongoing hepatitis A outbreak in Europe 2013 to 2014: imported berry mix cake suspected to be the source of infection in Norway.

On 7 March 2014, an increase in hepatitis A virus (HAV) infections was identified in Norway. As of 12 April, 19 cases of HAV infection with a virus strain identical to an ongoing European outbreak have been identified. Six probable cases are currently under investigation. On 11 April, a frozen berry mix cake imported from another European country was found as the likely source of the outbreak; the importer has withdrawn the product in Norway.

Neumonía nosocomial y mutirresistencias en una unidad de cuidados intensivos de adultos de un hospital de tercer nivel / Pneumonia nosocomial and multiresistances in adult in a tertiary referral hospital

OBJETIVO: Determinar la incidencia y etiología de la Neumonía Nosocomial (NN) en la Unidad de Cuidados Intensivos (UCI) de adultos del Hospital Universitario Reina Sofía (HURS) de Córdoba. METODOLOGÍA: El Servicio de Medicina Preventiva del HURS elaboró un estudio epidemiológico observacional de cohortes prospectivo de los pacientes ingresados en la UCI de adultos entre 2006 y 2009. Se calcularon las siguientes medidas de incidencia: Incidencia Acumulada (IA) de pacientes infectados con NN, IA de neumonías y densidad de incidencia de neumonías asociadas a ventilación mecánica. Se procedió a realizar una estadística descriptiva con cálculos de frecuencias. RESULTADOS: Hubo 233 pacientes con NN (IA de pacientes con NN=5,3/100 pacientes ingresados). El 96,6% de los pacientes con NN habían estado sometidos a ventilación mecánica (VM)previa. La tasa de incidencia de NN asociada VM fue de 15,7/1000 días de ventilación. Se solicitaron cultivos en todas las NN. El microorganismo más frecuente causante de NN fue Acinetobacter spp. (41,7% de los aislamientos), seguido de P.aeruginosa (8%), S. aureus y C. albicans, ambos aislados en un 7,1% de los cultivos. El 40% de las NN fueron provocadas por microorganismos multirresistentes, destacando el A. baumannii (82,6%) seguido de S. aureus meticilin resistente (9,7%). Destaca la emergencia de Stenothropomonas maltophilia (3,9%). CONCLUSIÓN: Las cifras de incidencia de NN en la UCI han disminuido en la última década, pero siguen siendo superiores a las de otros estudios. Los microorganismos más frecuentemente involucrados en la neumonía han sido los gramnegativos, y de ellos en primer lugar A. baumannii. Prácticamente la totalidad de los aislamientos de este microorganismo fueron multirresistentes

OBJECTIVE: To determine the incidence and etiology of Nosocomial pneumonia (NP) in adult ICU of Reina Sofia University Hospital (RSUH) of Córdoba. METHODOLOGY: The Department of Preventive Medicine of RSUH conducted a prospective cohort study for admitted patients at adults’ ICU from 2006 to 2009. The following incidence rates were calculated: accumulated incidence (AI) rate of patients with NP and incidence density of pneumonia associated with mechanical ventilation. We conducted a descriptive statistical analysis with calculation of the frequencies. RESULTS: There were registered 233 patients with NP (AI of NP of admitted patients 5.3/100). About 96.6% of patients with NP were previously subjected to mechanical ventilation (MV). The incidence rate of NP associated MV was 15.7/1000 days of ventilation. Culture was requested to all cases with NP. The most frequent microorganism of NP was Acinetobacter spp. (41.7% of cultures) followed by P.aeruginosa (8%). S.aureus and C.albicans were isolated in 7% of cultures. About 40% of NP were caused by multidrug-resistant microorganisms, like A.baumannii (82.6%) followed by methicillin resistant S. aureus (9.7%). Also we noted the emergence of Stenothropomonas maltophilia (3.9%). CONCLUSION: Incidence rates of NP in the ICU have declined in the last decade, although our rates are still higher than the reported in other studies. The microorganisms most frequently involved in NP were gram negative, of which the most frequent was A.baumannii. Nearly all isolated microorganisms were multidrug-resistant

Underlying illness severity and outcome of nosocomial pneumonia: prospective cohort study in intensive care unit.

BACKGROUND: Previous studies have suggested that the final outcome of a patient with nosocomial pneumonia (NP) may depend on the patient's illness severity upon admission to the intensive care unit (ICU). AIM: To investigate the relationship between developing NP during hospitalization in an adult ICU and the risk of death with special focus on illness severity at admission in the unit. METHODS: A prospective cohort study was performed among all patients admitted for at least 24h to the ICU of a university reference hospital in Spain from 2006 to 2009. A stratified univariate study was performed according to the patients' illness severity at admission, estimated using the Acute Physiology And Chronic Health Evaluation (APACHE) II index. To determine whether the NP was independently associated with increased mortality in ICU, a multivariate logistic regression analysis was carried out, adjusting for potential confounders. RESULTS: In all, 4427 patients were studied, of whom 233 acquired NP while admitted. Patients who developed NP had a 2.6 higher risk (95% confidence interval: 2.1-3.0) of dying compared with those who did not develop NP. When stratified by the APACHE II index, the significant association remained at each stratum, although the strength of the association decreased as the value of the index increased. In the multivariate analysis, NP was independently associated with death in the ICU. The interaction between NP and the APACHE II index, with a negative coefficient, was also significant. CONCLUSIONS: Developing NP while admitted to the ICU was independently associated with increased mortality. However, the strength of the association decreased as the severity of patient illness upon admission to the ICU increased, not influencing death of patients with severe APACHE II values.

A Shigella sonnei outbreak traced to imported basil--the importance of good typing tools and produce traceability systems, Norway, 2011.

On 9 October 2011, the University Hospital of North Norway alerted the Norwegian Institute of Public Health (NIPH) about an increase in Shigella sonnei infections in Tromsø. The isolates had an identical 'multilocus variable-number tandem repeat analysis' (MLVA) profile. Most cases had consumed food provided by delicatessen X. On 14 October, new S. sonnei cases with the same MLVA-profile were reported from Sarpsborg, south-eastern Norway. An outbreak investigation was started to identify the source and prevent further cases. All laboratory-confirmed cases from both clusters were attempted to be interviewed. In addition, a cohort study was performed among the attendees of a banquet in Tromsø where food from delicatessen X had been served and where some people had reported being ill. A trace-back investigation was initiated. In total, 46 cases were confirmed (Tromsø= 42; Sarpsborg= 4). Having eaten basil pesto sauce or fish soup at the banquet in Tromsø were independent risk factors for disease. Basil pesto was the only common food item that had been consumed by confirmed cases occurring in Tromsø and Sarpsborg. The basil had been imported and delivered to both municipalities by the same supplier. No basil from the specific batch was left on the Norwegian market when it was identified as the likely source. As a result of the multidisciplinary investigation, which helped to identify the source, the Norwegian Food Safety Authority, together with NIPH, planned to develop recommendations for food providers on how to handle fresh plant produce prior to consumption.

Surveillance of travel-associated gastrointestinal infections in Norway, 2009-2010: are they all actually imported?

The Norwegian Surveillance System for Communicable Diseases (MSIS) includes variables related to travel for clinicians to fill when notifying travel-associated infections. We measured the completeness and validated the travel-history information for salmonellosis, campylobacteriosis, giardiasis and shigellosis reported in 2009-2010. Of all 8,978 selected infections in MSIS, 8,122 (91%) were reported with place of infection of which 5,236 (65%) were notified as acquired abroad, including 5,017 with symptoms. Of these, 2,972 (59%) notifications had information on both date of arrival in Norway and date of symptom onset, so time between travel and illness onset could be assessed. Taking in account the incubation period, of the 1,435 infections reported as travel-associated and for which symptom onset occurred after return to Norway, 1,404 (98%) would have indeed been acquired abroad. We found a high level of completeness for the variable 'place of infection'. Our evaluation suggests that the validity of this information is high. However, incomplete data in the variables 'return date to Norway' and 'date of symptoms onset', only allowed assessment of the biological plausibility of being infected abroad for 59% of the cases. We encourage clinicians to report more complete travel information. High quality information on travel-associated gastrointestinal infections is crucial for understanding trends in domestic and imported cases and evaluating implemented control measures.

Outbreak of Shigella sonnei infection in Norway linked to consumption of fresh basil, October 2011.

We report a Shigella sonnei outbreak of 46 cases that occurred in Norway during October 2011. Two municipalities were involved. A large cluster (42 cases)was concentrated in north Norway, while a smallcluster (4 cases) occurred in the south-east region.Epidemiological evidence and trace back investigations have linked the outbreak to the consumption of imported fresh basil. The product has been withdrawn from the market. No further cases have been reported since 25 October.