Transfusion-associated adverse events incidence and severity after the implementation of an active hemovigilance program with 24 h follow-up. A prospective cohort study.

BACKGROUND: Hemovigilance (HV) is usually based on voluntary reports (passive HV). Our aim is to ascertain credible incidence, severity, and mortality of transfusion-associated adverse events (TAAEs) using an active HV program. STUDY DESIGN AND METHODS: Prospective cohort study to estimate transfusion risk after 46,488 transfusions in 5830 patients, using an active HV program with follow-up within the first 24 h after transfusion. We compared these results to those with the previously established passive HV program during the same 30 months of the study. We explored factors associated with the occurrence of TAAEs using generalized estimating equations models. RESULTS: With the active HV program TAAEs incidence was 57.3 (95% CI, 50.5-64.2) and mortality 1.1 (95% CI, 0.13-2.01) per 10,000 transfusions. Incidence with the new surveillance model was 14.0 times higher than with the passive. Most events occurred when transfusions had already finished (60.2%); especially pulmonary events (80.4%). Three out of five deaths and 50.3% of severe TAAEs were pulmonary. In the multivariate analysis surgical patients had half TAAEs risk when compared to medical patients (OR, 0.53; 95% CI, 0.34-0.78) and women had nearly twice the risk of a pulmonary event compared to men (OR, 1.84; 95% CI, 1.03-3.32). Patient's age, blood component type, or blood component shelf-life were unrelated to TAAEs risk. DISCUSSION: Active hemovigilance programs provide additional data which may lead to better recognition and understanding of TAAEs and their frequency and severity.

Aumento significativo de la colonización por Staphylococcus aureus entre los estudiantes de medicina durante la realización de las prácticas en el hospital / Significant increase in the colonisation of Staphylococcus aureus among medical students during their hospital practices

INTRODUCCIÓN: La vigilancia y el control de Staphylococcus aureus resistente a la meticilina (SARM) debe ser una prioridad para todos los centros, incluyendo la detección activa de portadores. En este marco nuestro primer objetivo fue determinar la prevalencia de portadores nasales de Staphylococcus aureus sensible a la meticilina (SASM) y SARM entre los estudiantes de medicina del Hospital Clínico San Carlos. Al ser la prevalencia entre el personal sanitario superior a la de la población general, establecimos la hipótesis de que entre los estudiantes aumentaría durante las prácticas clínicas de los 3 últimos años. Métodos En 2008 llevamos a cabo una estimación epidemiológica de prevalencia de portadores, realizando un exudado nasal a los estudiantes de tercer curso, y en 2012 se la realizamos a los de la misma promoción cuando estaban en sexto. Resultados Se encontró un aumento significativo (p < 0,03) de portadores de SASM, pasando del 27 al 46%. No hubo portadores de SARM en tercero, y sí un caso en sexto. El 89% de S. aureus fueron resistentes a la penicilina y el 27% a la eritromicina y la clindamicina. Se aislaron 19 Staphylococcus coagulasa negativos RM que representan un reservorio para la transferencia horizontal de genes, concretamente el gen mecA, a S. aureus. Conclusiones Aumenta la colonización por SASM de forma significativa entre los estudiantes de medicina durante su estancia en el hospital. Adquieren y pueden ser una fuente de patógenos nosocomiales y, por lo tanto, deberían prestar especial cuidado a las medidas higiénicas, como el lavado correcto de manos, durante su actividad hospitalaria

INTRODUCTION: Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years. METHODS: We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year. RESULTS: We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred. CONCLUSIONS: Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital

[Significant increase in the colonisation of Staphylococcus aureus among medical students during their hospital practices]. / Aumento significativo de la colonización por Staphylococcus aureus entre los estudiantes de medicina durante la realización de las prácticas en el hospital.

INTRODUCTION: Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years. METHODS: We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year. RESULTS: We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred. CONCLUSIONS: Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital.