ABSTRACT
Durante la atención sanitaria el paciente está expuesto a una gran variedad de microorganismos, por lo que la utilización de un máximo nivel de higiene en toda labor asistencial es fundamental para reducir la transmisión cruzada de toda aquella enfermedad infecciosa evitable. Los 3 mecanismos indispensables para la prevención de la infección en los centros sanitarios son la limpieza, la desinfección y la esterilización. El uso científico y racional de desinfectantes y antisépticos, así como la aplicación de forma correcta de las técnicas de asepsia en el cuidado de los pacientes y en la manipulación y el suministro de los materiales, son los ejes fundamentales en la prevención de las infecciones relacionadas con la asistencia sanitaria. El adecuado conocimiento de los conceptos y normas de uso de antisépticos y desinfectantes pone a disposición del trabajador la herramienta esencial que permite evitar la diseminación de agentes infecciosos, a la vez que le proporciona las bases científicas para su uso racional
During health care, the patient is exposed to a wide variety of microorganisms. Maximum hygiene in all care activities is therefore essential in order to reduce the cross-transmission of preventable infectious diseases. The 3 key mechanisms for the prevention of infection in health centers are cleaning, disinfection and sterilization. The scientific and rational use of disinfectants and antiseptics, and the correct application of aseptic techniques in the care of patients and in the handling and supply of materials are the fundamental considerations for the prevention of healthcare related infections. Adequate knowledge of the concepts and standards of use of antiseptics and disinfectants offers healthcare workers the essential tool needed to avoid the spread of infectious agents, while also establishing the scientific basis for their rational use
Subject(s)
Humans , Antisepsis , Anti-Infective Agents , Infection Control , Patient Safety , Cross Infection/prevention & control , Sanitizing Products , General Cleaning Products , Sterilization , Environmental Pollution , FomitesABSTRACT
During health care, the patient is exposed to a wide variety of microorganisms. Maximum hygiene in all care activities is therefore essential in order to reduce the cross-transmission of preventable infectious diseases. The 3 key mechanisms for the prevention of infection in health centers are cleaning, disinfection and sterilization. The scientific and rational use of disinfectants and antiseptics, and the correct application of aseptic techniques in the care of patients and in the handling and supply of materials are the fundamental considerations for the prevention of healthcare related infections. Adequate knowledge of the concepts and standards of use of antiseptics and disinfectants offers healthcare workers the essential tool needed to avoid the spread of infectious agents, while also establishing the scientific basis for their rational use. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
Subject(s)
Anti-Infective Agents, Local , Antisepsis/methods , Asepsis/methods , Cross Infection/prevention & control , Sterilization/methods , Detergents , Disinfectants , Environmental Pollution , Fomites , Housekeeping, Hospital/methods , Humans , HygieneABSTRACT
The administration of voriconazole by the intravenous (i.v.) route in patients with moderate or severe renal failure is limited because of potential toxic effects of the accumulation of the solvent vehicle sulphobutylether beta cyclodextrin sodium. This study aimed to assess the impact of intravenous voriconazole administration on renal and liver function in critically ill patients with impaired renal function treated with this antifungal drug. The study population consisted of a retrospective cohort of patients admitted to medical-surgical intensive care units (ICUs) who were treated with i.v. voriconazole for more than 3 days. Patients with impaired renal function were those with serum creatinine concentration >1.5 mg/dL, creatinine clearance <50 mL/min, or under any extrarenal depuration procedure. Renal damage was defined as an increase of at least = 2 times initial serum creatinine level or starting of an extrarenal depuration procedure during voriconazole therapy. Liver damage was defined as an increase of = 4 times the initial serum concentration of liver enzymes, or = 2 times in patients with previous impaired liver function. A total of 69 patients was included in the study of which 26 (37.7%) had impaired renal function at the beginning of voriconazole treatment (serum creatinine >2.5 mg/dL in 10 patients). Mean (SD) duration of voriconazole treatment was 13.0 (9.5) days in patients with normal renal function and 11.2 (6.3) days in those with altered renal function. Renal damage during voriconazole therapy occurred in 13 (30.2%) patients with initial normal renal function and in 4 (15.4%) in patients with impaired renal function (P = 0.257). Liver damage during treatment with voriconazole was observed in 12 (27.9%) patients with normal initial renal function and in 3 (11.5%) patients with impaired renal function (P = 0.281). Renal failure developing during voriconazole treatment was associated with a significantly higher mortality rate (82.4% vs. 44.%, P = 0.01), except in the subgroup of patients with altered renal function before starting i.v. voriconazole (60% size=1>vs. 75%, P = 0.385). The use of i.v. voriconazole in ICU patients with pretreatment impaired renal function was not associated with renal or liver damage nor with an increase in ICU mortality.
Subject(s)
Antifungal Agents/administration & dosage , Pyrimidines/administration & dosage , Renal Insufficiency , Triazoles/administration & dosage , Adult , Aged , Cohort Studies , Critical Illness , Female , Humans , Infusions, Intravenous , Kidney/drug effects , Liver/drug effects , Male , Middle Aged , Retrospective Studies , VoriconazoleABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Tomography, Emission-Computed/methods , Pancreas/injuries , Pancreas , Abdominal Injuries/complications , Abdominal Injuries/surgery , Abdominal Injuries , Radiography, Abdominal , AbdomenABSTRACT
No disponible
Subject(s)
Humans , Adult , Embolism, Fat/diagnosis , Multiple Trauma/complications , Embolism, Fat/complications , Accidents, Traffic , Nervous System Diseases/diagnosis , Nervous System Diseases/etiologyABSTRACT
No disponible
Subject(s)
Male , Adult , Humans , Liver Transplantation/statistics & numerical data , Liver Transplantation/trends , Immunosuppressive Agents/therapeutic use , Liver Diseases/complications , Carcinoma/complications , Liver Neoplasms/complications , Liver Neoplasms/diagnosis , Liver Neoplasms/surgeryABSTRACT
No disponible
Subject(s)
Male , Female , Adult , Humans , Liver Failure, Acute/diagnosis , Hepatocytes/pathology , Hepatic Encephalopathy/etiology , Hypoproteinemia/etiology , PrognosisABSTRACT
INTRODUCTION: Antiaggregant and anticoagulant therapy has possible sever secondary effects, being the most serious intracranial bleeding. OBJECTIVES: Compare morbi-mortality between surgical and medical treatments in anticoagulated and/or antiaggregated patients with any kind of intracranial bleeding. Also risk factors and main indications of those treatments are studied. PATIENTS AND METHODS: Descriptive and retrospective study including 105 patients admitted in our Critical Care Unit, with intracranial bleeding, under anticoagulant or antiaggregant treatment. We study the type of bleeding (subarachnoid, epidural, subdural and intraparenchimal bleeding) and the relation between morbi-mortality and treatment applicated using relative risk like analytic tool. RESULTS: Major bleeding risk appears after the six first months from the beginning of the treatment. Thirty-four patients died with a relative risk of 1.55 in the surgical patients from the medical treatment patients. Relative risk between anticoagulated patients and antiaggregated ones was 1.16. Serious consequences happened on eight of the 49 patients under surgical treatment, and on 13 of the 52 patients under medical treatment. CONCLUSIONS: Surgical treatment has more morbi-mortality. Oral anticoagulation has only a little more relative risk than treatment with antiaggregants. Both groups had serious consequences.
Subject(s)
Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Brain/surgery , Intracranial Hemorrhages , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Vitamin K/therapeutic use , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Hemostasis/drug effects , Humans , Hyperlipidemias/epidemiology , Intracranial Hemorrhages/chemically induced , Intracranial Hemorrhages/mortality , Intracranial Hemorrhages/therapy , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Factors , Smoking/epidemiologyABSTRACT
Introducción. Los antiagregantes y los anticoagulantes son fármacos con posibles efectos secundarios graves, siendo uno de los más graves la aparición de hemorragias intracraneales. Objetivos. Comparar la morbimortalidad del tratamiento neuroquirúrgico (TNQ) frente al tratamiento médico conservador (TMC) en pacientes bajo tratamiento anticoagulante (AC) y/o antiagregante (AA), que presentan algún tipo de complicación hemorrágica intracraneal, y describir tanto las indicaciones más frecuentes de dichos tratamientos como los distintos factores de riesgo vascular presentes en los enfermos. Pacientes y métodos. Análisis descriptivo y retrospectivo sobre un total de 105 pacientes, en tratamiento con anticoagulantes y/o antiagregantes, que ingresaron en la Unidad de Cuidados Intensivos de nuestro hospital con hemorragias intracraneales. Se analiza el tipo predominante de sangrado y su morbimortalidad, tanto en relación con el tratamiento de base (AC frente a AA) como con el tratamiento realizado (TNQ frente a TMC), y para ello se calcula el riesgo relativo. Resultados. El riesgo hemorrágico mayor se establece a partir de los seis primeros meses tras el inicio del tratamiento. Se produjeron un total de 34 fallecimientos, con un riesgo relativo de los pacientes sometidos a TNQ del 1,55 respecto al TMC. El riesgo relativo de los pacientes que fallecieron y tomaban sólo anticoagulantes fue del 1,16 respecto a los que recibían antiagregantes. Las secuelas graves ocurrieron en 18 de los pacientes sometidos a TNQ y en 24 de los que estuvieron bajo TMC. Conclusiones. En nuestra serie, el TNQ se relaciona con mayor morbimortalidad y se objetiva que la toma de anticoagulantes orales apenas supone un mayor riesgo relativo que la toma aislada de antiagregantes. Tanto en los enfermos sometidos a TNQ como en los de TMC hay graves secuelas (AU)
