Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel / Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital

Con el objetivo de incrementar la cultura de seguridad en relación con la higiene de manos en el Complejo Hospitalario Universitario Insular Materno-Infantil a través de la presencia de recordatorios y mensajes en todo el centro sobre la importancia de la higiene de manos en la prevención de infecciones, hemos desarrollado nuevo material promocional en el mencionado Complejo Hospitalario, formado por el Hospital Universitario Insular y el Hospital Materno-Infantil, ambos centros de tercer nivel con 450 camas cada uno y acreditados para la docencia MIR. Se contrataron los servicios de un caricaturista profesional, que adaptó el lenguaje a los modismos locales, usando los personajes que habitualmente aparecen en las viñetas del periódico y se siguió trabajando con otros profesionales del diseño gráfico. Se midieron los indicadores de adherencia y consumo de productos de base alcohólica, constatándose un incremento de ambos en los meses posteriores a la implantación de la estrategia. Además se hizo una revisión de infraestructuras relacionadas con la higiene de manos, con lo que comprobamos una clara mejoría en la mayoría de las áreas asistenciales. El material fue muy bien acogido por parte de los profesionales. No se realizó ninguna otra intervención distinta de las habituales, por lo que pensamos que esta estrategia está mejorando la cultura de seguridad en relación con la higiene de manos en nuestros centros (AU)

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting (AU)

[Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital]. / Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel.

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting.

Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico / Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery

Objetivo: Analizar nuestros resultados tras 10 años de adrenalectomías laparoscópicas convencionales (LC) y compararlos con los que obtiene la técnica por puerto único (LESS) recientemente introducida en nuestro medio. Material y método: Hemos revisado retrospectivamente los casos de 75 pacientes intervenidos de suprarrenalectomía por el mismo cirujano, por LC o LESS, en nuestro centro entre agosto de 2005 y junio de 2015. Se describen la edad, el sexo, el tamaño, la lateralidad, el diagnóstico preoperatorio, el tiempo quirúrgico, el sangrado intraoperatorio, la reconversión a cirugía abierta, la estancia media, las complicaciones intra y postoperatorias y el resultado anatomopatológico. Se utilizó el test de Fisher y de Chi cuadrado para comparar datos categóricos, y el test de «t» de Student para la comparación de medias con distribución normal. Se consideró significación estadística cuando p < 0,05. Resultados: La técnica de LC fue realizada en 51 pacientes y la LESS en 24. No se obtuvieron resultados estadísticamente significativos en cuanto al tiempo quirúrgico (LC: 103,9 ± 13,21 min vs LESS: 101,46 ± 13,65 min; p = 0,07), sangrado estimado (LC: 258,82 ± 136,92 cc vs LESS: 131,25 ± 36,74 cc; p = 0,46), complicaciones intraoperatorias (5 casos en LC vs ninguno en LESS; p = 0,47) ni posquirúrgicas (2 en el grupo de la LC vs una en el de LESS; p = 0,69) catalogadas según el Sistema Clavien modificado. La estancia hospitalaria fue menor en el caso del LESS (LC: 3,55 ± 0,69 días vs LESS: 2,21 ± 0,31 días; p = 0,01). Conclusiones: La suprarrenalectomía con LC es el abordaje de elección para el tratamiento quirúrgico de la enfermedad adrenal. La técnica LESS es segura y mejora los resultados cosméticos si se realiza por equipos experimentados sin aumentar la morbilidad

Objective: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. Material and method: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p < 0.05. Results: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9 ± 13.21 min vs. LESS: 101.46 ± 13.65 min; p = 0.07), estimated bleeding (LC: 258.82 ± 136.92cc vs. LESS: 131,25 ± 36,74cc; p = 0.46), intraoperative complications (5 cases in LC, none in LESS; p = 0.47), nor for postoperative complications (two in LC vs. one in LESS; p = 0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55 ± 0.69 days vs. LESS: 2.21 ± 0.31 days; p = 0.01). Conclusions: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams

Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery. / Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico.

OBJECTIVE: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. MATERIAL AND METHOD: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p<0.05. RESULTS: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9±13.21min vs. LESS: 101.46±13.65min; p=0.07), estimated bleeding (LC: 258.82±136.92cc vs. LESS: 131,25±36,74cc; p=0.46), intraoperative complications (5 cases in LC, none in LESS; p=0.47), nor for postoperative complications (two in LC vs. one in LESS; p=0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55±0.69 days vs. LESS: 2.21±0.31 days; p=0.01). CONCLUSIONS: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams.

Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical / Improvement in urinary tract infections rates in a department of internal medicine

Objetivo. Valorar el impacto de una intervención desarrollada en el servicio de Medicina Interna del Hospital Universitario Insular de Gran Canaria para prevenir las infecciones del tracto urinario asociadas a sondaje vesical (ITU-SV). Material y métodos. El proyecto se desarrolló en 3 fases de vigilancia prospectivas de 2 meses de duración cada una entre 2009 y 2011. Durante las fases 1 y 2 se siguieron los criterios diagnósticos de los Centers for Disease Control and Prevention (CDC) de 2004 para la clasificación de las infecciones y se obtuvieron los indicadores de resultado. En la fase 3 se emplearon los criterios de los CDC de 2009 y se obtuvieron tanto indicadores de resultado como de proceso. Se comparó la incidencia acumulada de ITU-SV de las 3 fases mediante el test de tendencia ji-cuadrado. Resultados. El número total de días de sondaje vesical (SV) disminuyó desde la primera a la tercera fase, así como la incidencia acumulada de ITU-SV. Sin embargo, en la segunda fase la media de días de SV aumentó, volviendo a disminuir en la tercera fase. Se realizó una intervención con envío de recordatorios a través de la historia clínica electrónica durante la tercera fase, en la que se logró disminuir las tasas de ITU-SV y reducir la duración media de SV. Conclusiones. Las tasas de ITU-SV podrían ser minimizadas mediante un enfoque multidisciplinar que incluya tanto formación a los sanitarios implicados como vigilancia, retroalimentación y uso específico de recordatorios electrónicos(AU)

Objective. To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. Material and methods. Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)–diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. Results. The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. Conclusions. A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital(AU)

[Improvement in urinary tract infections rates in a department of internal medicine]. / Proyecto de mejora en prevención de infecciones del tracto urinario asociadas a sondaje vesical.

OBJECTIVE: To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria. MATERIAL AND METHODS: Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)-diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test. RESULTS: The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts. CONCLUSIONS: A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital.

Vigilancia de infecciones y otros eventos adversos en pacientes en diálisis en el área sur de Gran Canaria / Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria

Introducción: Las infecciones bacterianas representan un gran desafío en las estrategias de gestión del riesgo, prevención y seguridad del paciente en hemodiálisis de las cuales las infecciones del acceso vascular (AV) representan la primera causa morbi-mortalidad en estos pacientes. Métodos: Estudio prospectivo de incidencia de eventos adversos e infecciones de 7 meses (marzo-septiembre 2008) en las unidades de Hemodiálisis del Área sanitaria Sur de Gran Canaria (Hospital y Centro periférico) utilizando la metodología del Dialysis Surveillance Network del CDC. Resultados: Se vigilaron 1545 pacientes/mes, 60,5% con fístula (FAV), 35,5% con catéter permanente (CP), 3,0% con prótesis y 1,0% con catéter temporal. La incidencia de eventos en ambos centros fue 8,7 casos por 100 pacientes-mes; la tasa de eventos infecciosos fue de 9,1 para FAV y 20,6 para CP en ámbito hospitalario, mientras las tasas de otras infecciones (respiratorias, herida, orina) fueron similares. Se realizó cultivo antes de empezar tratamiento antibiótico en el 91,0% frente a sospecha de bacteriemia y/o infección AV. El 90,0% de tratamientos se ajustaron con antibiograma. Destaca una baja incidencia de bacterias mutirresistentes mientras que las infecciones relacionadas con el AV fueron causadas en proporción similar por bacterias grampositivas y gramnegativas. Conclusiones: El acceso vascular es el principal factor de riesgo para el desarrollo de infecciones. La vigilancia epidemiológica he permitido detectar oportunidades de mejora en ámbitos asistenciales distintos, integrándose como elemento fundamental en el desarrollo de estrategias multidisciplinarias de seguridad del paciente (AU)

Background: Bacterial infections pose a great challenge to risk management activities in the area of chronic haemodialysis, as vascular access related infections are the main cause of mortality among these patients. Methods: Prospective surveillance study lasting 7 months (March-September, 2008) at the two haemodialysis units in a district health area in Gran Canaria, Spain. We have used methodology proposed by CDC´s Dialysis Surveillance Network. Results: 1545 patientsmonth were enrolled, 60,5% having an arterio-venous fistula (AVF), 35,5% permanent catheter (PC), 3,0% graft and 1,0% temporary catheters. Events incidence rate at both centers was 8,6 cases per 100 patients-month, 9,1 rate for FAV and 2,9 rates for CP, So, the greatest incidence of vascular access related infections was for permanent catheter as compared with AFV. Nevertheless the other type of infections (respiratory, urinary tract, skin and chronic ulcers) showed a similar rate. Microbiological cultures before antibiotic treatment were performed in 82,2 %, but increased up to 91,0% when a vascular related infection was suspected. Empiric treatment was adjusted to antibiogram results in 90,0% of occasions. A low incidence of multirresistant microbes was seen. Gram-positive and gram-negative bacteria appeared in a similar proportion. Conclusions: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, appearing as a key element in the risk management and patient safety areas (AU)

Surveillance for infections and other adverse events in dialysis patients in southern Gran Canaria.

BACKGROUND: Bacterial infections pose a major challenge to risk management activities in the area of chronic haemodialysis, as vascular access-related infections are the main cause of mortality among these patients. METHODS: Prospective surveillance study lasting 7 months (March-September, 2008) at two haemodialysis units in a district health area Gran Canaria, Spain. We used the methodology proposed by CDC´s Dialysis Surveillance Network. RESULTS: 1545 patients/month were recorded, 60.5% with an arteriovenous fistula (AVF), 35.5% with a permanent catheter (PC), 3.0% with grafts and 1.0% with temporary catheters. The rate of adverse events was 8.6 cases per 100 patients/month, 9.1 for AVF patients, and 2.9 for PC. Nevertheless, the other types of infections (respiratory, urinary tract, skin and chronic ulcers) showed similar rates. Microbiological cultures were taken in 82.2%, but this rate increased to 91.0% when a vascular access-related infection was suspected. Empirical treatment was adjusted to antibiogram results in 90.0% of occasions. A low incidence of multi-resistant microbes was observed. Gram-positive and gram-negative bacteria appeared in similar proportions. CONCLUSIONS: Vascular access is the main risk factor for infectious events. Epidemiological surveillance has allowed us to detect areas of improvement in different settings, acting as a key element in risk management and patient safety.

Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias / Assessment of a hand hygiene program on healthcare-associated infection control

Objetivo. Evaluar el impacto de una campaña de promoción de la higiene de manos sobre las tasas de infección en un hospital de tercer nivel en Las Palmas de Gran Canaria. Métodos. Estudio descriptivo ecológico, valorando frecuencia de higiene de manos en 3 áreas asistenciales y las tasas de infecciones. Se consideraron 4 momentos temporales: basal (2005), fase 1 de intervención (2006), fase 2 de intervención (2007) y postintervención (2008). La intervención consistió en introducir productos de base alcohólica, feedback sobre resultados de cumplimiento, diseño y colocación de carteles y sesiones de educación sanitaria, con demostraciones prácticas. Se usaron criterios estandarizados para medir variables. Resultados. Se detectó un incremento en la tasa de cumplimiento a lo largo de los 3 periodos, desde el 19,6% en el periodo basal, al 40,0% final (p<0,001). El incremento del cumplimiento fue más acusado entre las oportunidades de riesgo alto (del 12,0–28,4%; p<0,001), aunque solo tras la primera fase de la campaña y entre las de riesgo medio (del 23,6–41,7%; p<0,001). No obstante, los indicadores de infección aumentaron en todas las áreas vigiladas, en especial la prevalencia de pacientes infectados, del 8% en 2005 al 12,2% en el año 2008. Conclusiones. A pesar del incremento en el cumplimiento de la higiene de manos en las áreas vigiladas, no se han conseguido reducir las tasas de infecciones nosocomiales en el hospital. Una estrategia más eficiente debería implicar a responsables clínicos y directivos en todos los aspectos del control de las infecciones(AU)

Aim. to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. Methods. Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. Results. an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19,6% at baseline to 40,0% (p<0,001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12,0% to 28,4%; p<0,001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12,2% in 2008. Conclusions. Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control(AU)

[Assessment of a hand hygiene program on healthcare-associated infection control]. / Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias.

AIM: to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. METHODS: Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. RESULTS: an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p<0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p<0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008. CONCLUSIONS: Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control.

Resultados del tratamiento de la escoliosis idiopática del adolescente mediante instrumentación posterior híbrida / Adolescent idiopathic scoliosis: Results of treatment with hybrid posterior instrumentation

Objetivos: Describir los resultados clínicos y radiológicos así como la repercusión en la calidad de vida del enfermo tras el tratamiento quirúrgico de la escoliosis idiopática del adolescente mediante instrumentación posterior híbrida. Material y método: Estudio retrospectivo de 26 sujetos intervenidos desde 2001 hasta 2006, con un seguimiento medio de 37,8 meses. Se obtuvieron, mediante la clasificación de Lenke de las curvas, los siguientes resultados: el 42,3% fue de tipo i, el 46,2% fue de tipo iii, el 7,7% fue de tipo v y 3,8% fue de tipo vi. Se intervino a todos los sujetos mediante instrumentación posterior híbrida con tornillos pediculares distales y ganchos proximales. Se registraron las necesidades transfusionales y las complicaciones. Se realizó una evaluación clínica mediante el cuestionario SRS-22 (Scoliosis Research Society` Sociedad de Investigación de la Escoliosis¿). Asimismo, se realizó una evaluación radiológica prequirúrgica, posquirúrgica inmediata y al final del seguimiento. Resultados: Se registraron 3 infecciones superficiales, un hemotórax y una luxación de gancho. Mediante el cuestionario SRS-22 se obtuvieron las siguientes puntuaciones medias: 4,41 en dolor; 4,39 en actividad; 3,91 en autoimagen; 3,98 en salud mental, y 3,81 en satisfacción. La corrección radiológica media posquirúrgica en las curvas torácicas fue del 58% y en las curvas lumbares fue del 60%, con una pérdida media de 5,5° a 7° al final del seguimiento. No hubo casos de seudoartrosis. Discusión y conclusiones: La instrumentación y fusión posterior híbrida es una técnica eficaz y segura, con bajo índice de seudoartrosis y fracasos. Los resultados fueron buenos en cuanto al dolor y a la actividad, pero fueron discretos en cuanto a la autoimagen y a la satisfacción personal. No se encontró asociación estadísticamente significativa entre la edad de los sujetos, el grado de corrección de la curva y la puntuación del cuestionario SRS-22 (AU)

Purpose: Report on the clinical and radiological results obtained by surgical treatment of adolescent idiopathic scoliosis by means of hybrid posterior instrumentation. The repercussions of surgery on the patients¿ quality of life are also described. Materials and methods: Retrospective study of 26 patients operated between 2001 and 2006, with a mean follow-up of 37.8 months. In terms of the Lenke classification, 42.3% of patients had type 1 curves, 46.2% type 3 curves, 7.7% type 5 curves, and one case of type VI curves. All patients were subjected to a hybrid posterior instrumentation with distal pedicular screws and proximal hooks. Transfusion needs and complications were duly recorded. A clinical assessment was performed by means of the SRS-22 questionnaire. A radiological assessment was conducted preoperatively, postoperatively and at the end of follow-up. Results: There were three superficial infections, one hemothorax and one hook dislocation. The administration of the SRS-22 questionnaire produced the following mean scores: 4.41 for pain, 4.39 for activity, 3.91 for self-image, 3.98 for mental health and 3.81 for satisfaction. Mean post-surgical radiological correction for thoracic and lumbar curves was 58% and 60%, respectively, with a mean loss of 7 and 5.5 degrees at the end of follow-up. There were no cases of Pseudoarthrosis. Discussion and conclusions: Hybrid posterior instrumentation and fusion is an efficient and safe technique, with a low rate of pseudoarthrosis and failure. Results were good as regards pain and activity, but fair in terms of self-image and personal satisfaction. We found no statistically significant association between the patients´ age, the degree of curve correction and the score on the SRS-22 questionnaire (AU)

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. MAIN RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente a 1,6% ; p = 0,04); la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedad pulmonar obstructiva crónica (EPOC) (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones postquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso (AU)

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two time periods in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between them adherence to recommendations was reinforced. Main results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32.7% in the last year (p < 0,001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, the NNIS index-risk 2 being more frequent in period A (16.8%) than in period B (5.4%) (p<0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (COPD) (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial (AU)

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla / Effect of surveillance on surgical site infection rate in knee and hip arthroplasty

Objetivo. Determinar la adherencia al protocolo de profilaxis quirúrgica y su influencia en la modificación de la tasa de infección de la herida quirúrgica en un departamento de Cirugía Ortopédica. Material y métodos. Los pacientes intervenidos de prótesis de cadera o rodilla en el Hospital Universitario Insular de Las Palmas de Gran Canaria fueron seguidos por personal entrenado en el control de infecciones durante tres años, recogiendo datos sobre infecciones y factores de riesgo en dos períodos de observación: período A, de 24 meses, y período B, de 12 meses. Entre ambos se realizaron actividades de promoción del uso adecuado de la pauta de profilaxis quirúrgica antibiótica. Resultados. Se estudiaron 1.088 pacientes. En el período A, el 3,3% de las intervenciones se infectaron, comparadas con el 2,0% del período B (p = 0,14). La profilaxis antibiótica adecuada pasó del 8,7% al 32,7% (p < 0,001). Se determinó el índice NNIS (National Nosocomial Infections Surveillance) en 383 pacientes, siendo más frecuente el riesgo 2 en el período A (16,8%) que en el B (5,4%) (p < 0,001). La frecuencia de insuficiencia renal fue mayor en el período A (3,4% frente al 1,6%; p = 0,04), la diabetes y la neoplasia fueron similares en ambos períodos; en el período B predominaron enfermedades pulmonares obstructivas crónicas (14,6 frente a 11,0; p = 0,05) y obesidad (12,8 frente a 10,3; p = 0,12). Las medias de duración de las intervenciones, edad y estancia fueron idénticas en ambos períodos. Conclusiones. La acción de mejora introducida, aunque no seguida por todos los traumatólogos, se acompaña de un descenso de la tasa de infecciones posquirúrgicas, posiblemente con menor coste para el hospital y más seguridad para los pacientes. Este programa de vigilancia parece ser beneficioso

Objective. To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. Material and methods. Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. Results. A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. Conclusions. Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]. / Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla.

OBJECTIVE: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery. MATERIAL AND METHODS: Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced. RESULTS: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods. CONCLUSIONS: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial.

Bioseguridad ambiental en un hospital con grandes obras. Medidas correctoras y organización de control / Environmental biosafety in a hospital undergoing renovation work: corrective measures and control organisation

El objetivo de este trabajo es el de valorar la efectividad de las medidas organizativas en el control de la Bioseguridad Ambiental en un hospital de tercer nivel con grandes obras. Se describen las medidas de carácter organizativo puestas en marcha en abril de 2000 en un complejo hospitalario con grandes obras y reformas; se valoran los resultados del muestreo ambiental y su repercusión en la actividad clínica diaria. La mayoría de los controles efectuados mostraron resultados satisfactorios, pero durante el período de seguimiento hemos detectado situaciones de bioseguridad inadecuada que nos ha obligado a cancelar temporalmente las prestaciones y a someter a las zonas a profundas remodelaciones de mejora (en el caso de Oncohematología Infantil) o a un cambio de la estructura organizativa (Qui´rofanos del H. Materno-Infantil, Oncohematología de adultos). El bloque quirúrgico de adultos (sometido a remodelación en período previo al inicio de la vigilancia) ha sido el área que mejores resultados ha presentado. No se han detectado brotes de aspergilosis ni de legionelosis nosocomiales, ni aumento en la incidencia de estos procesos en el período de vigilancia. La puesta en funcionamiento de la Comisión de Obras y de una política proactiva de prevención en esta materia se ha mostrado eficaz en cuanto a la detección y control de la bioseguridad ambiental y nos ha permitido la coexistencia de la asistencia con grandes obras dentro y alrededor de lo dos hospitales

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Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects.

OBJECTIVE: To assess the factors that could predict a successful completion of a weight loss program. STUDY DESIGN: A single-centered, cross-sectional, prospective study conducted over 4 y. SUBJECTS: Data were obtained on 1018 overweight subjects (788 women, 230 men) aged 14.8-76.3 y (mean 38.4) and body mass index (BMI) of 31.7 (range 25.03-57.1) seeking help to lose weight at a specialist obesity clinic. MATERIALS AND METHODS: A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for free-time exercise and day-to-day activity. Follow-up was weekly until the desired weight loss was achieved ('successful completion') or the patient dropped-out of the program ('failure'). Cox's regression analysis was used to evaluate success and the variables included were compliance with the program, age, gender, initial BMI, physical activity, alcohol consumption, smoking habit, hypertension, diabetes, hypercholesterolemia, cardiovascular disease, previous dietary programs, cause of obesity, age at which excessive weight was first noted and parental obesity. RESULTS: Factors predictive of completion were: gender (males responded better), previous dietary programs (predictive of dropout), initial BMI (higher index, lower completion), and age (younger age, poorer outcome). There was an interaction between parental obesity and offspring childhood obesity. Absence of parental obesity and adult-onset obesity had a higher probability of program completion. CONCLUSIONS: In a standard weight reduction program the recommendations of dietary restriction and moderate exercise seems less effective for women, persons with high BMI, younger age groups and those who have had other attempts at weight loss. Poorest outcomes applied to those subjects with childhood obesity and who had obese parents.

[Attitudes of nursing staff in Western Málaga to HIV/AIDS infection]. / Actitudes ante la infección VIH/sida del personal de enfermería de Málaga Occidental.

OBJECTIVES: To identify how nursing staff at two care levels in the western area of Malaga view Human immunodeficiency Virus infection (HIV/AIDS), evaluating differences that might exist in function of age, sex, professional status, work seniority, contact with infected people, perceived risk, information received and general information about the disease. DESIGN: A cross-sectional study with an analytic component. Stratified randomised sampling for the two levels gave a total of 156 subjects. SETTING: The primary and specialist health care levels in the western area of Malaga. PARTICIPANTS: Nursing staff at both care levels working for at least a year and belonging to the full-time staff. INTERVENTION: A self-administered questionnaire which gathered: personal and work characteristics, knowledge, attitudes, place where health care delivered, perceived risk, information received and contact with patients. MAIN RESULTS: In the main, the study group was composed of nurses (71.3%) and women (68.6%) with average age of 32.7 and work seniority of 9.1 years. CONCLUSIONS: Negative attitudes were found to run at 56% in Specialist Care and 32.3% in Primary, a result associated with these variables: work seniority, perceived risk, care level and information.