Risk factors for health care-associated infections: From better knowledge to better prevention.

BACKGROUND: Health care-associated infections (HCAIs) are preventable with adoption of recognized preventive measures. The first step is to identify patients at higher risk of HCAI. This study aimed to identify patient risk factors (RFs) present on admission and acquired during inpatient stay which could be associated with higher risk of acquiring HCAI. METHODS: A case-control study was conducted in adult patients admitted during 2011 who were hospitalized for >48 hours. Cases were patients with HCAIs. Controls were selected in a ratio of 3:1, case matched by the admission date. The likelihood of increased HCAI was determined through binary logistic regression. RESULTS: RFs identified as being the more relevant for HCAI were being a man (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7), being aged >50 years (OR, 2.9; 95% CI, 1.3-6.9), and having an insertion of a central venous line during hospital stay (OR, 12.4; 95% CI, 5.0-30.5). CONCLUSIONS: RFs that showed statistical significance on admission were the patient's intrinsic factors, and RFs acquired during hospitalization were extrinsic RFs. When a set of RFs were present, the presence of a central venous line proved to be the more relevant one.

Endemic methicillin-resistant Staphylococcus aureus: Nurses' risk perceptions and attitudes.

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care-associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.

Hip fracture and pressure ulcers - the Pan-European Pressure Ulcer Study - intrinsic and extrinsic risk factors.

Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8.8% and 55% have been reported. There are few studies focusing on the specific patient-, surgery- and care-related risk indicators in this group. The aims of the study were: - to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery, - to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age >or=71 (P = 0.020), dehydration (P = 0.005), moist skin (P = 0.004) and total Braden score (P = 0.050) as well as subscores for friction (P = 0.020), nutrition (P = 0.020) and sensory perception (P = 0.040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0.005) and pulmonary disease (P = 0.006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.

Leg ulceration in Portugal: quality of life.

This study was undertaken to examine the impact of chronic leg ulceration on patients' health-related quality of life in an audit of practice in Lisbon, Portugal, and to observe the changes following 12 weeks of treatment. A questionnaire was administered at entry into an observational study and following 12 weeks of treatment. Patients entering the study were asked to complete the Nottingham Health Profile (NHP), Euroqol and visual analogue (VA) pain questionnaires at entry and after 12 weeks. Principal analysis compared final scores with those found at baseline and compared results with Portuguese normative data. In total, 98 patients entered the study and completed the initial questionnaire, with 68 (69.3%) patients completing the follow-up questionnaire. There were significantly (P < 0.001) higher scores for the patients compared with normative data for all domains of the NHP (all P < 0.001). Improvements were noted for all NHP scores after 12 weeks, although only bodily pain showed a significant improvement [mean difference (d) = 10.5, P = 0.003], with significant improvement also in Euroqol (d = 0.10, P = 0.027). Energy and social isolation improved substantially in the eight (11.8%) patients whose ulcers healed, but did not achieve statistical significance, although VA pain score did (d = 4.85, P < 0.001). Patients suffering from leg ulceration show modest improvements in perceived health following 12 weeks of usual care in Portugal. Improvements in practice may enhance the magnitude of these improvements.

A prospective study on incidence of bacterial infections in portuguese dialysis units.

BACKGROUND: Viral infection has been the main epidemiologic concern in the hemodialysis unit; however, bacterial infection is responsible for more than 30% of all causes of morbidity and mortality in our patients, vascular access infection being the culprit in 73% of all bacteremias. METHODS: A prospective multicenter cohort study of bacterial infections incidence, conducted from January to July 2004 in five hemodialysis units, to record and track bacterial infections, using a validated database from CDC's Dialysis Surveillance Network Program. RESULTS: 4,501 patient-months (P-M) were surveilled, being dialyzed through a native fistula (AVF) in 60.6%, a graft (PTFE) in 31.3%, a tunneled catheter (TC) in 7.6%, and a transient catheter (C) in 0.5%. As target events, we registered 166 hospitalizations - 3.7/100 P-M (2.2/100 P-M in patients with AVF, 4 in PTFE, 9.9 in TC, and 19 in C), and 182 intravenous antibiotic courses. Of these 182 antibiotic treatments, 47.8% included vancomycin, only 30% had blood cultures drawn pretreatment, and only 36% were positive. We recorded 98 infections at the vascular access site 2.18/100 P-M (0.95 in AVF, 1.6 in PTFE, 12.6 in TC, and 42.85 in C) and 2.13 infections/100 P-M at other sites. The isolated microorganisms were Staphylococcus epidermidis in 40.1%, Staphylococcus aureus in 30.1%, Pseudomonas in 13.3%, and Escherichia coli in 3.3%. Although we found a diversity of practice patterns, the number of target events (8.4/100 P-M) and the bacterial infections incidence (4.31/100 P-M) were remarkably homogeneous in the five centers. CONCLUSION: (1) High incidence of bacterial infections, causing major morbidity; (2) infectious risk is vascular access type-dependent, with dramatic rise in catheters; (3) underutilization of blood cultures to orient diagnosis and therapy, and (4) high rates of vancomycin prescription.

[Epidemiology of chronic wounds treated in Primary Health Care in Portugal]. / Epidemiologia das feridas crónicas tratadas nos Cuidados de Saúde Primários em Portugal.

UNLABELLED: This cross-sectional study of a sample of patients with wounds of duration > 2 weeks, attempts to characterize patients and type of wounds treated in community services and assess patient's views with regard to wounds and care received. 144 health centres were randomly selected so as to be nationally representative. RESULTS: 1424 wounds in 1115 patients aged > or = 18 yrs were assessed. Of these, 57.4% were treated in the clinic and 42.6% at home. There was a predominance of female patients (57.7%) and average age was 69.9 (clinic) and 77.1 (home) years. Over 80% of patients were retired. Leg ulcers were the main type of wound, followed by pressure ulcers. Average wound duration was 7.4 months for pressure ulcers and 19.4 months for leg ulcers. Of 574 clinic patients a significant number complained of discomfort and pain but over 90% were satisfied with care received. DISCUSSION: Patient population was characterized as elderly, low income and suffering from chronic underlying disease. Expectations regarding healing are low. An education/ intervention project has been started to promote evidence-based practice.

[Quality of life in patients with leg ulcers in Portugal]. / Qualidade de vida em doentes com úlcera de perna em Portugal.

OBJECTIVE: To evaluate health related quality of life (HRQoL) in a sample of patients suffering from chronic leg ulceration in Portugal. DESIGN: Questionnaire administered at baseline and following 12 weeks of treatment. SETTING: Community health clinics and out-patient departments of hospitals within the catchment area. PARTICIPANTS: Patients suffering from chronic venous ulceration being cared for by community and hospital staff. METHODS: Patients entering the study were asked to complete the Nottingham Health Profile (NHP) Euroqol and Visual Analogue (VA) pain questionnaires at entry and after 12 weeks. Principal analysis compared final scores with those found at baseline, and compared results with UK based data. RESULTS: In all, 98 patients entered the study and completed the initial questionnaire, with 68 (69.3%) patients completing the follow up questionnaire. There were significantly (p<0.001) higher scores for the Portuguese patients compared with Portuguese normative data for all domains of the NHP (all p<0.001). Improvements were noted for all scores after 24 weeks. After 12 weeks bodily pain showed a significant improvement (mean difference [d]=10.5, p=0.003), with significant improvement in Euroqol (d=0.10, p=0.027). Energy and social isolation improved substantially in the 8 (11.8%) who healed, though not statistically, but VA pain score did (d=4.85, p<0.001). CONCLUSIONS: Patients suffering from leg ulceration show modest improvements in perceived health following 12 weeks of care. Improvements in practice may enhance the magnitude of these improvements.

[Microbiology of leg ulcers and microbiologic diagnosis of the infection]. / Microbiologia das úlceras de perna e diagnóstico microbiológico da infecção.

Of all the complications which can interfere with healing, infection is among those which have a greater impact not only on the wound but also on the patient's quality of life and on the costs of care. The author addresses the microbiology of leg ulcers, the problem of the qualitative versus quantitative analysis and the continuing debate regarding the indication for sampling wounds, methods and interpretation of the results in the microbiological diagnosis of wound infection.

[Leg ulcers in Portugal: an underestimated health care problem]. / Ulceras de perna em Portugal: um problema de saúde subestimado.

To determine the prevalence and aetiology of leg ulceration in a population of patients registered with five health centres within Lisbon, a study was undertaken to identify patients receiving care from community and hospital. Identification of patients was through health professionals, with a simple questionnaire completed for all patients identified who were registered with the five health centres. In 263 patients were identified in a population of 186,000 (total prevalence 1.41/1,000 population). The prevalence was similar between men and women (1.3 and 1.46/1,000, respectively). As expected this was highly age dependent, being most common in patients aged over 80 years (6.5 and 4.9/1,000, respectively). The ulceration was highly chronic in nature, with median ulceration of 18 months. Of the 240 with ulcer duration recorded, 158 (66%) had the present ulcer for longer than one year, and 40 (17%) for longer than five years. The cause of ulceration was unknown to the health professional treating the patient in 86 (33%) of the cases. Of those with a cause, most commonly this was venous (80%) with 10% mixed arterial/venous ulceration and 3% frank arterial disease. Most care was provided by community services, with 145 (55%) treated in health centres and 77 (29%) treated in the patient's home. The mean number of treatments per week was 3.0, with 21 (9%) of patients being seen on a daily basis. Most patients (80%) had seen a specialist doctor for their ulceration, most often a dermatologist (48%) and a vascular surgeon (33%). The prevalence of chronic leg ulceration is similar to other reported studies in western Europe, and indicates that approximately 14,000 patients suffer from leg ulceration at any one time in Portugal. This produces a high burden on both hospital and community services.