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.

Depuración extrarrenal continua sin anticoagulación / No disponible

No disponible

Valoración de las necesidades de los pacientes ingresados en una Unidad de Cuidados Intensivos / Assessment of the needs of patients admitted to an Intensive Care Unit

No disponible

[Satisfaction survey administered to the relatives of critical patients]. / Encuesta de satisfacción a los familiares de pacientes críticos.

OBJECTIVE: To know the family needs of patients admitted to our Intensive Care Unit (ICU). DESIGN: Prospective, descriptive study performed over a 6-month period. SETTING: ICU of the Insular University Hospital in Gran Canary Islands. PARTICIPANTS: Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. INTERVENTION: A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. MAIN VARIABLES: Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. RESULTS: Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified.

Encuesta de satisfacción a los familiares de pacientes críticos / Satisfaction survey administered to the relatives of critical patients

Objetivo. Conocer la satisfacción de los familiares de pacientes ingresados en nuestra Unidad de Cuidados Intensivos (UCI). Diseño. Estudio prospectivo descriptivo durante un período de 6 meses. Ámbito. UCI polivalente del Hospital Universitario Insular de Gran Canaria. Sujetos. Familiares de pacientes adultos ingresados en la UCI durante más de 48 horas y que fueron dados de alta a planta de hospitalización. Intervención. Se realizó una encuesta personal a los familiares directos de los pacientes, en el momento del alta de la unidad, llevada a cabo por personal médico no informador. Variables de interés principales. Se recogieron datos demográficos de los pacientes y de los familiares entrevistados, diagnóstico de ingreso, y la valoración acerca de la información, cuidados, empatía con el personal y la comodidad. Resultados. Se entrevistó a familiares de 99 pacientes. El 80% recibieron la información con terminología comprensible, entendían lo que le ocurría a su familiar y los medios que se estaban poniendo para su curación, a pesar de que al 74% nunca se les había explicado la tecnología utilizada. El 90% creían recibir una información sincera y que los cuidados eran los adecuados. A nivel de empatía con el personal médico, para casi todos eran amables; sin embargo, al 73% ninguno le preguntó si necesitaba algo. El 85% estaban seguros de que alguien les llamaría a casa si ocurría algún cambio en el estado de su familiar y se sentían cómodos durante el tiempo de visita; el 74% no tuvo sentimiento de soledad ni aislamiento. Conclusiones. La mayoría de los familiares estaban muy satisfechos con los cuidados recibidos por ellos y por sus familiares enfermos en la UCI, aunque detectamos la necesidad de mejorar en determinados aspectos de la comunicación con los familiares

Objective. To know the family needs of patients admitted to our Intensive Care Unit (ICU). Design. Prospective, descriptive study performed over a 6-month period. Setting. ICU of the Insular University Hospital in Gran Canary Islands. Participants. Adult patients admitted to the ICU for more than 48 hours who were discharged to the hospitalization ward. Intervention. A modified Society of Critical Care Medicine Family Needs Assessment instrument was administered to the first-degree relatives of patients after discharge by face-to-face interviews by not-informing personnel. Main variables. Data were gathered on demographic information on the patients and their interviewed relatives, reason for admission, and evaluation on information, care, empathy with the personnel and comfort. Results. Family members of 99 patients were interviewed. A total of 80% of those interviewed considered the information had been in terms that they could understand, that they understood what was happening to the patient and why things were being done. However, 74% answered that the personnel had never explained the equipment being used. About 90% thought that they had received sincere information and that adequate care was being given. Considering empathy with the personnel, almost all considered they were nice but that 73% of them had never been asked if they needed anything. A total of 85% of them were sure that someone would phone them if there was any significant change in their relative's condition, and they felt comfortable during the time of visit; 74% did not feel alone or isolation. Conclusions. Most family members were highly satisfied with the care provided to them and their relatives in the intensive care unit, but the need to improve some aspects of the communication with families was identified

[Quality of artificial nutritional support in an intensive care unit]. / Calidad del soporte nutricional artificial en una unidad de cuidados intensivos.

OBJECTIVES: To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit. DESIGN: Prospective cohort study over a 5 months period. SETTING: Intensive Care Unit of the Insular University Hospital in Gran Canaria. PATIENTS: Adult patients who were prescribed enteral and or parenteral nutrition for > or = 2 days and we followed them for the first 14 days of nutrition delivery. INTERVENTION: The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding > 1 hour in the days of artificial nutrition were analyzed. RESULTS: Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear. CONCLUSIONS: In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies.

Calidad del soporte nutricional artificial en una unidad de cuidados intensivos / Quality of artificial nutritional support in an intensive care unit

Objetivo: Evaluar cuáles son los factores que influyeron en las diferencias entre la cantidad de nutrientes administrados, pautados y teóricamente requeridos en una unidad de cuidados intensivos. Diseño: Estudio prospectivo de cohortes durante un período de 5 meses. Ámbito: UCI polivalente del Hospital Universitario Insular de Gran Canaria. Pacientes: Pacientes adultos a quienes se les prescribía nutrición enteral y/o parenteral durante ≥ 2 días, siguiéndolos durante los primeros 14 días. Intervención: Se calcularon diariamente las calorías pautadas y las administradas, mientras que los requerimientos calóricos teóricos se calcularon tras el alta de la Unidad, según la ecuación de Harris-Benedict a la que se le aplicaba un factor de estrés. Asimismo se recogieron las causas por las que se interrumpió la dieta durante más de 1 hora en los días de nutrición artificial analizados. Resultados: Se incluyeron 59 pacientes consecutivos que recibían soporte nutricional enteral (NET) y/o parenteral (NPT), lo que suponía un total de 465 días de nutrición. La nutrición artificial se inició en las primeras 48 horas del ingreso. La Nutrición Enteral fue la vía de administración más utilizada. De las calorías teóricamente requeridas se pautaron el 79% y se administraron el 66%; asimismo se administraron el 88% de las pautadas. El bajo ratio de calorías administradas-pautadas afectaban principalmente y de manera significativa a la Nutrición Enteral, debido principalmente a intolerancia gastrointestinal. Observamos una variablidad importante entre los miembros del staff en cuanto a tomar la decisión de comenzar, suspender, reiniciar o reducir la NET cuando aparecen síntomas de intolerancia. Conclusiones: En nuestra Unidad existe una diferencia importante entre los requerimientos calóricos teóricos y la cantidad efectivamente administrada; este déficit es más manifiesto en la nutrición enteral. El conocimiento de esta situación permite tomar medidas encaminadas a optimizar el soporte nutricional de nuestros pacientes. Posiblemente la motivación en el personal médico y de enfermería en llevar a cabo protocolos de nutrición que se establezcan podría ser la medida más efectiva, lo que habría que confirmar en estudios posteriores (AU)

Objectives: To assess what are the reasons for discrepancies between the amount of nutrients delivered, prescribed and theoretical requirements, in an intensive care unit. Design: Prospective cohort study over a 5 months period. Setting: Intensive Care Unit of the Insular University Hospital in Gran Canaria. Patients: Adult patients who were prescribed enteral and or parenteral nutrition for ≥ 2 days and we followed them for the first 14 days of nutrition delivery. Intervention: The prescribed and the delivered calories were calculated every day, whereas the theoretical requeriments were calculated after the ICU stay, by using the Harris-Benedict formula adjusted with a stress factor. Also the reason for cessation of enteral tube feeding> 1 hour in the days of artificial nutrition were analyzed. Results: Fifty-nine consecutive patients, receiving nutritional support either enterally or intravenously, and 465 nutrition days analyzed. Nutrition was initiated within 48 hours after ICU admission. Enteral nutrition was the preferential route used. Seventy-nine percent of the mean caloric amount required was prescribed, and 66% was effectively delivered; also 88% of the amount prescribed was delivered. The low ratio of delivered-prescribed calories concerned principally enteral nutrition and was caused by gastrointestinal intolerance. We observe a wide variation in practice patterns among physicians to start, increase, reduce or stop enteral nutrition when symptoms of intolerance appear. Conclusions: In our ICU exists an important difference between the caloric theoretical requests and the quantity really delivered; this deficit is more clear in the enteral nutrition. The knowledge of this situation allows to take measures directed to optimizing the nutritional support of our patients. Possibly the motivation in the medical and nursery personnel in carrying out nutritional protocols it might be the most effective measurement, which it would be necessary to confirm in later studies (AU)