Transmisión nosocomial comparada de los virus gripales / Comparative nosocomial transmission of influenza viruses

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Real-time surveillance systems: Applicability for the control of influenza in acute care.

BACKGROUND: The high morbidity and mortality caused by influenza viruses translate into a great impact on specialized health care. Apart from the annual vaccination, the relevance of other measures to prevent and control this infection is unknown. The objective of our research was to determine the importance of a real-time surveillance system to establish early extended transmission precautions. METHODS: Quasi-experimental before-and-after study comparing the influenza cases detected in hospitalized adults during the 2016/2017 season (264 patients) with those detected after the implementation of a real-time surveillance system in the 2017/2018 season (519 patients). The improvements included early microbiological diagnosis, immediate communication of results, constant updating of patient information, coordination among professionals, periodic surveillance of the adequacy of preventive measures, and greater control of roommates. The effectiveness of the intervention was determined from the nosocomial infection rate in each season. RESULTS: After the real-time surveillance system for influenza was implemented, patients with early microbiological diagnosis and immediate isolation increased significantly (13.7% vs 68.2%; P < .001). In addition, nosocomial infections decreased from 17% to 9.2% (P = .001) and overall hospital stay was significantly reduced. Assuming that the entire effect was due to the intervention, the absolute risk reduction was 7.8% and number needed to treat was 12.8. CONCLUSION: The results in our study reveal the impact of nosocomial transmission of influenza virus in a tertiary hospital and highlight the need to supplement traditional strategies with novel methodologies such as modern surveillance systems based on early diagnosis, close case monitoring, and coordination among professionals.

[Impact of nosocomial transmission of influenza virus in an acute hospital]. / Impacto de la transmisión nosocomial del virus de la gripe en un hospital de agudos.

OBJECTIVE: The increase in morbidity and mortality associated the influenza virus infections represents an important global challenge, with particular relevance within health institutions.The aim of the study was to highlight the impact, repercussions and characteristics of the nosocomial transmission of influenza virus. METHODS: A sample of 286 hospitalized patients in a third-level hospital with confirmed influenza (virus RNA in respiratory specimens) is included. The study design was observational, through the collection of positive microbiological results from the 2016-2017 season. A comparative statistical analysis was carried out between cases of community-acquired influenza and hospital-acquired cases. RESULTS: 14.3% of the total sample (41 cases) was considered of nosocomial origin. Significant differences were observed in the percentage of vaccinated between hospital-acquired (34.1%) and community-acquired (50.2%); and in the number of days of hospitalization after diagnosis between both groups. The attack rate was 0.66%. CONCLUSIONS: The nosocomial acquisition of the influenza virus resulted in a greater severity of the process and in the increase of days of hospital stay. Strict adherence to control measures and epidemiological surveillance of influenza cases has allowed to reduce the attack rate.

OBJETIVO: El incremento de la morbimortalidad asociado a la infección por el virus de la gripe supone un importante reto a nivel mundial, con especial relevancia dentro de las instituciones sanitarias. El objetivo del estudio fue analizar el impacto, repercusiones y características de la transmisión nosocomial del virus de la gripe. METODOS: Se incluyó una muestra de 286 pacientes hospitalizados en un centro de tercer nivel con gripe confirmada (ARN del virus en muestras respiratorias). El diseño del estudio fue observacional, mediante recogida de los resultados microbiológicos positivos de la temporada de gripe 2016-2017. Se realizó un análisis estadístico comparativo entre los casos de gripe comunitaria y los casos nosocomiales. RESULTADOS: El 14.3% del total de la muestra (41 casos) se consideró de origen nosocomial. Se observaron diferencias significativas en el porcentaje de vacunados entre los casos de infección nosocomial (34,1%) y comunitaria (50,2%), y en el número de días de ingreso tras diagnóstico (12 ±22 días para los casos nosocomiales y 6 ±8 días para los comunitarios). La tasa de ataque fue del 0,66%. CONCLUSIONES: La adquisición nosocomial del virus de la gripe se tradujo en una mayor gravedad del cuadro y en el incremento de los días de estancia hospitalaria. El estricto cumplimiento de las medidas de control y vigilancia epidemiológica de los casos de gripe ha permitido lograr una tasa de ataque reducida.

Impacto de la transmisión nosocomial del virus de la gripe en un hospital de agudos / Impact of nosocomial transmission of influenza virus in an acute hospital

Fundamentos: El incremento de la morbimortalidad asociado a la infección por el virus de la gripe supone un importante reto a nivel mundial, con especial relevancia dentro de las instituciones sanitarias. El objetivo del estudio fue analizar el impacto, repercusiones y características de la transmisión nosocomial del virus de la gripe. Métodos: Se incluyó una muestra de 286 pacientes hospitalizados en un centro de tercer nivel con gripe con firmada (ARN del virus en muestras respiratorias). El di seño del estudio fue observacional, mediante recogida de los resultados microbiológicos positivos de la temporada de gripe 2016-2017. Se realizó un análisis estadístico comparativo entre los casos de gripe comunitaria y los casos nosocomiales. Resultados: El 14.3% del total de la muestra (41 casos) se consideró de origen nosocomial. Se observaron diferencias significativas en el porcentaje de vacunados entre los casos de infección nosocomial (34,1%) y comunitaria (50,2%), y en el número de días de ingreso tras diagnóstico (12 ±22 días para los casos nosocomiales y 6 ±8 días para los comunitarios). La tasa de ataque fue del 0,66%. Conclusiones: La adquisición nosocomial del virus de la gripe se tradujo en una mayor gravedad del cuadro y en el incremento de los días de estancia hospitalaria. El estricto cumplimiento de las medidas de control y vigilancia epidemiológica de los casos de gripe ha permitido lograr una tasa de ataque reducida

Background: The increase in morbidity and mortality associated the influenza virus infections represents an important global challenge, with particular relevance within health institutions. The aim of the study was to highlight the impact, repercussions and characteristics of the nosocomial transmission of influenza virus. Methods: A sample of 286 hospitalized patients in a third-level hospital with confirmed influenza (virus RNA in respiratory specimens) is included. The study design was observational, through the collection of positive microbiological results from the 2016-2017 season. A comparative statistical analysis was carried out between cases of community-acquired influenza and hospital-acquired cases. Results: 14.3% of the total sample (41 cases) was considered of nosocomial origin. Significant differences were observed in the percentage of vaccinated between hospital-acquired (34.1%) and community-acquired (50.2%); and in the number of days of hospitalization after diagnosis between both groups. The attack rate was 0.66%. Conclusions: The nosocomial acquisition of the influenza virus resulted in a greater severity of the process and in the increase of days of hospital stay. Strict adherence to control measures and epidemiological surveillance of influenza cases has allowed to reduce the attack rate

In-hospital mortality rates after CABG by autonomous regions in Spain.

PURPOSE: The paper's purpose is twofold: to provide a predictive model for estimating in-hospital mortality rates after coronary artery bypass grafting (CABG) in Spanish autonomous regions (AR) after adjusting relevant factors; and to determine whether there is a difference between expected and observed mortality rates. DESIGN/METHODOLOGY/APPROACH: All patients registered in a minimum basic data set (MSBD) undergoing CABG between 2000 and 2004 were selected. After bivariate analysis to explore associations between in-hospital death and other variables, a multivariate analysis using logistic regression was conducted. The predictive model was evaluated using calibration and discrimination techniques. Standardized mortality ratios by AR were calculated. FINDINGS: The expected Spanish in-hospital mortality rate after CABG was 7.68 and the observed rate was 7.69 deaths per 100 operations. Discrimination obtained with the model resulted in an area under the curve of 0.70 (95 per cent CI, 0.69-0.71). When each AR's mortality rate is calculated and compared with the observed rate, some ARs present an observed mortality rate higher or lower than the expected rate according to adjusted variables in the model. RESEARCH LIMITATIONS/IMPLICATIONS: The MSBD registry does not contain patients' critical data, such as arterial damage severity, or in which hospital procedures were performed. PRACTICAL IMPLICATIONS: There are factors related to individual patient variation, financial resources or healthcare quality in different ARs, which should be investigated in follow-up studies. ORIGINALITY/VALUE: The paper shows that, although the global expected mortality rate is almost the same as the observed Spanish mortality rate, this similarity disappears when AR rates are compared.

Development and validation of a questionnaire to assess satisfaction with hospital emergency care.

OBJECTIVE: To develop and validate a questionnaire to determine satisfaction with the hospital emergency department. DESIGN: Cross-sectional study to validate a telephone questionnaire designed in Spanish by a panel of experts. SETTING: The emergency department of Hospital Gregorio Marañón, a tertiary level hospital of the Spanish national health system. PARTICIPANTS: A sample of 651 emergency department patients completed the questionnaire. MAIN OUTCOME MEASURES: The psychometric properties of the questionnaire were evaluated; namely, construct, criterion validity, predictive validity and internal consistency. RESULTS: Two dimensions--comfortable service and personalised service--were identified from the exploratory factor analysis, and these accounted for 63% of the variance. Both factors showed a positive correlation with the global assessment items 'global satisfaction with the attention received in the emergency ward' and 'Would you recommend this emergency department?' The predictive validity of the questionnaire was assessed by means of discriminant analysis, which showed that 66.7% of patients were correctly classified. Internal consistency measured by Cronbach's alpha resulted in a value greater than 0.80 for both dimensions. CONCLUSIONS: This questionnaire fulfils the necessary psychometric properties to be considered a useful and reliable tool for measuring patient satisfaction with hospital emergency services.

Demanda de atención hospitalaria por gripe A/H1N1: evaluación de los primeros 1.000 casos atendidos / Hospital care of patients with A/H1N1 influenza: Evaluation of the first 1000 reported cases in Spain

Introducción y objetivos: A pesar del enorme impacto que se prevé tenga la pandemia por gripe A/H1N1 en países del hemisferio norte, todavía son escasos los datos disponibles de su repercusión a nivel hospitalario. El objetivo de este trabajo es evaluar la asistencia prestada a los pacientes atendidos por posible gripe A y su evolución en un hospital de tercer nivel.Material y método: Desde la aparición de los primeros casos se estableció un circuito específico de atención a pacientes con posible gripe A en la unidad de admisión, urgencias y hospitalización. Se diseñó un registro nominal con variables epidemiológicas y variables clínicas.Resultados: A 31 de agosto de 2009 se habían evaluado 1.018 pacientes por posible gripe A, de los que el 77% cumplía criterios clínicos. Entre los pacientes con sospecha de gripe A, la edad media (desviación estándar) fue de 31,71 (17,2) años, el 52% eran mujeres, un 3,3% de ellas embarazadas o puérperas. Ingresó el 23,4%, y la estancia media global fue de 3,5 días y de 2,5 días para los adultos que ingresaron en la unidad de corta estancia. Un 2,8% presentó neumonía y 2 pacientes necesitaron atención en unidad de cuidados intensivos (uno de ellos falleció).Conclusiones: Nuestra serie muestra una epidemia de gripe que se comporta de forma benigna con un porcentaje considerable de neumonías, pero que evolucionan favorablemente. A pesar del alto porcentaje de ingresos, y para evitar el menoscabo de la atención a otros enfermos, consideramos que un modelo asistencial basado en unidades específicas, estancias cortas y seguimiento posthospitalario puede ser adecuado (AU)

Introduction and objectives: Influenza A is expected to have a great impact in countries in the northern hemisphere yet little has been reported about how this outbreak can affect hospital care. The aim of this study is to assess patients who demand care for flu symptoms and their outcome. Material and methods: From the beginning of the outbreak a specific protocol was established for the care of patients with potential influenza A in admission, emergency and hospitalization ward. A nominal registry was designed with clinical and epidemiological data.Results: 1018 patients were evaluated for potential influenza A from the beginning of the outbreak until the 31st August, 2009. 77% of them fulfilled clinical criteria and were classified as suspected cases. Mean age was 31,7 years (SD17,2), 52% were women, 3,3% pregnant or puerperal. The admission rate was 23,4% with a global mean stay of 3,5 days, and 2,5 for the adults who were admitted to the short stay hospital unit. 2,8 % had pneumonia, two patients required admission to the intensive care unit and one of them died.Conclusions: Our data show an outbreak with mild illness, with a remarkable percentage of pneumonia but with good outcome. Despite of the high percentage of admissions, and in order to avoid the misleading attention to other patients, we believe that an assistance model based in specific units, short stay and post-discharge follow up could be suitable (AU)

[Hospital care of patients with A/H1N1 influenza: evaluation of the first 1000 reported cases in Spain]. / Demanda de atención hospitalaria por gripe A/H1N1: evaluación de los primeros 1.000 casos atendidos.

INTRODUCTION AND OBJECTIVES: Influenza A is expected to have a great impact in countries in the northern hemisphere yet little has been reported about how this outbreak can affect hospital care. The aim of this study is to assess patients who demand care for flu symptoms and their outcome. MATERIAL AND METHODS: From the beginning of the outbreak a specific protocol was established for the care of patients with potential influenza A in admission, emergency and hospitalization ward. A nominal registry was designed with clinical and epidemiological data. RESULTS: 1018 patients were evaluated for potential influenza A from the beginning of the outbreak until the 31(st) August, 2009. 77% of them fulfilled clinical criteria and were classified as suspected cases. Mean age was 31,7 years (SD17,2), 52% were women, 3,3% pregnant or puerperal. The admission rate was 23,4% with a global mean stay of 3,5 days, and 2,5 for the adults who were admitted to the short stay hospital unit. 2,8 % had pneumonia, two patients required admission to the intensive care unit and one of them died. CONCLUSIONS: Our data show an outbreak with mild illness, with a remarkable percentage of pneumonia but with good outcome. Despite of the high percentage of admissions, and in order to avoid the misleading attention to other patients, we believe that an assistance model based in specific units, short stay and post-discharge follow up could be suitable.

Diseño y validación de un cuestionario para evaluar la satisfacciónde los pacientes atendidos en las consultas externas de un hospital de Madrid en 2006 / Design and validation of a questionnaire to evaluate satisfaction of patients of the hospital outpatient clinics in Madrid, Spain, 2006

Fundamento: Para conocer la calidad de la asistenciasanitaria es imprescindible incorporar el punto de vista delpaciente realizando estudios de satisfacción. Las encuestas desatisfacción precisan unas propiedades psicométricas quegaranticen su fiabilidad y validez. El objetivo de este trabajo esdiseñar y validar un cuestionario para conocer la satisfacciónde los pacientes con las consultas externas hospitalarias.Métodos: Estudio de validación de un cuestionarioautocumplimentado, diseñado por un grupo de expertos,compuesto por 12 preguntas que se aplicó a una muestra de677 pacientes de las consultas externas del hospital GregorioMarañón. Se analizó el comportamiento métrico delcuestionario en cuanto a validez de constructo, de criterio ycapacidad predictiva y la consistencia interna.Resultados: Se analizó el comportamiento métrico delcuestionario respecto a la validez de constructo identificándose 2factores “calidad clínica” y “calidad administrativa” que explicanel 63% de la varianza, validez de criterio concurrente (coeficientede correlación de Spearman de 0,85 respecto al criterio dereferencia “satisfacción global con la atención recibida enconsultas externas”, OR 1,19 respecto al criterio de referencia“conoce el nombre del médico que le atiende en la consulta”),capacidad predictiva del cuestionario medida mediante análisisdiscriminante obteniéndose un 84% de los casos clasificadoscorrectamente y consistencia interna (Alfa de Cronbach 0,90).Conclusiones: El cuestionario reúne suficientes propiedadespsicométricas como para que pueda ser considerado unaherramienta útil y fiable para medir la satisfacción de lospacientes con las consultas externas hospitalarias(AU)

Background: In order to improve the quality of healthcare it is necessary to know the point of view of the patientsthrough satisfaction surveys. Satisfaction surveys need somepsychometric properties to guarantee its reliability andvalidity. The aim of this paper is to design and to validate aquestionnaire to determine the satisfaction of patients of thehospital outpatient clinics.Methods: Validation of a satisfaction questionnaire,designed by an expert group and composed for 12 questions.The questionnaire was given to a sample of 677 patientsattended in the hospital Gregorio Marañón outpatient clinics.The psychometric properties of the questionnaire wereestablished: construct validity, concurrent criterion validity,predictive capacity and internal consistency.Results: Two dimensions were identified in the constructvalidity analyses, explaining 63% of the variance: “clinicalquality” and “administrative quality”. The concurrent validityanalysis showed a Spearman’s rank correlation coefficient of0.85 related to the standard criterion “global satisfaction withthe attention provided in outpatient clinics” and an OR of 1.19related to the criterion “do you know the name of the physicianwho attended you?” The predictive capacity of the questionnairewas measured by discriminated analysis, obtaining 84% ofcorrect classified, and the internal consistency test gave aCronbach´s alpha of 0.90.Conclusions: Our questionnaire has enough psychometricproperties to be considered an useful and feasible tool tomeasure the satisfaction of patients of the hospital outpatientclinics(AU)

Caídas en el hospital: registro del año 2005 / In-hospital falls: register for 2005

Objetivos: Describir la incidencia de caídas en pacientes ingresados en el Hospital General Universitario Gregorio Marañón durante el año 2005, así como las características de éstos y del contexto en que se producen estas caídas. Material y método: Estudio descriptivo realizado en 2005. Cuando se producía una caída se recogían en una ficha prediseñada las variables referentes al estado físico y mental del paciente y su entorno. Los datos se analizaron calculando frecuencias absolutas, porcentajes, medias, desviaciones típicas, rango y mediana. Resultados: La incidencia de caídas en el año 2005 fue del 0,6%. La edad media fue de 71,4 ± 14,89 años, con más frecuencia en varones (55,4%). El 14,7% de los pacientes presentaba un antecedente de caídas en el último mes. El 65,9% se produjo en la habitación; el 69,2%, en días laborables, y el 47%, en el turno de noche. Destaca que los pacientes presentaban más frecuentemente limitaciones de la movilidad y alteración de los sentidos, y tomaban varios fármacos. El timbre inalcanzable, el calzado inadecuado y la escasa iluminación fueron las características del entorno más registradas. Conclusiones: Es importante intensificar el registro de caídas para conocer las circunstancias en que éstas se producen y así poder instaurar estrategias de prevención

Objective: To describe the incidence of falls in patients admitted to the Hospital General Universitario Gregorio Marañón in 2005 and to identify the clinical characteristics and context of these falls. Material and method: A descriptive study was carried out during 2005. When a fall was reported, variables related to the patient's physical and mental status and to the context in which the fall was produced were recorded on a predesigned sheet. Data were analyzed using absolute frequencies, proportions, means, standard deviations, median, and range. Results: The incidence of falls in 2005 was 0.6%.The mean age was 71.4 (14.89) years. Falls were more frequent among males (55.4%). Of patients who fell, 14.7% had suffered a fall in the previous month. A total of 65.9% of falls occurred inside the patient's room, 69.2% on work days and 47% in the night shift. Gait impairment, sensory defects and use of several drugs were more frequent among patients who fell. The most frequently reported environmental characteristics were an unreachable bell, unsuitable footwear, and insufficient lighting. Conclusions: Recording of falls should be increased to identify their causes and to design new prevention strategies

[Design and validation of a questionnaire of the hospital outpatient clinics in Madrid, Spain, 2006]. / Diseño y validación be un cuestionario para evaluar la satisfacción de los pacientes atendidos en las consultas externas de un hospital de Madrid en 2006.

BACKGROUND: In order to improve the quality of health care it is necessary to know the point of view of the patients through satisfaction surveys. Satisfaction surveys need some psychometric properties to guarantee its reliability and validity. The aim of this paper is to design and to validate a questionnaire to determine the satisfaction of patients of the hospital outpatient clinics. METHODS: Validation of a satisfaction questionnaire, designed by an expert group and composed for 12 questions. The questionnaire was given to a sample of 677 patients attended in the hospital Gregorio Marañón outpatient clinics. The psychometric properties of the questionnaire were established: construct validity, concurrent criterion validity, predictive capacity and internal consistency. RESULTS: Two dimensions were identified in the construct validity analyses, explaining 63% of the variance: "clinical quality" and "administrative quality". The concurrent validity analysis showed a Spearman's rank correlation coefficient of 0.85 related to the standard criterion "global satisfaction with the attention provided in outpatient clinics" and an OR of 1.19 related to the criterion "do you know the name of the physician who attended you?" The predictive capacity of the questionnaire was measured by discriminated analysis, obtaining 84% of correct classified, and the internal consistency test gave a Cronbach's alpha of 0.90. CONCLUSIONS: Our questionnaire has enough psychometric properties to be considered an useful and feasible tool to measure the satisfaction of patients of the hospital outpatient clinics.