Precauciones de aislamiento en un hospital pediátrico de tercer nivel / Isolation precautions in a tertiary paediatric hospital

Introducción: Una de las medidas de control para prevenir la transmisión de infecciones en el hospital es la aplicación de precauciones de aislamiento. En las áreas pediátricas, debido al tipo de pacientes e infecciones, así como a las características arquitectónicas de las unidades de hospitalización, es difícil una aplicación y seguimiento estrictos de las mismas. Material y métodos: Estudio observacional descriptivo de las precauciones de aislamiento aplicadas en el área pediátrica del Hospital Universitario Vall d’Hebron de Barcelona, de enero a diciembre de 2007. Las precauciones de aislamiento utilizadas son las de los Centers for Disease Control and Prevention de los EE. UU. y las del Departament de Salut de la Generalitat de Catalunya. Resultados: Un 5,4% de los pacientes ingresados precisaron medidas de aislamiento. La unidad de pediatría general es la que generó un mayor número de aislamientos (10,7%). Los microorganismos aislados con mayor frecuencia fueron el virus respiratorio sincitial y el rotavirus, y la precaución de aislamiento más aplicada, la de contacto (90% de los aislamientos). La unidad de cuidados intensivos neonatal y el servicio de oncología y hematología son las áreas donde se requirieron un mayor número de aislamientos en pacientes con infección o colonización por bacterias multirresistentes (el 48 y el 67% del total de aislamientos, respectivamente). Conclusiones: El establecimiento de un programa de vigilancia y control de la transmisión de las infecciones es necesario para reducir la tasa de infecciones nosocomiales. Conocer la frecuencia de aislamientos en cada centro y la disponibilidad de recursos para su correcta aplicación, es fundamental para conseguir este objetivo (AU)

Introduction: Isolation is one of the measures to prevent the spread of nosocomial infections. However, in children’s hospitals, given the type of patients and infections, and the architectural features of hospital wards, isolation precautions are sometimes difficult to implement and enforce. Material and methods: An observational, descriptive study was conducted on the isolation precautions taken at the Children’s Hospital Vall d’Hebron in Barcelona, from January to December,2007. The isolation precautions applied were those of the Centers for Disease Control and Prevention from the USA, and those of the Department of Health of the Generalitat de Cataluña. Results: Of the patients admitted during the study period, 5.4% needed isolation. The General Paediatrics ward generated the highest number of isolations (10.7%). The most frequently microorganisms needing isolation precautions were respiratory syncytial virus and rotavirus. Contact precautions was the type of isolation most applied (90% of isolations). The Neonatal Intensive Care Unit and the Paediatric Oncology and Haematology Service were the areas with a greater number of patients isolated due to infection or colonization by multiresistant bacteria (48% and 67% of the isolations, respectively). Conclusions: The implementation of a surveillance and infection control program is essential to reduce the rate of hospital-acquired infections. Knowledge of the frequency of isolated patients at each centre and the availability of resources for the correct application of isolation precautions are fundamental for these goals to be achieved (AU)

[Isolation precautions in a tertiary paediatric hospital]. / Precauciones de aislamiento en un hospital pediátrico de tercer nivel.

INTRODUCTION: Isolation is one of the measures to prevent the spread of nosocomial infections. However, in children's hospitals, given the type of patients and infections, and the architectural features of hospital wards, isolation precautions are sometimes difficult to implement and enforce. MATERIAL AND METHODS: An observational, descriptive study was conducted on the isolation precautions taken at the Children's Hospital Vall d'Hebron in Barcelona, from January to December, 2007. The isolation precautions applied were those of the Centers for Disease Control and Prevention from the USA, and those of the Department of Health of the Generalitat de Cataluña. RESULTS: Of the patients admitted during the study period, 5.4% needed isolation. The General Paediatrics ward generated the highest number of isolations (10.7%). The most frequently microorganisms needing isolation precautions were respiratory syncytial virus and rotavirus. Contact precautions was the type of isolation most applied (90% of isolations). The Neonatal Intensive Care Unit and the Paediatric Oncology and Haematology Service were the areas with a greater number of patients isolated due to infection or colonization by multiresistant bacteria (48% and 67% of the isolations, respectively). CONCLUSIONS: The implementation of a surveillance and infection control program is essential to reduce the rate of hospital-acquired infections. Knowledge of the frequency of isolated patients at each centre and the availability of resources for the correct application of isolation precautions are fundamental for these goals to be achieved.

Nosocomial infections in Spain: results of five nationwide serial prevalence surveys (EPINE Project, 1990 to 1994). Nosocomial Infections Prevalence Study in Spain.

OBJECTIVE: To determine trends in rates of nosocomial infections in Spanish hospitals. DESIGN: Prospective prevalence studies, performed yearly from 1990 through 1994. SETTING: A convenience sample of acute-care Spanish hospitals. PARTICIPANTS AND PATIENTS: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately. RESULTS: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P = .0001). Patients admitted to intensive-care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis. CONCLUSIONS: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicated that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

[Prevalence of the use of urinary drainage systems in Spanish hospitals]. / Prevalencia de uso de los sistemas de drenaje urinario en los hospitales españoles. Grupo de Trabajo EPINE.

BACKGROUND: Urinary catheterization constitutes the main risk factor in urinary infections or nosocomial origin. The use of closed urinary drainage systems is fundamental to decrease this risk. The prevalence of the use of a urethral catheter as well as the proportion of closed type drainage systems in the Spanish medium was studied with the aim of improving the degree of the adoption of control measures for this type of infections. METHODS: The prevalence of patients submitted to urinary catheterization (distinguishing between open and closed systems) in an important sample of Spanish hospitals was determined from the data provided by the EPINE project (1990-1993). The evolution over 4 years in addition to distribution by hospitalization areas were studied. Likewise, the results corresponding to an intervention program carried out in the authors' hospital are presented. RESULTS: The global prevalence of urinary catheterization ranges from 13.1% to 14.6%. The proportion of closed systems did not surpass 56.4% of the total with this system being completely implemented only in one fourth of the hospitals studied. A significant variation was not observed in this phenomenon during the study period. In the authors' hospital, the increase observed in the prevalence of closed urinary catheterization was associated to a marked decrease in the prevalence of urinary infection with values ranging from 4.3% to 0.8%. CONCLUSIONS: The prevalence of the use of open type urinary catheterization in Spanish hospitals remains high. The efficacy of the implementation of control measures of the urinary drainage systems is clearly proved.