Decontamination of filtering facepiece respirators using a low-temperature-steam-2%-formaldehyde sterilization process during a pandemic: a safe alternative for re-use.

BACKGROUND: The coronavirus disease 2019 pandemic has caused problems with respirator supplies. Re-use may minimize the impact of the shortage, but requires the availability of an efficient and safe decontamination method. AIM: To determine whether low-temperature-steam-2%-formaldehyde (LTSF) sterilization is effective, preserves the properties of filtering facepiece (FFP) respirators and allows safe re-use. METHODS: Fourteen unused FFP2, FFP3 and N95 respirator models were subjected to two cycles of decontamination cycles. After the second cycle, each model was inspected visually and accumulated residual formaldehyde levels were analysed according to EN 14180. After one and two decontamination cycles, the fit factor (FF) of each model was tested, and penetration tests with sodium chloride aerosols were performed on five models. FINDINGS: Decontamination physically altered three of the 14 models. All of the residual formaldehyde values were below the permissible threshold. Irregular decreases and increases in FF were observed after each decontamination cycle. In the sodium chloride aerosol penetration test, three models obtained equivalent or superior results to those of the FFP classification with which they were marketed, both at baseline and after one and two cycles of decontamination, and two models had lower filtering capacity. CONCLUSION: One and two decontamination cycles using LTSF did not alter the structure of most (11/14) respirators tested, and did not degrade the fit or filtration capacity of any of the analysed respirators. The residual formaldehyde levels complied with EN 14180. This reprocessing method could be used in times of shortage of personal protective equipment.

El coste de la infección en artroplastia de cadera: estudio de casos y controles emparejado / The cost of infection in hip arthroplasty: a matched case-control study

Objetivo. La infección de localización quirúrgica (ILQ) representa el 30% de todas las causas de infecciones relacionadas con la atención sanitaria (IRAS), siendo una de las complicaciones más temidas en pacientes quirúrgicos. Se estimó el exceso de costes directos de la ILQ mediante un estudio de casos y controles emparejado y anidado en una cohorte, en un hospital de agudos en España (Hospital Universitario Ramón y Cajal). Material y método. Los casos fueron pacientes que desarrollaron un primer episodio de ILQ según los criterios establecidos por el National Healthcare Safety Network de los CDC. Los controles fueron emparejados a los casos en una razón de 1:1, teniendo en cuenta la clasificación de la American Society of Anesthesiologists, la edad, el sexo, la fecha de la cirugía y el diagnóstico principal. Resultados. Este estudio encontró que la infección en reemplazo de cadera incrementó los costes directos en un 134%. Asimismo, el exceso de costes debido a la infección causada por Staphylococcus aureus resistente a la meticilina fue 69% mayor que el exceso de costes debido a las infecciones causadas por otros microorganismos. onclusiones. La ILQ después de reemplazo de cadera sigue siendo una complicación costosa desde la perspectiva del hospital. Los costes debidos a la ILQ pueden ser utilizados para priorizar intervenciones preventivas de vigilancia y control de las infecciones relacionadas con la atención sanitaria (AU)

Objective. Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. Material and method. Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. Results. This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. Conclusions. SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI (AU)

The cost of infection in hip arthroplasty: a matched case-control study. / El coste de la infección en artroplastia de cadera: estudio de casos y controles emparejado.

OBJECTIVE: Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. MATERIAL AND METHOD: Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. RESULTS: This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. CONCLUSIONS: SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI.

Emergence and outbreak of carbapenemase-producing KPC-3 Klebsiella pneumoniae in Spain, September 2009 to February 2010: control measures.

This report describes the epidemiological features of the first outbreak caused by KPC3 carbapenemase-producing Klebsiella pneumoniae (KPC-3-KP) in Spain and how it was effectively controlled. From 16 September 2009 to the end of February 2010, seven patients infected or colonised with KPC-3-KP were detected. Stool surveillance cultures were recovered from patients, doctors, nurses, nursing assistants, cleaners and hospital porters working in the affected units. Hand swabs were taken from workers and patients' relatives for culturing. Environmental samples were also taken. Patients infected or colonised with KPC-3-KP were placed in single rooms under contact precautions and 4% chlorhexidine soap was used for their daily hygiene. Staff attended educational seminars and workshops on hand hygiene and isolation of patients. An alcohol-based disinfectant was used for surface cleaning and disinfecting. The floor was cleaned with a disinfectant containing benzalkonium chloride and didecyldimethylammonium. All samples collected were negative for KPC-3-KP. After implementing the control measures, no further cases were reported in the affected units. All cases had comorbidities, long hospital stay and aggressive/intensive antimicrobial treatment. This study emphasises the importance of early intensification of infection control to interrupt the transmission of KPC-producing organisms.

Factores asociados a ingreso en unidad de cuidados intensivos enpacientes hospitalizados por Influenza pandémica A/H1N1 2009 / Factors associated to admission to Intensive Care in patients hospitalized due to pandemic Influenza A/H1N1 2009

Objetivo: Determinar los factores de riesgo para ingreso en la unidad de cuidados intensivos (UCI) en pacientes con infección por virus pandémico (H1N1) 2009.Dise˜no: Estudio de cohorte retrospectivo en pacientes ingresados por Influenza A/H1N1 2009durante el periodo pandémico. Ámbito: Hospital Universitario Ramón y Cajal. Pacientes: Todos los pacientes ingresados con reacción en cadena de la polimerasa en transcripción inversa (RT-PCR) positiva para virus de Influenza A/H1N1 2009.Variables de interés: Historia de factores de riesgo para Influenza grave, vacunación para Influenza estacional 2008-2009, síntomas y signos clínicos, pruebas de laboratorio, hallazgos en la radiografía de tórax, tiempo en la administración de antiviral y estancia hospitalaria. Resultados: La mediana de edad de 100 casos fue 38 años (mínimo: 4 meses, máximo: 80 años).El 77% tuvo al menos un factor de riesgo, siendo el asma la comorbilidad más frecuente en los menores de 18 años y el hábito tabáquico en los mayores. La mediana de tiempo entre el comienzo de los síntomas y el inicio de antiviral fue 3 días (mínimo: 0 días, máximo: 18 días).El 19% de los pacientes fueron ingresados en UCI y el 2% fallecieron por gripe. En el análisis multivariable, enfermedad metabólica y presencia de infiltrados en la radiografía de tórax se asociaron de forma significativa a ingreso en la UCI. Conclusión: Una radiografía de tórax anormal en el momento del ingreso, junto con la presencia de ciertas comorbilidades, especialmente enfermedades metabólicas, sugieren la posibilidad de peor pronóstico de gripe pandémica (H1N1) 2009 (AU)

Objective: The present study explores the possible factors related to severe cases of pandemic flu. Design: A retrospective cohort study was conducted in patients hospitalized with Influenza A/H1N1 2009 during the pandemic period. Setting: Ramon y Cajal University Hospital (Madrid, Spain).Patients: All hospitalized patients with positive RT-PCR (real-time polymerase chain reaction)for Influenza A/H1N1 2009 virus. Main variables: The main variables collected were: history of risk factors for severe Influenza, history of immunization, clinical presentation, laboratory tests, chest X-ray report, administration of antiviral treatment, and hospital stay. Results: The median age of the 100 cases was 38 years (range 4 months to 80 years). Seventy seven percent of the patients had at least one risk factor. Asthma was the most common factor among patients younger than 18 years, versus smoking in the older subjects. Antiviral therapy was initiated a median time of three days (range 0 to 18 days) after the onset of illness. Nineteen percent of the patients were admitted to Intensive Care, and 2% died. Metabolic disease and abnormal chest X-ray findings were factors associated to admission to the ICU. Conclusion: As in other studies, abnormal chest X-ray findings upon admission and metabolic disease were related to poor outcomes of 2009 pandemic Influenza A (H1N1) infection in our patients (AU)

Incidencia y factores asociados a la infección de localización quirúrgica tras artroplastia de cadera / Incidence and associated factors of surgical site infections after hip arthroplasty

Introducción. La infección de localización quirúrgica (ILQ) posterior a artroplastia de cadera es la complicación más temida causando hospitalización prolongada, incremento de morbilidad, mortalidad y altos costes. La identificación de los factores implicados en su aparición puede orientar intervenciones para la reducción del riesgo de infección. Material y métodos. Los datos de ILQ y sus factores de riesgo fueron prospectivamente recolectados por el sistema de vigilancia de infección asociada a la atención sanitaria INCLIMECC (Indicadores Clínicos de Mejora Continua de la Calidad), a partir de 3.067 procedimientos de artroplastia de cadera realizados en el Hospital Universitario Ramón y Cajal entre octubre de 1999 y diciembre de 2009. Análisis de regresión logística binaria multivariable con el software SPPS versión 15.0 para Windows fue utilizado para la construcción de un modelo predictivo de ILQ. Resultados. La incidencia global de ILQ fue de 2,71 casos por cada 100 intervenciones. En el análisis univariable, la mayoría de los factores analizados estuvieron asociados al riesgo de infección articular. El análisis de regresión logística multivariable sólo identificó tres factores independientemente asociados a ILQ: edad, estancia preoperatoria e índice NHSN (p<0,05). Conclusiones. Aunque el índice NHSN y la estancia preoperatoria son potenciales marcadores de la presencia de otros factores para ILQ como diabetes mellitus, obesidad, neoplasia y artritis reumatoide, el análisis de éstos por separado podría aumentar el poder predictivo del modelo multivariable (AU)

Introduction. Prosthetic joint infection after hip arthroplasty is the most feared complication and is responsible for prolonged hospitalisation and an increased risk of morbidity and mortality. To identify the factors involved in its onset may lead to interventions to reduce the risk of infection. Material and methods. We prospectively reviewed data collected from the health care infection surveillance system (INCLIMECC) on 3067 hip arthroplasties undertaken in the Ramon y Cajal University Hospital between October 1999 and December 2009. Multivariate analysis was performed using logistic binary regression to create mathematical models to predict joint infection after hip arthroplasty. Results. The overall incidence of joint infection after hip arthroplasty was 2.71%. Unadjusted univariate analysis showed multiple variables associated with joint infection. After multivariable logistic regression analysis, we found the following independent predictors: age, days of hospitalisation prior to the intervention and risk index of the National Healthcare Safety Network (NHSN) (p<.05). Conclusions. NHSN risk index and the days of hospitalisation prior to the intervention are associated to other risk factor of joint infection after hip arthroplasty, such as Diabetes Mellitus, obesity and rheumatoid arthritis. Nevertheless is important to analyse these factors separately to increase the predictive power of the multivariate model (AU)

[Factors associated to admission to Intensive Care in patients hospitalized due to pandemic Influenza A/H1N1 2009]. / Factores asociados a ingreso en unidad de cuidados intensivos en pacientes hospitalizados por Influenza pandémica A/H1N1 2009.

OBJECTIVE: The present study explores the possible factors related to severe cases of pandemic flu. DESIGN: A retrospective cohort study was conducted in patients hospitalized with Influenza A/H1N1 2009 during the pandemic period. SETTING: Ramon y Cajal University Hospital (Madrid, Spain). PATIENTS: All hospitalized patients with positive RT-PCR (real-time polymerase chain reaction) for Influenza A/H1N1 2009 virus. MAIN VARIABLES: The main variables collected were: history of risk factors for severe Influenza, history of immunization, clinical presentation, laboratory tests, chest X-ray report, administration of antiviral treatment, and hospital stay. RESULTS: The median age of the 100 cases was 38 years (range 4 months to 80 years). Seventy-seven percent of the patients had at least one risk factor. Asthma was the most common factor among patients younger than 18 years, versus smoking in the older subjects. Antiviral therapy was initiated a median time of three days (range 0 to 18 days) after the onset of illness. Nineteen percent of the patients were admitted to Intensive Care, and 2% died. Metabolic disease and abnormal chest X-ray findings were factors associated to admission to the ICU. CONCLUSION: As in other studies, abnormal chest X-ray findings upon admission and metabolic disease were related to poor outcomes of 2009 pandemic Influenza A (H1N1) infection in our patients.