Conocer el grado de concordancia de dos métodos para detectar la colonización bacteriana de las manos del personal sanitario / No disponible

Hemos comparado los métodos "impronta de dedos" y "frotis de palma" para detectar colonización de manos por flora bacteriana. Se realizó un análisis de regresión logística para verificar la relación de los resultados del cultivo de ambos métodos de muestreo con variables explicativas probadas asociadas con la colonización bacteriana de las manos. Tras demostrar que ambos métodos no son concordantes respecto a la detección de flora colonizadora de las manos (S. epidermidis), se realizó análisis de dependencia de ambos métodos respecto a bacterias formalmente colonizadoras de manos y fosas nasales (S. aureus). Los resultados del cultivo de frotis de palma están asociados con variables explicativas probadas relacionadas con la colonización de manos como son la "ejecución del lavado higiénico de manos" y "tiempo transcurrido desde último lavado de manos" y, además, existe relación con la colonización nasal por Staphylococcus aureus. Estos resultados no se encontraron con los resultados del cultivo de impronta de dedos, por lo que el método frotis de palma evidencia más especificidad para detectar flora colonizadora en las manos

We have compared two sampling methods to isolate bacterial flora on hands, "finger imprint" and "palm smear", in order to detect colonizing bacterial flora. We carried out a logistic regression analysis of culture results from the two sampling methods with proven explanatory variables related to colonization on hand. After the evidence that both methods were not concordant in respect with the detection of hand colonizing flora (S.epidermidis), dependence analysis was carried out between both sampling methods in relation with formal colonizing bacterial flora on hands and nostril smear (S. aureus). Culture results from palm smear are associated with proven explanatory variables related to colonization on hand as 'time elapsed since last hand-washing' and 'performance of hygienic hand washing' and, in parallel, are related to Staphylococcus aureus nostril colonization. These results were not found with culture results from finger imprint. So, culture results from palm smear appear to have more specificity to detect hand colonizing bacterial flora

[Use of non-invasive ventilation in acute respiratory failure. Multicenter study in intensive care units]. / Utilización de la ventilación no invasiva en la insuficiencia respiratoria aguda. Estudio multicéntrico en unidades de cuidados intensivos.

OBJECTIVES: Study the use of non-invasive ventilation (NIV) in patients with acute respiratory failure in intensive care units (ICUs) in Spain. METHODS: A questionnaire was sent to 254 ICUs, after which, they were invited to participate in a multicenter, retrospective study, providing detailed information on ventilated patients. RESULTS: Answers were received from 123 hospitals. Of these, 119 used NIV, although its use varied greatly. NIV is the treatment of choice in 89% of the units for chronic obstructive pulmonary disease (COPD), in 79% for acute pulmonary edema (APE), in 53% for postextubation failure, in 53% for pneumonia 53%, and in 17% for acute respiratory distress syndrome (ARDS). It was used occasionally in COPD in 11% of the units, and in 21% of the units for APE. Eighteen hospitals provided additional information on 432 ventilated patients, 232 (54%) of whom received NIV as first line therapy. Presence of pneumonia or acute respiratory distress syndrome (ARDS) was an independent predictive factor of NIV failure (ORa=5.71; CI 95%, 1.83-17.8; p=0.003). Admission in a unit with experience in NIV in >50 patients/year (ORa=0.22; CI 95%, 0.07-0.63; p=0.005) and a higher PaO2/FiO2 ratio after one hour of ventilation (ORa=0.98 per point; CI 95%, 0.97-0.99; p<0.001) were protector factors. CONCLUSIONS: In Spain, NIV is widely used but it may continue to be underused in COPD and APE. The diagnosis of pneumonia or ARDS was an independent predictive risk factor. Admission in an ICU with NIV in more than 50 patients/year also have higher PaO2/FiO2 ratio after one hour of ventilation were predictive factors of success.