[Intervention to improve hand hygiene compliance in Catalonia, Spain]. / Estrategia para mejorar la práctica de higiene de manos en Catalunya.

Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated.

Estrategia para mejorar la práctica de higiene de manos en Catalunya / Intervention to improve hand hygiene compliance in Catalonia, Spain

La higiene de manos (HM) es la medida individual más importante y efectiva para reducir el riesgo de infecciones relacionadas con la atención sanitaria. Sin embargo, es habitual encontrar resultados de cumplimiento de las indicaciones de HM bajos entre los profesionales sanitarios. El principal objetivo de esta estrategia fue dar un nuevo impulso a la promoción de la HM en los hospitales y concienciar a los profesionales sobre la importancia de esta acción. La estrategia se planteó como un estudio de intervención multicéntrico para promover la HM en los centros sanitarios de Catalunya en el período 2009-2010. La intervención se basó en 4 grandes ejes: encuesta de barreras y facilitadores, difusión de material gráfico, formación a diferentes niveles y evaluación con indicadores. Con esta estrategia se alcanzó el 57% del número de camas de agudos de la red pública concertada y privada de la comunidad. La encuesta reveló que la formación era percibida como el principal aspecto facilitador de la práctica de HM. En el curso de formación online se registraron 15.376 profesionales. El cumplimiento global de las indicaciones de HM (basada en los "cinco momentos para la HM") fue del 56,45% en el área de agudos. Las acciones de promoción de HM llevadas a cabo en los últimos 4 años han ido aumentando el número de centros adheridos a esta estrategia de la Alianza para la Seguridad del Paciente en Catalunya. La formación online fue una de las intervenciones más bien valoradas por los profesionales para promover el conocimiento y cumplimiento de las indicaciones de HM. El indicador de cumplimiento de las indicaciones de HM parece seguir aumentando en los hospitales de Catalunya evaluados (AU)

Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated (AU)

Seroepidemiology of hepatitis B virus infection in pregnant women in Catalonia (Spain).

BACKGROUND: In recent years there has been a substantial reduction in hepatitis B incidence as a result of routine vaccination of preadolescents and the selective vaccination of high risk groups and newborns of HBsAg+ mothers. OBJECTIVES: To determine the prevalence of hepatitis B virus infection markers and of serologic markers of hepatitis B vaccination in a representative sample of pregnant women in Catalonia. STUDY DESIGN: A representative sample was obtained by random cluster sampling (hospitals with maternity units) stratified by provinces. Anti-HBc, anti-HBs and HBsAg were determined using an ELISA test (Behring, Marburg, Germany). The crude and adjusted odds ratios for the sociodemographic variables analyzed were also calculated. RESULTS: The global prevalence of carriers of HBsAg+ was 0.1% (95% CI 0.0-0.3), that of hepatitis B infection (anti-HBc+) was 5% (95% CI 3.9-6.1) and that of serologic markers of vaccination (anti-HBs+ and anti-HBc-) was 16.4% (95% CI 14.5-18.2) The prevalence of infection increased with age from 3.0% (15-19 years age group) to 14.8% (40-44 years age group). The prevalence of anti-HBc+ was higher in women born in Asia (27.6%) and Africa (18.8%) than in those born in Spain (3.7%), Europe (3.3%) and America (4.6%), with the differences being statistically significant. CONCLUSIONS: The results of this study confirm the change in the pattern of endemicity of hepatitis B infection in pregnant women in Catalonia after the introduction of vaccination programmes. They also confirm the increasingly important role played by immigration in the epidemiology of hepatitis B.

Declining hepatitis A seroprevalence in adults in Catalonia (Spain): a population-based study.

BACKGROUND: One of the main uses of seroprevalence studies it to evaluate vaccination programmes. In 1998, a programme of universal vaccination of preadolescents in schools with the hepatitis A vaccine was begun in Catalonia. The objective of this study was to investigate the prevalence and risk factors of hepatitis A virus infection (HAV) in a sample of the adult population of Catalonia in 2002 and to evaluate the changes with respect to a survey carried out in 1996. METHODS: The prevalence of HAV antibodies was determined by a third generation competitive immunometric assay in a representative sample of 1292 people aged >15 years. The association between the prevalence and different sociodemographic variables was determined by multiple logistic regression analysis. RESULTS: The standardized global prevalence of HAV antibodies in 2002 was 68.2%, increased with age (p < 0.0001) and was associated with being born outside Catalonia (OR: 1.75; 95% CI 1.11-2.76) and lower social class (OR: 1.14; 95% CI 1.05-1.25). Compared with the last survey carried out in 1996 the standardized global prevalence was lower (68.2% vs 77.8%; p < 0.0001) as was the prevalence in people under 45 years. CONCLUSION: The prevalence of the hepatitis A virus is decreasing in the adult population of Catalonia, especially in the younger age groups. The programme of vaccination of adolescents begun in 1998 to control the disease can provide indirect protection to the unvaccinated population.

Rubella immune status of indigenous and immigrant pregnant women in Catalonia, Spain.

BACKGROUND: The objective of the study was to determine the prevalence of rubella antibodies in representative samples of pregnant women in Catalonia. METHODS: A representative sample of pregnant women in Catalonia was obtained by random sampling by clusters (hospitals with maternity units) stratified by provinces. Blood was obtained from the umbilical cord at childbirth in 1538 women (of whom 308 were immigrants) and was tested for rubella antibodies by ELISA (Enzime-linked immunosorbent assay). RESULTS: The global prevalence of antibodies was 93.4% [95% confidence interval (CI): 93.3-93.5] and was significantly higher in indigenous women (94.9;95%CI:93.3-95.9) compared with immigrants [89.0; 95%CI: 85.5-92.5 (P<0. 0001)] with crude Odds ratio (OR) of 2.15 (95%CI: 1.40-3.32).The prevalence was higher in women living in rural habitats (97%) and those in higher social classes (96.3%); OR 2.54 (95%CI: 1.22-5.30) and 2.17 (95%CI: 1.24-3.81), respectively. CONCLUSION: Fertile female immigrants from countries with no vaccination or where vaccination coverage is low should be actively approached for vaccination to reduce the risk of infection and congenital rubella.

Community-based seroepidemiological survey of hepatitis E virus infection in Catalonia, Spain.

The objective of the study was to investigate the prevalence of immunoglobulin G (IgG) antibodies to hepatitis E virus (HEV) infection in a population sample from Catalonia and to analyze the demographic and clinical variables associated with the presence of these antibodies. A total of 1,280 subjects between 15 and 74 years of age were selected randomly from urban and rural areas. Data for sociodemographic and clinical variables were collected by using a questionnaire. IgG antibodies to HEV were determined by an immunoenzymatic method. The odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for studied variables. Multiple logistic regression analysis was used to determine which variables were independently associated with the prevalence of HEV infection. Anti-HEV antibodies were detected in 96 (7.3%) of the 1,280 samples analyzed. The prevalence of antibodies was greater among males (7.8%) than among women (7%) and increased with age for both sexes, from 3% among subjects 15 to 24 years of age to 12% among subjects >/=65 years of age. Bivariate analysis of the sociodemographic and clinical variables showed an association between the prevalence of hepatitis E virus infection and minor surgery (OR, 1.96; 95% CI, 1.24 to 3.11), abdominal surgery (OR, 1.74; 95% CI, 1.12 to 2.73), and, for women, being uniparous or multiparous (OR, 2.84; 95% CI, 1.19 to 6.79). The multivariate analysis showed an association with minor surgery only (OR, 1.68; 95% CI, 1.03 to 2.70). In conclusion, anti-HEV antibodies were detected in 7.3% of the Catalan population. The seroprevalence of anti-HEV antibodies increased with age and was associated with previous minor surgery.