Impacto de un programa de gestión de riesgo en la tasa de úlceras por presión / Impact of interventions in the pressure ulcer rate

Objetivo. Evaluar el impacto de un programa de gestión de riesgos en la prevención de úlceras por presión (UPP) en una unidad de cuidados intensivos (UCI) de adultos. Pacientes y métodos. Ámbito: UCI de pacientes adultos de un hospital asistencial docente. Diseño: Estudio cuantitativo, prospectivo con evaluación antes y después, en 3 etapas: 1) Estudio de incidencia de las UPP; 2) Intervención mediante la aplicación de un programa de gestión de riesgos, y 3) Evaluación del impacto. Resultados. La adherencia a las medidas preventivas presentó un aumento significativo entre el mes de inicio (11,7%) de la intervención y el mes final (58,5%) de la evaluación. La tasa de las UPP inicial fue de 20,9 y la tasa postintervención de las UPP igual a 14,0×1.000 días/camas ocupadas (p<0,05). Conclusiones. El programa de gestión de riesgos utilizando medidas de prevención resultó efectivo logrando disminuir la tasa de las UPP en más de 33 puntos (AU)

Objective. To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU). Material and methods. A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact. Results. Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program. Conclusions. The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33% (AU)

[Impact of interventions in the pressure ulcer rate]. / Impacto de un programa de gestión de riesgo en la tasa de úlceras por presión.

OBJECTIVE: To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU). MATERIAL AND METHODS: A quantitative, prospective study performed with a «before and after¼ evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact. RESULTS: Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program. CONCLUSIONS: The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%.

Vigilancia epidemiológica de las infecciones intrahospitalarias: revisión / Epidemiologic surveillance of the intrahospital infections: revision

Entre las diferentes actividades asignadas al comité de infecciones intrahospitalarias (IIH), la vigilancia epidemiológica (VE) de las IIH, es la columna vertebral del programa de control de infecciones. Esta actividad permite realizar el diagnóstico epidemiológico de las infecciones nosocomiales, entregando datos que facilitan la planificación, implementación y evaluación de los programas de intervención. Entre los diferentes métodos de VE existentes, se recomienda la utilización de los con metodología activa por su sensibilidad. La presente revisión pretende evaluar las diferentes metodologías de VE, sus objetivos y definiciones de infecciones nosocomiales.

[Is the epidemiological surveillance system of nosocomial infections recommended by the American CDC applicable in a Chilean hospital?]. / Es aplicable el sistema de vigilancia epidemiológica de las infecciones intrahospitalarias que recomienda el CDC-americano (sistema NNIS) en un hospital chileno?

BACKGROUND: The National Nosocomial Infections Surveillance System (NNIS system) is the method for surveying nosocomial infections used by the Centers for Disease Control (CDC). This strategy allows the comparison of different hospitals, using rate adjustments. In Chile, this system is not used. AIM: To report the application of this system in a tertiary reference hospital in Chile. MATERIALS AND METHODS: We performed a six months prospective cohort study. The active surveillance was carried out by using the intensive care unit and surgery components of the NNIS system. Tabulation and analysis of the data were done according to the NNIS system. In a parallel prevalence study, we determined the NNIS system sensitivity to detect nosocomial infections. RESULTS: A total of 492 patients were followed with a global nosocomial infection rate of 14%, for discharged patients. The calculated sensitivity and specificity of the system was 84.2 and 97% respectively. In the intensive care unit, 45 of 169 patients had nosocomial infections, with an adjusted rate of 2.8% for mean hospitalization time and severity of illness. In the cardiovascular and thoracic surgical units, 216 and 107 procedures were surveyed, respectively. The global rates of nosocomial infections were 7.4 and 7.5%, respectively. The adjusted rates according to risk factors were 0.9 and 2.3%, respectively. CONCLUSIONS: These data indicate that the surgical units had surgical site infections rates similar to those reported by the CDC. Nosocomial infections rates in Chile can be compared with rates observed in other countries. The epidemiological data collected can be useful to focus intervention or preventive strategies.

Microbiological characteristics of yeasts isolated from urinary tracts of intensive care unit patients undergoing urinary catheterization.

We studied 70 intensive care unit patients to determine the incidence of nosocomial candiduria associated with indwelling urinary catheters and to assess microbiological characteristics of the yeasts. The yeasts were isolated, 13 of 17 in urine cultures and 4 of 17 in blood cultures, and colonization had occurred 3 days after the insertion of indwelling urinary catheters. For four strains the MICs of the antifungal drugs were high.

Contamination of peritoneal dialysis fluid by filamentous fungi.

Peritonitis is a frequent complication in peritoneal dialysis. It may be caused by contamination of the dialysis tubing or by extension of the catheter exit site. Gram-positive bacteria are the most common organism, accounting for 60% of all documented cases of continuous ambulatorial peritonitis dialysis. Fungi are isolated from to 1-15% of cases. Forty-nine out of 490 bottles containing fluid for peritoneal dialysis were randomly selected for microbiological analysis in São Paulo, Brazil. In this report the contamination of peritoneal dialysis fluid by Chaetomium globosum and Chrysonilia sitophila is reported.