Risk factors for Healthcare-associated Infection on a Rehabilitation Unit / Factores de riesgo de Infección Nosocomial en una Unidad de Rehabilitación

Objective: Ascertain healthcare-associated infection (HAI) prevalenceand identify risk factors associated with a higher incidence of infectionin a Rehabilitation Ward.Materials and Methods: Two-year retrospective cohort study conducted in a post-acute Rehabilitation Ward of a tertiary-care, public,university-affiliated hospital. Demographic and clinical data were collected from electronic medical record. The assessment of risk factorswas done by comparison of patients with or without HAI. Univariateand multivariate logistic regression analysis was used to identify riskfactors.Results: There were 262 admissions to the Rehabilitation Ward during the study period. One-hundred thirty-one HAIs were detected in95 (36.3%) of the 262 patients. The most common infections wereurinary tract infections (87.8% of all infections). An age-sex adjustedmultivariate logistic regression model showed that urinary catheter,surgery in the last 30 days and length of stay ≥ 30 days were independent risk factors for HAI. Length of stay was associated with anincreased odd of developing HAI (median length of 28 days for thosewithout HAI, 35 days for those with only one HAI and 55 days for patients having ≥ 2 HAI). Only one patient died of infection.Conclusions: HAI is a frequent complication in a post-acute Rehabilitation Ward. The logistic regression model identified patients withurinary catheter, surgery in the last 30 days and length of stay ≥ 30days as having an higher risk for HAI, thereby being the main targetsof surveillance and adoption of preventive measures. (AU)

Objetivo: Determinar la prevalencia y los factores de riesgo de infección nosocomial en pacientes ingresados en una Unidad de Rehabilitación.Material y Métodos: Estudio de cohorte retrospectivo de dos añosrealizado en una Unidad de Rehabilitación posaguda de un hospitalpúblico. La evaluación de los factores de riesgo se realizó mediante lacomparación de pacientes con o sin infección nosocomial. Se utilizóun análisis de regresión logística univariado y multivariado para identificar los factores de riesgo.Resultados: Hubo 262 ingresos a la Unidad de Rehabilitación duranteel período de estudio. Se detectaron 131 infecciones nosocomialesen 95 (36,3%) de los 262 pacientes. Las infecciones más frecuentes fueron las del tracto urinario (87,8%). Un modelo de regresiónlogística multivariado ajustado por edad y sexo mostró que el catéterurinario, la cirugía en los últimos 30 días y la duración de la estancia≥ 30 días fueron factores de riesgo independientes para infecciónnosocomial. La duración de la estancia se asoció con una mayor probabilidad de desarrollar una infección nosocomial (duración media de28 días para aquellos sin infecciones, 35 días para aquellos con solouna infección y 55 días para pacientes con ≥ 2 infecciones). Solo unpaciente murió de infección.Conclusiones: La infección nosocomial es una complicación frecuente en una Unidad de Rehabilitación. El modelo de regresión logísticaidentificó a los pacientes con catéter urinario, cirugía en los últimos30 días y estadía ≥ 30 días con mayor riesgo de infección, por lo queson los principales objetivos de la vigilancia y adopción de medidaspreventivas. (AU)

Botulinum toxin improves pain in chronic anal fissure.

HIGHLIGHTS: Chronic anal fissure is a common condition associated with intense pain.Local botulinum toxin injection is a valid option in its management.Pain intensity scores significantly improved after BoNT injection.Side effects were rare and mild.Our results support the inclusion of BoNT in the management algorithm of chronic anal fissure. INTRODUCTION: Chronic anal fissure is a common condition associated with intense pain. Local botulinum toxin injection is a valid option in its management. The purpose of this study was to evaluate the efficacy of botulinum toxin on pain relief in chronic anal fissure patients. METHODS: We conducted a retrospective cohort study, involving 81 consecutive patients referred to a chronic pain management unit due to a chronic anal fissure for treatment with botulinum toxin, during a 4 year period. Data were collected from hospital records regarding pre-treatment and post-treatment pain (numeric rating scale), side effects, need for botulinum toxin reinjection and need for surgical treatment. We used standard statistical methods for inter (t-test and qui2) and intra-group (paired sample t-test) comparisons, according to variables distribution. RESULTS: Pain intensity rest score significantly improved after BoNT injection [variation: -4.2 ± 2.9 (p < 0.001)], as did pain post-defecation score [variation: -5.1 ± 3.0 (p < 0.001)]. 8.6% needed botulinum toxin reinjection and 23.5% were submitted to surgery. Side effects were reported in 8.6%. DISCUSSION: The efficacy of botulinum toxin use on pain reduction along with its non-permanent and minor side effects support its role in the resolution of chronic anal fissure. However, treatment failure in the long term is still significant. CONCLUSION: Botulinum toxin is effective on pain relief in patients with chronic anal fissure, which supports its inclusion in the management algorithm of this condition.