Protocolo de trabajo de la SEMPSPGS para el Proyecto Infección Quirúrgica Zero. Año 2022 / Working group of the Zero Surgical Infection Project. Protocol for the year 2022 (SEMPSPGS)

El Grupo Coordinador del Proyecto Infección Quirúrgica Zero (IQZ) ha revisado y actualizado el Protocolo IQZ para el año 2022,tras dos años de interrupción por la pandemia de la Covid. Se han reformulado los objetivos y se han introducido novedades enlas medidas preventivas principales, como el cambio universal a la antisepsia de la piel con aplicadores de clorhexidina alcohólicaa partir del 30 de Junio, y la introducción de una sexta medida preventiva para 2022, aplicada en fase piloto, de uso restringidoy condicional, y que no contabiliza para el bundle (suturas impregnadas de antiséptico). Del mismo modo, se han propuestodos estrategias transversales para el buen desarrollo del proyecto: una mayor exigencia de la verificación del cumplimiento delas medidas preventivas y la cooperación funcional con otros programas de calidad y seguridad del paciente existentes en loshospitales españoles.(AU)

The Coordinating Group of the Zero Surgical Infection Project (ZSI) has reviewed and updated the ZSI Protocol for the year 2022, aftertwo years of interruption due to the Covid pandemic. The objectives have been reformulated and novelties have been introducedin the main preventive measures, such as the universal change to skin antisepsis with alcoholic chlorhexidine applicators fromJune 30, and the introduction of a sixth preventive measure for 2022, applied in the pilot phase and of restricted and conditionaluse, which does not count towards the bundle (sutures impregnated with antiseptic). In the same way, two transversal strategieshave been proposed for the good development of the project: a greater demand for verification of compliance with preventivemeasures and functional cooperation with other quality and patient safety programs existing in Spanish hospitals.(AU)

Antisepsia de la piel previa a la cirugía y a la inserción de catéteres: preguntas y respuestas. Documento de Consenso de la SEMPSPH / No disponible

Introducción: La antisepsia de la piel (AP) es un punto clave en la prevención de las infecciones de localización quirúrgica (ILQ) y las bacteriemias asociadas a catéteres (BAC). Existen importantes controversias a las que hemos querido responder en éste documento, que está redactado en un formato resumido de preguntas y respuestas. Material y Métodos: Tras una búsqueda bibliográfica, se han utilizado técnicas de grupo de discusión para redactar las preguntas y respuestas. Se examina el papel de la AP en la prevención de ILQ, BAC y contaminación en la toma de hemocultivos, y la posibilidad de que dicha AP tenga ciertos efectos secundarios: toxicidad en procedimientos neuroaxiales y resistencias a los antisépticos. Resultados y conclusión: Se han formulado y contestado 28 preguntas, con sus correspondientes recomendaciones. Se apoya el baño previo antes de las intervenciones quirúrgicas y cateterismos, así como la no eliminación del vello o bien su corte, pero sin utilizar rasuradora. Se recomienda la solución del 2% de clorhexidina en 70% de isopropanol, antes de la incisión quirúrgica y cateterismos, utilizando preferiblemente aplicadores. Se dan también directrices para el uso seguro de la clorhexidina en procedimientos neuroaxiales y para controlar el posible aumento de las resistencias a los antisépticos

Introduction: Skin antisepsis (AP) is a key point in the prevention of surgical site infections (SSI) and catheter-associated bacteremia (CAB). There are important controversies that we have tried to answer in this document, which is written in a summary format of questions and answers. Material and Methods: After a bibliographic search, group discussion techniques were used to write the questions and answers. The role of skin antisepsis in the prevention of SSI and CAB or blood cultures contamination are examined. Moreover we studied two possible secondary effects of this antisepsis: toxicity in neuroaxial procedures and resistance to antiseptics. Results and conclusion: 28 questions have been formulated and answered, with corresponding recommendations. The previous bath before the surgical interventions and catheterisms is supported, as well as the non-elimination of the hair or its cut without using a razor. A solution of 2% chlorhexidine in 70% isopropanol is recommended prior to surgical incision catheterization or blood culture, preferably by using applicators. Guidelines are given for the safe use of alcohol-chlorhexidine in neuroaxial procedures and for controlling the possible increase in resistance to antiseptics

[Epidemic of Serratia marcescens in a tertiary neonatal intensive care unit: multivariate analysis of risk factors in a case-control study]. / Epidemia de Serratia marcescens en una unidad de cuidados intensivos neonatales de un hospital terciario. Estudio multivariante de los factores de riesgo a través de un diseño de casos y controles.

An epidemic of Serratia marcescens was studied in a neonatal intensive care unit in a tertiary hospital by evaluating both infections and colonizations by this microorganism. Over a 14-month period, 26 infants were infected with S. marcescens (bacteriemias or bronchopneumonias). All the S. marcescens isolates studied by PFGE were identical, although their antimicrobial resistance varied. No environmental reservoirs were found. In the concurrent case-control study, the risk factors for infection were stay of more than 1 month, mechanical ventilation and anemia.

[Early-onset post-surgical pneumonia]. / Meta-efecto de la profilaxis quirúrgica. prevención de la neumonía post-quirúrgica precoz.

OBJECTIVE: to ascertain the impact of surgical antimicrobial prophylasis on the prevention of early-onset post-surgical (EOPP), using an analytical cohort study covered 26,826 patients at the La Paz University Teaching Hospital (General Surgery and Speciality Surgery). The multivariate model showed several risk factors of early-onset post-surgical pneumonia as age, emergency admission, type of surgery, duration of intervention, etc., and one protection factor, antimicrobial prophylasis (OR=0.18, General Surgery and OR=0.44, Speciality Surgeries). Then, antimicrobial prophylasis, aside from its known effect on surgical site infection, was associated as with reduction (2-5 times) of incidence of early-onset postsurgical pneumonía.

Surgical site infection of 7301 traumatologic inpatients (divided in two sub-cohorts, study and validation): modifiable determinants and potential benefit.

The widespread use of peri-surgical chemoprophylaxis is decreasing the incidence of surgical site infection in Traumatology, which nevertheless remains as a problem amenable to further reduction. We have tried to identify modifiable determinants of the avoidable incidence of surgical site infection, and to estimate the potential benefit from implementing adequate measures targeting those determinants. In a firts sub-cohort of 5320 traumatologic patients with a post-surgical stay of more than 2 days, in Madrid's La Paz Hospital, between 1991 and 1996. The epidemiological surveillance was prospective during their hospital stay but also includes data on readmissions due to infection so as to analyse the actual incidence of surgical site infection, both before and after discharge. Bivariate and multivariate (multiple logistic regression model) analyses of risk factors for surgical site infections have been performed. In this sub-cohort, 212 patients (3.9%) suffered some type of nosocomial infection. The incidence of surgical site infection before discharge in cases of clean surgery was 1.6%, rising to 2% when cases readmitted for infection after discharge were considered. The multivariate analysis of risk factors for surgical site infection identified the following: contaminated ('dirty') surgery (OR: 10.5), inadequate chemoprophylaxis (OR: 1.5) and a pre-surgical stay of more than 4 days (OR: 1.6). Next, a second sub-cohort, consisting of 1981 patients, treated between 1997 and 1999, was analysed to validate the results of the first multivariate analysis. The validation model (and the global cohort with 7301 patients) corroborates the importance of the same three factors. Last, we calculated that controlling two modifiable factors, pre-surgical stay and peri-surgical chemoprophylaxis, could avoid 56% of surgical site infections.