Programa de Reducción de la Infección Quirúrgica del Observatorio de Infección en Cirugía (PRIQ-O). Documento de priorización y consenso Delphi de recomendaciones para la prevención de la infección de localización quirúrgica / Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection

La infección de localización quirúrgica es la complicación más frecuente y más evitable de la cirugía, pero las guías clínicas para su prevención tienen un seguimiento insuficiente. Presentamos los resultados de un consenso Delphi realizado por un panel de expertos de 17 sociedades científicas con revisión crítica de la evidencia científica y guías internacionales, para seleccionar las medidas con mayor grado de evidencia y facilitar su implementación. Se revisaron 40 medidas y se emitieron 53 recomendaciones. Se priorizan 10 medidas principales para su inclusión en bundles de prevención: ducha preoperatoria; correcta higiene quirúrgica de manos; no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica; profilaxis antibiótica sistémica adecuada; uso de abordajes mínimamente invasivos; descontaminación de la piel con soluciones alcohólicas; mantenimiento de la normotermia; protectores-retractores plásticos de herida; cambio de guantes intraoperatorio, y cambio de material quirúrgico y auxiliar antes del cierre de las heridas. (AU)

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure. (AU)

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection.

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Antibiotic prophylaxis for hernia repair.

BACKGROUND: The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES: The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH METHODS: We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline using the following terms: #1 antibiotic* OR antimicrob* OR anti infecti* OR antiinfecti*; #2 prophyla* OR prevent*; #3 #1 AND #2; #4 clean AND (surgery OR tech* OR proced*); #5 herni*; #6 (wound infection) AND #4; #7 #3 AND (#4 or #5 or #6). National Research Register, ISI-Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled-trials.com and clinicaltrials.gov) were checked to identify further studies. SELECTION CRITERIA: Only randomised clinical trials were included. DATA COLLECTION AND ANALYSIS: In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta-analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis. MAIN RESULTS: The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 - 0.82). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 - 0.81). AUTHORS' CONCLUSIONS: Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.

Utility of a thematic network in primary health care: a controlled interventional study in a rural area.

BACKGROUND: UniNet is an Internet-based thematic network for a virtual community of users (VCU). It supports a virtual multidisciplinary community for physicians, focused on the improvement of clinical practice. This is a study of the effects of a thematic network such as UniNet on primary care medicine in a rural area, specifically as a platform of communication between specialists at the hospital and doctors in the rural area. METHODS: In order to study the effects of a thematic network such as UniNet on primary care medicine in a rural area, we designed an interventional study that included a control group. The measurements included the number of patient displacements due to disease, number of patient hospital stays and the number of prescriptions of drugs of low therapeutic utility and generic drug prescriptions by doctors. These data were analysed and compared with those of the control center. RESULTS: Our study showed positive changes in medical practice, reflected in the improvement of the evaluated parameters in the rural health area where the interventional study was carried out, compared with the control area. We discuss the strengths and weaknesses of UniNet as a potential medium to improve the quality of medical care in rural areas. CONCLUSION: The rural doctors had an effective, useful, user-friendly and cheap source of medical information that may have contributed to the improvement observed in the medical quality indices.

[Tularemia: study of 27 patients]. / Tularemia: análisis de 27 casos.

BACKGROUND: There has been an important tularemia outbreak recently in Spain, which has prompted a high epidemiological interest. Our objective was to describe the series of tularemia cases with emphasis being paid on clinical characteristics and evolution of the disease. PATIENTS AND METHOD: We describe 27 cases of tularemia studied clinically and epidemiologically (survey of the Health Territorial Service at Burgos). Two cases were seen in December 2000 as isolated forms, while the rest of cases accumulated in form of outbreak between September 1997 and the first months of 1998. We performed a follow-up of patients including a questionnaire (via phone) to assess relapses or disease's consequences and complications. RESULTS: 48% patients were males and patients' mean age was 52 years (27 to 72). 96% patients had handled hares in relation to hunting practices. Main symptoms were weariness (92%), general discomfort (88%), lymph node enlargement (85%) and fever (81%). Skin lesions were seen in 77% patients. A delay in the initial diagnosis was found in 40% cases. Main complications included: lymph node suppuration (25%) and persistent weariness (18%). In patients with and without a diagnostic delay, 62/21% had lymph node enlargement longer than 1 month, 46/7% had adenopathy suppuration (p < 0.05) and 31/7% had persistent weariness, respectively. CONCLUSIONS: Clinical and epidemiological features of tularemia are similar to those described in previous reports. The disease behaved in a uniform and benign form without serious or evolutive complications. Diagnostic delay was the main added morbidity factor.

Tularemia: análisis de 27 casos / Tularemia: study of 27 patients

FUNDAMENTO: Recientemente en nuestro país se ha descrito un importante brote epidémico de tularemia, que ha suscitado un gran interés epidemiológico. El objetivo de este trabajo es presentar nuestra serie incidiendo en las características clínicas y evolución de la enfermedad. PACIENTES Y MÉTODO: Se describen 27 casos de tularemia que fueron estudiados clínica y epidemiológicamente (encuesta del Servicio Territorial de Sanidad de la provincia de Burgos). Dos de los casos ocurrieron en diciembre del año 2000 de forma aislada, mientras que el resto se acumuló con el brote epidémico observado entre septiembre de 1997 y los primeros meses de 1998. Se completó el estudio mediante seguimiento y cuestionario telefónico dirigido a valorar recaídas o secuelas de la enfermedad. RESULTADOS: El 48 por ciento fueron varones, siendo la edad media de los pacientes de 52 años (extremos, 27-72). El 96 por ciento había manipulado liebres en relación con la caza. La clínica principal fue astenia (92 por ciento), malestar general (88 por ciento), presencia de adenopatías (85 por ciento) y fiebre (81 por ciento). Se observaron lesiones cutáneas en el 77 por ciento de los casos. En el 40 por ciento se detectó un retraso diagnóstico inicial. La principales complicaciones descritas fueron: supuración de las adenopatías (25 por ciento) y astenia persistente (18 por ciento). En los pacientes con y sin retraso diagnóstico, un 62 y un 21 por ciento presentaron persistencia de las adenopatías durante más de un mes, un 46 y un 7 por ciento supuración de éstas (p < 0,05) y un 31 y un 7 por ciento astenia persistente, respectivamente. CONCLUSIONES: La características clínicas y epidemiológicas de esta enfermedad son consistentes con la bibliografía previa. La enfermedad se ha comportado de forma uniforme, benigna y sin complicaciones graves o evolutivas de consideración, siendo el retraso diagnóstico el principal factor de morbilidad sobreañadido. (AU)

Profilaxis antibiótica y reparación herniaria. Resultado de una revisión sistemática cuantitativa / Antibiotic prophylaxis and hernia repair. Systematic quantitative review results

FUNDAMENTOS. La utilidad de la profilaxis antibiótica en la reparación herniaria se encuentra actualmente en controversia. Los estudios comparativos han mostrado resultados dispares, por lo que es difícil tener una idea clara de su utilidad. El objetivo del presente estudio es hacer una revisión sistemática cuantitativa o metaanálisis de los estudios controlados publicados sobre profilaxis antibiótica en la reparación herniaria, para mostrar la mejor evidencia posible sobre la utilidad de dicha profilaxis. MÉTODOS: Se han seguido los pasos descritos para la realización de una revisión sistemática cuantitativa, basados en la práctica de la medicina basada en la evidencia: formulación de una pregunta relevante (¿es útil la profilaxis antibiótica en la reparación herniaria inguinal electiva por vía abierta en la prevención de la infección postoperatoria de la herida quirúrgica?), búsqueda de las mejores evidencias disponibles, criterios de selección de los ensayos hallados, análisis de cada uno de ellos, combinación de resultados (método de Yusuf y Peto) y conclusiones. RESULTADOS. Se han hallado 12 estudios, de los cuales 8 han cumplido los criterios de inclusión en el metaanálisis. Nuestros resultados muestran que la profilaxis antibiótica en la reparación herniaria, se utilice o no material protésico, disminuye la tasa de infecciones en el 42 por ciento, 61 por ciento y 48 por ciento en herniorrafias, hernioplastias y en conjunto, respectivamente. El número de pacientes necesario a administrar profilaxis para evitar una infección postoperatoria es de 42 en herniorrafias, 37 en hernioplastias y 40 en la reparación herniaria de forma global. CONCLUSIONES. La profilaxis antibiótica en la reparación herniaria es útil en la prevención de la infección de herida. Sin embargo, esto no implica su administración indiscriminada, sino que hay que basarla en la tasa local de infección de herida y en el análisis de los factores de riesgo de los pacientes, para evitar su administración cuando se estime que el beneficio es escaso (AU)

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