[ Contact isolation and prevention of spreading of serious infections in an intensive care unit. Description of a protocol]. / Aislamiento de contacto y prevención de diseminación de infecciones graves en una unidad de cuidados intensivos. Descripción de un protocolo.

Hospital infection (HI) represents a serious care problem in critical patients. The presence of this complication is associated to an increase in the baseline seriousness of the patient, that is translated into greater care effort, multiplication of workload and greater mortality. This situation is clearly complicated when the causal agent of the infection is a multiresistant bacteria, since it also requires specific measures aimed at avoiding crossed transmission of the infection to other patients in addition to route treatment. The objective of the Nursing Note is to communicate our routine action in the face of this problem. From January 2003 to December 2004, 2420 patients were admitted to our Department. Of these 190 had some ICU hospital acquired infection (8.48%). Isolation steps were begun in 112 patients (4.62%) and also preventive measures as they were immunodepressed patients (inverse isolation) or patients at risk of presenting colonization or infection by multiresistant germs (preventive isolation) or due to suffering a demonstrated infection by said microorganisms. The mean seriousness, measured by the Simplified Acute Physiology Score (SAPS II), of the sample was 30+/-16 points. Those infected had a mean seriousness of 44+/-15 points and those isolated 49+/-19 points. Nursing workloads, measured by Nine Equivalents of Nursing Manpower Use Score (NEMST) were 150+/-274 points for all the sample, while the infected patients had 737+/-460 and the isolated ones 811+/-452 points. Global mortality in said period was 12.6%, while those infected had a mortality of 32% and the isolated ones 43%. The average costs per stay were 5069 euro. Patients who suffered any infection during their stay in the ICU increased their stay cost up to 26,630 euro and those isolated up to 29,050 euro. Faced with this situation, it was decided to stress the Contact Isolation procedures to achieve correct fulfillment of the preventive measures and achieve reduction in the hospital infection rates and crossed transmission between patients by multiresistant pathogens.

Aislamiento de contacto y prevención de diseminación de infecciones graves en una unidad de cuidados intensivos. Descripción de un protocolo / Isolation of contact and prevention of spreading of serious infections in an intensive care unit. Description of a protocol

La infección nosocomial (IN) representa un grave problema asistencial en los pacientes críticos. La presencia de esta complicación se asocia a un incremento de la gravedad basal del paciente, que se traduce en un mayor esfuerzo asistencial, la multiplicación de las cargas de trabajo y una mayor mortalidad. Esta situación se complica de forma manifiesta cuando el agente causal de la infección es una bacteria multirresistente, ya que además del tratamiento habitual requiere unas medidas específicas encaminadas a evitar la transmisión cruzada de la infección a otros pacientes. El objetivo de esta «Nota de Enfermería» es dar a conocer nuestra rutina de actuación ante este problema. Desde enero de 2003 a diciembre de 2004 ingresaron en nuestro servicio 2.420 pacientes, de los cuales 190 presentaron alguna IN adquirida en la unidad de cuidados intensivos (UCI) (8,48%). Se instauraron medidas de aislamiento en 112 pacientes (4,62%), bien como medida preventiva por ser pacientes inmunodeprimidos (aislamiento inverso) o por ser pacientes de riesgo de presentar una colonización o infección por gérmenes multirresistentes (aislamiento preventivo), o por presentar una infección demostrada por dichos microorganismos. La gravedad media de la muestra, medida por SAPS II (Simplified Acute Physiology Score), fue de 30 ± 16 puntos. Los infectados presentaron una gravedad media de 44 ± 15 puntos y los aislados de 49 ± 19. Las cargas de trabajo de enfermería, medidas por NEMST (Nine Equivalents of Nursing Manpower Use Score) fueron de 150 ± 274 puntos para el global de la muestra, mientras que los pacientes infectados tuvieron 737 ± 460 y los aislados 811 ± 452. La mortalidad global en dicho período fue del 12,6%, mientras que los infectados presentaron una mortalidad del 32% y los aislados del 43%. Los costes promedio por estancia fueron de 5.069 A. Los pacientes que presentaron alguna infección durante su estancia en UCI incrementaron su coste por estancia hasta 26.630 A y los aislados hasta 29.050. Ante esta situación, se decidió enfatizar en los procedimientos de aislamiento de contacto para conseguir el correcto cumplimiento de las medidas preventivas y lograr una reducción en las tasas de infección nosocomial y de transmisión cruzada entre pacientes por patógenos multirresistentes

Hospital infection (HI) represents a serious care problem in critical patients. The presence of this complication is associated to an increase in the baseline seriousness of the patient, that is translated into greater care effort, multiplication of workload and greater mortality. This situation is clearly complicated when the causal agent of the infection is a multiresistant bacteria, since it also requires specific measures aimed at avoiding crossed transmission of the infection to other patients in addition to route treatment. The objective of the Nursing Note is to communicate our routine action in the face of this problem. From January 2003 to December 2004, 2420 patients were admitted to our Department. Of these 190 had some ICU hospital acquired infection (8.48%). Isolation steps were begun in 112 patients (4.62%) and also preventive measures as they were immunodepressed patients (inverse isolation) or patients at risk of presenting colonization or infection by multiresistant germs (preventive isolation) or due to suffering a demonstrated infection by said microorganisms. The mean seriousness, measured by the Simplified Acute Physiology Score (SAPS II), of the sample was 30±16 points. Those infected had a mean seriousness of 44±15 points and those isolated 49±19 points. Nursing workloads, measured by Nine Equivalents of Nursing Manpower Use Score (NEMST) were 150±274 points for all the sample, while the infected patients had 737±460 and the isolated ones 811±452 points. Global mortality in said period was 12.6%, while those infected had a mortality of 32% and the isolated ones 43%. The average costs per stay were 5069 e. Patients who suffered any infection during their stay in the ICU increased their stay cost up to 26,630 e and those isolated up to 29,050 e. Faced with this situation, it was decided to stress the Contact Isolation procedures to achieve correct fulfillment of the preventive measures and achieve reduction in the hospital infection rates and crossed transmission between patients by nultiresistant pathogens