Infección Asociada al Cuidado de la Salud en una Unidad de internación pediátrica no crítica: Información para la acción / Health Care Associated Infection in a Non Critical Pediatric Inpatient Unit: Information for Action

Introducción: La Infección Hospitalaria (IH) es la que se contrae en el hospital u otro servicio de salud, estableciéndose un plazo de 48-72 horas luego del ingreso al hospital para determinar que ha sido adquirida en la institución. La tasa de prevalencia global de IH en áreas no críticas para adultos correspondió al 9% y para pacientes pediátricos al 4,9% en Argentina, según informara el Ministerio de Salud de la Nación en el año 2011.Objetivos: Describir los casos de IH ocurridos en la Unidad de internación del Servicio de Pediatría de un Hospital General, entre los años 2012-2015 inclusive. Material y Método: Estudio Descriptivo, Retrospectivo y Observacional. Se incluyeron todos los pacientes que habiendo sido internados en la Unidad de Pediatría entre los años 2012-2015 su diagnóstico de egreso fue IH, correspondiéndose a un total de 78 casos. Los datos se volcaron en una planilla Excel y fueron analizados con el Programa STATA 8.0 para Windows y el Whonet.Resultados: La mediana de edad fue de 8 meses, observándose un predominio de varones n=50 (64%). Los diagnósticos de IH fueron Neumonía n= 32, gastroenteritis n= 23, sepsis n=9, Bacteriemia n= 8, insuficiencia respiratoria aguda baja n= 4, Infección del tracto urinario n=2. En 33 pacientes no hubo rescate etiológico. Se observa una disminución de infección intrahospitalaria de 66%, entre los años 2015 y 2014. Conclusiones:El presente trabajo demuestra que, con medidas de bioseguridad económicamente insignificantes en relación al beneficio obtenido, se puede disminuir y controlar las infecciones intrahospitalarias.(AU)

ntroduction: The Hospital Infection (HI) is the one contracted in the hospital or other health service, establishing a period of 48-72 hours after admission to the hospital to determine that it has been acquired in the institution. The overall prevalence rate of HI in non-critical adult areas corresponded to 9% and for pediatric patients to 4.9% in Argentina, according to the Ministry of Health of the Nation in 2011. Objectives: Describe HI cases that occurred in the Inpatient Unit of the Pediatric Service of a General Hospital, between the years 2012-2015 inclusive.Material and Method: Descriptive, retrospective and observational study. All the patients who had been admitted to the Pediatric Unit between the years 2012-2015 were included, their diagnosis of discharge was HI, corresponding to a total of 78 cases. The data was turned into an Excel spreadsheet and analyzed with the STATA 8.0 Program for Windows and the Whonet. Results: The median age was 8 months, with a predominance of males n = 50 (64%). The diagnoses of HI were pneumonia n = 32, gastroenteritis n = 23, sepsis n = 9, bacteremia n = 8, low acute respiratory failure n = 4, urinary tract infection n = 2. In 33 patients there was no etiological rescue. A 66% decrease in intrahospitalary infection was observed between 2015 and 2014.Conclusions: The present work shows that, with economically insignificant biosecurity measures, in relation to the benefit obtained, intrahospital infections can be reduced and controlled.Key Words:Infection, pediatrics, biosecurity

Hepatic encephalopathy: Ever closer to its big bang.

Hepatic encephalopathy (HE) is a neuropsychiatric disorder that commonly complicates the course of patients with liver disease. Despite the fact that the syndrome was probably first recognized hundreds of years ago, the exact pathogenesis still remains unclear. Minimal hepatic encephalopathy (MHE) is the earliest form of HE and is estimated to affect more that 75% of patients with liver cirrhosis. It is characterized by cognitive impairment predominantly attention, reactiveness and integrative function with very subtle clinical manifestations. The development of MHE is associated with worsen in driving skills, daily activities and the increase of overall mortality. Skeletal muscle has the ability to shift from ammonia producer to ammonia detoxifying organ. Due to its large size, becomes the main ammonia detoxifying organ in case of chronic liver failure and muscular glutamine-synthase becomes important due to the failing liver and brain metabolic activity. Gut is the major glutamine consumer and ammonia producer organ in the body. Hepatocellular dysfunction due to liver disease, results in an impaired clearance of ammonium and in its inter-organ trafficking. Intestinal bacteria, can also represent an extra source of ammonia production and in cirrhosis, small intestinal bacterial overgrowth and symbiosis can be observed. In the study of HE, to get close to MHE is to get closer to its big bang; and from here, to travel less transited roads such as skeletal muscle and intestine, is to go even closer. The aim of this editorial is to expose this road for further and deeper work.