[Control of major cardiovascular risk factors of ischemic heart disease in secondary prevention in Aragón: COCINA study]. / Control de los principales factores de riesgo cardiovascular de la cardiopatía isquémica en prevención secundaria en Aragón: estudio COCINA.

UNLABELLED: Ischemic heart disease remains a leading cause of death in Spain. According to the American Heart Association/American College of Cardiology (AHA/ACC) and European national societies, secondary prevention for these patients consists of control of major cardiovascular risk factors (CVRF) and suitable lifestyle habits. OBJECTIVE: To determine the degree of control of CVRF in the Aragonese population in secondary prevention. DESIGN: Cross-sectional study of a sample of 705 patients of Aragon who had suffered a cardiac event, selected opportunistically in consultations of family physicians participating in the 3 provinces of Aragon. The study was conducted in the second half of 2012. INTERVENTION: To measure the degree of control of different FRVC and lifestyle habits in this population. VARIABLES MEASURED: Anthropometric, different cardiovascular risk factors, treatment and lifestyle. RESULTS: 58% of men and 52% of women met criteria for monitoring of measured variables. The best result was obtained with smoking cessation and the worst with BMI. Hypertension, Dyslipidemia and Diabetes Mellitus achieve poor control results. CONCLUSION: The results show that the degree of control of CVRF is still low, especially in variables such as dyslipidemia and Diabetes Mellitus. Only 16.5% of control patients met criteria given the pharmacologically-modifiable cardiovascular risk factors.

[Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)]. / Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013).

OBJECTIVES: To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. METHOD: A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. RESULTS: The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI=3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI=4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p>0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. CONCLUSIONS: Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study.

Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales / Use of ineffective practices in primary health care: professional opinions

Objetivo. Estimar la frecuencia de prácticas inefectivas en la atención primaria (AP) en función de la opinión de profesionales clínicos, así como valorar la importancia, consecuencias y factores que pueden estar contribuyendo a su mantenimiento. Material y métodos. Encuesta de opinión online a una muestra de conveniencia de 575 profesionales de la AP seleccionados a partir de artículos publicados en los últimos años de las revistas Atención Primaria y Semergen. Resultados. Respondieron 212 encuestados (37%). Para el 70,6% (IC 95%: 64,5-73,7) el problema de las prácticas inefectivas resultó frecuente o muy frecuente en AP y la importancia fue valorada con una puntuación media de 7,3 (DE = 1,8) sobre 10. Las principales consecuencias de las prácticas inefectivas fueron poner en peligro la sostenibilidad del sistema (48,1%; IC 95%: 41,2-54,9) y el daño a los pacientes (32,1%; IC 95%: 25,7-38,5). Contribuyeron a su mantenimiento los propios pacientes (28%; IC 95%: 22,6-35,0), la carga de trabajo (26,4%; IC 95%: 20,3-32,5) y la falta de formación continuada (19,3%; IC 95%: 13,9-24,7). Los procesos clínicos con mayor grado de utilización inadecuada fueron la prescripción de antibióticos en determinadas infecciones, la periodicidad del cribado del cáncer de cérvix, el control farmacológico de la diabetes tipo 2, la utilización de psicofármacos en ancianos y el uso de analgésicos en pacientes con hipertensión o insuficiencia renal. Conclusiones. La utilización de intervenciones inefectivas en AP fue apreciada como un problema muy relevante que afectaría a muchos pacientes, pondría en peligro la sostenibilidad del sistema y causaría daño a los pacientes (AU)

Objective. To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. Material and methods. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. Results. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD] = 1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. Conclusions. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients (AU)

[Use of ineffective practices in Primary Health Care: professional opinions]. / Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales.

OBJECTIVE: To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. MATERIAL AND METHODS: An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. RESULTS: A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. CONCLUSIONS: The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients.

[Patient safety culture in family and community medicine residents in Aragon]. / Cultura de seguridad del paciente en residentes de medicina familiar y comunitaria de Aragón.

INTRODUCTION: having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. METHODS: an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. RESULTS: positive results were seen in «the Patient Care Tracking/Follow-up¼. There were significant differences in the «Information Exchange With Other Settings¼, «Staff Training¼ and «Overall Perceptions of Patient Safety and Quality¼. Study participants viewed «Work Pressure and Pace¼ negatively. CONCLUSIONS: the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices.

Mortalidad reducible como indicador de efectividad de los servicios sanitarios en España antes y después de las transferencias / Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences

Objetivo. Describir la evolución de la mortalidad reducible por acción de los servicios sanitarios (MRASS) en España y evaluar si las transferencias sanitarias han supuesto algún cambio significativo. Métodos. La MRASS se definió a partir de una lista de causas utilizada en otros estudios. Se analizan tasas de MRASS ajustadas por edad y sexo en los períodos 1999-2001 y 2006-2008, justo antes y 5 años tras culminar el proceso de transferencias. Resultados. La MRASS representó el 24% de las defunciones en personas de 0-74 años. Descendió entre ambos períodos en mayor medida (19,4%) que el resto de causas (14,5%). El grupo de causas que más descendieron fueron: cardiopatía isquémica (28,0%), resto de enfermedades vasculares (26,8%), enfermedades quirúrgicas y errores médico-quirúrgicos (25,9%) y diabetes (22,5%). Aunque existieron diferencias entre comunidades autónomas (CCAA), no se apreció que estas diferencias ni la evolución de la MRASS se relacionaran con las transferencias. Navarra y Madrid presentaron las menores tasas de MRASS y Canarias, Asturias, Andalucía, Ceuta y Melilla, las mayores. Baleares fue la CCAA donde más disminuyó la MRASS. Conclusiones. La MRASS representa una importante proporción de la experiencia de mortalidad de personas de 0-74 años. Ha descendido en todas las CCAA, y aunque hay grandes diferencias entre ellas, no parece que el proceso de transferencias sanitarias influyera en su evolución en el período estudiado. Pese a limitaciones, la MRASS es un indicador que se debe considerar para monitorizar y detectar debilidades en la efectividad de los sistemas asistenciales(AU)

Objective. To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were tranferred to local authorities. Methods. MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. Results. MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. Conclusions. MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems(AU)

Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel / Incidence of postoperative adverse events in a tertiary hospital

Objetivos. Determinar la proporción de reintervenciones, mortalidad, incidencia, gravedad y grado de evitabilidad de eventos adversos posquirúrgicos (EAP) en un hospital de tercer nivel. Métodos. Revisión retrospectiva de una muestra aleatoria de 350 cirugías realizadas en 2009 en pacientes mayores de 14 años. Para identificar los EAP, determinar su gravedad y establecer su grado de evitabilidad se utilizaron clasificaciones preestablecidas. Resultados. Se detectaron 113 EAP en 61 pacientes, el 17,4% de los 350 pacientes estudiados. El 4,3% de los pacientes fue reintervenido y la mortalidad a los 30 días fue del 2,6%. Los EAP más frecuentes fueron: infección de herida quirúrgica (15,0%), hematoma o hemorragia de herida (9,7%) y anemia por sangrado (8,8%). Los factores asociados a los pacientes que adquirieron un EAP fueron el uso anestesia general, grado ASA≥3, estancia media, edad media y servicios con cirugía de mayor repercusión sistémica. Cerca del 70% de los EAP estaban recogidos en el informe de alta. El 72,6% de EAP fueron de gravedad leve, el 11,5% de gravedad moderada y el 15,9% muy graves. Un 39,9% de EAP tenían una probabilidad alta de haberse evitado. No se encontró relación entre la evitabilidad y la gravedad de los EAP. Conclusiones. La alta proporción de pacientes intervenidos con EAP, las reintervenciones consecuentes y la mortalidad en el postoperatorio inmediato señalan la importancia de implantar acciones para reducir la magnitud y el impacto de los eventos adversos, teniendo en cuenta que más del 40% de los EAP podría ser evitado(AU)

Objectives. To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. Methods. Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. Results. Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. Conclusions. The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided(AU)

[Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences]. / Mortalidad reducible como indicador de efectividad de los servicios sanitarios en España antes y después de las transferencias.

OBJECTIVE: To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were transferred to local authorities. METHODS: MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. RESULTS: MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. CONCLUSIONS: MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems.

[Incidence of postoperative adverse events in a tertiary hospital]. / Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel.

OBJECTIVES: To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. METHODS: Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. RESULTS: Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. CONCLUSIONS: The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided.

[Easier said than done: evaluation of quality programs of a hospital]. / Del dicho al hecho: evaluación de los programas de calidad de un centro hospitalario.

OBJECTIVES: a) To evaluate the management of Quality Programs within the clinical services at Hospital Clínico Universitario Lozano Blesa (HCULB) and its impact on the improvement of the centre and its services. b) To propose recommendations to improve the management and impact of these programs. METHOD: A two-stage study was carried out: 1st stage: Analysis of the annual HCLUB Quality Program records for clinical services created in 2007. 2nd Stage: A structured interview with the physicians responsible for Quality Control regarding the aforementioned programs. RESULTS: Each Quality Program had an average of 5 objectives with a mean of complexity level of 76.1% (

Validación de un instrumento para evaluar el funcionamiento y repartir incentivos entre los servicios de un hospital / Validation of an instrument to assess functioning and distribute incentives among the services of a hospital

Objetivo: Diseñar y examinar la fiabilidad de una herramienta para evaluar los resultados y distribuir incentivos entre los servicios del hospital. Material y Métodos: Se definieron de forma explícita las características de la herramienta de evaluación (representatividad, transparencia, claridad, pertinencia, accesibilidad, veracidad, carácter reproducible, sensibilidad, especificidad, estabilidad, eficiencia y aceptación) y se utilizaron dichos criterios para seleccionar indicadores y desarrollar los modelos de evaluación específicos de cada servicio. Para validar el método se midió su precisión (coherencia intra e interobservador, coeficiente de variación y bondad de ajuste a la normal) y su validez de contenido, de construcción y de criterio con respecto a una encuesta de opinión previa entre el equipo directivo (correlación de Pearson e índice Kappa). Resultados: La herramienta desarrollada constaba de 15 modelos de evaluación elaborados a partir de 49 indicadores (31 de actividad, cuatro de costes y 14 de calidad asistencial). Se evaluaron 56 unidades aistenciales, cuya calificación media fue de 73,5 ñ 18,1 puntos, con un mínimo de 29 y un máximo de 100. En Actividad la puntuación media fue de 52,1 ñ 14,7 sobre 70, en Costes de 13,7 ñ 7,4 sobre 20 y en Calidad de 7,6 ñ 2,1 sobre 10. El modelo se ajustaba a una distribución normal, con un CV de 0,25, un error intraobsevador de 0,25 por ciento e interobservador del 0,48 por ciento. La correlación con la opinión del equipo directivo era positiva (r = 0,43 p = 0,004), pero los índices de concordancia kappa eran bajos (0,21). Conclusiones: El método de evaluación probado es preciso, está bien construido y tiene una aparente validez de criterio. Queda ahora por demostrar si sirve para mejorar los resultados y la calidad de la asistencia prestada (AU)

[Use of the NNIS index for determining the intrinsic risk of surgical infection]. / Ulitización del índice NNIS para determinar el riesgo intrínseco de infeccíon quirúrgica.

BACKGROUND: To perform valid comparisons of rates of surgical wound infection (SWI) methods of adjustment must be carried out to eliminate the bias produced by the different profile of patients attended. MATERIAL AND METHODS: We studied retrospectively the SWI which occurred in 2,651 anaesthetized operations. The rates of SWI were analyzed according to the National Nosocomial Infection Surveillance-derived risk index (NNIS risk index). RESULTS: The average rate of SWI was 5.1%. The tree components of the NNIS risk index (contaminated or dirty surgical operation, ASA preoperative score > or = 3, time of anaesthesia > of the percentile 75th) were each one independent and they showed similar risks of surgical infection (odds ratio 1.6, 1.9, and 2.1 respectively). The rates of SWI in each level of the NNIS risk index were: index 0: 3.3%; index 1: 5.6%; index 2: 10.8%; index 3: 3.0%. The rates of SWI showed a good correlation with the NNIS risk index (gamma coefficient: 0.35 SE: 0.07). In addition, the index determined growing rates of SWI at each level of the traditional classification of operations (except in the contaminated ones), in the majority of the main operative procedures and among operations of abdominal and extraabdominal localizations. CONCLUSIONS: The NNIS risk index is a better indicator of the intrinsic risk of patients than the traditional surgical wound classification alone.

[The annual incidence and mortality associated with hospital infections of the lower respiratory tract in a regional hospital]. / Incidencia anual y mortalidad asociada a las infecciones intrahospitalarias del tracto respiratorio inferior en un hospital comarcal.

BASIR. The incidence and the associated mortality to lower respiratory tract nosocomial infections (LRTI) were studied in a small regional hospital to evaluate if the different structural complexity of hospitals has some repercussions on the morbidity and the mortality of those infections. MATERIAL AND METHODS. The study was carried out in Calatayud hospital, a small regional hospital of 122 beds belonging to Health Area III of Aragón. All LRTI that occurred during 1992 were recorded by means of a prospective surveillance system based on a daily revision of hospital medical records. The accumulated incidence of LRTI (AI-LRTI), the accumulated incidence of infected patients (AIIP) and the associated mortality rate (AMR) were used as morbidity and mortality indicators of LRTI. The relative effect of the exposition to some variables on morbidity and mortality was estimated by means of the odds ratio (OR). RESULTS. Altogether, 64 LRTI were detected in 63 patients during the period of study, accounting for 21% of all nosocomial infections of the whole year and supposing an AI-LRTI and an AI IP of 1.5 cases per 100 patients admissions. The incidence was bigger in males (OR = 1.7), in older than 70 years (OR = 3.7) and in patients that were admitted in services of general surgery (AI-LRTI = 3.8%) and traumatology (AI-LRTI = 2.1%). The AMR to LRTI was 24%, accounting for 12% of hospital global mortality during that year. CONCLUSIONS. Results point out that LRTI could be an important cause of nosocomial morbidity and associated mortality also in small hospitals. It would be required that in this sort of centers, depending of the more frequent kind of LRTI, suitable precautions were adopted systematically to avoid as far as possible the emergence of LRTI and their negatives consequences.

[Annual incidence and control of nosocomial infections in a county hospital]. / Incidencia anual y control de las infecciones intrahospitalarias en un hospital comarcal.

BACKGROUND: The recommendation of Centers for Disease Control that hospitals must have a person trained in infection control per 250 beds has been understood as a law of all or nothing hindering implementation of hospital infection surveillance and control programs in small hospitals. Since the importance that small regional hospitals have in the Spanish Health System, the aim of this study is to describe the magnitude and characteristics of nosocomial infections (NI) in a small regional hospital in case this position needs being reconsidered. METHODS: The study was carried in Hospital de Calatayud, a small regional hospital of 122 beds belonging to Health Area III of Aragon. All the NI that occurred during 1992 were recorded by means of an uninterrupted system of prospective surveillance based on a multirecord revision. Both of the Accumulate Incidence of NI (AINI) and Accumulate Incidence of Patients with one or more NI (AINP) were calculated and the main variables associated with NI were described. RESULTS: Altogether, 298 NI were detected in 242 patients during that year. The AINI was 7.1% and the AINP was 5.8% with a mean of 1.2 (SD = 0.6) HI per infected patient. The most frequent types of NI were urinary tract infection, surgical wound infection and lower respiratory tract infection. Some pathogen microorganism were identified in 43% of NI. The microorganisms most frequently associated with NI were Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Mortality associated with NI was 11% and the average stay of patients with some NI was 22.9 days (SD = 22.1). CONCLUSIONS: Results point out the need for implementing hospital infections surveillance and control programs in small hospitals too.