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Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario / Adverse events and associated factors in patients who died in a University Hospital

Fundamento y objetivo. El presente trabajo de investigación pretende relacionar los eventos adversos (EA) asociados a la asistencia sanitaria con otro indicador de calidad asistencial como es la mortalidad hospitalaria, determinando la proporción de fallecidos en los que está presente algún EA y qué factores se asocian a una mayor proporción de EA en personas fallecidas. Material y métodos. Inicialmente se realizó un estudio descriptivo de mortalidad de base hospitalaria, seguido de un estudio de casos y controles en pacientes fallecidos. Se estudió la presencia de EA, la probabilidad con la que se hubieran podido prevenir y predecir y su asociación con diversos factores. Resultados. La proporción de EA encontrada fue del 19,8% (82/414), siendo la proporción de pacientes fallecidos que padeció algún EA del 15,5% (64/414). La razón de EA por persona era de 1,28. El EA más frecuente fue la infección nosocomial. El 48,8% de los EA eran prevenibles. No se ha encontrado una diferencia en la presencia de EA por edad ni por sexo. Entre los factores que se asociaron a la presencia de EA destacan la intervención quirúrgica, la estancia y el tipo de servicio en el que estaban ingresados los pacientes. Discusión. La proporción de pacientes fallecidos con EA, el porcentaje de EA prevenibles, el tipo más frecuente (la infección nosocomial) y la relación de la estancia y la intervención quirúrgica con su presencia, nos hacen centrar la atención en el desarrollo de medidas que reduzcan la estancia hospitalaria y en la difusión de las medidas de prevención y control de la infección nosocomial(AU)

Objective. This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. Methods. First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. Results. The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. Discussion. The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection(AU)

[Adverse events and associated factors in patients who died in a university hospital]. / Factores asociados a eventos adversos ocurridos en fallecidos en un hospital universitario.

OBJECTIVE: This study aims to associate adverse events related to health care with another indicator of quality of care such as hospital mortality, and determining the proportion of adverse events (AEs) and associated factors in deceased patients. METHODS: First a descriptive study of hospital-based mortality was performed, followed by a case-control study in deceased patients. We studied the presence of AEs, the probability which they could be predicted and prevented, and their association with several factors. RESULTS: The proportion of AEs found was 19.8% (82/414), and the proportion of deceased patients who suffered an AE was 15.5% (64/414). The AE ratio per person was 1.28. The most common AE was nosocomial infection, and 48.8% of all AEs were preventable. No difference was found with the presence of an AE by age or sex. Factors associated with the presence of AEs were surgery, length of stay and hospital unit to which patients were admitted. DISCUSSION: The proportion of AEs found between patients who died, the percentage of preventable AEs, the most common AE (nosocomial infection) and the association of their presence with stay and the surgery should make us focus on the development of measures to reduce hospital stay and the dissemination of information on prevention and control of nosocomial infection.

Factores predisponentes, facilitadores y reforzantes respecto al tabaquismo en trabajadores sanitarios / Predisposing, enabling and reinforcing factors regarding smoking in healthcare workers

Objetivos: Ante la elevada prevalencia de tabaquismo que continúa existiendo entre el personal sanitario, se ha llevado a cabo este estudio a fi n de identifi car y analizar los Factores Predisponentes, Facilitadores y Reforzantes (PRECEDE) respecto al tabaquismo en trabajadores de un Hospital Universitario Valenciano. Métodos: Se ha realizado un estudio cualitativo transversal, basado en un cuestionario no estructurado sobre los factores que motivan el consumo de tabaco en una muestra aleatoria de 120 trabajadores del Hospital Universitario Dr. Peset, diferenciándose cuatro categorías (n=30): Nunca fumadores, Fumadores habituales, Ex Fumadores sin recaída y Fumadores tras recaída. Resultados: Los principales factores PRECEDE identifi - cados en cada grupo fueron: Nunca Fumadores: Predisponentes (Conocimiento, “sé que es perjudicial”), Facilitadores (entorno familiar no fumador) y Reforzantes (Experiencia, “lo probé y no me gustó”). Fumadores: Predisponentes (“fumar es mi vicio”), Facilitadores (situaciones de estrés) y Reforzantes (“me hace sentir bien”). Ex Fumadores sin Recaídas: Predisponentes (problemas de salud), Facilitadores (deporte, presión familiar y social) y Reforzantes (ahorro económico). Fumadores tras Recaída: Predisponentes (creencia “por uno no pasa nada”), Facilitadores (entorno de fumadores) y Reforzantes (sensación de calma). Conclusiones: Según el estudio realizado, es recomendable que los programas de educación sanitaria contra el tabaquismo en el ámbito hospitalario presten especial atención a los factores relacionados con falsas creencias todavía existentes en el personal sanitario, así como a los entornos de los fumadores (AU)

Objectives: Since a high prevalence of tobacco addiction continues existing among healthcare workers, this study has been carried out in order to identify and to analyze Predisposing, Enabling and Reinforcing factors (PRECEDE) regarding smoking habits in healthcare workers at a Valencian University Hospital. Methods: We performed a qualitative cross-sectional study based on a non-structured questionnaire about factors that motivate smoking habit. A random sample of 120 health-care workers from Dr Peset University Hospital were interviewed and distributed among four categories (n=30): Non-smokers, Smokers, Ex- Smokers without relapses and Smokers with relapse. Results: The most important PRECEDE factor for each group was: Never-smokers: Predisposing (Knowledge, “I know that smoking is detrimental to health”), Enabling (non-smoker’s family environments) and Reinforcing (Experience, “I tried it and I did not like it”). Smokers: Predisposing (“smoking is my vice”) Enabling (stressful situations) and Reinforcing (“it makes me feel good”). Ex-Smokers without Relapses: Predisposing (Health problems), Enabling (Sport, family Pressure and social Perception) and Reinforcing (Cost). Smokers after Relapse: Predisposing (Belief It’s just one cigarette), Enabling (smoker’s environment) and Reinforcing (sensation of calm). Conclusions: According to this study, health promotion programs against smoking in hospitals should pay special attention to factors related to false beliefs among healthcare workers and smoker’s settings (AU)

[Occupational accidents at an Acute Care Hospital]. / Accidentes de trabajo en un hospital de agudos.

BACKGROUND: To obtain a better knowledge of the determining factors and circumstances giving rise to occupational accidents will foster the implementation of corrective measures. The aim of this study is that of describing the trend of occupational accidents (OA's) over the course of time and of determining the risk factors regarding workers being forced to take time off for sick leave at the "Dr. Peset" Hospital in Valencia. METHODS: Description and retrospective analysis of the occupational accidents having occurred at the "Dr. Peset" Hospital in Valencia throughout the 1992-1995 period. The trend and seasonality of the series (seasonal indexes, SI's) were estimated by deterministic methods. A logistic regression model was employed to identify the factors providing a prior indication workers being off on sick leave and to determine the probability of the occurrence thereof. RESULTS: The highest OA rates were found among the kitchen and laundry workers (10.00 OA's per 100 workers/year). The OA's involving sick leave continued to show a trend of around zero, February being the months showing the highest SI (SI = 139.8). Those processed without sick leave showed an upward trend (r2 = 0.23, p < 0.0001), May being the month involving the largest number of casualties (SI = 134.2). The probability of an accident resulting in a worker being forced to take time of for sick leave increases significantly with age, when the accident in question takes place in the afternoon/evening, if it takes place in the kitchen/laundry, and if a sprain or tendinitis is involved. CONCLUSIONS: The measures taken involving the number of casualties entailing OA's which result in temporary incapacity should revolve around the less-skilled positions and the kitchen and laundry departments.

[The comparison of adverse reactions to anti-influenza vaccines of split-vision and surface antigens]. / Comparación de las reacciones adversas a las vacunas antigripales de virus fraccionados y de antígenos de superficie.

BACKGROUND: Fear of adverse reactions is one of the reasons why influenza immunization programs for hospital workers have not met wide acceptance. We conducted a study in order to compare the frequency of adverse reactions following administration of standard split-virion (VVF) and subunit-virion (VAS) influenza vaccines, mostly among hospital personnel. METHODS: Trial with volunteers who were systematically assigned to receive one of the vaccines, alternating every ten participants, during the influenza inmunization campaing 1994-95. The adverse effects were recorded by telephone interview 10 days after vaccination. RESULTS: Out the 182 subjects recruited, 163 were included in the study, of whom 100 received VAS and 63, VVF. Almost 13% of the participants reported any adverse effects with no significant difference between both groups (VAS: 11% and VVF: 15.6%, p = 0.38). There were also no significant differences relating to systemic and local reactions, separately. The subjects who had adverse reactions to previous influenza vaccination showed more frecuent systemic reactions (25% vs. 7.5%, p = 0.04) in a significant way. CONCLUSIONS: Both vaccines have been proved to be very safe, only causing adverse reactions in a small proportion and very mild in every case. The VAS presents a frequency of adverse effects similar to that of VVF, in spite of containing only surface antigens. It's likely that a certain hypersensitivity to influenza vaccine exists in some people, specially to the split-virion one.