Search

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated., Methods: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention., Results: In 2019, the cumulative incidence of SSIs was 10.6% (n = 80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections., Conclution: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions., (Copyright © 2021 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: Hand hygiene (HH) is the single most important and effective measure to reduce the risk of healthcare-related infections. However, low compliance with HH indications among healthcare professionals is often low. The objective of this study was to evaluate the implementation of a multimodal strategy to promote HH among healthcare professionals., Methods: We used the "Application guide of the multimodal strategy of the World Health Organization for the improvement of hand hygiene", which consists of: changes to the system, education and training, evaluation and feedback, workplace reminders, organizational safety climate and monitoring of compliance with HH. The strategy was designed as an intervention study to promote HH in the Maternal and Child Insular University Hospital Complex in the period 2012-2020., Results: Overall compliance with the HH indications at the end of the study period was 59.2%. The use of alcoholic-based products increased with respect to previous years (p <0.05), reaching 70 liters/1000 hospital admissions in the final year. Healthcare professionals perceived training and accessibility to an alcohol-based preparation at each point of care as the most effective measures for promoting good HH practice., Conclusions: The implementation of a multimodal intervention significantly improved compliance with handwashing and the use of alcohol-based products among healthcare professionals. Despite having previous training on hand hygiene, HH knowledge among professionals remains incomplete. Prior training followed by time worked are the most important determinants of knowledge and perceptions about hand hygiene.

Introduction: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated., Methods: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention., Results: In 2019, the cumulative incidence of SSIs was 10.6% (n=80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections., Conclusion: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions., (Copyright © 2021 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Multidrug resistant organisms (MDRO) are an important cause of nosocomial infections, with complicated clinical-therapeutic management and elevated morbidity-mortality, and an increase in healthcare costs. In long term care facilities (LTCFs) colonization/infection by MDRO among residents is increasing, and they may act as reservoirs and vehicles for the dissemination and production of outbreaks by resistant strains in acute hospitals. This study aimed at determining the prevalence of carriers of some common MDRO, and identifying factors associated with carrier state., Material and Methods: A cross-sectional prevalence study was conducted on 235 residents in two LTCFs in the province of Las Palmas de Gran Canaria (Canary Islands, Spain) between October and November of 2012. The presence of MMR was investigated in nasal, pharyngeal and rectal swabs using selective media. Risk factors associated with carrier state were calculated using univariate and multivariate analysis., Results: More than one-third (36.2%) of residents were found to be carriers of ≥ 1 distinct MDROs. More than one-quarter (26.6%) were carriers of ESBL producing Enterobacteriaceae, and 10.2% were MRSA carriers. Factors found to be associated with colonization by any MDRO were: prior colonization or infection by MDRO, hospitalization in the past 3 months, recurrent infections of the urinary tract, and peripheral arterial disease., Conclusions: The prevalence of MDRO in the LTCFs settings studied is greater than that found in the literature, and in particular ESBL producing Enterobacteriaceae. Due to the high prevalence of infection/colonization by MDRO, it is possible that residents of LTCFs could act as important reservoirs of MDRO, and facilitate their spread into the acute care setting., (Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.)

Background: The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery., Objectives: The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI)., Methods: Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation., Results: Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients., Conclusion: FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later., (Copyright © 2013 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become an important hospital-acquired pathogen, with transfer of the organism from a carrier or infected patient to uninfected patients by the hands or clothing of staff as the main mode of transmission., Methods: Investigation of a cluster of new cases of MRSA resistant to mupirocin and fusidic acid, using epidemiological and microbiological resources., Results: From September 2010 to February 2012, sixteen patients had at least one culture positive for MRSA resistant to mupirocin and fusidic acid. Some not apparently related cases and outbreaks appeared. By analysing cultures taken from patients and staff using pulsed-field gel electrophoresis, it was demonstrated that most likely this situation was started by an auxiliary nurse who was a carrier of the MRSA. Healthcare worker decontamination using oral antibiotic therapy was unsuccessful. Eventually, the situation was controlled by placing the carrier in a different job, with no further cases to date (September, 2012)., Conclusion: This report illustrates the risk of nosocomial transmission linked to care delivered by healthcare workers., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

This report describes an outbreak caused by Pseudomonas aeruginosa in a neonatal care unit possibly linked to feeding bottles heaters. Infection control measures were undertaken such as reinforcement of contact isolation precautions, environmental microbiologic sampling, educational sessions on hand hygiene, and use of sterilized water to refill feeding bottles heaters. The sustained eradication of P aeruginosa isolates after implementing control measures on feeding bottles heaters strongly suggests those as the source of the outbreak., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Objective: To evaluate the impact on the urinary tract infections (UTI) rates of an intervention implemented in the Department of Internal Medicine of the Hospital Universitario Insular de Gran Canaria., Material and Methods: Infection control practitioners implemented a three phase project, each lasting two months, focusing on surveillance and feed-back, between 2009 and 2011. During phases 1 and 2, the 2004 Centers for Disease Control and Prevention (CDC)-diagnostic criteria for nosocomial infections were followed, and only rates of infections were calculated. For phase 3, the criteria published in 2009 were used, and rates of infections plus processes rates were obtained. The cumulative incidence of UTI in the three periods was compared using a chi-square for trends test., Results: The total number of catheter days, as well as the cumulative incidence of UTI dropped from phase 1 to 3. Nevertheless, in phase 2 the mean urinary catheter days increased. We detected a decrease in the UTI rates and urinary catheter days mean after introducing an electronic reminder in the patient electronic charts., Conclusions: A multidisciplinary approach, including surveillance, reminders, and feed-back, has proved useful in controlling UTI rates in our hospital., (Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.)

Aim: to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas., Methods: Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria., Results: an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p<0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p<0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008., Conclusions: Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control., (Copyright 2009 SECA. Published by Elsevier Espana. All rights reserved.)

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen, both in-hospital and in the community. Although there are several guidelines with recommendations for the control of this microorganism, the measures proposed are not uniformly implemented in Spanish hospitals. The objective of this document is to provide evidence-based recommendations that are applicable to Spanish hospitals, with the aim of reducing transmission of MRSA in our health care centers. The recommendations are divided into the following groups: surveillance, active detection of colonization in patients and health care workers, control measures for colonized or infected patients, decolonization therapy, environmental cleaning and disinfection, antimicrobial consumption, measures for non-hospitalized patients, and others. The main measures recommended include appropriate surveillance, hand hygiene, and implementation of active surveillance, contact precautions, and environmental cleaning.

Objectives: Surveillance programs for nosocomial infection control may find out opportunities for improvement. The aim of this study was to determine the incidence of surgical site infection and their potential risk factors after hysterectomy in a tertiary hospital in Gran Canaria, Spain., Study Design: Prospective study on patients undergoing abdominal or vaginal hysterectomy between 1st June 2000 and 31st December 2004. Surgical site infection incidence rates were calculated according to procedure, and National Nosocomial Infection Surveillance (NNIS) system risk categories. We also reviewed antimicrobial prophylaxis use and morbidity. To determine associate risk factors a multivariate analysis was performed., Results: A total of 1540 women were surveyed; neoplasm (30.5%), obesity (24.3%), and diabetes (16.2%) grouped the main morbidity. About 81 cases (5.2%) met criteria for postoperative surgical site infection (6.0% for abdominal procedure and 3.1% for vaginal procedure). Most patients (86.4%) had adequate antimicrobial prophylaxis, but inadequacy was more frequent by vaginal (17.6%) than abdominal procedure (12.0%) (p=0.005). NNIS high-risk patients had significantly higher infection rates than did low-risk patients (p=0.01). The most common causative organism isolated was Escherichia coli (17.5%). Multivariate analysis showed obesity, inadequate antimicrobial prophylaxis, and abdominal procedure as the main risk factors., Conclusion: Rate of surgical site infection is high. Enhanced and multidisciplinary efforts are needed.

Objective: To determine whether continuous surveillance of hospital-associated infections with regular feedback to the staff reduces the infection rate in orthopedic surgery., Material and Methods: Prospective surveillance in two periods of time in an orthopedic surgery department at a Spanish university hospital. Two infection control nurses and an epidemiologist surveyed all patients over a 3-year period for infections and potential risk factors. After an initial 24-month period (period A), surveillance for 12 months was conducted (period B). Between these periods, adherence to recommendations was reinforced., Results: A total of 1,088 patients were surveyed. In period A, 3.3% of all operations were followed by an infection, compared with 2.0% in period B (p = 0.14). Adherence to recommended schedule of surgical prophylaxis increased from 8.7% in the first year to 32,7% in the last year (p = 0.001). We also determined the NNIS (National Nosocomial Infections Surveillance) index risk in 383 patients, with the NNIS index-risk 2 as more frequent in period A (16.8%) than the period B (5.4%) (p < 0.001). Renal failure frequency was higher in period A (3.4% vs. 1.6%; p = 0.04). However, diabetes and neoplasms were the same in both periods. In period B, chronic obstructive pulmonary disease (14.6 vs. 11.0; p = 0.05) and obesity (12.8 vs. 10.3; p = 0.12) predominated. The means for surgical intervention, hospital stay, and age, were very similar in both periods., Conclusions: Surveillance of hospital-associated infections including regular feedback to the staff is accompanied by a reduction in infection rates, possibly with lower cost and more patient safety. Thus, such a surveillance program for orthopedic surgery department seems to be beneficial.

Introduction: Nosocomial infection is a frequent complication in neonatal intensive care units (NICUs) attending patients who require lengthy hospitalization and frequent invasive techniques., Patients and Methods: This study is part of a prospective surveillance program for nosocomial infection in Spain. All patients admitted to NICUs between June 1999 and March 2005 were observed. CDC criteria were used as the standard definition for nosocomial infection., Results: A total of 1236 neonates (58% male) were admitted during the surveillance period, involving 19,420 days in the NICU. The average birth weight was 1947.6 +/- 1009.5 g and average gestational age was 32.9 +/- 5.4 weeks. The most frequent associated pathology was respiratory distress (23.06%). A total of 316 nosocomial infections were diagnosed in 226 neonates, 76.7% affecting premature neonates (< 1500 g). The most frequent location was bacteremia (56.3%), and there was a predominance of coagulase-negative staphylococci (46.05%). Gram-negative microorganisms were isolated in 32.1% of the cases (Escherichia coli and Pseudomonas aeruginosa were the most frequent pathogens). Overall incidence of nosocomial infection was 25.6%. Overall mortality was 6.6%, with higher mortality in the group with nosocomial infections (8.7%)., Conclusions: Nosocomial infection rates are acceptable, with a typical epidemiological pattern for these units. Presence of a central catheter increased the risk. A program to promote proper hand washing should be considered. We do not recommend a continuing surveillance strategy in these units.

Background and Objective: For the treatment of obesity, an adecuate control of associated cardiovascular risk factors (CRF) is fundamental. The objective of this study was to assess the relationship between body mass index (BMI) and CRF, and the effect of a weight loss program on overweight subjects., Patients and Method: A single-centered cross-sectional prospective study was carried out during 1997-2001 on 1,018 overweight subjects (788 women and 230 men) who were seeking aid to lose weight at an obesity clinic. A program involving a hypocaloric, Mediterranean diet was prescribed plus recommendations for spare-time exercise. Variables measured included weight, height, blood pressure, serum lipids and blood glucose concentrations, measured both at baseline and at the end of the weight loss program., Results: After adjusting for age, variables showing a significant increase upon higher BMI were: blood pressure, HDL cholesterol (HDL-C) (inverse relationship, only in women), triglycerides and blood glucose. Total cholesterol (CLT), LDL cholesterol (LDL-C) and CLT/HDL-C showed no relationship with BMI. Weight loss had beneficial effects on blood pressure and triglycerides, regardless of the initial values, and on CLT, LDL-C and CLT/HDL-C when the initial levels were increased. No significant changes were found with regard to HDL-C., Conclusions: Overweight and obese subjects carry a burden of common coronary risk factors which ncrease upon greater obesity. Weight loss has important beneficial effects with regard to coronary risk factors associated with overweight and obesity, particularly if these factors are previously altered, even when weight loss is < 5% of initial weight.

Objectives: To identify how nursing staff at two care levels in the western area of Malaga view Human immunodeficiency Virus infection (HIV/AIDS), evaluating differences that might exist in function of age, sex, professional status, work seniority, contact with infected people, perceived risk, information received and general information about the disease., Design: A cross-sectional study with an analytic component. Stratified randomised sampling for the two levels gave a total of 156 subjects., Setting: The primary and specialist health care levels in the western area of Malaga., Participants: Nursing staff at both care levels working for at least a year and belonging to the full-time staff., Intervention: A self-administered questionnaire which gathered: personal and work characteristics, knowledge, attitudes, place where health care delivered, perceived risk, information received and contact with patients., Main Results: In the main, the study group was composed of nurses (71.3%) and women (68.6%) with average age of 32.7 and work seniority of 9.1 years., Conclusions: Negative attitudes were found to run at 56% in Specialist Care and 32.3% in Primary, a result associated with these variables: work seniority, perceived risk, care level and information.