RESUMEN
The difficulties encountered in studying the presence of extrinsic risk factors in the framework of prevalence surveys of hospital-acquired infections (HAI) have led to the use of a variety of methodological approaches. This study examined the effect of retrospective approaches for obtaining data regarding exposure to extrinsic risk factors. The EPINE database for 1990 was used and a simulation model was created. All the evaluated approaches differed in their impact upon the association between risk factors and infections. Prevalence of exposure on the day of the survey, prevalence of exposure at any time before the survey was conducted, and total prevalence were found to be significantly associated with the probability of exposure and duration of exposure. For exposure periods of less than four days, the prevalence of exposure during the week prior to the survey was higher than that encountered on the day of the survey. In studying exposure to risk factors retrospectively, no evidence-based justification could be found to determine how many days prior to the day of actual exposure should be included in the study. However, the site of infection determined the proportion of devices removed due to HAI, and this proportion was not very high in this study. Limiting data to recording the presence of the risk factor on the day of the survey, without investigating past exposures, can provide an adequate estimate of the burden of extrinsic risk factors in one-day, point-prevalence surveys.
Asunto(s)
Cateterismo/efectos adversos , Infección Hospitalaria/epidemiología , Respiración Artificial/efectos adversos , Traqueostomía/efectos adversos , Infección Hospitalaria/etiología , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , España/epidemiologíaRESUMEN
Although closed urinary drainage systems (CUDS) reduce the risk of catheter-associated urinary tract infection (CAUTI), open systems are still used in Spain. The object of this work was to describe the progress of CUDS use and factors associated with the drainage system type used in Spanish hospitals. The databases of the EPINE study (Study of Prevalence of Nosocomial Infections in Spain) from 1990 to 2000 were used. The EPINE study includes hospitalized patients of all ages in acute-care Spanish hospitals. Seventy-six thousand, seven hundred and eighty-eight catheterized patients were studied, and the whole database was used for the trend analysis of global hospital-acquired infection (HAI). The patient and the hospital were the two units of observation used in the analysis. Full implementation was defined as 90% CUDS use. A logistic regression model was applied to study factors influencing the use of CUDS and to determine prevalence trend. An odds ratio (OR) >1 indicates an incremental trend. The Pearson correlation coefficient between annual percentage of CUDS use and CAUTI prevalence was calculated. Variables for the year 2000 were compared using the Mann-Whitney U test between hospitals with and without full implementation. The prevalence of urinary catheterized patients in Spain increased from 12.4% in 1990 to 15.2% in 2000 (OR 1.019, 95% CI 1.016-1.021). The proportion of CUDS used increased from 50.6% in 1990 to 70% in 2000 (OR 1.1, 95% CI 1.095-1.104) and correlated with a significant decrease of UTIs (r = 0.65, P = 0.03). In 1990, 28.5% of hospitals had full implementation of CUDS and by 2000 this had risen to 40.3% (OR 1.093, 95% CI 1.06-1.127). Patients in medium (200-500 beds) and large (>500 beds) hospitals, as well as those with three of more diagnoses and two or more intrinsic risk factors had an increased probability of having a CUDS, whereas being hospitalized in areas other than intensive care, being male and less than 65 years old were associated with a lower probability of CUDS use. The median prevalence of catheterized patients in hospitals with full implementation, was significantly lower than in those without it (P = 0.049). Although CUDS use is increasing, there is still much work required to reach full implementation. Keeping CUDS for more severely ill patients may reflect a higher concern over the consequences of UTI in these patients. Nevertheless, it is necessary to change a practice that exposes patients to a known UTI risk factor and reach a consensus on indications for catheter insertion.
Asunto(s)
Infección Hospitalaria , Drenaje/instrumentación , Control de Infecciones/métodos , Cateterismo Urinario/instrumentación , Infecciones Urinarias , Adulto , Anciano , Comorbilidad , Consenso , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Drenaje/efectos adversos , Drenaje/estadística & datos numéricos , Diseño de Equipo , Femenino , Tamaño de las Instituciones de Salud/estadística & datos numéricos , Humanos , Control de Infecciones/normas , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prevalencia , Factores de Riesgo , España/epidemiología , Estadísticas no Paramétricas , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/estadística & datos numéricos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & controlRESUMEN
OBJECTIVE: To find out the exposures with biological material in health care workers in primary health care, registered in the biological accidents database from Preventive Medicine Service in Miguel Servet Universitary Hospital of Zaragoza. DESIGN: Descriptive study of a retrospective cohort. SITE: Primary health care, Areas II and V of Zaragoza.Participants. Workers in this areas, distributed by: physician, nursing staff, auxiliary, orderly, housekeeping staff, others. MEASUREMENTS AND MAIN RESULTS: Data of: workers, accident, serologic source, worker protection and vaccinal status of hepatitis B. The incidence of accidents was 26 (period 1997-1999). Most proportion of accidents were declared by nursing (78%). The highest occupational incidence was in auxiliary (63 ). In 90,1% of the cases, the accident was needlestick injury. The source was known in 67,7% of cases. The accidents occurred in hands in 96,8% of cases, and only one third of workers carried gloves. CONCLUSIONS: Results obtained are similar with previous studies about this event. We must insist on the need to declare these accidents, providing more information and accessibility for the declaration to worker. Moreover, we must insist on the correct application in the health care field of the standard precautions, because almost 50% of accidents are evitable, and to increase hepatitis B vaccination covertures.
Asunto(s)
Accidentes de Trabajo/estadística & datos numéricos , Productos Biológicos/efectos adversos , Personal de Salud , Atención Primaria de Salud , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To describe the demographic pattern and tendency of the infections by MRSA between 1992 and 1997. DESIGN AND METHODS: Descriptive study of the infections by MRSA in a tertiary-care hospital. RESULTS: 267 MRSA infections, 131 infections were included within 58 buds and 136 cases isolated form. The more affected services were Internal Medicine, Urology, Neurology, Vascular surgery and intensive care unit. A tendency was observed to the increase in > 65 years cases and in medical services. CONCLUSIONS: The increase of elderly cases in medical services and > 65 years carriers in their nose could translate the existent situation in the community.
Asunto(s)
Hospitales Comunitarios , Meticilina/uso terapéutico , Penicilinas/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Anciano , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal/microbiología , España , Infecciones Estafilocócicas/microbiologíaRESUMEN
OBJECTIVES: The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme. RESULTS: The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%). CONCLUSIONS: High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.
Asunto(s)
Accidentes de Trabajo/economía , Costos de la Atención en Salud , Personal de Salud , Lesiones por Pinchazo de Aguja/economía , Costos y Análisis de Costo , Árboles de Decisión , Humanos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The characteristics of a population based series of 3,066 women diagnosed with breast cancer collected by the Cancer Registry of Zaragoza, Spain from 1960 to 1990 are herein described. Gross short and long term survival, as well as specific survival were estimated according to age at diagnosis, tumor stage and the period in which the patient was diagnosed. METHODS: Every patient was followed up to verification of death or to the latest information available up to January 1, 1991. Diagnosis specified in writing in the clinical history and support by surgical or anatomopathologic reports were required. The data concerning place and site of residence and the vital status of the cases were verified by the municipal and civil registries, death certificates and burial registries. The survival curves were estimated by the Kaplan-Meier method, and short and long term survival, by age and tumor stage at diagnosis and the diagnostic period were also evaluated. RESULTS: Gross survival was estimated as 89.1% in the first year, 50.9% at 5 years, and 34.7%, 28.4% and 20.0% at 10, 15, 20 and 25 years, respectively. Survival at 5 years according to TNM clinical stage classification (UICC-AJC 1978) was 90% for stage I, 69.5% for stage II, 44.6% for stage III and 20.6% for stage IV. The cases diagnosed between 1980 and 1990 presented better survival than those previously diagnosed. The differences were statistically significant in all the cases (p < 0.001, log-rank test). CONCLUSIONS: A slight improvement has been observed in the survival of women diagnosed with breast cancer in Zaragoza, Spain during the study period. Despite of that fact, the survival rates were worse than those observed in other countries with similar socioeconomic development.
Asunto(s)
Neoplasias de la Mama/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , España/epidemiología , Tasa de Supervivencia , Factores de TiempoRESUMEN
The study and follow-up of contacts is one of the main goals of the battle against tuberculosis. We studied 640 contacts of 141 patients diagnosed of active pulmonary tuberculosis (PT) in our center between 1985 and June 1990. The average per index case (IC) was 4.5. Contacts were classified according to the IC bacteriology (positive bacilloscopy and culture: 448 cases; negative bacilloscopy and positive culture: 126 cases; and both tests negative: 66 cases). PPD was positive in 342 cases (53.4%) and the number of infected contacts was significant when IC showed positive bacilloscopy and culture (251 cases), cough (328 cases). Twelve new cases of tuberculosis (1.9%) were detected, with an average age of 29.6 years. Chemoprophylaxis was completed during one-year period by 121 contacts (43.5%). The systematic study of contacts allow us to detect new patients and infected cases, helping to break the epidemiological chain of transmission of the disease.
Asunto(s)
Tuberculosis Pulmonar/transmisión , Adolescente , Adulto , Anciano , Niño , Preescolar , Trazado de Contacto , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Tuberculosis Pulmonar/diagnósticoRESUMEN
423 cases of pulmonary tuberculosis (PT) are described, dividing them into two major groups depending on the presence (Group 1:54 cases) or the absence (Group 2:369 cases) of infection by the Acquired Immunodeficiency Virus, in order to compare their clinical-epidemiological characteristics. 70.37% patients of Group 1 had an age between 15 and 30 years and 72.2% (39 cases) were parenterally drug addicts. In the Group 1, fever, general and digestive symptoms were predominant (p < 0.004, p < 0.01 and p, 0.00001); a miliar profile was observed in 8 cases (14.8%) and the radiology was normal in 7 cases (12.9%), with predominance of condensation semiology and cavitation in Group II (p < 0.003 and p < 0.00001). In addition, we observed extrapulmonary affection in 42.6% cases (23 patients) of Group I (p < 0.0004) and the diagnosis of tuberculosis determined the presence of AIDS in 26 cases (48.1%).
Asunto(s)
Seronegatividad para VIH , Seropositividad para VIH/complicaciones , Tuberculosis Pulmonar/complicaciones , Adolescente , Adulto , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: In this study we introduce a new view of hospital infection, to apply time series techniques to it. Our objective is to complement hospital infection's epidemiological surveillance by means of obtaining alert and alarm thresholds that make easy to the epidemiologist the decision of intervention, in case they are exceeded. METHODS: We have used the classic time series analysis described by Rumeau-Rouquette, and ARIMA (Autoregresive Integrated Moving Average) models developed by Box and Jenkins. The study focus on three hospital units: one intensive care, one long term care and one surgical unit. The nosocomial infection intervals have been calculated with a 68% (1SD) and 95% (2SD) confidence levels. RESULTS: We detect an ascending general trend in the last two units, without the detection of seasonal variations. Two ARIMA (1, 0, 0) models we obtained for surgery and long term care, discarding other better adjusted models, more complex and difficult to obtain, but with no real advantage in prediction power. Confidence intervals were calculated with both methods. We did not find general trend and seasonal variations for intensive care unit. No model was considered valid, because of its high random component. The nosocomial infection intervals have been calculated with mean +/- 1SD and mean +/- 2SD. CONCLUSIONS: We think that more precise knowledge of hospital infection, with a high random component in our study, can be in addition useful to assign priority to human and material resources.
Asunto(s)
Infección Hospitalaria/epidemiología , Análisis de Varianza , Humanos , Incidencia , Modelos Estadísticos , Pronóstico , Estaciones del Año , España/epidemiologíaRESUMEN
Psychosocial factors are analyzed for a group of 44 coronary patients, males under 40 years of age and women under 45. The questionnaires describe a group which is predominantly masculine, with a personality inclined toward developing different pathological symptoms, full of stress and anxiety, having previously experienced vital events, on-the-job stress, gastric pathologies and possessing a very limited capability of dealing with problems. Without possessing the behavioural pattern known as a type "A" personality. The data presented tends to confirm the importance of psychosocial factors among young coronary patients and the possibility and suitability of their being evaluated by the general practitioner.
Asunto(s)
Infarto del Miocardio/psicología , Adulto , Factores de Edad , Enfermedad Coronaria/psicología , Femenino , Humanos , Masculino , Pruebas de Personalidad , Factores de Riesgo , Factores Socioeconómicos , Personalidad Tipo ARESUMEN
246 cases of brucellosis registered by the Medicine Preventive Service of Miguel Servet Hospital for the period 1981-87 are retrospectively studied. It emphasizes the consumption of non controlled dairy products as the most frequent (54.5%) risk factor. A greater prevalence of professional and contact with cattle risk factors are observed in the male patients coming from rural areas.
Asunto(s)
Brucelosis/epidemiología , Enfermedades Profesionales/epidemiología , Adolescente , Adulto , Brucelosis/etiología , Niño , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Estudios Retrospectivos , Factores de Riesgo , EspañaRESUMEN
The present study is based on the analysis of records concerning 2,123 cases of cancer registered between 1973 and 1982 in the Health Sector of Calatayud. We pretend to find out what sort of role is played by the gathered cancer information registries on the Community Health Diagnosis elaboration and, therefore, on the Primary Care Planning. An important loss of cases (23% in men and 13% in women) and a clear influence of socioeconomic factors concerning Epidemiology and even Cancer Care are remarked. Delay times of diagnosis are higher than on the other series: breast (17.4 months), skin (39.9 months), larynx (7.7 months). A preferential care about the improvement of the Sanitary Education of population, their accessibility to Sanitary System and medical praxis of the Primary Care professionals are proposed.