RESUMEN
BACKGROUND: Environmental surfaces are a potential vehicle for the transmission of norovirus outbreaks in closed and semi-closed settings. Testing of environmental samples may help control outbreaks. AIM: To assess the level of environmental contamination by norovirus in acute gastroenteritis outbreaks in closed or semi-closed settings (nursing homes, schools, kindergartens, youth accommodations, hospitals and social health centres) in the Barcelona region between January 2017 and March 2019. METHODS: A prospective surveillance study was carried out. Environmental samples (529) were collected in 46 of the 50 outbreaks of acute norovirus gastroenteritis from environmental surfaces of common areas, bathrooms and kitchens in closed and semi-closed settings when the outbreak was notified and 10 days later. Instructions for taking environmental samples were distributed to public health inspectors. Norovirus was detected by reverse transcription polymerase chain reaction. FINDINGS: Environmental samples were positive for norovirus in 31 (67.4%) outbreaks. Norovirus was most frequently detected on elevator buttons (4/17, 24%), toilet handles (16/66, 24%) and handrail bars (7/34, 21%). Positive samples from the first sampling were mainly found in bathrooms and greater viral persistence in the second sampling was found on elevator buttons and TV remote controls. Nursing homes were the setting with the most types of environmental surfaces contaminated (82% in first samples and 55% in second samples). CONCLUSION: The probability of virus detection is independent of the time between notification of the outbreak or symptom onset and sample collection. Our results suggest possible defects in cleaning protocols and disinfection in closed and semi-closed settings.
Asunto(s)
Brotes de Enfermedades/prevención & control , Monitoreo del Ambiente , Contaminación de Equipos/estadística & datos numéricos , Heces/virología , Norovirus/aislamiento & purificación , Infecciones por Caliciviridae/transmisión , Contaminación de Equipos/prevención & control , Gastroenteritis/epidemiología , Gastroenteritis/virología , Hospitales , Humanos , Norovirus/genética , Casas de Salud , Estudios Prospectivos , Instituciones Académicas , España/epidemiologíaRESUMEN
En septiembre de 2006 se puso en funcionamiento en nuestro centro una nueva área de atención quirúrgica, integrada en el propio complejo hospitalario. Es una nueva estructuración de los espacios quirúrgicos que forma parte de la estrategia de la organización en su tarea de mejora continua en la atención al paciente. Se trata de un área de Cirugía Mayor Ambulatoria denominada Unidad de Cirugía sin Ingreso, y su gestión se ha estructurado en base a la gestión por procesos. Describiremos en este trabajo la metodología empleada para poner en marcha esta unidad y los pasos necesarios para el control de la mejora continua. Creemos que el desarrollo metodológico del subproceso de Unidad de Cirugía sin Ingreso ha sido muy satisfactorio, tanto en cuanto a la metodología aplicada, como por la experiencia del trabajo en equipo (AU)
In September 2006 our center started a new surgical care area, integrated in the hospital premises. As a new structuration of the surgical spaces, it is a part of the organizations strategy towards continuous improvement in patient care. It is a Major Ambulatory Surgery area known as Outpatient Surgery Unit, and its being managed under the methodology of process management. This paper describes the methodology used to set up this unit, and the necessary steps for monitoring continuous improvement. We believe that the methodological development of the Outpatient Surgery Unit subprocess has been very satisfactory, regarding both the applied methodology and the experience of teamwork (AU)