Profilaxis con antimicrobianos en cirugía

Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey

In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group's hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.

[Effect of surveillance on surgical site infection rate in knee and hip arthroplasty]

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 time periods 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 them adherence to recommendations was reinforced.

MAIN 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, the NNIS index-risk 2 being more frequent in period A (16.8%) than in 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 (COPD) (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 most patient safety. Therefore, such a surveillance program for orthopedic surgery department seems to be beneficial.

Efecto de la vigilancia sobre la tasa de infección de la herida quirúrgica en prótesis de cadera y rodilla

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.

[Quality improvement program of nosocomial infection in colorectal cancer surgery]

BACKGROUND AND OBJECTIVE

The surgical-site infection (SSI) is a complication of colorectal neoplasia surgery. The objectives of the study were to identify the SSI risk factors associated with colon surgery and to describe a strategy of quality improvement using surgical-site rates.

PATIENTS AND METHOD

Prospective cohort study of in-patients undergoing neoplasia colorectal surgery between 1st July 2002 to 30th June 2003. A descriptive analysis was implemented. Benchmarking was used as tool of quality improvement, and the outcomes were measured using the standardized infection ratio (SIR). To define the risk factors, the Chi square test and logistic regression test were used in univariate and multivariate analysis, respectively.

RESULTS

148 patients were included in the study. The SSI accumulative incidence rate (IA) was 10.14%, and the incidence rate was 6.47 SSI per 1000 days. The SIR was 1.53 the first semester and 1.02 the second one. The multivariate analysis identified two risk factors associated with SSI: unscheduled admission (odds ratio [OR] = 7.47, 95% confidence interval [CI] 2.03-27.48) and a risk index of American Society of Anaesthesiologists (ASA) > or = 3 (OR = 6.77, IC 95%, 1.15-39.84).

CONCLUSIONS

An unscheduled admission and high risk ASA index were risk factors associated with SSI in patients undergoing colorectal surgery. The program of quality improvement based on benchmark achieved a reduction of SSI rates similar to the standard ones.