Highlights • Transfer from another hospital, skin problems, having a urinary catheter, and having a central line were the most significant risk factors for health care–associated infections present ...at admission. • Having a central line was the main risk factor for health care–associated infections acquired during hospitalization. • This study represents one of the first in Portugal to estimate the association between factors present at admission and during hospital stay in the development of health care–associated infections. • This study may contribute to the design of an infection risk assessment tool to be applied in the future.
Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care–associated infections. A survey ...and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.
Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8·8% and 55% have been reported. There are few studies focusing on the specific patient‐, surgery‐ and ...care‐related risk indicators in this group. The aims of the study were
•
to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery.
•
to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age ≥71 (P = 0·020), dehydration (P = 0·005), moist skin (P = 0·004) and total Braden score (P = 0·050) as well as subscores for friction (P = 0·020), nutrition (P = 0·020) and sensory perception (P = 0·040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0·005) and pulmonary disease (P = 0·006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.
This cross-sectional study of a sample of patients with wounds of duration > 2 weeks, attempts to characterize patients and type of wounds treated in community services and assess patient's views ...with regard to wounds and care received. 144 health centres were randomly selected so as to be nationally representative.
1424 wounds in 1115 patients aged > or = 18 yrs were assessed. Of these, 57.4% were treated in the clinic and 42.6% at home. There was a predominance of female patients (57.7%) and average age was 69.9 (clinic) and 77.1 (home) years. Over 80% of patients were retired. Leg ulcers were the main type of wound, followed by pressure ulcers. Average wound duration was 7.4 months for pressure ulcers and 19.4 months for leg ulcers. Of 574 clinic patients a significant number complained of discomfort and pain but over 90% were satisfied with care received.
Patient population was characterized as elderly, low income and suffering from chronic underlying disease. Expectations regarding healing are low. An education/ intervention project has been started to promote evidence-based practice.
Of all the complications which can interfere with healing, infection is among those which have a greater impact not only on the wound but also on the patient's quality of life and on the costs of ...care. The author addresses the microbiology of leg ulcers, the problem of the qualitative versus quantitative analysis and the continuing debate regarding the indication for sampling wounds, methods and interpretation of the results in the microbiological diagnosis of wound infection.
Leg ulceration in Portugal: quality of life Furtado, Katia; Pina, Elaine; Moffatt, Christine J ...
International wound journal,
March 2008, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This study was undertaken to examine the impact of chronic leg ulceration on patients’ health‐related quality of life in an audit of practice in Lisbon, Portugal, and to observe the changes following ...12 weeks of treatment. A questionnaire was administered at entry into an observational study and following 12 weeks of treatment. Patients entering the study were asked to complete the Nottingham Health Profile (NHP), Euroqol and visual analogue (VA) pain questionnaires at entry and after 12 weeks. Principal analysis compared final scores with those found at baseline and compared results with Portuguese normative data. In total, 98 patients entered the study and completed the initial questionnaire, with 68 (69·3%) patients completing the follow‐up questionnaire. There were significantly (P < 0·001) higher scores for the patients compared with normative data for all domains of the NHP (all P < 0·001). Improvements were noted for all NHP scores after 12 weeks, although only bodily pain showed a significant improvement mean difference (d) = 10·5, P = 0·003, with significant improvement also in Euroqol (d = 0·10, P = 0·027). Energy and social isolation improved substantially in the eight (11·8%) patients whose ulcers healed, but did not achieve statistical significance, although VA pain score did (d = 4·85, P < 0·001). Patients suffering from leg ulceration show modest improvements in perceived health following 12 weeks of usual care in Portugal. Improvements in practice may enhance the magnitude of these improvements.
Viral infection has been the main epidemiologic concern in the hemodialysis unit; however, bacterial infection is responsible for more than 30% of all causes of morbidity and mortality in our ...patients, vascular access infection being the culprit in 73% of all bacteremias.
A prospective multicenter cohort study of bacterial infections incidence, conducted from January to July 2004 in five hemodialysis units, to record and track bacterial infections, using a validated database from CDC's Dialysis Surveillance Network Program.
4,501 patient-months (P-M) were surveilled, being dialyzed through a native fistula (AVF) in 60.6%, a graft (PTFE) in 31.3%, a tunneled catheter (TC) in 7.6%, and a transient catheter (C) in 0.5%. As target events, we registered 166 hospitalizations - 3.7/100 P-M (2.2/100 P-M in patients with AVF, 4 in PTFE, 9.9 in TC, and 19 in C), and 182 intravenous antibiotic courses. Of these 182 antibiotic treatments, 47.8% included vancomycin, only 30% had blood cultures drawn pretreatment, and only 36% were positive. We recorded 98 infections at the vascular access site 2.18/100 P-M (0.95 in AVF, 1.6 in PTFE, 12.6 in TC, and 42.85 in C) and 2.13 infections/100 P-M at other sites. The isolated microorganisms were Staphylococcus epidermidis in 40.1%, Staphylococcus aureus in 30.1%, Pseudomonas in 13.3%, and Escherichia coli in 3.3%. Although we found a diversity of practice patterns, the number of target events (8.4/100 P-M) and the bacterial infections incidence (4.31/100 P-M) were remarkably homogeneous in the five centers.
(1) High incidence of bacterial infections, causing major morbidity; (2) infectious risk is vascular access type-dependent, with dramatic rise in catheters; (3) underutilization of blood cultures to orient diagnosis and therapy, and (4) high rates of vancomycin prescription.
O principal objetivo deste trabalho é analisar as opções políticas adotadas pelo governo Cabo-verdiano desde a independência até o ano 2010 e perceber se estas foram suficientemente eficazes para ...minimizar os efeitos da insularidade no país. Como podemos verificar ao longo da sua história, Cabo Verde sempre almejou converter as suas fraquezas em fontes de forças e dinamismo, mas isso não se verificou em todas as opções políticas do governo. Com advento da II República, e a queda do regime monopartidário, foi redesenhada uma nova arquitetura política, no qual trouxe consigo transformações institucionais importantes que possibilitaram o país alcançar resultados positivos no seu desenvolvimento económico. Porém, essas transformações institucionais e estruturais na economia Cabo-verdiana foram acompanhados igualmente de alguns riscos. Referimos aqui aos efeitos da crise da zona Euro, e ao possível esgotamento de alguns dos fluxos de financiamento interno, que poderão ou não ter consequências diretas para a economia. Estamos convencidos que uma das formas para ultrapassar tais efeitos é responder com estratégias políticas proactivas e flexíveis, tendo como exemplo a especialização setorial competitiva dentro do mundo global. Só assim o país é capaz de minorar estas consequências e dar seguimento ao projeto de desenvolvimento e crescimento económico. Aposta no setor do turismo de modo integrado, sustentável e de qualidade parece ser uma das alternativas, assim como a opção pela integração cuidada e não plena no espaço da CEDEAO.
Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8.8% and 55% have been reported. There are few studies focusing on the specific patient-, surgery- and ...care-related risk indicators in this group. The aims of the study were: - to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery, - to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age >or=71 (P = 0.020), dehydration (P = 0.005), moist skin (P = 0.004) and total Braden score (P = 0.050) as well as subscores for friction (P = 0.020), nutrition (P = 0.020) and sensory perception (P = 0.040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0.005) and pulmonary disease (P = 0.006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.
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