UNIVERSITAT DE BARCELONA APLICACIÓN DEL
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1. 13 14 15 16 BACTERIEMIAS NOMBRE N MICRO SERVICIO Hemocultivo SERVICIO Ingreso FECHA RECEPCION HEMOCULTIVO FECHA POSITIVIDAD HEMOCULTIVO INTERVALO POSITIVIDAD HEMOS POSITIVOS HEMOS PRACTICADOS GRAM AISLAMIENTO AISLAMIENTO2 AISLAMIENTO3 TIPO BACTERIEMIA OTROS CULTIVOS ANEXO 3 HOJA DE RECOGIDA DE DATOS DE LAS 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 4 32 33 34 35 BACTERIEMIAS Cont EDAD SEXO ORIGEN INFECCION DIAS DE INGRESO DIAS POSTCIRUGIA ENFERMEDAD DE BASE DIAGNOSTICO CIRUGIA FIEBRE SONDA SHOCK GRANULOPENIA METASTASIS CORTICOIDES PRONOSTICO ATB PREVIO ATB DURANTE ATB EMPIRICO ATB DEFINITIVO ANEXO 3 36 37 38 39 40 41 42 43 45 HOJA DE RECOGIDA DE DATOS DE LAS BACTERIEMIAS Cont FOCO PERFUSION DIAS CAT FLEBITIS TIPO CATETER TIPO FOCO EXITUS EVOLUCION BACTERIEMIA PRIMARIA COMENTARIOS 043 124 Vil Q2. 107 113 264 APLICACI N DEL PROTOCOLO DE ADECUACI N HOSPITALARIA 114 Schaberg D Culver D Gaynes R Major Trends in the Microbial Etiology of Nosocomial Infection Am J Med 1991 91 3B 72S 75S 115 Eykin S Sepsis Stafiloc cica Lancet Ed Esp 1988 12 48 55 116 Smith IM Vickers AB Natural history of 338 treated and untreated patients with Staphylococcal septicaemia 1936 1955 Lancet 1960 1 1318 1322 117 Jessen O Rosendal K B low P Faber V Eriksen KR Changing Staphylococci and Staphylococcal infections A ten year study of bacteria and cases of bacteremia N Engl J Med 1969 281 627 635 118 Peacock JE Jr Marsik FJ Wenzel RP Methicillin resistant Staphylococcus aureus introduction and sread within a hospital Ann Intern Med 1980 93 526 532 119 Goldman DA Epidemiology of Staphylococcus aureus and group A Streptococci In Bennet JV Brachman PS Hospital Infection Little Brown and Company Third Edition Boston 1992 BIBLIOGRAFIA 265 120 Wheat LJ Kohler RB White A Treatment of nasal carriage of coagulase positive Staphylococci In Maibach HI Aly R eds Skin Microbiology relevance to clinical infection New York Springer 1981 pp 50 58 121 Hanifin JM Rogge JL Staphylococcal infections in patients with atopic dermatitis Arch Dermatol 1977 113 1383 1386 122 Tuazon CU P rez A Kishaba T Sheagren JN Staphylococcus aureus among insulin injecting diab
3. Johnson A Oppenheim BA Vascular catheter related sepsis diagnosis and prevention J Hosp Infec 1992 20 67 78 88 Knudsen AM Roshdal VT Espersen F Fridmodt Moller N Skinhoj P Bentzon MW Catheter related Staphylococcus aureus infections J Hosp Infect 1993 23 123 131 89 Martinez JA Gatell JM Montoliu J Lens XM Cases A L pez Pedret J Revert L Estudio prospectivo de 75 episodios de sepsis en pacientes hemodializados Med Clin Barc 1989 92 47 51 260 APLICACI N DEL PROTOCOLO DE ADECUACI N HOSPITALARIA 90 Mayo JW Wenzel RP Rates of hospital acquired bloddstream infections in patients with specicfic malignancy Cancer 1982 50 187 190 91 McGowan JE Parrot PL Duty VP Nosocomial bacteremia potential for prevention of procedure related cases JAMA 1977 237 2727 2730 92 Mermel L McCormick R Springman S Maki D The Pathogenesis and Epidemiology of catheter related infection withpulmonary artery Swan Ganz Catheters A prospective study utilizing molecular subtyping Am J Med 1991 91 3B 197S 205S 93 Serrano Heranz R Mensa J Almela M Cruceta A Moreno A Marco F et al Bacteriemia por Staphylococcus aureus relacionada con cat teres intravenosos Enf Infec y Microbiol Clin 1992 10 Suppl 3 51 54 94 Smyth CG Keane NA Lane BE Cunney RJ McNamara EB Al Ansari NA Vascular catheter related sepsis diagnosis and prevention Letter J Hosp Infect 1992 22 81 95
4. Am J Med 1991 91 3B 8S 15S 322 McGowan J New laboratory techniques for Hospital Infection Control Am J Med 1991 91 3B 245S 251S VIII ANEXOS ANEXO 1 PROTOCOLO DE ADECUACION DEL INGRESO A CONDICIONES DEL PACIENTE 1 P rdida brusca de Consciencia o Desorientaci n 2 Frecuencia cardiaca lt 50 o gt 140 1 p m 3 Presi n Arterial Sist lica lt 90 o gt 200 mm Hg Presi n Arterial Diast lica lt 60 o gt 120 mm Hg 4 P rdida brusca de visi n o audici n 5 P rdida brusca de la movilidad corporal 6 Fiebre persistente gt 38 5 C durante m s de 5 d as 7 Hemorragia activa 8 Alteraciones electrol ticas o gaseosas severas 8 1 Na lt 123 mEq o gt 156 mEq I 8 2 K gt 2 5 mEq o gt 6 mEg l 8 3 pCO lt 20 mEq o gt 36 mEq l 8 4 pH arterial gt 7 30 o gt 7 45 9 ECG con Isquemia aguda 10 Evisceraci n o deshiscencia de suturas ANEXO 1 PROTOCOLO DE ADECUACION DEL INGRESO B SERVICIOS ASISTENCIALES 11 Medicaci n intravenosa y o reposici n de fluidos no se incluye la alimentaci n por sonda 12 Cirugia o T cnica especial en 24 horas que requiera Anestesia general o local Equipamiento o medios disponibles unicamente en r gimen de ingreso 13 Monitorizaci n de signos vitales cada 2 horas 14 Quimioterapia que requiera observaci n continua Reacciones t xicas detectables 15 Antibi ticos im cada 8 horas 16 Ventilaci n as
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8. 61 67 251 Hern ndez I Porta M Miralles M Garcia F Bol mar F La cuantificaci n de la variabilidad en las observaciones cl nica Med Clin Barc 1990 95 424 429 252 Argim n JM Jim nez J M todos de investigaci n aplicados a la atenci n primaria de salud Medici n de variables Fiabilidad Ed Doyma Barcelona 1991 111 116 253 Sackett DL Haynes RB Togwell P Epidemiologia clinica Una ciencia para la medicina cl nica Ed Diaz de Santos S A Madrid 1989 37 254 Fleiss JL Statistical Methods for rates and proportions Ed John Wiley amp sons New York 1981 212 225 255 Colton T Estadistica en Medicina Correlaci n Ed Salvat Barcelona 1990 pp 216 288 APLICACI N DEL PROTOCOLO DE ADECUACI N HOSPITALARIA 256 Departament de Sanitat i seguretat Social Ordre de 20 d Octubre de 1989 per la qual es fixen els valors de les Unitats b siques de pagament i de la Tarifa intermedia per l any 1989 DOGC 1741 de Novembre de 1989 pp 1475 1476 257 Departament de Sanitat i Seguretat Social Ordre de 8 de juny de 1990 per la qual s estableixen els valors de les Unitats b siques de pagament per la contraprestraci del centres d assist ncia hospital ria per l any 1990 DOGC de 13 de Juny de 1990 258 Departament de Sanitat i Seguretat Social Ordre de 4 d Abril de 1991 per la qual s estableixen els valors de les Unitats b siques de pagament per la contraprestaci dels centre
9. Am J Med 1991 91 3B 179S 184S 160 Kappstein I Daschner FD Potential inroads to reducing hospital acquired Staphylococcal infection and its cost J Hosp Infect 1991 19 Suppl B 31 34 161 Goldmann DA The role of barrier precautions in infection control J Hosp Infect 1991 18 Sup A 515 523 162 Rao N Jacobs S Joyce L Cost effective erradication of an ouutbreak of methicillin resistant Staphylococcus aureus in a community teaching hospital Infect Control Hosp Epidemiol 1988 9 255 260 163 Trilla A Marco F Moreno A Prat A Soriano E Jim nez de Anta MT et al Epidemiolog a cl nica de un brote de infecci n nosocomial por Staphylococcus aureus resitente a meticilina y aminogluc sidos eficacia de las medidas de control Med Clin Barc 1993 100 205 209 BIBLIOGRAFIA 213 164 Schwartz WB Mendelson DN Hospital cost containment in the 1980 N Engl J Med 1991 324 15 1037 1042 165 Hernanz C Ordofiez A El precio de la salud Med Clin Barc 1991 97 99 103 166 Wenzel R Pfaller M Feasible and desirable future targets for reducing the costs of hospital infections J Hosp Infect 1991 18 Sup A 94 98 167 Drummond MF Davies LM Evaluation of the costs and benefits of reducing hospital infection J Hosp Infect 1991 18 Sup A 85 93 168 Glenister H Taylor L Bartlett C Cooke M Sedgwick J Leigh D An assessment of selective surveillance methods for detecting hospital acqui
10. Lancet 1959 1 213 217 104 Williams GT Shaw EJ Hovang ET Tabagchali S Bacteriemia in a London Teaching Hospital 1966 1975 Lancet 1976 2 1292 1293 105 Martin M Pfaller M Wenzel R Coagulase Negative Staphylococcal Bacteremia Mortality and HospitalStay Ann Intern Med 1989 110 9 16 106 Ponce de Leon S Wenzel R Hospital acquired bloodstream infection with Staphylococcus epidermidis Review of 100 cases Am J Med 1984 77 639 644 107 Waldovogel FA Sraphylococcus aureus En Mandell GL Douglas RG BIBLIOGRAFIA 263 Bennet JE Enfermedades Infecciosas Vol II Ed Panamericana 1991 108 National Nosocomial Infection Study United States 1975 1976 MMWR 1977 26 371 318 109 Sheagren JN Staphylococcus aureus The persistent pathogen Second of Two Parts N Engl J Med 1984 310 22 1437 1442 110 Sheagren JN Staphylococcus aureus The persistent pathogen First of Two Parts N Engl J Med 1984 310 1368 1373 111 CDC Nosocomial Infection Surveillance 1984 CDC Surveillance Summary MMWR 1986 35 19 29 112 Espersen F Frimodt Moller N Thamdrup Rosdhal V Skinhoj P Bentzon MW Changing pattern of bone and joint infections due to Staphylococcus aureus study of cases of bacteriemia in Denmark 1959 1988 Rev Infect Dis 1991 13 3 347 358 113 Neu HC Fracaro M Bopp H O Keefe M O Connor J Bacteraemia a New York perception J Antimicrob Chemoter 1990 25 Suppl C
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13. durante al menos cuatro horas Inyecciones intramusculares o subcutanias al menos dos veces al dia Medida de las alteraciones electrol ticas Drenajes y heridas de cirugia major tubos toracicos T tubos hemovacs Penrose que requieran curas Monitoritzaci n por parte de la enfermera al menos 3 veces al dia bajo las ordenes del medico ANEXO 2 PROTOCOLO DE EVALUACION DE ADECUACION DE LOS DIAS DE ESTANCIA Cont C CONDICIONES DEL PACIENTE 1 2 Durante las 24 horas del mismo dia o el dia anterior a la revisi n imposibilidad de vaciar o mover los intestinos no atribuible a alteraciones neurologicas Durante las 48 horas del mismo dia o anteriores al dia de la revisi n a Transfusi n debida a una perdida de sangre b Fibrilaci n ventricular o evidencia ECG de isquemia aguda c Temperatura rectal de 38 5 C si el pacient ha sido admitidos por otra raz n que no sea la fiebre d Coma o p rdida de conocimiento durante al menos una hora e Estado confusional agudo no debido a abstinencia alcoholica f Alteraciones hematol gicas neutropenia importante anemia trombocitopenia leucocitosis eritrocitosis trombocitosis que den signos o s ntomas Alteraciones neurologicas agudas y progresivas 3 En los 14 dias antes del dia de la revisi n Episodio documentado de un nuevo infarto de miocardio o un accidente cerebrovascular ANEXO 3 HOJA DE RECOGIDA DE DATOS DE LAS 10 11 12
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23. istida continua o intermitente cada 8 horas ANEXO 2 PROTOCOLO DE EVALUACION DE ADECUACION DE LOS DIAS DE ESTANCIA A SERVICIOS MEDICOS 10 11 Intervenci n quir rgica el mismo dia Intervenci n quir rgica programada para dia siguiente y que requiere una evaluaci n preoperat ria Cateteritzaci n card aca el mismo dia Angiografia el mismo dia Bi psia interna el mismo dia Toracocentesis o paracentesis el mismo dia Procedimientos diagn sticos invasivos del sistema nervioso central el mismo dia Tests que requieran un control dietetico estricto mientras dure de la dieta Tratamientos nuevos o experimentales que requieran un control estricto y ajustes de dosis bajo supervisi n m dica Monitoritzaci n por parte del m dico al menos 3 veces al dia las observaciones tienen que estar anotadas en la historia Dia postoperatorio despu s de hacer uno de los procedimientos de los puntos 1 03a 7 ANEXO 2 PROTOCOLO DE EVALUACION DE ADECUACION DE LOS DIAS DE ESTANCIA Cont B SERVICIOS DE ENFERMERIA Atenciones respiratorias uso del respirador de forma continua o intermitente y o terapia inhalatoria fisioterapia respiratoria presi n respiratoria positiva al menos tres veces al dia Terapia parenteral uso intermitente o continuo de liquidos intravenosos con alguna reposici n electrolitos proteinas medicaci n Monitoritzaci n continua de los signos vitales al menos cada 30 minutos
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