Original article
Incidence of nosocomial infection in open prostate surgery
Incidencia de infección nosocomial en cirugía abierta de próstata
C. Díaz-Ageroa,
, M.J. Pita-Lópeza, A. Robustillo-Rodelaa, G. Rodríguez-Caravacab, B. Martínez-Mondéjarc, V. Monge-Jodraa
Corresponding author
a Servicio de Medicina Preventiva, Hospital Universitario Ramón y Cajal, Madrid, España, Spain
b Servicio de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España, Spain
c Servicio de Medicina Preventiva, Hospital Universitario Severo Ochoa, Leganés, Madrid, España, Spain
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"apellidos" => "Rodríguez-Caravaca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "B." "apellidos" => "Martínez-Mondéjar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "V." "apellidos" => "Monge-Jodra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Preventiva, Hospital Universitario Ramón y Cajal, Madrid, España, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Preventiva, Hospital Universitario Severo Ochoa, Leganés, Madrid, España, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de infección nosocomial en cirugía abierta de próstata" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infections related to health care are a side effect and major cause of mortality and morbidity among patients. Of them, one of the most common is surgical site infection (SSI). Patients who develop SSIs are 60% more likely to enter an Intensive Care Unit (ICU), five times more than those who are re-admitted into hospital and twice as likely to die than patients without SSI.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Furthermore, the development of an SSI prolongs hospitalization, increases costs significantly and is a major health and emotional cost to patients and their families.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is believed that a third or more of the infections could be prevented in many hospitals.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Many of the preventive measures are inexpensive and generally, they are less expensive than the cost of caring for an infected patient.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The first system of ongoing prospective surveillance of hospital infections, the National Nosocomial Infection Surveillance System (NNIS) was established in the U.S. in the 70s, proving its cost-effectiveness.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In 1997, <span class="elsevierStyleItalic">VICONOS</span>, the Continuous Surveillance of Hospital Infection Programme, was implemented in Spain, which later changed its name to <span class="elsevierStyleItalic">INCLIMECC</span> (Indicators of Continuous Quality Improvement).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Currently many agencies such as the World Health Organization (WHO), in its Alliance for Patient Safety, or Quality Plan of the National Health System, focus their efforts on reducing hospital infections, with a strong emphasis on SSI.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Between 1 January and 31 December 2009, a study was conducted on hospital infection surveillance focused on SSI in 14 public hospitals of the Autonomous Region of Madrid, with the aim of measuring the rates of SSI and assessing the correct application of preoperative preparation and preoperative antibiotic prophylaxis protocols established at the hospitals and services under surveillance.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This article describes the data obtained in the three participating hospitals that performed the procedure for monitoring open prostate surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a prospective observational study including all patients undergoing open prostate surgery who were hospitalized ≥48<span class="elsevierStyleHsp" style=""></span>h from 1 January to 31 December 2009 in participating hospitals. They were monitored from admission to discharge. Surveillance of possible readmissions due to infection continued until 31 January 2010. The study included three acute hospitals of the Autonomous Region of Madrid. The hospitals that provided data on the surgery were the Ramón y Cajal University Hospital (1090 beds), the Fundación Alcorcón University Hospital (448 beds) and the Severo Ochoa de Leganés University Hospital (412 beds).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Data were collected by nursing staff belonging to the Preventive Medicine Services, specifically trained to this end, supervised and validated by medical specialists in preventive medicine. Information was taken from the medical records, nursing notes, clinical records, diagnostic techniques and microbiological results and direct contact with the medical and health team of the areas under surveillance.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A format predesigned by the <span class="elsevierStyleItalic">INCLIMECC</span> surveillance program was used for data collection, which includes demographic variables, intrinsic and extrinsic risk factors, surgical interventions according to the International Classification of Diseases 9th Clinical Modification Revision (ICD-9-CM), ASA risk, type of surgery (emergency or scheduled), antibiotic prophylaxis, degree of contamination of the surgery, preoperative preparation and infections diagnosed.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Preoperative antibiotic prophylaxis is classified as adequate or inadequate according to each center's antimicrobial policy, established by Hospital and Antimicrobial Infection committees. Participating hospitals recommended a single intravenous dose of 2<span class="elsevierStyleHsp" style=""></span>g of cefazolin or amoxicillin clavulanate administered in the hour before surgery. In the case of allergies, the use of ciprofloxacin (200<span class="elsevierStyleHsp" style=""></span>mg), levofloxacin (500<span class="elsevierStyleHsp" style=""></span>mg) or vancomycin (1<span class="elsevierStyleHsp" style=""></span>g) was recommended. We considered the prophylaxis of choice to be inadequate when the antimicrobial used was not recommended in the center's guidelines; inadequate for initiation when administered over 60<span class="elsevierStyleHsp" style=""></span>min before surgery, or thereafter, and inadequate duration when it extended beyond 24<span class="elsevierStyleHsp" style=""></span>h after surgery.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Preoperative preparation was described as “correct” if all the steps of the protocol in force at each hospital were complied with, “incorrect” if it they were not fully complied with (e.g., not washing with antiseptic soap, rinsing with antiseptic, or shaving the skin with a razor, etc.); “not prepared” if no steps had been taken, and if no information was provided in the medical record or if the surgical report stated “no record.” The definition criteria for SSI were established by the Centers for Disease Control and Prevention (CDC).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">To calculate hospital stay and demographic variables, a descriptive statistical analysis was performed with calculation of central trend measurements (mean and median) and dispersion measurements for continuous variables; and in the case of categorical variables, frequency distribution was calculated. To determine the frequency of nosocomial infection cumulative incidence was calculated. Comparison of hospital stay between patients with and without infection was done using the nonparametric Mann–Whitney test.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Calculations were performed using SPSS 15.0 software.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">325 patients were included in the study, in which 330 surgical interventions were performed, as 4 patients were reoperated due to postoperative bleeding (one of them on two occasions). 100% of the interventions were programmed and reoperations were urgent. 3.08% of the patients were classified as ASA 1 risk, 73.54% as ASA 2 and 23.28% as ASA 3. The surgical interventions performed are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 67.06 years (±7.74) and mortality was 0%.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Of the patients operated, 11 developed a nosocomial infection of some type (3.38%). In total, 12 nosocomial infections were recorded: nine SSI, three urinary tract infections (UTI) and one case of postoperative pneumonia. Moreover, one patient developed a UTI that presented secondary bacteraemia.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The overall rate of SSI observed was 2.77% (9 infected patients), four with superficial infections (1.23%), one serious infection (0.31%) and four organ/space infections (1.23%).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The three UTIs were caused by different microorganisms, <span class="elsevierStyleItalic">P. aeruginosa</span> (also the cause of secondary bacteraemia), <span class="elsevierStyleItalic">E. faecium</span> and <span class="elsevierStyleItalic">Staphylococcus</span> sp. Samples were not taken from the patient with pneumonia. The most common microorganism isolated in the SSI cultures was <span class="elsevierStyleItalic">E. coli</span> in 55.6%, followed by <span class="elsevierStyleItalic">E. faecalis</span> (22.2%). The rest of the microorganisms isolated were <span class="elsevierStyleItalic">Acinetobacter iwofii</span>, <span class="elsevierStyleItalic">E. cloacae</span>, <span class="elsevierStyleItalic">P. aeruginosa</span>, <span class="elsevierStyleItalic">S. epidermidis</span>, <span class="elsevierStyleItalic">S. aureus</span>, <span class="elsevierStyleItalic">S. aureus</span> resistant to methicillin (MRSA) and <span class="elsevierStyleItalic">Streptococcus</span> spp., each in 11.1% of the crop. In three of the SSI cultures (33%) more than one organism was isolated (a superficial SSI, a deep SSI and organ/space SSI).</p><p id="par0075" class="elsevierStylePara elsevierViewall">0.62% (2) of the patients received no prophylaxis although it was indicated. The percentage of appropriate surgical prophylaxis both when indicated and as the antibiotic of choice, initiation and duration, for all patients who received it, was 47.42%. The main cause of inappropriate antibiotic prophylaxis was its election (55.4% of inappropriate prophylaxis were due to the choice of antimicrobial, 40.6% due to duration and 4% due to initiation). Antibiotic prophylaxis was maintained for an average of 2.2 days. The antimicrobials used as prophylaxis are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">According to the data obtained from medical records, the percentage of correctly prepared patients was 92%. 1.4% was not prepared for surgery, 2% were incorrectly prepared and in 4.6% of the cases, the preparations implemented were not mentioned in the clinical record.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Average hospital stay was 9.6 days (±8.01), with a median of 8 days (interquartile range [IR]: 6–10). Patients who developed SSI had an average stay of 24.73 days (±17.27), with a median of 17 days (IR: 9.5–46.5) compared with an average stay of 9.09 days (±6.97) and a median of 8 days (IR: 6–10) of uninfected patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The existence of a infection control program is a key part of healthcare and is a reflection of the standard of care provided at a center; moreover, SSIs prolong hospital stay, so any measure that helps to reduce their incidence will also decrease the mean hospital stay and therefore related costs.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study, the incidence of SSI was 2.77%, with an overall hospital infection rate of 3.38%. The bibliography contains highly variable SSI rates in urological surgery, from 0.3% to 33%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–16</span></a> In the studies conducted in Japan,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–11</span></a> the rates of infection generally found were higher than those of studies conducted in Europe or the U.S.,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–17</span></a> also generally with a higher number of surgical interventions, in which the SSI ranged from 0.3 to 3.2%, which is closer to ours.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In a study conducted at the Marqués de Valdecilla hospital in Santander between 2002 and 2005, also with patients that underwent open prostate surgery and with a similar methodology,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> SSI found was 4.36%, ranging from 2.06% in 2004 and 7% in 2003. With respect to the overall rate of hospital infection, the figures ranged from 6.62% in 2002 and 5.59% in 2004, with an average of 6.1%, slightly higher than what we found.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In retropubic prostatectomies, our rate (4.41%) did not differ from that found in other studies conducted outside Spain, which described rates of between 0.3 and 7.5%.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–13,15,16,19</span></a> This also occurred in the case of radical prostatectomy, with an SSI of 1.86% in the literature ranging from 1.6 to 2.3%.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10,14,15</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Despite being the most frequent infection related to the surgical wound, SSI has a lower rate than in other studies, 0.92%. For example, in the study conducted in Santander, the rate of SSI in urological surgery ranged from 2.75% to 4.07%, with a mean of 3.42%.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The microorganisms most frequently isolated in SSIs were Gram-negative (<span class="elsevierStyleItalic">E. coli</span> and <span class="elsevierStyleItalic">E. faecalis</span>), as in most of the studies, except those conducted in Japan, where MRSA was the most common organism (11% in our study).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,11</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Antibiotic prophylaxis is a proven effective measure to reduce the frequency of postoperative bacterial infections.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Controlling the application of the prophylaxis is just as important as controlling its non-administration when it is indicated and errors in its use, which may result from incorrect choice (indication of the antibiotic administered), from the moment of administration and duration. The appropriate surgical prophylaxis, particularly its administration in the 60<span class="elsevierStyleHsp" style=""></span>min prior to the surgical incision, is one of the objectives proposed by different organizations, such as the WHO in its initiative, “Safe Surgery Saves Lives”, within the framework of its “World Alliance for Patient Safety.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In our study 0.62% of patients in whom antibiotic prophylaxis was indicated, did not receive it, a figure very similar to the 0.14% of the Ballestero Diego et al. study on the adequacy of antibiotic prophylaxis in Urology; however, our rate of adequacy of prophylaxis was far lower (47.42% vs. 83.16%).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In the case of inadequate prophylaxis, the most common reason for it is the incorrect choice of antimicrobial, although all centers have established recommendation protocols. This is followed by extended prophylaxis, lasting a mean of 2.2 days. Numerous studies have been carried out in urological surgery, comparing short antimicrobial prophylaxis guidelines to those of prophylaxes lasting several days; no advantage was found in their extension and the European Association of Urology recommends a single preoperative dose of prophylaxis in clean-contaminated surgery.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23–26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Preoperative preparation of the patient comprises a set of measures that are routinely practiced following the protocols established in the rules of each hospital. The different measures include the patient showering or bathing with antiseptic soap, as well as preparing the patient's skin with antiseptic solution to reduce the number of resident and transient bacteria to a minimum, thus reducing the risk of wound contamination and infection. It is comparable to the surgical team washing its hands. 92% of the patients studied had adequate preparation; this figure could be higher in 4.6% of the cases, as the patient's preparation was not mentioned in the clinical record. Most studies published focus on antibiotic prophylaxis, whereas little research has been carried out on compliance with preoperative patient preparation protocols.</p><p id="par0135" class="elsevierStylePara elsevierViewall">One limitation of this study is the absence of active post-discharge surveillance, as it was not feasible to use a uniform method at all the centers due to their characteristics. We believe that using a different methodology at each participating hospital, tailored to its particular characteristics and those of its health area would provide very different and difficult to collect data, especially if the patient's subjective opinion is taken into account, which has proven not to be too reliable.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a> Because of this, and for the lack of a robust and standardized post-discharge surveillance method, we decided not to carry it out.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,30</span></a> This may underestimate infection rates, especially after those procedures in which hospitalization is shorter. Infections that due to their seriousness led to readmission are included, which means that only the non-serious ones would have been missed, which would supposedly be superficial infections. As in other studies, we did not establish differences regarding other variables such as catheterization and bacteriuria after, which could increase the risk of UTIs.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Hospital infection must continue to be monitored so as to analyze trends and to assess the impact of potential improvement measures to be carried out. Surveillance and control of infections associated with health care provide indicators that must be taken into account in health care quality and patient safety programmes and should be a goal that involves not only Preventive Medicine services but also each center's management, surgeons and nursing staff.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">Project funded by the Department of Health of the Autonomous Region of Madrid, with subsidies of the Autonomous Regions for the implementation of the National Health System Patient Safety strategies of the Ministry of Health and Social Policy in the year 2009 (RD 16/06/2009).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres98368" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec85527" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres98367" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec85528" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-18" "fechaAceptado" => "2011-01-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec85527" "palabras" => array:5 [ 0 => "Prostatectomy" 1 => "Surgical wound infection" 2 => "Incidence" 3 => "Monitoring" 4 => "Antibiotic prophylaxis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec85528" "palabras" => array:5 [ 0 => "Prostatectomía" 1 => "Infección de herida quirúrgica" 2 => "Incidencia" 3 => "Vigilancia" 4 => "Profilaxis antibiótica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To know the rate of nosocomial infections in open prostate surgery and to assess the application of pre-surgery preparation and preoperative antibiotic prophylaxis protocols at three public hospitals in the Autonomous Community of Madrid.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective observational and multicentre study, including all the patients operated on at the services monitored and admitted for more than 48<span class="elsevierStyleHsp" style=""></span>h between 1 January and 31 December 2009. They were monitored from admittance until their discharge.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The rate of hospital infection observed was 3.38%. The most frequent infection was surgical localization, with an incidence rate of 2.77% (superficial<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.23%; deep<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.31%; organ-space<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.23%). The percentage of appropriate surgical prophylaxis, both in the indication and in the selection of antibiotics, initiation and duration, with respect to all those patients that received it, was 47.42%. According to the data obtained from their clinical records, the percentage of patients in which the pre-surgery preparation protocol was correctly complied with, was 92%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results obtained in this multicentre study can serve not only as a reference to other public hospitals but they are also comparable to other international monitoring systems. Monitoring and controlling infections associated with healthcare must be a key aspect in Patient Care and Safety programmes.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer las tasas de infección nosocomial en cirugía abierta de próstata y valorar la aplicación de los protocolos de preparación prequirúrgica y profilaxis antibiótica preoperatoria establecidos en tres hospitales públicos de la Comunidad de Madrid.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo observacional multicéntrico, incluyendo a todos los pacientes intervenidos quirúrgicamente en los servicios sometidos a vigilancia e ingresados durante más de 48 horas, entre el 1 de enero y el 31 de diciembre de 2009. Fueron vigilados desde el ingreso hasta el alta.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La tasa de infección hospitalaria observada fue del 3,38%. La infección más frecuente fue la de localización quirúrgica, con una incidencia del 2,77% (superficial<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,23%; profunda<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,31%; órgano-espacio<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,23%). El porcentaje de profilaxis quirúrgicas adecuadas, tanto en indicación como en elección del antibiótico, inicio y duración, respecto a todos aquellos pacientes que la recibieron fue del 47,42%. Según los datos obtenidos de las historias clínicas el porcentaje de pacientes en los que se cumplió correctamente el protocolo de preparación prequirúrgica fue del 92%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados obtenidos en este estudio multicéntrico, no sólo pueden servir como referencia a otros hospitales públicos, sino que también son comparables con otros sistemas de vigilancia internacionales. La vigilancia y control de las infecciones asociadas a la asistencia sanitaria deben ser un aspecto clave en los programas de calidad asistencial y seguridad del paciente.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Díaz-Agero C, et al. Incidencia de infección nosocomial en cirugía abierta de próstata. Actas Urol Esp.2011;35:266–71.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Interventions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">SSI \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Open prostate biopsy (60.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suprapubic prostatectomy (60.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (7.38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retropubic prostatectomy (60.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 (41.85%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (4.41%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radical prostatectomy (60.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">161 (49.54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1.86%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local excision of prostate lesion (60.61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perineal prostatectomy (60.62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other prostatectomy (60.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (1.23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">325 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (2.77%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183645.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Does not include transurethral resection.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ICD-9 CM codes included in the “prostatectomy” (PRST)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> procedure and surgical interventions carried out.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ampicillin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>gentamicin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.13% (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>clavulanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.80% (124) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cefazolin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.74% (173) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cefacetrile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61% (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.49% (18) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Levofloxacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.22% (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 February | 11 | 0 | 11 |
| 2018 January | 10 | 0 | 10 |
| 2017 December | 9 | 1 | 10 |
| 2017 November | 4 | 0 | 4 |
| 2017 October | 17 | 4 | 21 |
| 2017 September | 16 | 1 | 17 |
| 2017 August | 13 | 3 | 16 |
| 2017 July | 24 | 6 | 30 |
| 2017 June | 21 | 3 | 24 |
| 2017 May | 11 | 3 | 14 |
| 2017 April | 14 | 6 | 20 |
| 2017 March | 14 | 10 | 24 |
| 2017 February | 13 | 4 | 17 |
| 2017 January | 6 | 0 | 6 |
| 2016 December | 10 | 6 | 16 |
| 2016 November | 20 | 4 | 24 |
| 2016 October | 41 | 7 | 48 |
| 2016 September | 12 | 5 | 17 |
| 2016 August | 15 | 1 | 16 |
| 2016 July | 20 | 5 | 25 |
| 2016 June | 16 | 8 | 24 |
| 2016 May | 25 | 13 | 38 |
| 2016 April | 21 | 10 | 31 |
| 2016 March | 21 | 15 | 36 |
| 2016 February | 23 | 14 | 37 |
| 2016 January | 25 | 14 | 39 |
| 2015 December | 22 | 11 | 33 |
| 2015 November | 8 | 5 | 13 |
| 2015 October | 18 | 8 | 26 |
| 2015 September | 14 | 2 | 16 |
| 2015 August | 16 | 5 | 21 |
| 2015 July | 7 | 1 | 8 |
| 2015 June | 2 | 0 | 2 |
| 2015 May | 7 | 2 | 9 |
| 2015 April | 30 | 7 | 37 |
| 2015 March | 25 | 3 | 28 |
| 2015 February | 17 | 3 | 20 |
| 2015 January | 25 | 5 | 30 |
| 2014 December | 26 | 5 | 31 |
| 2014 November | 23 | 2 | 25 |
| 2014 October | 37 | 7 | 44 |
| 2014 September | 37 | 5 | 42 |
| 2014 August | 24 | 3 | 27 |
| 2014 July | 39 | 4 | 43 |
| 2014 June | 16 | 2 | 18 |
| 2014 May | 11 | 2 | 13 |
| 2014 April | 15 | 5 | 20 |
| 2014 March | 35 | 1 | 36 |
| 2014 February | 19 | 4 | 23 |
| 2014 January | 13 | 2 | 15 |
| 2013 December | 8 | 3 | 11 |
| 2013 November | 18 | 4 | 22 |
| 2013 October | 20 | 9 | 29 |
| 2013 September | 20 | 8 | 28 |
| 2013 August | 18 | 4 | 22 |
| 2013 July | 7 | 0 | 7 |
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