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Lancet 1995 L> T3,@o^6   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>>L0 B: (    6M  `} M _+Haga clic para cambiar el estilo de ttulo , ,/  0M  ` M kHaga clic para modificar el estilo de texto del patrn Segundo nivel Tercer nivel Cuarto nivel Quinto nivel7    l  0M ^ ` M X*  0 M ^  M Z*  0X%M ^ ` M Z*B  s *޽h ? 3380___PPT10.n  *Diseo predeterminado 0L0   (  j  BA \ ?   BP}M?) ,$ 0 CURSO SOBRE CONTROL DE LA INFECCIN EN EL HOSPITAL: Unidad de Medicina Preventiva y Salud Pblica. 1. Bacteriemas 2. La Infeccin del lecho Quirrgico Dra. Mxima Lizn Garca c@0 4'$/''$ '$3 '$"'$3%3%  2l  % R   s *     0hM p ,$ 0 D ,   BMԔ q BCOMPLEJO HOSPITALARIO DE TOLEDO 26 Abril 2005.>C'&# $H  0޽h ? 33rj___PPT10J.n @ +PD'  = @B Di' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-g6B fade*<3<* D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =-g6B fade*<3<* +p+0+ 0 ++0+ 0 +"! 0L0 0tE(  t t 0MT,$ 0 O IMPORTANCIA de la IN$D t 0MI ,$ 0 XAlta Incidencia. Alta Mortalidad. Costes elevados. Indicador de Calidad. Difcil manejo.&YY 8X t 0M s ,$ 0 B̙ b t <v޽h @ ?"` 33___PPT10.r "+wkD'  = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(D' =-g6B fade*<3<*tD%' =%(D' =%(Du' =A@BB BB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*tD' =1:Bvisible*o3>+B#style.visibility<*t%(D' =-g6B fade*<3<*tD%' =%(D' =%(Du' =A@BB BB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*t"D' =1:Bvisible*o3>+B#style.visibility<*t"%(D' =-g6B fade*<3<*t"D%' =%(D' =%(Du' =A@BB BB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*t"3D' =1:Bvisible*o3>+B#style.visibility<*t"3%(D' =-g6B fade*<3<*t"3D%' =%(D' =%(Du' =A@BB BB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*t3ID' =1:Bvisible*o3>+B#style.visibility<*t3I%(D' =-g6B fade*<3<*t3ID%' =%(D' =%(Du' =A@BB BB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*tIYD' =1:Bvisible*o3>+B#style.visibility<*tIY%(D' =-g6B fade*<3<*tIYD' =%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(D' =-g6B fade*<3<*t++0+t0 ++0+t0 ++0+t0 + 0L0  @(  x  <A >? >H  0޽h ? 33< 0L0 ##P(("#(    0XY,$ 0 8FRECUENCIA DE IN EN UNA UNIDAD DE REANIMACIN.1996-2000..98$  <(x ,$ 0 ) 322 (49,38%) pacientes sufrieron al menos una IN durante su estancia. La frecuencia de IN fue de 49,38 por 1000 pacientes-da con estancia > 48 horas. El 77,85 % de las IN fueron mltiples. La IN ms frecuente de la cohorte es la bacteriemia. *6c3%+̙%̙̙̙k S # # #"." ``,$D  0  H(33v @?   V8,76   @`  H 133v @?   W11,96   @`  H933v @?   W12,89   @`  HB33v @?  T78   @`   HD33v @?  mInfeccin de Tracto Urinario.  @`   HDU33v @?=   V9,66   @`   H^33v @?=   W13,19   @`   Hg33v @? =   W14,21   @`   H\p33v @? =  T86   @`  Hr33v @?=  oInfeccin de Herida Quirrgica.    @`  Ht33v @?   W12,69   @`  HL33v @?   W17,33   @`  H33v @?   W18,67   @`  H33v @?  U113   @`  H33v @?  Y Neumona.    @`  H33v @? =  W10,11   @`  H33v @? =  W13,80   @`  H33v @? =  W14,87   @`  H33v @? =  T90   @`  H33v @? =  w'Infeccin Tracto respiratorio inferior.((  @`=  <,? # {IA: Incidencia acumulada de infecciones por 100 ingresos. DI: Densidad de incidencia de infecciones por 1000 pacientes da.||  @`  H33v @?7   W22,92   @`  H(33v @?7   W31,28   @`  HX33v @? 7   W33,71   @`  H0 33v @? 7  U204   @`  H 33v @?7  \ Bacteriemia.    @`  <X0 ̙?" S 7  PDI @`   <h0 ̙?" S 7  PIA @` ! <(0 ̙?"  S 7  Q(%) @` " <10 ̙?"  S 7  On @` # <;0 ̙?" S 7  Z LOCALIZACIN   @`ZB $ s *o ?##ZB % s *o ?S #ZB & s *o ?S #ZB ' s *1 ?S S  ( B=0 Ԕ6P 7Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004 (87&H  0޽h ? 33___PPT10+6D' {0 = @B D' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*GD' =1:Bvisible*o3>+B#style.visibility<*G%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*HD' =1:Bvisible*o3>+B#style.visibility<*H%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*+p+0+0 ++0+0 +  0L0 @(  r  S p  0  H  0޽h ? 33F 0L0 `w(    0h0 9T,$ 0 G BACTERIEMIAS:$  < ?"7,1,$ 0 b&  @`  B0 Ԕ ^ BACTERIEMIA SIGNIFICATIVA : Los microorganismos tienen significado clnico y no se deben a una contaminacin durante el proceso de extraccin o durante la manipulacin de la sangre. EUROPA 27,2 episodios por cada 1000 ingresos hospitalarios. 50% Sin foco aparente 50% con foco primario + Dispositivos IV Bacteriemias Primarias Bacteriemias Secundarias !''%! %K%$%'3"%'3% $  ,  ^  6Ԕ Ppr  <0 fԔ 0  : Xb  0Ԕ T  <v޽h @ ? 33___PPT10.r "+u7D' 0 = @B D' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(DP' =%(D' =K@BBBBPB0B%(/%( E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 +! 0L0 p)2$z(  $l T  *$0F ,$D  0" $ B$0 ff"`) P PERFUSIN(   f $ 6Vf $ 6Vf`B $B 0DԔ M `B  $B 0DԔ M `B  $B 0DԔ M   $ B<0 "` 7  UTRAYECTO SUBCUTNEO DEL CATTER  3  $ B0 "`F  X"TRAYECTO INTRAVASCULAR DEL CATTER## 3ZB $ s *D*rrZB $ s *DNZB $ s *DZB $ s *D>>ZB $ s *DrZB $ s *D  fB $ 6D̙efB $ 6D̙ fB $B 6D̙t  f $ 6;  O $ T0 XX?"`=   MGrmenes que migran extraluminalmente desde la piel contaminada. Colonizacin*N(2A  3)I $ T`0 XX?"`/   WGrmenes que se adhieren a la fibrina depositada en el catter y desarrollan la biocapaX(2X P: $ TX0 XX?"`TV  ZGrmenes que pueden infectar el catter va hematgena desde un foco sptico. Colonizacin*[(2N  3  $ T0 XX?"` W*  PGrmenes que migran hacia la luz del catter a partir de conexiones contaminadasQ(2Q  $ T0 XX?"`M% QConexiones y llaves de paso(2  $ 6\0 "`)r\  :Tope(2  $ 60 "`   _)Punto de insercin del catter en al piel*(2* fB $B 6DpS fB $ 6Dp M fB  $ 6Dps c fB !$ 6Dp*p fB "$ 6DpO })fB $$ 6Dp Y NY fB %$ 6Dp+ fB &$ 6Dpp x fB '$B 6Dpr )$ 0L0 YT,$ 0 UPATOGENIA de la BN primaria$ /$ B$4 Ԕ   TMaki 0$ B4 Ԕ` <Sitges 1$ <4 Ԕ 6Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004&7 6& 2$ Bh 4 Ԕ2n 2Modificado de: Dr. M. Cortia-Tesis Doctoral 200433$T $ <v޽h @ ? 33___PPT10f.r "+o-AD'  = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*)$%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<**$%(D' =-o6Bwipe(up)*<3<**$+8+0+)$0 +!6 0L0 #  (    0$4 PT,$ 0 NFACTORES DE RIESGO I$  <4  ?"PtJ,$ 0 JSu conocimiento permite intervenciones dirigidas a la prevencin y posibilidades de comparacin de grupos homogneos de pacientes y servicios. Permite la construccin de  indicadores de riesgo . Factores de riesgo endgenos o intrnsecos. Gravedad del enfermo: Edad del enfermo Severidad de la enfermedad de base Terapias inmunosupresoras Leucopenias Perdida de integridad cutanea Infecciones a distancia Factores de riesgo exgenos o extrnsecos. Relacionados con maniobras diagnstico-teraputicas.,1+6,̙+̙6,E"z @`r  0 I,$@  0  0 4 ̙"`0=*,$D  0 [%INFECCION RELACIONADA CON DISPOSITIVO& 2&H  0޽h ? 33,,___PPT10f,+x~D+' I4 = @B D]+' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D*' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*<D' =1:Bvisible*o3>+B#style.visibility<*<%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*<VD' =1:Bvisible*o3>+B#style.visibility<*<V%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*VbD' =1:Bvisible*o3>+B#style.visibility<*Vb%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*bD' =1:Bvisible*o3>+B#style.visibility<*b%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*D' =%(DF' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-u6Bwipe(right)*<3<*++0+0 ++0+0 ++0+0 +c 0L0 3+(    0`N4 YT,$ 0 D$   < S4 ',$ 0 >   60    ` mFACTORES DE RIESGO III $  0z4  p0  Caracteristicas del cateter: Cloruro de polivinilo (80s). Poliuretano. Biocompatibilidad. < tasas B que polivi. Silicona. Para uso prolongado. = tasas que poliuret. Implantables/semi Poliuretano impregnado. Clorhexidina, Sulfadiacina argntica. Si tasas y previsin > 5 das. N de Luces: s/t Nutricin parenteral > n luces B. Lugar insercin: Subclavia: Complicaciones mecnicas Yugular: Complicaciones infecciosas Femoral: Complicaciones inf y mecnicas   vJ! q v    +$q̙̙--   M  w ^  6Ԕ P ^  6Ԕ  H  0޽h ? 33___PPT10+RD ' j4 = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 +=# 0L0 z(    0t4 YT,$ 0 D$   <4 ',$ 0 >   64    `,$ 0 lFACTORES DE RIESGO IV $F  004  p0 ,$ 0 BTunelizacin: Controversia. Indicado en pacientes con riesgo de infeccin. Forma parte de la tcnica de insercin de catteres semiimplantables. Conexin del catter con el equipo de infusin. Los grmenes emigran haca la luz del cateter. Cuidado del catter: Higiene de manos Tcnica asptica Cuidado y mantenimiento.  u vu! < v   u. /̙$<̙̙6 sXU  BA 4?? ` X 4$D 0 0   B|4 Ԕ ,$  0 @ MANIPULACIN H  0޽h ? 33KC___PPT10#+!D' 4 = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*Dn' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*D_' =%(D' =%(D' =A@BBBB0B%(E' =4 B`BPB`B?<*%(/%,( < +D' =1:Bvisible*o3>+B#style.visibility<*  %(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*  D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*  ++0+0 ++0+0 ++0+0 ++0+0 ++0+ 0 +j% 0L0 'O(    0t4 Y,$ 0 q7Algunos datos sobre factores de riesgo en bacteriemias.88$M  <4 PPi,$ 0 gFuerte correlacin positiva entre las tasas de Infeccin nosocomial y el uso de dispositivos mdicos. *he   @@W  r #""r0 PpG ,$D  0  6@4 ?@  \  3  @`  6 4 ?   V0,64   @`  6(4 ?`  X TRAUMTICOS.    @`  64 ? `  ZCATETER VENOSO @`  6(4 ? @  V1,06   @`  68 ?   V0,65   @`  68 ?`  X QUIRRGICOS.    @`  68 ?  `  TCENTRAL.   @`  688 ? @W  \  3  @`  68 ? W  V0,32   @`  628 ?` W  W CORONARIOS.    @`   6D48 ?  `W  T  @` ) 6dD8 ?@@ \ENVIN-UCI 2002 @` * 6M8 ? @ W NNIS 2003   @` + 6 W8 ?`@  X TIPO UCIs.   @` , 68`8 ? @` Z DISPOSITIVO.   @``B . 0o ? @@@ZB 0 s *1 ? @`B 1 0o ? W @W ZB 2 s *1 ?`@`W ZB 3 s *1 ? @ W ZB 4 s *1 ?@W ZB ; s *o ?   ZB < s *1 ?`  ZB > s *1 ?`  `B B 0o ?  W ZB F s *o ?@@ `B I 0o ?@ @W `B 8 0o ? @ `B E 0o ?@@@z T6 K 0rq,$D 0 L <e8 Tm T _!Frecuencia uso de dispositivos = ""  M <Lk8   `,N das con dispositivo N das de estancia--ZB N s *DԔ 6  B4p8 ԔW  6Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 200477&H  0޽h ? 33; 3 ___PPT10 +|^D '  = @B DB ' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D%' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*K%(D' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*r%(D' =-o6Bwipe(up)*<3<*r+p+0+0 ++0+0 +  0L0 K(    HЁ8  ?,$  0 9Utilizacin mensual de cateter central. CHUAB 1996-2000. D:08@    ~  BA ?̙?< H  0޽h ? 33___PPT10+JgBDm' 8 = @B D(' = @BA?%,( < +O%,( < +D_' =%(D' =%(D' =A@BBBB0B%(E' =4 B`BPB`B?<*%(/%,( < +D' =1:Bvisible*o3>+B#style.visibility<*9%(D' =+4 8?dCB1+#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*9D' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*9+8+0+0 +; 0L0 ,,\+(    08 ,$ 0  La DI de BN (primaria y secundaria) es de 28,70 por 1000 pacientes da de CVC en una unidad de Reanimacin. Traumticos: 25,22  Quirrgicos: 32,69 En la etiologa de las BN, los Estafilococos representan un 52%.,n*C'$̙̙ ̙ ̙̙>&  8 5# "`,$@  0T 6 c $X99? 8B 7 3 !  $< 8 #  > <B 9 #   <B : #   <B ; #    <B < #  , - <B = #  > ? H > C  > H ? C f0 d H @ C f H A C f& g Z H B C f H C C f QH D C f H E C f, GH F C f H G C f  =H H C f H I C f 4H J C f| H K C f *H L C fs H M C fU H N C fiH O C fH P C f_H Q C f H R C fV<B S #  >  <B T #   <B U #  <B V #  <B W #    <B X #  , - <B Y #  > ? <B Z #  <B [ #   <B \ #   <B ] #   <B ^ #   <B _ #   <B ` # wx<B a # <B b # mn<B c # <B d # cd<B e # <B f # Z[<B g # <B h # PQ<B i # <B j # FG<B k # <B l # =><B m # <B n # 34<B o #   p 68  H *^  ^Das de catter venoso central hasta aparicin de Bacteriemia$_^E q 6ĸ8    A0$G r 68   A5$G s 68   B10$G t 68  /  B15$G u 6H8   A  B20$G v 68   T  B25$G w 68 A T [ A1$G x 68   [ A2$G y 6H8 8 L [ A3$G z 68   [ A4$G { 68 .A[ A5$G | 68 [ A6$G } 68 $7[ A7$G ~ 6p8 [ A8$G  608 .[ A9$G  6\< [ B10$G  6h< )[ B11$G  6 < [ B12$G  6<  [ B13$G  6`< v[ B14$G  6 < [ B15$G  6< m[ B16$G  6"< [ B17$G  6`'< c[ B18$G  6 ,< [ B19$G  60< Y[ B20$G  65<  `Das de Catter venoso central&G  <l:< T  XNmero de Bacteriemias&GB  3 !  $   B @< Ԕ)@  7Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004 $87&H  0޽h ? 33___PPT10+)D' E< = @B D>' = @BA?%,( < +O%,( < +D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*mD' =1:Bvisible*o3>+B#style.visibility<*m%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*nD' =1:Bvisible*o3>+B#style.visibility<*n%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*5%(D' =-o6Bwipe(up)*<3<*5+8+0+0 +D' 0L0 "w"12"(    08< P {1ANLISIS REGRESIN de COX Bacteriemia Nosocomial..2$ u # #":.  0 ,$D   0  <0[< ?  W0,055 f @`  <Ld< ?P  W2,937 3 @`  <Tf< ? P  gndice de Comorbilidad 5. @`  <o< ? W0,330 f @`  <p< ?P  W1,193 3 @`   << ?P  kIngreso con carcter urgente. @`   <T< ?u W0,078 f @`   <\< ?P u W1,646 3 @`   <l< ?P u W Obesidad.   @`   <|< ?   W0,000 f @`  <0< ?P   W3,478 3 @`  << ? P  gndice de Comorbilidad 4. @`  <<< ?   W0,000 f @`  << ?P    W3,576 3 @`  << ? P  gndice de Comorbilidad 3. @`  << ?,   W0,001 f @`  << ?P ,   W2,406 3 @`  << ?, P   gndice de Comorbilidad 2. @`  <D? ?K ,  W0,003 f @`  <, ? ?P K ,  W2,045 3 @`  < ? ?K P ,  gndice de Comorbilidad 1. @`  <8? ?i K  W0,119 f @`  <$? ?P i K  W1,010 3 @`  <,? ?i P K  eCatter Venoso Central. @`  <6? ?yi  W0,001 f @`  <'? ?P yi  W0,984 3 @`  <xH? ?yP i  REdad @`  6S? ?y P > |Z|X# #  @`   6]? ?P y POR @` ! 6lf? ?P y U VARIABLES   @``B " 01 ?ZB # s *1 ?yyZB $ s *1 ?i i ZB % s *1 ?K K ZB & s *1 ?, , ZB ' s *1 ?  ZB ( s *1 ?  ZB ) s *1 ?  `B * 01 ?uu`B + 01 ?uZB , s *1 ?P P uZB - s *1 ?u`B . 01 ?uZB / s *1 ?ZB 0 s *1 ? 2 HHl? Ԕp@0 6Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 200477&H  0޽h ? 33UM___PPT10-+D'  = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*+J 0L0 ~(  u  0\? O,$D 0 mCOMORBILIDAD Pr>chi2=0,0046 TRAQUEOSTOMA Pr>chi2=0,0000 OBESIDAD Pr>chi2=0,0045 INGRESO URGENTE Pr>chi2=0,0248 ALCOHOL Pr>chi2=0,0322 CATETER VENOSO Pr>chi2=0,0083 HEPATOPATA Pr>chi2=0,0289 NEOPLASIA Pr>chi2=0,0126 DRENAJE Pr>chi2=0,0052 VENTILACIN MECNICA Pr>chi2=0,0290 k(2B      $&#$$!$)  0 ? 0p],$ 0 z0ANLISIS de KAPLAN-MEYER Bacteriemia Nosocomial..1$  3 ,A?Comorbilidad"`,$D 0  3 $A?Obesidad w,$D 0  3 .A?Traqueostomia,$D 0  3 $A?urgencia,$D  0   BD? Ԕ)3 7Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004 $87&H  0޽h ? 33TL___PPT10,+D '  = @B D[ ' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 me$(  $/ $ BP? Ԕ&  MEDIDAS DE CONTROL DE LAS BACTERIEMIAS*: Adiestramiento del personal sanitario Vigilancia de las BN Higiene de las manos Insercin del catter con tcnica aseptica Cuidado del punto de insercin. Cambio y tipo de apsitos Seleccin y reemplazamiento del catter intravascular. Administracin de fluidos, sistemas sin agujas y nutricin parenteral. Puntos de inyeccin. Preparacin y control de las mezclas administradas. Filtros. Equipos ad hoc para la administracin de la terapia IV. P*&v̙v*$̙b F = _* $ BX? Ԕ{ = Centers for Disease Control and Prevention. Guidelines for the Prevention of Intravascular catheter related infection. MMWR 2002; 51 (RR10). *PA>JH $ 0޽h ? 33* 0L0 R(    6?   ECLASIFICACIN DE LAS RECOMENDACIONES SEGN LA FUERZA DE LA EVIDENCIA.FF   0L?   gCATEGORIA IA: Fuertemente recomendadas. Apoyadas por estudios epidemiolgicos bien diseados. CATEGORIA IB: Fuertemente recomendadas, vistas como eficaces por expertos. Estudios sugestivos con fuerte fundamentacin terica. CATEGORIA II: Sugeridos para su implementacin en muchos hospitales. SIN RECOMENDACIN: Evidencias insuficientes o falta de consenso.h0Z  3  O  3  q  3  6  3 .H  0޽h ? 33 0L0 | ((  ( ( 0? YT,$ 0 D$  ( <@? ',$ 0 >  ( 6DD    ` hRECOMENDACIONES I $@ ( 0D  p  Adiestramiento del personal: Educar al personal en procedimientos de uso, insercin y mantenimiento de cteteres IA. Evaluar y actualizar periodicamente los conocimientos IA. Asegurar el n apropiado de enfermeras y personal de cuidados IB. Vigilancia de las bacteriemias: Monitorizar visualmente o por palpacin a travs del apsito. Si sospecha de infeccin levantar apsito IB Registrar quien inserta, fecha de insercin, cambio apsito de una forma reglada II. No cultivar las puntas de catter rutinariamente IA. t  v !  v  S̙5̙=̙ $h̙Q̙1̙̙,g nH ( 0޽h ? 33___PPT10+*իD ' D = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*(%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*(%(+p+0+(0 ++0+(0 + 0L0 `X08(  8 8 0pD YT,$ 0 D$  8 <8D ',$ 0 >  8 6<D    ` iRECOMENDACIONES II $ 8 0_D  @c  =Higiene de manos: Lavado de manos con jabn antisptico o locin alcoholica antes y despus de la palpacin, cambio de apsito etc IA. La palpacin NO se efectuar tras la aplicacin del antisptico al menos que se mantenga la tcnica asptica IA. El uso de guantes no exime de la Higiene de Manos IA. Tcnica aseptica en insercin y cuidados: Mantenimiento de la tca. asptca durante el cuidado IA. Uso de guantes, estriles o no, como proteccin del trabajador IC. Uso de guantes estriles para CVC o A IA. Uso de guantes, estriles o no, para cambiar los apsitos IC.   v*!  v  r̙l̙1̙( $2̙̙>̙̙̙̙9̙̙̙̙PA .H 8 0޽h ? 33___PPT10+RD ' KD = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*8%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*8%(+p+0+80 ++0+80 + 0L0 z r @< (  < < 0 RD YT,$ 0 D$  < <UD ',$ 0 >  < 6XD    ` jRECOMENDACIONES III $h < 0D  3  \Cuidado del punto de insercin: Antisepsia Cutanea: Desinfeccin piel (Clorhex 2%, Clorhex alcoho 0,5%, PVI o alcohol 70%) IA. Uso Clorhex enni os < 2 meses. No recomendacin. Dar tiempo a que el antiseptico haga su efecto. Dejar secar antes de la insercin. 2 PVI. IB No aplicar disolventes orgnicos (acetona y otros) sobre la piel durante la insercin o el cambio de apsito. IA Tipo y frecuencia en cambio de aposito: Usar gasa esteril o apsitos estriles transparentes semipermeables, indistintamente. IA. CVC tunelados y curados no requieren apsito. II. Femoral: Complicaciones inf y mecnicas    vL1 ̙(!  v   ̙ ̙(̙̙Z̙l̙& $T  ̙  ̙  ,  ̙  ̙  (  ̙̙+!1   ^ < 6Ԕ P ^ < 6Ԕ  H < 0޽h ? 33___PPT10+RD ' D = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*<%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*<%(+p+0+<0 ++0+<0 + 0L0 P@!(  @ @ 0\D YT,$ 0 D$  @ <D ',$ 0 >  @ 6hD    ` iRECOMENDACIONES IV $L @ 0 D  p  dTipo y frecuencia en cambio de aposito (II): Si el paciente est sudoroso o el punto de insercin sangra o exuda, es preferible gasa en lugar de apsito transparente. II. Reemplazar el apsito si este est hmedo o visiblemente manchado IB. Cambiar el apsito al menos semanalmente en adultos u adolescentes, segn paciente II. No usar cremas antibiticas en el punto de insercin (excepto hemodialisis), favorecen la colonizacin por hongos y las resistencias antibiticas IA. No sumergir el cateter en agua. Las duchas se pueden permitir si se garantiza la proteccin impermeable del cateter y la conexin II. - 7 v̙ - x̙A̙R̙̙̙̙P_ [UH @ 0޽h ? 33___PPT10+RD ' D = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*@%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*@%(+p+0+@0 ++0+@0 + 0L0 `,,(  ,0 , <D Ԕ NSeleccin y recambio de catter: Seleccin del catter de ms bajo riesgo anticipando el tipo y duracin de la terapia IV. IA. Retirar los cateteres no necesarios IA. Evitar los cambios rutinarios de CVC o A. IA. Reemplazar en adultos los CVP al menos cada 72-96 horas para evitar flebitis. Dejarlos en nios hasta terminar terapia o ante complicaciones IB. Reemplazar los cateteres insertados en una situacin urgente, sin garantias de asepsia, a las 48 h. II. No reemplazar rutinariamente el catter en pacientes con fungemia o bacteriemia si la fuente de infeccin no es el catter. II.! 2. v2! Y̙#̙*̙̙b̙z̙P  ) U > , BD Ԕ JRECOMENDACIONES V $H , 0޽h ? 33 0L0 pX$(  X' X <tF Ԕ #Seleccin y recambio de catter (II): Reemplazar CVC si se observa purulencia en el punto de insercin, indicativo de infeccin . IA. Evitar el uso de gua para reemplazar un catter en pacientes con sospecha de infeccin relacionada IA. Evitar los cambios rutinarios de CVC o A. IA. Cambio del sistema de administracin de fluidos: Reemplazar todo el sistema con una frecuencia no mayor de 72 horas, al menos que haya infeccin IA. Reemplazar las bolsas de sangre (4 h), o emulsiones lipdicas dentro de las 24 horas de iniciada la infusin IB. Z& 2 v21 2e v̙2r v2& [̙c̙*̙/ $a̙m̙̙ 4 X BHF ԔY KRECOMENDACIONES VI $H X 0޽h ? 335 0L0 \](  \_ \ <F Ԕ Cambio sistema de administracin de fluidos (II): Reemplazar las soluciones de dextrosa y aminoacidos no ms frecuentemente que 72 horas, II. Reemplazar los sueros de infusin de propofol cada 6-12 h, segn recomendaciones del fabricante IA. Sistemas sin agujas: Cambiar el componente sin agujas al menos tan frecuentemente como el sistema II. Cambiar los tapones con una frecuencia no mayor que 72 horas, segn fabricante II. Minimizar el riesgo de contaminacin frotando el punto de conexin de la llave con antisptico IB. 2! 2 v2! 2  v2 v20 $X̙b̙̙ $N̙Q̙^̙̙,Z N V \ B2F Ԕ LRECOMENDACIONES VII $H \ 0޽h ? 33 0L0 `8(  `9 ` <:F Ԕ Inyecciones IV a traves de las llaves: Desinfectar el punto de inyeccin con alcohol de 70 o PVI antes de acceder al sistema IA. Poner los tapones a todos los puntos que no esten en uso IB. Filtros en el sistema: No utilizar filtros de forma rutinaria para evitar infecciones IA. Formar equipos de terapia IV: Designar personal adiestrado para la insercin y mantenimiento de los cateteres IV IA. '! 2 v2! 2D v2! 2X v2 v2% $W̙;̙̙ $@̙̙ $S  ̙    ̙  >   ` BUF Ԕ/ MRECOMENDACIONES VIII $H ` 0޽h ? 33M  0L0    u (   '   <8dF  ) gDENSIDAD DE INCIDENCIA (DI) DE BACTERIEMIA ASOCIADA A VIA CENTRAL (VC) EN REANIMACION. AOS 1996-2001.hh   C B*CDEF{?)@@*A   NA 7?? 7   c z0e0e    BCDE4F @  5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E|| p@XH  Px  0 @    P``H    TfF  ?7 !  Poisson Trend Analysis: p < 0,01!0! , R   s *fp R   s *f` `R   s *fP p    B\F ԔW r>Elaboracin propia a partir de datos del Sistema de Vigilancia??H   0޽h ? 33  0L0 P(  r  S rF P  F  H  0޽h ? 33 0L0 WO(    <F Ԕ0  d 1. Infeccines incisionales. Incisionales superficiales, afectan a piel y subcutneo. Incisionales profundas, inferiores a capa miofascial. 2. Infeccin de rganos o espacios. Infeccin generalizada de organo o espacio. Las cifras de incidencia de IQ varan segn los diferentes estudios, del 2,8 al 20% dependiendo de las caractersticas de cada hospital y de los procedimientos quirrgicos utilizados. En general los hospitales docentes son los que presentan mayores tasas. L o ) .1 0 0 #''9'6 ' /         ,       (      {  BF Ԕ{ e%Infeccin de localizacin quirrgica $&%$H  0޽h ? 33! 0L0 &&(  `  s *"` E `  s *̙"`S  `  s *"`@ `  s *"` 2  BC/DEFT77=[yyq6yMjk[L&-4NqNNzL5[=E!N{Ekk6 c/ 0Nlr=N==Zr- > \/'(@                  S Z LB  c $D` LB  c $D CLB   c $D LB   c $D LB   c $Dp p`2   s *f"``2   s *f"`z `2  s *f"`/ `2  s *f"`/M `2  s *f"`j`  s *3"`@`  s *3"`@`  s *3"`S `  s *3"`S    # B[CDEF>.[=5L[@  "`=  # B[CDEF>.[=5L[@  "` {   # B[CDEF>.[=5L[@  "`j  # B[CDEF>.[=5L[@  "`   <F  @Piel 0  BF mWl' j Tejido Subcu 0   BTF 2W xFascia y musculo 0$  BF  *  gOrgano y espacio 0 X  # "BCDE|F4m# GG+GvBL-{%$-4+mkPG\Ak588>AOPTP  @          "` X  # "BCDE|F43m# GG+GvBL-{%$-4+mkPG\Ak588>AOPTP  @          "` S X  # "BCDE|F4m# GG+GvBL-{%$-4+mkPG\Ak588>AOPTP  @          "`S     <F  P  xSuperficial o Incisional"0  ! BdF 2]  lIncisional Profunda"0   " <F  ]  uDe organo y espacio "0  # 0tF W9 \INFECCIN DEL LECHO QUIRRGICO"0 2 $ <F G1H= "`zCw ZPus en la incisin Dolor, enrojecimiento, calor En la incisin. El cirujano abre la herida$[0[> % B8F GmH7 }J ZAbsceso que afecta fascia y msculo, hallado durante RX o reoperacin. Drenaje purulento. 4[0XBM & <|F GH1-f "`S J  UMediastinitis, endocarditis, osteomielitis, meningitis, ventriculitis, intraabdominal$V0V6 + H  0޽h ??0$%& 33H' 0L0 {(    0$F { `,$ 0 MPATOGENIA de la IHQ$~  < K  ?" ,$ 0 < Flora endgena presente en el momento de la incisin quirrgica. Cada procedimiento quirrgico presenta una flora endgena diferente. Flora exgena procedente del: Equipos quirrgico Ambiente Durante la incisin se produce la siembra de grmenes Profilaxis quirrgica perioperatoria.BHq̙7̙̙?̙7  %  , @`l  6Ԕ"  =H  0޽h ? 33U!M!___PPT10-!.VJ+J(D '  K = @B DL ' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*DU' =%(D' =%(D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*BD' =1:Bvisible*o3>+B#style.visibility<*B%(D' =-g6B fade*<3<*BDU' =%(D' =%(D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*BD' =1:Bvisible*o3>+B#style.visibility<*B%(D' =-g6B fade*<3<*BD ' =%(DW ' =%(D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =%(D' =%(D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D' =A@BB BB0B%()))E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*=D' =1:Bvisible*o3>+B#style.visibility<*=%(D' =-g6B fade*<3<*=+p+0+0 ++0+0 + 0L0  (    0K A^ INFECCIN DE LOCALIZACIN QUIRRGICA SE INTENTA CONSEGUIR EL MNIMO IRREDUCTIBLE. Uno de los criterios utilizados en la valoracin de la frecuencia De ILQ es el GRADO DE CONTAMINACIN DE LA CIRUGA. CIRUGIA LIMPIA = < 1,5% enfermos intervenidos CIRUGIA LIMPIA CONTAMINADA = < 3% enfermos intervenidos CIRUGIA CONTAMINADA = < 9% enfermos intervenidos CIRUGIA SUCIA = < 20% enfermos intervenidos LA ADMINISTRACCIN DE PROFILAXIS ANTIBITICA PERI- OPERATORIA PROTEJE DE LA ILQ. LA BUENA PRACTICA OPERATORIA ES UN FACTOR A TENER EN CUENTA. d 0&ffN$ff33ff ,%?^  68cP H  0޽h ? 3380___PPT10.VJ 0L0 DG(  DZ D 6l>K  @p INCIDENCIA ACUMULADA (IA)* DE IHQ POR GRADO DE CONTAMINACIN DE LA CIRUGA Y AO. Procedimientos seleccionados. COMPLEJO HOSPITALARIO UNIVERSITARIO DE ALBACETE D C B*CDEF{?)@pVq~ D BA D?? ( Dl D 0A I??  I D B AK Ԕt {?Elaboracin propia a partir de datos del Sistema de Vigilancia  @?H D 0޽h ? 33R 0L0  Lz(  L` L c $A J??R  J L 0A Z??/8 Z$D 0XB L 0D L <$JK  @ 0  YN=621"0   L 0|OK  V kN=41840   L 08NK    YN=123"0   L 0UK  T XN=20"0    L 0XK 0 `  ZN=1182"0 2 .  L BLK Ԕ ZINDICES DE RIESGO NNIS ASA > 2 Ciruga Contaminada Sucia Tiempo Interv > 75%$[C̙N  L BcK Ԕ7  OCastilla la Mancha  H L 0޽h ? 33 0L0 tl(    BiK Ԕ  & g1INFECCIONES QUIRRGICAS POTENCIALMENTE EVITABLES:22  HmK Ԕ  I3Se estima en un 19,8 % el nmero de ILQ prevenibles. Esta frecuenca se correlaciona negativamente con el tiempo de intervencin 24% en intervenciones de hasta 60 minutos 7,8% en intervenciones mayores de 180 La misma correlacin se mantiene en cuanto al ASA 28% prevenibles en ASA I 9% en ASA 4.rvvToo2v+orT  2  '    ; "  ByK Ԕ" [6c :J. Rosello 2004. Modelizacin a partir de Datos del EPINE.;;, H  0޽h ? 3380___PPT10.VJ&)  0L0 `n(  r  S uK  `}  K  V  C .Amomento pxB;^  <DK i Porcentaje de Infeccin de Herida Quirrgica en funcin de la relacin temporal entre la administracin del antibitico y el comienzo de la intervencin.&0 3 H  0޽h ? 3380___PPT10.WJ@}Y 0L0  P(  Pc P <K    PORCENTAJE DE ADECUACIN DE LA PROFILAXIS PERIOPERATORIA AL PROTOCOLO POR SERVICIO. COMPLEJO HOSPITALARIO UNIVERSITARIO DE ALBACETE 200360 P NA X? 03 XLB P c $D`H P 0޽h ? 33^ 0L0 0@(  @ @ 0`K PT,$ 0 MFACTORES DE RIESGO $ @ <ܢK  ?"` ,$ 0 Su conocimiento permite intervenciones dirigidas a la prevencin y posibilidades de comparacin de grupos homogneos de pacientes y servicios. Permite la construccin de  indicadores de riesgo . Factores de riesgo endgenos o intrnsecos. Gravedad del enfermo. Factores de riesgo exgenos o extrnsecos. Relacionados con maniobras diagnstico-teraputicas.,,6,̙+̙6 @`T @ <v޽h @ ? 33___PPT10.r "+u7D '  = @B D' = @BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*@%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*@D' =1:Bvisible*o3>+B#style.visibility<*@%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*@D' =1:Bvisible*o3>+B#style.visibility<*@%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*@ D' =1:Bvisible*o3>+B#style.visibility<*@ %(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*@ 5D' =1:Bvisible*o3>+B#style.visibility<*@ 5%(D~' =%(D&' =%(D' =A@BBBB0B%(E5' =1B B`BPB,54*3>B ppt_c='`B@BPB<*@5kD' =1:Bvisible*o3>+B#style.visibility<*@5k%(+p+0+@0 ++0+@0 +F 0L0 ;;@GGN;(  *  0K Y,$ 0 LANLISIS UNIVARIANTE Variables cualitativas. Infeccin de Herida Quirrgica..M$8  0tK p m P''6 ` # #"NB`,$D  0  ZK __?  U0,000̙ @`  ZK __?f  T2,963 @`  Z$K __? f kPresencia de Bacteriemia.  @`  Z@K __?` U0,000̙ @`   ZHK __?f` T0,403 @`   ZW __?f` v$Presencia de Profilaxis antibitica. %% @`   Z W __?i.  U0,024̙ @`   ZW __?fi.  T1,763 @`   ZW __?if.  _ Traqueotoma.  @`  ZW __?   U0,000̙ @`  Z0W __?f   Q-3 @`  Z :W __? f  .Tipo de Ciruga por Clasificacin de Alteimer. // @`  Z\CW __?i U0,014̙ @`  Z4W __?fi T0,343 @`  Z8NW __?fi nComa de cualquier etiologa.  @`  Z^W __?.   U0,000̙ @`  ZgW __?f.   Q-3 @`  ZiW __?. f  u#Divisin Topogrfica de la Ciruga. $$ @`  Z zW __?   U0,000̙ @`  ZW __?f   T5,853 @`  Z$W __? f  [ Drenajes.   @`  Z4W __?H   U0,010̙ @`  ZW __?fH   T2,153 @`  ZЧW __?H f  [ Dilisis.   @`  ZW __? U0,023̙ @`  ZW __?f U0,0043 @`  ZW __?f oTraumatismo Craneoenceflico.  @`   Z0W __?   U0,001̙ @` ! ZW __?f   T5,863 @` " ZW __? f  _ Desnutricin.  @` # ZW __? H  U0,046̙ @` $ ZW __?f H  T2,053 @` % ZW __? fH  fInsuficiencia renal.  @` & ZO __? U0,000̙ @` ' Z O __?f T6,413 @` ( ZO __?f lReintervencin Quirrgica.  @` ) ZdO __?V U0,034̙ @` * Z'O __?fV T1,483 @` + Z1O __?Vf mndice de Comorbilidad > 2.  @` , Z$:O __?V V0,0001̙ @` - ZBO __?fV Q-3 @`K . ZEO __?fVF>6___PPT9 kTipo de Ingreso .(  @`  / Z$MO __? zp*Ff'ff @` 0 ZTQO __?f TRR f @` 1 ZiO __?f \ VARIABLES.  f @`~B 2 N__1 ?xB 3 H__1 ?xB 4 H__1 ?VVxB 5 H__1 ?xB 6 H__1 ?~B 7 N__1 ?``~B 8 N__1 ?`xB 9 H__1 ?ff`xB : H__1 ?`~B ; N__1 ?`xB < H__1 ?H H xB = H__1 ?  xB > H__1 ?xB ? H__1 ?  xB @ H__1 ?  xB A H__1 ?  xB B H__1 ?iixB C H__1 ?  xB D H__1 ?. . xB E H__1 ? F 0dqO @f,$ 0 6P*: valor de la p al 95% para la prueba de la chi cuadrado o test de Fisher. Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004 tM8 K'  7 & g G 64{O  G * 2'b  <v޽h @ ?"` 33] U ___PPT105 .r "+CCqD '  = @B DT ' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D{' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*F%(D' =-g6B fade*<3<*F+p+0+0 ++0+F0 +1 0L0 6&.&P..%(  .  0|2O Y,$ 0 PANLISIS UNIVARIANTE Variables cuantitativas. Infeccin de la Herida Quirrgica..Q$<  0O p m P''  `P   # #"B6 P`  ,$D  0  ZO __?P   V0,0000̙ @`  Z@O __?` P  oDas de Ventilacin mecnica.  @`  Z̲O __?P   V0,0000̙ @`  ZO __?` P  s!Das con tratamiento antibitico. "" @`   ZO __?P   V0,0000̙ @`   Z,O __?` P  pDas con Nutricin parenteral.  @`   ZP __?`T P  dDas con drenajes.  @`  Z8P __?P  V0,0000̙ @`   Z IP __?`P w%Estancia en das Hospitalaria global. && @`  ZYP __?PV  V0,0000̙ @`d  Z[P __?`VPF>6___PPT9 *Estancia en das en Unidad de Reanimacin.(+ + @`   ZnP __?PP V zp*Ff'ff @`  ZTP __?`PPV \ VARIABLES.  f @`~B  N__1 ?`P PxB  H__1 ?`V VxB  H__1 ?` xB   H__1 ?` ~B ! N__1 ?`  ~B " N__1 ?`P` xB # H__1 ?PPP ~B $ N__1 ? P  xB % H__1 ?`  xB & H__1 ?`T T xB ' H__1 ?` xB ( H__1 ?`  xB ) H__1 ?`  xB * H__1 ?`Y YxB + H__1 ?`  xB , H__1 ?`   - 0}P @+ W :  . 6P p,$ 0 P*: valor de la p al 95% para la prueba de la T de Student o la de Kruskall-Wallis. Tabla Elaborada por Dr. M. Cortia-Tesis Doctoral 2004 V S' 7& '  nb  <v޽h @ ?"` 33] U ___PPT105 .r "+PՎD '  = @B DT ' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-g6B fade*<3<*D{' =%(D' =%(D3' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*D' =%(D8' =A@BB BB0B%(D' =1:Bvisible*o3>+B#style.visibility<*.%(D' =-g6B fade*<3<*.+p+0+0 ++0+.0 + 0L0 `|(  ?  B<P ԔI   MEDIDAS DE CONTROL DE LAS INFECCIONES DE LOCALIZACIN QUIRRGICA*: Preparacin Preoperatoria Antispticos de manos y piel. Profilxis antimicrobiana Aspectos intraoperatorios. Vestimenta y paos quirrgicos. Tcnica Quirrgica. Atencin Postoperatoria. Vigilancia.PDv̙vD$̙PP   [  BP Ԕ{ o= Centers for Disease Control and Prevention. Guidelines for the Prevention of Surgical Infection. MMWR 1999. *P n      H  0޽h ? 3380___PPT10.XJ'j 0L0 pR(    6P   ECLASIFICACIN DE LAS RECOMENDACIONES SEGN LA FUERZA DE LA EVIDENCIA.FF   0TP   gCATEGORIA IA: Fuertemente recomendadas. Apoyadas por estudios epidemiolgicos bien diseados. CATEGORIA IB: Fuertemente recomendadas, vistas como eficaces por expertos. Estudios sugestivos con fuerte fundamentacin terica. CATEGORIA II: Sugeridos para su implementacin en muchos hospitales. SIN RECOMENDACIN: Evidencias insuficientes o falta de consenso.h0Z  3  O  3  q  3  6  3 .H  0޽h ? 3380___PPT10.YJ2]+ 0L0 g_(    0pP YT,$ 0 D$   <P ',$ 0 >   6P   ` gRECOMENDACIONES I$$  0Q  @  PREPARACIN PREOPERATORIA: Normalizar glucosa < 200 mg/dl en diabticos IB. Dejar de fumar o abstenerse de fumar 30 das antes de la intervencin IB. Disminuir las dosis de esteroides Sin acuerdo. Considerar retrasar la ciruga en pacientes con malnutricin severa II Reducin de peso en pacientes obesos II. No realizar intervenciones electivas en pacientes con infecciones remotas IA. Acortar la estancia hospitalaria lo mximo posible IA Ducha con antiseptico la noche anterior IB h  v  ,̙F̙!̙ D̙%̙J̙2̙'̙̙>4 H  0޽h ? 33___PPT10.XJP*Kl+eD '  = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 |-(  | | 0P YT,$ 0 D$  | <P ',$ 0 >  | 6!Q   ` hRECOMENDACIONES II$Y | 0AQ  @  PREPARACIN PREOPERATORIA (II): No eliminar el vello a menos que interfiera la zona IA. Si se elimina el vello, inmediatamente antes de la intervencin y con maquinilla elctrica IA. Lavar y limpiar cuidadosamente la zona de incisin y su entorno previamente a la antisepsia cutnea IB. Utilizar un antisptico aceptable, alcohol 70-92, clorhexidina 4%, 2% 0,5% en una base alcohlica, o iodoforos IB Realizar la preparacin de la piel en crculos concentricos del centro a la periferia, la zona de la piel ha de ser lo suficientemente grande para permitir nuevas incisiones, si fuera necesario IB. No realizar intervenciones electivas en pacientes con infecciones remotas IA. Acortar la estancia hospitalaria lo mximo posible IA Ducha con antiseptico la noche anterior IB h   v   3̙[̙c̙p̙̙J̙2̙'̙̙PR ' 3  H | 0޽h ? 33___PPT10+RD ' :Q = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*|%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*|%(+p+0+|0 ++0+|0 + 0L0 #(    0.Q YT,$ 0 D$   <*Q ',$ 0 >   6TQ   ` hRECOMENDACIONES II$O  0~Q  @  ANTISEPSIA DE MANOS Y BRAZOS: TODOS LOS MIEMBROS DEL EQUIPO: Uas cortas y no usaran artificiales IB. Sobre el uso de esmalte de uas Sin recomendacin. No utilizaran joyera en manos y brazos II Realizaran el lavado qurrgico, incluyendo manos y antebrazos, antes de tocar el campo esteril, el instrumental o la piel preparada del paciente IB. Limpiar las ua antes del lavado IB. El lavado quirrgico tendr una duracin de 3-5 minutos y se utilizar el antisptico adecuado IB Tras el lavado se mantendran las manos lejos del cuerpo (codos flexionados), de forma que el agua corra desde la punta de los dedos haca los codos. Se secaran las manos con toalla esteril y se pondr la bata y guantes esteriles IB   v o̙ v  ̙%̙̙(̙̙!̙^̙̙  ̙b 9  H  0޽h ? 33___PPT10+RD ' sQ = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 d(    0WQ YT,$ 0 D$   <gQ ',$ 0 >   6`dQ   ` iRECOMENDACIONES III$  0Q  @  /PROFILAXIS ANTIMICROBIANA: Se seleccionara segn su eficacia frente a los patgenos que provocan ILQ en cada tipo de intervencin IA Se administrar por va IV, antes de comenzar la i intervencin, para garantizar unos niveles tisulares adecuados. 30antes y no ms de dos horas antes. Preferiblemente durante la induccin anestsica IA. En las cesareas se administrar la PX tras pinzar el cordn IA. No se prolongar la PX en el postoperatorio IB Se considerar la administraccin de ms dosis en las siguientes circunstancias: 1) Duracin de la intervencin mayor que la vida media plasmatica del frmaco, 2) Perdida de sangre importante, 3 Obesidad mrbida IB   ~ v  ̙c̙̙<̙+̙̙̙P l qf GH  0޽h ? 33___PPT10+RD ' Q = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 y(    0`Q YT,$ 0 D$   <Q ',$ 0 >   6Q   ` hRECOMENDACIONES IV$  0Q  @  EASPECTOS INTRAOPERATORIOS: QUIRFANOS: Ventilacin con presin positiva respecto a pasillos y zonas adyacentes, con un mnimo de 15 cambio de aire por hora y tres de ellos al menos, de aire fresco IB Filtrar el aire que circula y el aire fresco con filtros adecuados IB. Introducir el aire por el techo del quirfano y eliminarlo cerca del suelo IB. Sobre uso de flujo laminar o luces UV No recomendacin. Mantener las puertas de los quirfanos cerrada, excepto para el paso de equipos y personal. Limitar el nmero de personas en unquirfano IB Limpieza: No hay recomendacin sobre la desinfeccin de los quirfanos entre intervenciones, en ausencia de suciedad visible No recomendacin.>   v v v̙ ̙ ̙̙C̙K̙%̙̙̙ H  0޽h ? 33___PPT10+RD ' Q = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 {(    0dQ YT,$ 0 D$   <Q ',$ 0 >   6R   ` gRECOMENDACIONES V$@  0 R  @  ASPECTOS INTRAOPERATORIOS: Limpieza Fregar el suelo del quirfanos despues de la ltima operacin del da o de la noche con un desinfectante hospitalario aprobado IB No es preciso realizar una limpieza o desinfeccin especial despus de una intervencin contaminada o sucia IA. No utilizar alfombras adhesivas a la entrada del BQ para controlar la infeccin, no se ha demostrado su efecto IA. Toma de muestras: No realizar toma de muestras de forma rutinaria de las superficies o del aire. IB. Esterilizacin del material quirrgico: Segn procedimientos establecidos IB Realice una esterilizacin rpida solo en casos de emergencia. IB. No utilice la esterilizacin rpida o de flash para el proceso habitual del material quirrgico IB. e ve v̙ ̙ ̙̙l̙o̙̙̙3̙̙&̙$̙=̙+̙:DH  0޽h ? 33___PPT10+RD ' R = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 X(    0tR YT,$ 0 D$   <DR ',$ 0 >   6AR   ` hRECOMENDACIONES VI$  0bR  @  $DVESTIMENTA Y PAOS QUIRRGICOS: No hay recomendacin sobre como o donde lavar los trajes o sobre el uso restringido de los poijamas y batas Sin resolver. Cambiese el pijama cuando est visiblemente sucio, contaminado o manchado de sangre o fluidos IB. Utilice mascarilla quirrgica que le cubra por completo boca y nariz cuando se entre en el quirfano y el instrumental est ya preparado. Uilice la mascarilla durante toda la intervencin IB Utilizar calzas no previene la IQ IA El equipo quirrgico utilizar guantes esteriles que se pondran despues de la bata esteril. Los guantes se cambiaran ante pinchazo o rotura o > de dos horas de intervencin. IB Utilizar materiales en batas y paos que supongan una barrera eficaz cuando esten humedos IB. Los miembros del equipo de anestesia han de seguir tambien estas recomendaciones IA.   $ v   l̙^̙̙"̙̙Z̙Y{z  7H  0޽h ? 33___PPT10+RD ' IR = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 +v 0L0 F>(    04OR YT,$ 0 D$   <8DR ',$ 0 >   6yR   ` iRECOMENDACIONES VII$  0R  @  Tcnica quirrgica: Maneje los tejidos cpn suavidad, manteniendo una hemostasia eficaz y minimizando los tejidos desvitalizados IB. Use el cierre por primera intencin, o deje la incisin abierta para un cierre de segunda intencin si la zona quirrgica est contaminada IB. Si estima necesario el uso de drenajes, utilice un drenaje cerrado por aspiracin, colocando una incisin distinat a la de la herida. Retirar el drenaje lo ms rpidamente posible IB Atencin postoperatoria: Proteger la incisin durante las primeras 24-48 horas. Asegurese que los apsitos se mantienen secos IA. Cuando las incisiones se dejan abiertas no hay recomendacin sobre el cambio de vendajes con tcnica esteril o con tcnica limpia Sin recomendacin. 2  v  v  l̙̙̙ e̙̙P'V *H  0޽h ? 33___PPT10+RD ' R = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 + 0L0 ia(    0R YT,$ 0 D$   <0PR ',$ 0 >   6LR   ` jRECOMENDACIONES VIII$#  04R  @  Atencion postoperatoria (II): Lave sus manos con un antisptico antes y despues de cambiar los vendajes, o cuando tenga cualquier contacto con la zona quirrgica. IA. Eduque al paciente y a la familia sobre como cuidar la incisin, identificar los signos y sintomas de infeccin y donde comunicarlos II. VIGILANCIA: Utilice definiciones estandares IB. Observacin prospectiva, deteccin prospectiva directa o indirecta, e incluya un mtodo de vigilancia al alta que se acomode a sus recursos IB. En cada paciente registre aquellas variables que se asocien de forma demostrada con mayor riesgo de ILQ IB. Calcule periodicamente las tasa de infeccin y comuniquelas, estratificando por algn indicador de riesgo IB. R  v   v  ̙̙   ̙̙h̙j̙l ? H   4H  0޽h ? 33___PPT10+RD ' R = @B D' = @BA?%,( < +O%,( < +D' =%(%(D' =%(D' =K@BBBBPB0B%(/%(D' =1:Bvisible*o3>+B#style.visibility<*%(Dk' =%(D' =%(D' =K@BBBBPB0B%(/%( D' =1:Bvisible*o3>+B#style.visibility<*%(+p+0+0 ++0+0 +j 0L0 R(  Z  6ĻR  @p INCIDENCIA ACUMULADA (IA)* DE IHQ POR GRADO DE CONTAMINACIN DE LA CIRUGA Y AO. Procedimientos seleccionados. COMPLEJO HOSPITALARIO UNIVERSITARIO DE ALBACETE  C B*CDEF{?)@pVq~  BA m?? ( ml  0A n??  nH  0޽h ? 3380___PPT10.YJPK 0L0  (  c  <R    PORCENTAJE DE ADECUACIN DE LA PROFILAXIS PERIOPERATORIA AL PROTOCOLO POR SERVICIO. 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   Presentacin en pantalla ^6 DArialTahomaTimes New Roman WingdingsComic Sans MS Arial Black Arial NarrowSymbolDiseo predeterminado$Diapositiva de Microsoft PowerPointGrfico de Microsoft GraphClipArt Grfico de Microsoft Graph 2000Documento de Microsoft WordDiapositiva 1Diapositiva 2Diapositiva 3Diapositiva 4fBACTERIEMIAS: Hemocultivo positivo para bacterias u hongos (2:3). 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