The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.
Tuberculosis (TB) is an occupational risk hazard that explains 5 to 5.361 additional cases of TB per 100.000 individuals among healthcare workers (HCW) in relation to general population in developing countries. For each clinical case a number of additional infections are occurring, that can be detected by tuberculin skin test conversion among non-BCG vaccinated HCW or by interferon-gamma testing. Risk factors for HCW infection include number of TB patients examined, job characteristics and place of work, delay in diagnostic suspicion, patients with multidrug resistant strains, limited access to appropriate ventilation systems, noncompliance with aerosol dissemination precautions, immune suppressed and/or malnourished HCW. Molecular studies suggest that only 32 to 42% of TB cases among HCW are related to occupational exposure. Useful measures to prevent occupational TB acquisition include a number of administrative-, infrastructure-and personal-related measures that have proven to be successful in reducing occurrence of new infections including clinical TB cases among HCW. In Chile, two official government sponsored guidelines are currently available for preventing TB infection among HCW, issued by the national TBC Control Program and by the National Nosocomial infection Control Program. Major differences in recommendations between these guidelines indicate that an update is urgently needed.
Epidemiología Características y costos directos de infecciones respiratorias agudas en niños de guarderías infantilesLuis Delpiano M., Paola Kabalán B., Constanza Díaz V. y Andrea Pinto I.Acute respiratory infections in children of day care center: Characteristics and costsThe clinical profile of respiratory infections in 140 children who attend a day care center was described in a prospective study and direct costs were estimated. The costs estimation included diagnostic procedures, laboratory exams, drugs, kinesitherapy, parents' absenteeism, medical certificates and hospitalization. Two hundred and two respiratory episodes in 90 (64.2%) children, 75 (37.1%) in 30 infants and 127 (62.8%) in 60 toddlers were analyzed. There were 61.3% lower respiratory infections in infants versus 39.4% in toddlers (p < 0.002). Antimicrobials were prescribed in 42.6% of the medical attendance. Infants represent major costs regarding medical consultations, kinesitherapy, laboratory tests and refunds for medical certificates or leave of absence (p < 0.001). The mean global cost of a respiratory infection was US $ 129,3 for infants and US $ 53,0 for toddlers (p < 0.001). This situation needs the development of an intervention program.
Objective: To evaluate the risk of tuberculosis (TBC) among health care workers (HCW) of the Southern Metropolitan Health Service (SMHS) of Santiago, Chile. Method: A retrospective study using records of patients receiving TBC treatment in the SMHS from 2001 to 2006 was performed, in which HCW were identified. Total population of HCWs at risk was calculated using annual records of personnel hired at the SMHS. Data on TBC cases and rates were compared against data of the SMSH and hazard ratio (HR) and confidence intervals obtained. Results: Fourteen cases were identified, predominantly among auxiliary personnel (n: 4, 35.7%), nursing staff and ambulance drivers (n: 2, 14.3% each). Cases occurred in personnel from 41.7% of hospitals and 10.3% of ambulatory care centers within the SMHS and 92.2% involved personnel with direct patient care or contact. Pulmonary localization was seen in 11 (78.6%), and more than half (57.2%) had a positive sputum stain or culture. All cases initiated treatment, but 1 abandoned it and other died of liver failure associated to cirrhosis (7.1% each). Between 2003 and 2006, the annual rate of TBC among HCW ranged between 0 and 79 per 100.000, and during 2004 it-10.62). Conclusions: Despite TBC rate decline in Chile, this disease still represents a significant occupational risk for HCW. Notably, more than half of cases among HCWs are contagious, and despite treatment, some have a lethal evolution.
Update. Consensus on Ventilator Associated Pneumonia.Second Part: ProphylaxisVentilator associated pneumonia is a life threatening disease, in spite of advances in its treatment, consequently the development of prevention strategies is a key factor in improving the morbidity and mortality in intensive care units (ICU). The new developments in this fi eld in the last years led to the need to update the recommendations done in 2001. Then, a new search and analysis of scientifi c literature was performed. The obtained data support different strategies highlighting: semi-recumbent position at 45° of patients; incorporation of routinely oral hygiene procedures with chlorhexidine; preference of orotracheal intubation; performing subglotic aspiration; use of standard hand hygiene techniques; not routine change of ventilator circuits; and defi ning bundles to organize the work at ICU. Some strategies were recommended for being of similar effi cacy to others but cost-effective as: use of heat and moisture humidifi cators; and changing humidifi cators every 5 to 7 days. The use of open or closed endotracheal suctioning system does not affect the incidence of pneumonia. Some recommendations were not incorporated because of lack of evidence supporting effectiveness, controversial data or doubtful application to our country as selective digestive decontamination.Key words: Prevention, ventilator-associated pneumonia, guidelines, mechanical ventilation, consensus. Palabras clave: Prevención, neumonía asociada a ventilación mecánica, guías clínicas, ventilación mecánica, consenso. Universidad Austral de Chile, Valdivia (MCA).Hospital San Borja Arriarán, Santiago (LDM).Hospital Padre Hurtado, Santiago. Enfermera Control de IAAS (ECV).Hospital Clínico Universidad IntroducciónL a neumonía asociada a ventilación mecánica (NAVM) se mantiene como una entidad de alta mortalidad que afecta a las poblaciones sometidas a este procedimiento. A pesar de que se han diseñado estrategias para iniciar un tratamiento oportuno y apropiado, mejorando el pronóstico de mortalidad de los enfermos, no es menos cierto que la mortalidad atribuible es aún elevada con una terapia adecuada. Por esto, el desarrollo y ejecución de medidas de prevención adecuadas parece ser uno de los esfuerzos más acertados para la disminución de la morbi-mortalidad asociada a este cuadro.En los últimos nueve años, el desarrollo de la literatura científi ca enfocada a este aspecto ha sido enorme y muy variado, incluyendo nuevos tipos de intervenciones, a la vez que ha intentado esclarecer la utilidad de las más antiguas; por otro lado, en otras se ha logrado tener un mejor dato respecto a su evidencia, así como en algunas, por el poco tiempo de desarrollo que llevan, no ha sido posible dar una recomendación con la misma calidad de fundamento.Como se ha mencionado previamente, este artículo es parte de la actualización del consenso realizado, con anterioridad, por la Sociedad Chilena de Infectología en el año 2001. La metodología nuevamente ha buscado realizar recomendacio...
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