Laboratorio de Referencia Regional de Salud Pública de San Martín

Un Laboratorio de Referencia Regional de Salud Pública es el responsable de realizar acciones de diagnóstico, control de calidad, investigaciones y vigilancia epidemiológica dentro de la región San Martín a fin de contribuir con el control y vigilancia de la salud pública en la región. Su infraestructura debe considerar requerimientos de alta calidad, siguiendo los criterios establecidos por las normativas nacionales e internacionales vinculadas a la calidad de laboratorios, y considerando el equipamiento y las condiciones ambientales óptimas para el desarrollo de sus acciones dentro de cada uno de los ambientes de laboratorio, garantizando la calidad de sus procedimientos y el control biológico. En la actualidad, en el Perú, gran parte de los laboratorios que desempeñan funciones de vigilancia en el sector público no se encuentran en correctas condiciones para realizar las funciones que les corresponden ya que no cuentan con la infraestructura apropiada, lo cual pone en riesgo la eficacia de sus procedimientos de diagnóstico, control de calidad, investigaciones y vigilancia epidemiológica. Si bien existen laboratorios con óptimas condiciones de infraestructura y equipamiento adecuado, éstos se encuentran en el sector privado, lo cual genera que la población demandante tenga que pagar altos costos para obtener los servicios de diagnóstico, control de calidad y otros. El planteamiento arquitectónico permite el correcto desarrollo de las funciones de diagnóstico, control de calidad, investigaciones y vigilancia epidemiológica, en favor de la salud pública, a través de zonas de laboratorios óptimamente diseñados mediante una organización unidireccional, en donde todos los procedimientos se podrán realizar de manera eficaz y cumpliendo con los requerimientos establecidos en las normativas nacionales e internacionales. El proyecto desarrolla el diseño arquitectónico y las especialidades de ingeniería de la solución técnica del Laboratorio de Referencia Regional de Salud Pública de San Martín, haciendo énfasis en el desarrollo a detalle de las infraestructuras de los bloques del Laboratorio de Enfermedades Infecciosas y Laboratorio de Control de Calidad de Alimentos y Aguas.A Regional Public Health Reference Laboratory is in charge of carrying out diagnostic actions, quality control, investigations, and epidemiological surveillance within the San Martín region in order to contribute to the control and surveillance of public health in the region. Its infrastructure must consider high quality requirements, following the criteria established by national and international regulations related to the quality of laboratories, and considering the equipment and appropriate environmental conditions for the development of its activities within each of the laboratory environments, guaranteeing the quality of its procedures and biological control. At present, in Peru, a large part of the laboratories that carry out surveillance functions in the public sector are not in good conditions to carry out the functions that correspond to them since they do not have the appropriate infrastructure, which puts the quality of its diagnostic procedures, quality control, investigations and epidemiological surveillance at risk. Although there are laboratories with optimal infrastructure conditions and adequate equipment, they are in the private sector, which means that the demanding population has to pay high costs to obtain diagnostic, quality control and other services. The architectural plan allows the correct development of the functions of diagnosis, quality control, investigations and epidemiological surveillance, for the benefit of the public health of the population, through blocks of laboratories correctly designed through a unidirectional organization, where all the procedures can be carried out efficiently and complying with the quality requirements of national and international regulations. The project develops the design of the architecture and specialties of the general plan of the San Martín Regional Public Health Reference Laboratory, emphasizing the detailed development of the infrastructures of the blocks of the Infectious Diseases Laboratory and Quality Control Laboratory of Food and Water.Tesi

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)