Evaluación y propuesta de organización de los servicios de salud del sistema de salud (SISAN) de la Fuerza Aérea Peruana (FAP) en Lima y Callao en el periodo 2018-2020

El objetivo de esta investigación es mejorar la situación de salud de la población sujeta de atención de la Fuerza Aérea Peruana (FAP) residente en Lima Metropolitana y la Provincia Constitucional del Callao a través de la organización de la oferta de servicios de las instituciones prestadoras de servicios de salud (IPRESS) del primer nivel de atención y el Hospital Central FAP (HOSPI). El problema principal identificado fue el tiempo de espera prolongado y las crecientes listas de espera para el acceso a los servicios de salud en el HOSPI el que se encuentra saturado debido a la atención de personal FAP y familiares que podrían acudir al primer y segundo nivel atención y no lo hacen porque se encuentran desorganizados y con una débil capacidad resolutiva. Para el diagnóstico situacional del Sistema de Salud de la FAP (SISAN) se utilizaron dos metodologías: el modelo de Kast y Rosenzweig para el análisis interno y para el análisis del entorno se usó el modelo de Collerette y Schneider; después de lo cual se identificó una realidad problemática conformada por diferentes brechas entre la situación actual y la situación esperada. Los productos propuestos para resolver la realidad problemática, incluyen: a) Implementación de una Unidad de Atención Primaria de Salud (UAPS) en Lima Metropolitana y Callao a través de una Asociación Público Privada (APP) o contrato de servicio; b) Elaboración de una Directiva FAP con la cartera de servicios de salud prestados por la UAPS; c) Elaboración de una Directiva FAP de Referencias y Contrareferencias en Lima Metropolitana y Callao; y d) Elaboración de una Ordenanza FAP que establezca el petitorio de productos farmacéuticos en el primer nivel de atención del SISAN FAP. Para el análisis de la viabilidad y factibilidad de la implementación de los productos propuestos se utilizó la metodología Sistema de Análisis de Capacidad Institucional (SADCI), mientras que la evaluación de los posibles actores que se pudieran oponer a la implementación se realizó usando el método MACTOR; luego de lo cual se encontró que los productos son viables y podrían contribuir a la solución de los problemas planteados. Por último, se realizó un análisis gerencial que permitió llegar a la conclusión que la mejor alternativa de solución del problema es la implementación de una Unidad de Atención Primaria de Salud (UAPS), bajo la forma de una Asociación Público- Privada (APP) modalidad “bata blanca” en el primer nivel de atención del SISAN FAP en Lima Metropolitana y Callao

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically