Basic information on COVID-19 pandemic, due to SARS-Cov-2 Virus

The World Health Organization (WHO) declared the SARS-CoV-2 virus outbreak an internationally important public health emergency on 30 January  2020, and by 11 March declared it a pandemic. By 15 November 2020, according  to the WHO weekly report, there were  53.7 million confirmed cases and  1.3 million deaths reported globally. The Americas region is the most affected. The incubation period has been documented between 3 and 6 days. Transmission occurs from person to person by  respiratory droplets, which occur when a person speaks, coughs or sneezes.  The clinical presentation can range from a mild respiratory disease, with coughing, headache, and  general discomfort, which resolves in a few days, to a severe disease with shortness of breath, that requires immediate attention.  Global lethality reported as of November 26 is 2.3%. It is higher in people over the age of 65 and with underlying diseases such as high blood pressure, obesity, and diabetes. There is currently no specific antiviral treatment. Vaccines are in development and several of them have shown promising results, but there is still a need to conclude with global trials. Until vaccination can be initiated,  prevention and control measures should be continued.  The best way to prevent the disease is to avoid exposure to infected or possibly infected people, as the virus can be transmitted even if the person has no symptoms.La Organización Mundial de la Salud (OMS) declaró al brote por el virus SARS-CoV-2 como una emergencia de salud pública de importancia internacional el día 30 de enero de 2020, y para el 11 de marzo hizo la declaratoria de pandemia. Para el 15 noviembre de 2020, de acuerdo con el informe semanal de la OMS, se reportaron de forma global 53.7 millones de casos confirmados, y 1.3 millones de defunciones. La región de las Américas es la más afectada. El periodo de incubación ha sido documentado entre 3 a 6 días. La transmisión ocurre de persona a persona gotas respiratorias, que se producen cuando una persona habla, tose o estornuda.  El cuadro clínico puede ir desde una enfermedad respiratoria leve, con tos, cefalea, malestar general, que resuelve en unos días, hasta un cuadro grave con dificultad respiratoria que requiere atención inmediata. La letalidad global mundial reportada al 26 de noviembre es de 2.3%, es mayor en personas mayores de 65 años y con enfermedades subyacentes como hipertensión arterial, obesidad, y diabetes. Al momento no se cuenta con un tratamiento antiviral específico. Las vacunas están en desarrollo y varias de ellas han mostrado resultados prometedores, pero falta concluir con los ensayos. En tanto se puede iniciar la vacunación, se debe continuar con las medidas de prevención y control.  La mejor forma de prevenir la enfermedad es evitar exponerse a personas infectadas o posiblemente infectadas, ya que el virus puede transmitirse aún si la persona no tiene síntomas

International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009

Q3Artículo original95-106We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 throughDecember 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centersfor Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infec-tion Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective datafrom 155,358 patients hospitalized in the consortium’s hospital ICUs for an aggregate of 923,624 days. Although device utilizationin the developing countries’ ICUs was remarkably similar to that reported from US ICUs in the CDC’s NHSN, rates of device-asso-ciated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter(CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also farhigher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI),6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance ofStaphylococcus aureusisolatesto methicillin (MRSA) (84.1% vs 56.8%, respectively),Klebsiella pneumoniaeto ceftazidime or ceftriaxone (76.1% vs 27.1%, respec-tively),Acinetobacter baumanniito imipenem (46.3% vs 29.2%, respectively), andPseudomonas aeruginosato piperacillin (78.0%vs 20.2%, respectively) were also far higher in the consortium’s ICUs, and the crude unadjusted excess mortalities of device-relatedinfections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP)

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened

The research protocol. Part I

One of the principal aims in research is the publication of the study in scientific journals. This implies two challenges: the first one, the election of an adequate research design, and the second one, the concrete and simple wording of the results for the study to be accepted in the most appropriate journal according to the scope. Despite numerous supporting documents are available for both issues, the publication process is long, tiresome, and can discourage the most enthusiastic researcher. This is the first of a series of articles with the objective to describe the steps from the research question to the publication of the study. First of all, the importance of the research design will be addressed. The structure of the protocol is essential to achieve the objectives, and provides a way to organize the investigation in a logic, comprehensible and efficient manner

The research protocol II: study designs in clinical research

In clinical research that takes place in health-care areas, most of the studies are performed with human beings as research subjects. The main objectives of these studies are to know the characteristics of one or more groups, the behavior of human diseases, the etiology or causes of diseases, to identify the best diagnostic tools, or to establish the best treatment for a condition or disease in particular. Additionally, some studies are classified as basic bio-medical research; in these investigations, the subjects of study are laboratory animals, tissues, cells, or molecules. In general terms, the objectives of these studies are to understand the physiology, pathogenesis, or biological mechanisms that could explain functions or alterations in one or more systems or body organs. This article will only address clinical research designs

The research protocol IV: study variables

The variables in a research study are all that is measured, the information collected, or the data that is collected in order to answer the research questions, which are specified in the objectives. Their selection is essential to the research protocol. This article aims to point out the elements to be considered in the section of the variables. To avoid ambiguity, it is necessary to select only those that will help achieve the study objectives. It should subsequently be defined how they will be measured to ensure that the findings can be replicated; it is therefore desirable to include conceptual and operational definitions. From the methodological point of view, the classification of variables helps us understand how the relationship between them is conceptualized. Depending on the study design, the independent, dependent, universal, and confounding variables should be noted. Another indispensable element for planning statistical analyses is the scale of variable measurement. Therefore, one must specify whether the variables correspond to one of the following four: qualitative nominal, qualitative ordinal, quantitative range, or quantitative ratio. Finally, we should detail the measurement units of each variable

The research protocol VI: How to choose the appropriate statistical test. Inferential statistics

The statistical analysis can be divided in two main components: descriptive analysis and inferential analysis. An inference is to elaborate conclusions from the tests performed with the data obtained from a sample of a population. Statistical tests are used in order to establish the probability that a conclusion obtained from a sample is applicable to the population from which it was obtained. However, choosing the appropriate statistical test in general poses a challenge for novice researchers. To choose the statistical test it is necessary to take into account three aspects: the research design, the number of measurements and the scale of measurement of the variables. Statistical tests are divided into two sets, parametric and nonparametric. Parametric tests can only be used if the data show a normal distribution. Choosing the right statistical test will make it easier for readers to understand and apply the results

Basic information on COVID-19 pandemic, due to SARS-Cov-2 Virus

The World Health Organization (WHO) declared the SARS-CoV-2 virus outbreak an internationally important public health emergency on 30 January  2020, and by 11 March declared it a pandemic. By 15 November 2020, according  to the WHO weekly report, there were  53.7 million confirmed cases and  1.3 million deaths reported globally. The Americas region is the most affected. The incubation period has been documented between 3 and 6 days. Transmission occurs from person to person by  respiratory droplets, which occur when a person speaks, coughs or sneezes.  The clinical presentation can range from a mild respiratory disease, with coughing, headache, and  general discomfort, which resolves in a few days, to a severe disease with shortness of breath, that requires immediate attention.  Global lethality reported as of November 26 is 2.3%. It is higher in people over the age of 65 and with underlying diseases such as high blood pressure, obesity, and diabetes. There is currently no specific antiviral treatment. Vaccines are in development and several of them have shown promising results, but there is still a need to conclude with global trials. Until vaccination can be initiated,  prevention and control measures should be continued.  The best way to prevent the disease is to avoid exposure to infected or possibly infected people, as the virus can be transmitted even if the person has no symptoms.La Organización Mundial de la Salud (OMS) declaró al brote por el virus SARS-CoV-2 como una emergencia de salud pública de importancia internacional el día 30 de enero de 2020, y para el 11 de marzo hizo la declaratoria de pandemia. Para el 15 noviembre de 2020, de acuerdo con el informe semanal de la OMS, se reportaron de forma global 53.7 millones de casos confirmados, y 1.3 millones de defunciones. La región de las Américas es la más afectada. El periodo de incubación ha sido documentado entre 3 a 6 días. La transmisión ocurre de persona a persona gotas respiratorias, que se producen cuando una persona habla, tose o estornuda.  El cuadro clínico puede ir desde una enfermedad respiratoria leve, con tos, cefalea, malestar general, que resuelve en unos días, hasta un cuadro grave con dificultad respiratoria que requiere atención inmediata. La letalidad global mundial reportada al 26 de noviembre es de 2.3%, es mayor en personas mayores de 65 años y con enfermedades subyacentes como hipertensión arterial, obesidad, y diabetes. Al momento no se cuenta con un tratamiento antiviral específico. Las vacunas están en desarrollo y varias de ellas han mostrado resultados prometedores, pero falta concluir con los ensayos. En tanto se puede iniciar la vacunación, se debe continuar con las medidas de prevención y control.  La mejor forma de prevenir la enfermedad es evitar exponerse a personas infectadas o posiblemente infectadas, ya que el virus puede transmitirse aún si la persona no tiene síntomas

The research protocol III. Study population

The study population is defined as a set of cases, determined, limited, and accessible, that will constitute the subjects for the selection of the sample, and must fulfill several characteristics and distinct criteria. The objectives of this manuscript are focused on specifying each one of the elements required to make the selection of the participants of a research project, during the elaboration of the protocol, including the concepts of study population, sample, selection criteria and sampling methods. After delineating the study population, the researcher must specify the criteria that each participant has to comply. The criteria that include the specific characteristics are denominated selection or eligibility criteria. These criteria are inclusion, exclusion and elimination, and will delineate the eligible population. The sampling methods are divided in two large groups: 1) probabilistic or random sampling and 2) non-probabilistic sampling. The difference lies in the employment of statistical methods to select the subjects. In every research, it is necessary to establish at the beginning the specific number of participants to be included to achieve the objectives of the study. This number is the sample size, and can be calculated or estimated with mathematical formulas and statistic software

Descriptive statistics

Descriptive statistics is the branch of statistics that gives recommendations on how to summarize clearly and simply research data in tables, figures, charts, or graphs. Before performing a descriptive analysis it is paramount to summarize its goal or goals, and to identify the measurement scales of the different variables recorded in the study. Tables or charts aim to provide timely information on the results of an investigation. The graphs show trends and can be histograms, pie charts, “box and whiskers” plots, line graphs, or scatter plots. Images serve as examples to reinforce concepts or facts. The choice of a chart, graph, or image must be based on the study objectives. Usually it is not recommended to use more than seven in an article, also depending on its length