Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit

Background: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. Methods: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. Results: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. Conclusion: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections

Artigo: Movimentos sociais e ONGs: dos lugares e dos sujeitos

Retracing the trajectory of social movements in Brazil from the 1970s, and taking into account the political changes in the international scene throughout the 1980s, this paper analyzes the impact of the social movements and NGOs in the fields of law and citizenship, challenging and enlarging democracy. It also evaluates the new tendencies of collective actions in the 1990s, calling attention to the articulations through the increase of forums and networks in sub-national and international contexts (for instance the World Social Forum). Finally, it discusses the growing participation of civil society in social control as took place with the public policy councils. Key-words: democracy, social movements, NGOs.Resgatando a trajetória dos movimentos sociais no Brasil a partir dos anos 1970, o trabalho analisa, informado pelas alterações políticas no cenário internacional nos anos de 1980, os impactos desses sujeitos (movimentos sociais e ONGs) no campo do Direito e da cidadania, desafiando e ampliando a democracia. Avalia também as novas tendências da ação coletiva dos anos 1990, ressaltando as articulações através de fóruns e redes que se ampliam não apenas no contexto subnacional, como internacional (a exemplo do Fórum Social Mundial). Problematiza, ainda, a crescente participação da sociedade civil junto aos espaços de controle social, a exemplo dos Conselhos de políticas públicas

Ciencia ciudadana, prospección arqueológica y valorización del patrimonio en zonas rurales, el caso de Ulldemolins (Priorat, Tarragona)

Este trabajo presenta los resultados del proyecto desarrollado en el pueblo de Ulldemolins (Priorat, Tarragona, España) en el marco del programa (FECyT-20-16076) «Participación ciudadana y arqueología en zonas rurales». El área de Ulldemolins cuenta con múltiples afloramientos de sílex de fácil acceso, así como con un rico patrimonio arqueológico diseminado por los campos agrícolas. Este patrimonio ha permitido crear un proyecto sólido que combina la vinculación con la ciudadanía y laprospección arqueológica. Esta investigación pone en valor la figura del erudito Josep M.. Figueras Rius (1922-2014) y expone los nuevos yacimientos y hallazgos de la prospección arqueológica realizada, fundamentada en la valorización, la conservación y la divulgación del Patrimonio rural.This paper presents the results of the project developed in the village of Ulldemolins (Priorat, Tarragona, Spain) as part of the program (FECYT-20-16076) "Citizen participation and archaeology in rural areas". The area of Ulldemolins has many easily accessible flint outcrops, as well as a rich archaeological heritage scattered throughout the agricultural fields. This heritage has made possible to create a solid project that combines links with the citizens, archaeological surveying, and the application of new technologies. This work highlights the figure of the scholar Josep M.ª Figueras Rius (1922-2014) and presents the new sites and findings of the archaeological survey carried out, based on the valorisation, conservation, and dissemination of rural heritage

COVID-19 pandemic on health professionals in a third level hospital in Spain: job changes during the first wave, mental health at 4 months, and follow-up at 9 months

Objetivo: Determinar el impacto que ha tenido la pandemia COVID-19 en profesionales sanitarios, en términos de cambios laborales y de salud mental. Método: 1)Estudio transversal y 2) estudio longitudinal prospectivo sobre profesionales de la salud que trabajaron de forma directa con pacientes afectados por la pandemia COVID-19 durante el periodo comprendido entre marzo-junio de 2020 en un hospital de tercer nivel de Barcelona. Se recogieron datos basales (julio-noviembre de 2020) y de seguimiento (noviembre de 2020-marzo de 2021). Se recogieron datos relacionados con el puesto de trabajo y hábitos tóxicos con cuestionarios ad hoc, y de estrés percibido, estrés postraumático, depresión y ansiedad mediante cuestionarios validados. Resultados: En el grupo basal (estudio transversal) participaron 90 profesionales, 76% enfermeras. Más de un tercio estuvo de baja o tomó fármacos para gestionar el estrés. La mitad de los fumadores aumentó el consumo de tabaco, y uno de cada 5 aumentó el consumo de alcohol. Se asocia de forma significativa el cambio de turno habitual con la depresión, el perfil profesional con la ansiedad, y el estrés percibido con la edad. En el estudio longitudinal, el grupo de seguimiento (n=64) muestra niveles elevados de estrés y ansiedad, que se mantienen o incluso aumentan en el tiempo de forma significativa. Conclusiones: Los cambios estructurales acontecidos en el hospital durante la primera ola de la pandemia por la COVID-19 tuvieron un fuerte impacto en los profesionales, presentando muchos de ellos un aumento en los hábitos tóxicos, así como una salud mental alterada que se mantiene en el tiempo.Objective: To determine the impact that the COVID-19 pandemic has had on health professionals, in terms of work changes and mental health. Method: 1) Cross-sectional study and 2) longitudinal prospective study on health professionals who worked directly with patients affected by COVID-19 pandemic during the period between March-June 2020 in a tertiary hospital in Barcelona. Baseline (July-November 2020) and follow-up (November 2020-March 2021) data were collected. Data related to the job and toxic habits were collected with ad hoc questionnaires, and data related to perceived stress, post-traumatic stress, depression, and anxiety using validated questionnaires. Results: In the baseline group (cross-sectional study), 90 professionals participated, 76% nurses. More than a third were on sick leave or took drugs to manage stress. Half of smokers increased tobacco use, and one in 5 increased alcohol consumption. Habitual shift change is significantly associated with depression, professional profile with anxiety, and perceived stress with age. In the longitudinal prospective study, the follow-up group (n = 64) shows high levels of stress and anxiety, which are maintained or even significantly increased over time. Conclusions: The structural changes that occurred in the hospital during the first wave of the COVID-19 pandemic had a strong impact on professionals, many of them presenting an increase in toxic habits, as well as impaired mental health that is maintained over time

Impacto económico de las bacteriemias nosocomiales. Comparación de tres metodologías de cálculo

Resumen- Introducción: El coste incremental que comportan las bacteriemias nosocomiales (BN) se utiliza como medida del impacto de estas infecciones. Los métodos tradicionales de cálculo de coste sobrestiman este incremento al no contemplar variables confusoras. El objetivo de este trabajo es comparar 3 metodologías de cálculo del coste incremental de la BN para corregir los sesgos presentes en análisis previos. Métodos: Se compararon los pacientes que presentaron algún episodio de BN entre 2005 y 2007, con los pacientes con la misma patología sin BN. Los microorganismos causantes se agruparon según la tinción Gram y según si la bacteriemia era monomicrobiana o polimicrobiana, o producida por un hongo. Se compararon 3 métodos de cálculo: 1) estratificación por patología; 2) ajuste econométrico multivariante mediante un modelo lineal generalizado (MLG), y 3) un propensity score matching (PSM) antes del análisis multivariante para controlar los sesgos. Resultados: Se analizaron 640 hospitalizaciones con BN y 28.459 sin BN; el coste medio observado fue de 24.515 € y 4.851,6 €, respectivamente. En la estratificación por patología, el coste incremental medio estimado fue de 14.735 €; el grupo de microorganismos que ocasionó menor coste incremental fue el de grampositivos, con 10.051 €. En el MLG el coste incremental medio estimado fue de 20.922 €, mientras que utilizando PSM se estimó un coste incremental medio de 11.916 €. En las 3 estimaciones hay diferencias importantes según el grupo de microorganismos. Conclusiones: Utilizar metodologías más elaboradas mejora el ajuste en este tipo de estudios e incrementa el valor de los resultados obtenidos

Description of an intervention to prevent pressure-induced skin lesions caused by personal protective equipment (PPE) during the care of patients with COVID-19

Objetivos: Describir los resultados de una estrategia diseñada para evitar lesiones cutáneas por presión relacionadas con la utilización de los equipos de protección individual (EPIs). Metodología: Estudio descriptivo observacional prospectivo realizado entre marzo y junio de 2020 en profesionales del Parc de Salut Mar (PSMAR) que utilizaron EPIs en áreas de pacientes diagnosticados de COVID-19. Un servicio de vigilancia multidisciplinar se activó con el fin de realizar una detección precoz. Se suministró de forma individualizada a 1044 profesionales materiales para prevención de lesiones por presión, fricción y humedad de los EPIs sobre la piel de la cara. Resultados: De todos los profesionales, 32 fueron citados para una valoración presencial por lesiones: 6 presentaron úlceras por presión en estadios III y IV, 24 dermatitis, foliculitis y eczemas. La tasa de presentación de úlceras fue del 0,57% y la de dermatitis del 2,30% de la población de estudio. Conclusión: Los resultados de la aplicación de las medidas especificadas indican que han sido eficaces para prevenir úlceras por presión en la región de la cara provocadas por los EPIs. La adopción de medidas de prevención no solo para prevenir ulceras por presión sino para la prevención de dermatitis se hacen imprescindibles en situaciones en las que se requiere el uso continuado de EPIs en la región de la cara.Objective: To describe a strategy designed to avoid pressure-related skin lesions related to the use of personal protective equipment (PPE). Methods: This was a prospective descriptive observational study. Study population: healthcare professionals at the Parc Salut Mar (Barcelona) who used PPE for protection against COVID-19 between March 30 and June 15, 2020. Intervention: Each professional was provided with an individual kit to prevent PPE-induced lesions, friction, or moisture. A multidisciplinary surveillance team was deployed for the early detection of these adverse events. Results: Individual kits were provided to 1044 professionals, 32 of whom were scheduled for in-person medical assessments. Six participants (0.57%) developed Stage III or IV pressure ulcers, 24 (2.3%) had dermatitis, folliculitis, eczema and two participants did not show for their appointments. The overall rate of pressure ulcers was 0.57%; for dermatitis it was 2.3%. Conclusions: The use of preventive measures appears to be effective in preventing facial pressure ulcers induced by EPIs among healthcare professionals. Our resultsalso underscore the importance of expanding preventive measures to include not only pressure ulcers but also dermatitis

Moisturizing body milk as a reservoir of Burkholderia cepacia : outbreak of nosocomial infection in a multidisciplinary intensive care unit

Background: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. Methods: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. Results: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. Conclusion: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections