Vascular model for hemodialysis: A medical attention model [Accesos vasculares para hemodiálisis. Un modelo de atención]

Introduction: The vascular access for hemodialysis constitutes the angular stone for the handling of the patients who suffer for chronic renal insufficiency and require prolonged therapy. The handling of the accesses and in particular the arteriovenous fistulas are assumed in the immense majority of the services of health by the vascular surgeons, it is increased and acquired more use in present times when understanding to the hospital or center of health like a company or integrating them with the contract of companies for its operation in the concept of integral health services and to the patient like client, forces to establish organizational schemes for the benefit and implementation of these services of standarized way and with the required quality. Objective: To propose an organizational chart of operation for the evaluation, creation and handling of vascular access for hemodialysis and to demonstrate its feasibility. Patients and method: Design and proposed a protocol of handling of the vascular access for the patients who was put under hemodialysis in the unit of Bernardo Sepulveda general hospital from Ixtapa-Zihuatanejo operated by Medika Humana company of the Vitalmex Group, this protocol was implemented and the data of the procedures as well as the handling of the access would take shelter in the Nefrolink system. Results: 23 arteriovenous fistulas with different variants from surgical techniques were performed, and in all the cases was applied the protocol design previously raised, obtaining the use of all of them, reporting two failures that were corrected, all this in a period of ten months since May of the 2006 to February of the 2007 both months including and with an evaluation at the year of the cut of this series. Conclusions: Is demonstrated that was feasible to apply part of the organizational chart of operation for the evaluation, creation and handling of accesses for hemodialysis. The volume of complications is low and in relation to an evaluation and pursuit of the cases, this dice by the interrelation between nephrologists, vascular surgeon as well as the other parts implied in the evaluation and pursuit of the patients

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