Enric Limón
University of Barcelona
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Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Miquel Pujol; Enric Limón; Joaquín López-Contreras; Montserrat Sallés; Feliu Bella; Francesc Gudiol
The VINCat Program is a standardized surveillance program of healthcare infections in Catalonia, Spain. This program includes monitoring of surgical site infections (SSI) of elective colorectal surgery. The aim of this study was to define SSI rates in colorectal surgery among VINCat hospitals over a period of 4 years. We included consecutive elective colorectal interventions performed in VINCat hospitals from 2007 to 2010. Follow-up visits were performed 30 days after surgery. Prospective monitoring of SSI in colorectal surgery was performed according to standardized VINCat methodology. SSI was defined according to the Centers for Disease Control (CDC) and surgical risk factors according to the National Healthcare Safety Network (NHSN) classification. From 2007 to 2010, 49 centers performed 10,104 surgical procedures. The cumulative incidence of SSI was 20.8% (95% CI: 20.03-21.63). The annual cumulative SSI incidence rate did not vary significantly over the study period; however, there were significant differences among hospital infection rates. The relative frequency of organ-space infection increased from 25% in 2007 to 40% in 2010 (p<0.001). Laparoscopic surgery also increased (28% in 2007 to 42% in 2010, p<0.001). However, no changes were observed in mean surgery duration, ASA score and degree of surgical contamination. The VINCat Program incorporated a large number of Catalan hospitals that participated in standardized monitoring of colorectal surgery. The cumulative incidence rate of SSI for colorectal surgery was 20.8%, although there were large variations between hospitals.
Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Francesc Gudiol; Enric Limón; Esther Fondevilla; Josep M. Argimon; Benito Almirante; Miquel Pujol
In 2006 the VINCat Program was established in order to develop and support a standardized surveillance system of hospital-acquired infections (HAI). All acute care hospitals included in the public health system network of Catalonia (Spain) were invited to participate. The aim was to provide risk-adjusted, procedure-specific rates for most relevant infections. Data are collected by the local multidisciplinary infection control teams and transmitted electronically to the Coordinating Centre, which acts as the core of a network of infection control committees and has the support of a Technical Advisory Committee. The program website provides updated information on program activities, training workshops, aggregated data on past infection rates and access to databases, manuals and protocols. During the period 2007-2011, 64 hospitals have joined the program: 9 tertiary, 16 district and 39 small hospitals, providing records on 4.044 episodes of catheter-related blood stream infections, 14.389 elective colorectal surgical interventions, 14.214 hip and 29.599 knee arthroplasties, among the most significant indicators. Nowadays, it appears that VINCat has been successfully implemented and is well established as the official HAI surveillance program in Catalonia. Determinants for success have been: the maintenance of a close contact between the hospitals and the coordinating center, the timely and regular data feedback to institutions, the programs contribution towards reducing HAIs, the ongoing efforts to improve performance and, a key factor, the perception among the infection control professionals of the value added by the program to their daily work in different ways. Adequate funding, commitment of infection control teams and the generous collaboration of experts from different specialties are essential for maintaining the success of the VINCat Program.
Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Núria Freixas; Nieves Sopena; Enric Limón; Feliu Bella; Lourdes Matas; Benito Almirante; Miquel Pujol
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-related infection. Surveillance and prevention of MRSA is a priority in infection control programs. The aim of this study was to describe rates and trends of MRSA colonization or infection in 40 hospitals participating in the VINCat Program from 2008 to 2010. The study included all patients treated in acute care areas of participating hospitals. Hospitals were stratified into 3 groups based on size. The following annual indicators were reported: Methicillin-resistance rate, incidence density of new cases of MRSA and incidence density of MRSA bacteremia. Between 2008 and 2010, the yearly mean rate of resistance to methicillin remained stable for the study period (24%-25%), while the mean incidence of new cases of MRSA decreased from 0.65 to 0.54 cases per 1000 patient-days (p=NS) and the mean incidence of MRSA bacteremia decreased from 0.06 to 0.05 cases per 1,000 patient-days (p=NS). The implementation of a MRSA surveillance system in hospitals that participated in the VINCat Program provides information on the situation of each institution and facilitated interhospital comparisons in order to establish appropriate preventive measures.
Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Joaquín López-Contreras; Enric Limón; Lourdes Matas; Montserrat Olona; Montserrat Sallés; Miquel Pujol
The VINCat Program is a system for epidemiological surveillance of healthcare-related infections in which the majority of Catalan hospitals participate. It has a specific module for surgical site infections (SSI) surveillance. Primary hip and knee arthroplasties are basic indicators of the program due to their high frequency and the important morbidity of SSI of these sites. Results are presented for surgical site infection (SSI) surveillance of primary hip and knee arthroplasties for the first three years of the VINCat Program. The program requires SSI surveillance to be performed in a standardized, prospective and continuous manner by an infection control team from the centers. With primary arthroplasties, as with all procedures involving implants, the surveillance is maintained for 1 year after the intervention. The VINCat Program uses the SSI definitions of the Centers for Disease Control (CDC) and patients are stratified by surgical risk, following the classification of the National Healthcare Safety Network (NHSN). During the period 2007-2009, 51 Catalan hospitals participated in the SSI surveillance of prosthetic orthopedic surgery. The overall SSI rate in the interventions for total primary hip prosthesis (7,804 procedures) was 3.0% (IC 95%: 2.6-3.4) and for total primary knee prosthesis (16,781 procedures) was 3.3% (IC95%: 3.0-3.6). During the period 2007-2009, the overall SSI rates for total primary hip and knee arthroplasty were higher than those published by some surveillance systems in our environment. There were significant differences in the infection rates by procedure and in those adjusted by risk among the different hospitals.
Antimicrobial Resistance and Infection Control | 2013
Evelyn Shaw; Josep M. Badia; M Piriz; R Escofet; Enric Limón; Francesc Gudiol; Miquel Pujol
colon procedures were only slightly lower (18.8%) than those due to rectal surgery (22.3%). Both, overall SSI rates and organ/space SSI rates did not change significantly over the study period and were respectively: 2007 (20.8%/5.3%), 2008 (19.2%/6.9%), 2009 (21%/9%), 2010 (21%/8.5%), 2011 (20.7%/9.3%) and 2012 (19%/8.9%). Conclusion SSI rates in elective colorectal procedures at VINCat hospitals remained stable over the study period and were higher than those reported by other national programs. There is a need to clarify what surgical site infection rates in colorectal surgery should be considered for benchmarking standards.
Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Jordi Vallés; Enric Limón; Emili Diaz; Imma Fernández; Mercedes Palomar; Fernando Barcenilla; Francisco Álvarez-Lerma; Miquel Pujol
Hospital-acquired infections are a leading cause of morbidity and mortality, especially in the intensive care unit (ICU). Surveillance of device-associated infections plays a major role in infection control programs. In 2006, the Surveillance Program of Nosocomial Infections in Catalonia (VINCat Program) was started, with the major aim of reducing infection rates through a process of active monitoring. The study period comprised calendar years 2008 (with 21 ICUs participating), 2009 (with 21 ICUs participating), and 2010 (with 28 ICUs participating). Each participating hospital was required to have an infection control team made up of at least one physician, an infection surveillance nurse, and a microbiology laboratory. Hospitals were classified into three groups according to their size. Central venous catheter-associated bloodstream infection (CVC-BSI) and ventilator-associated pneumonia (VAP) were chosen as the device-associated infections to analyze. Incidence rates of device-associated infections were calculated by dividing the total number of device-associated infection (VAP or CVC-BSI) days by the total number of days use for the relevant device. Mechanical ventilation use ranged from 0.10 to 0.85 days (overall, 0.35), and central venous catheter use ranged from 0.18 to 0.98 days (overall, 0.65). Incidence rates of VAP ranged from 7.2 ± 3.7 to 10.7 ± 9.6 episodes of VAP/1000 ventilator days. Incidence rates of CVC-BSl ranged from 1.9 ± 1.6 to 2.7 ± 2.0 episodes of CVC-associated bloodstream infection/1000 central venous catheter days. The implementation of the VINCat Program allowed monitoring of nosocomial device-associated infections in ICUs in Catalonia and enabled corrective measures in ICUs with increased incidences of device-associated infections.
Enfermedades Infecciosas Y Microbiologia Clinica | 2012
Montserrat Olona; Enric Limón; Fernando Barcenilla; Santiago Grau; Francesc Gudiol
The first objective of the Catalonian Nosocomial Infection Surveillance Program (VINCat) is to monitor the prevalence (%) of patients with nosocomial infections (NI), patients undergoing urinary catheterization with closed circuit drainage (%) and patients undergoing antibiotic treatment (%). We present the results for the period 2008-2010. Comprehensive and point annual prevalence surveys were conducted that included conventionally hospitalized patients in acute care hospitals belonging to the VINCat Program. The number of participating hospitals was 46 (2008), 48 (2009) and 61 (2010), most belonging to the Network of Public Use Hospitals of Servei Català de la Salut. The results are presented globally and by hospital size (<200 beds, 200-500 beds, >500 beds). The prevalence of patients with active NI acquired during the current or the previous hospitalization (global NI/P%) was 7.6 (2008), 6.2 (2009) and 6.3 (2010). The prevalence of patients with active NI acquired during the current (actual NI/P%) was 6.2 (2008), 4.7 (2009) and 4.6 (2010).The results by hospital size shows that the variation occurred mainly in <200 beds hospitals. The proportion of closed circuit urinary catheterization use was 90.2%. The use of antibiotics varied between 34.6% and 37.6%, with no differences due to hospital size. The global prevalence of NI provides information on the burden of NI at the institutional and regional level. Between 17.3% and 26.9% of patients with NI at the time of the study had acquired it in a previous hospitalization at the same institution.
Antimicrobial Resistance and Infection Control | 2015
Evelyn Shaw; Aina Gomila; M Piriz; F. Obradors; R Escofet; R.M. Vazquez; Josep M. Badia; L. Martin; D Fraccalvieri; M. Brugues; Mc Nicolás; Elena Espejo; A. Castro; A.J. Cruz; Enric Limón; Francesc Gudiol; Miquel Pujol
Organ/space (O/S) infection in colorectal surgery remains a major health problem. In Catalonia, the VINCat Program has monitored 24,832 procedures during 2007-2014, showing a steady rate of O/S infection over the years, 8.2% (95% CI 7.9 - 8.6). Improving awareness of stakeholders could be an easy strategy for assembling quality programs within health systems.
Journal of Hospital Infection | 2018
Evelyn Shaw; A. Gomila; M. Piriz; R. Perez; J. Cuquet; A. Vazquez; Josep M. Badia; A. Lérida; D. Fraccalvieri; A. Marron; N. Freixas; A. Castro; A. Cruz; Enric Limón; F. Gudiol; S. Biondo; Jordi Carratalà; Miquel Pujol; D. Camprubí; L. Martín; C. Sanz; M. Brugués; X. Serra-Aracil; L. Mora; V. Diaz-Brito; E. Moreno; F. Obradors; E. Espejo; F. Aguilar; L. Pagespetit
BACKGROUND Accounting for time-dependency and competing events are strongly recommended to estimate excess length of stay (LOS) and risk of death associated with healthcare-associated infections. AIM To assess the effect of organ/space (OS) surgical site infection (SSI) on excess LOS and in-hospital mortality in patients undergoing elective colorectal surgery (ECS). METHODS A multicentre prospective adult cohort undergoing ECS, January 2012 to December 2014, at 10 Spanish hospitals was used. SSI was considered the time-varying exposure and defined as incisional (superficial and deep) or OS. Discharge alive and death were the study endpoints. The mean excess LOS was estimated using a multistate model which provided a weighted average based on the states patients passed through. Multivariate Cox regression models were used to assess the effect of OS-SSI on risk of discharge alive or in-hospital mortality. FINDINGS Of 2778 patients, 343 (12.3%) developed SSI: 194 (7%) OS-SSI and 149 (5.3%) incisional SSI. Compared to incisional SSI or no infection, OS-SSI prolonged LOS by 4.2 days (95% confidence interval (CI): 4.1-4.3) and 9 days (8.9-9.1), respectively, reduced the risk of discharge alive (adjusted hazard ratio (aHR): 0.36 (95% CI: 0.28-0.47) and aHR: 0.17 (0.14-0.21), respectively), and increased the risk of in-hospital mortality (aHR: 8.02 (1.03-62.9) and aHR: 10.7 (3.7-30.9), respectively). CONCLUSION OS-SSI substantially extended LOS and increased risk of death in patients undergoing ECS. These results reinforce OS-SSI as the SSI with the highest health burden in ECS.
Enfermedades Infecciosas Y Microbiologia Clinica | 2018
Santiago Grau; Esther Fondevilla; Daniel Echeverría-Esnal; Amaia Alcorta; Enric Limón; Francesc Gudiol
INTRODUCTION The overall increase in the use of carbapenems could lead to the selection of carbapenem-resistant bacteria. The objectives of this study were to analyze carbapenem use from 2008 to 2015 and their prescription profile in 58 hospitals affiliated to the VINCat Programme (nosocomial infection vigilance system). METHODS Retrospective, longitudinal and descriptive study of carbapenem use. Consecutive case-series study, looking for carbapenem prescription characteristics, conducted in January 2016. Use was calculated in defined daily doses (DDD)/100 patient-days (PD); prescription profiles were assessed using a standardized survey. RESULTS Carbapenem use increased 88.43%, from 3.37 DDD/100-PD to 6.35 DDD/100-PD (p<0.001). A total of 631 patients were included in the prescription analysis. Carbapenems were prescribed empirically in 76.2% of patients, mainly for urinary tract and intra-abdominal infections due to suspicion of polymicrobial mixed infection (27.4%) and severity (25.4%). CONCLUSION A worrying increase in carbapenem use was found in Catalonia. Stewardship interventions are required to prevent carbapenem overuse.