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      Impacto de la transmisión nosocomial del virus de la gripe en un hospital de agudos Translated title: Impact of nosocomial transmission of influenza virus in an acute hospital

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          RESUMEN

          Fundamentos:

          El incremento de la morbimortalidad asociado a la infección por el virus de la gripe supone un importante reto a nivel mundial, con especial relevancia dentro de las instituciones sanitarias. El objetivo del estudio fue analizar el impacto, repercusiones y características de la transmisión nosocomial del virus de la gripe.

          Métodos:

          Se incluyó una muestra de 286 pacientes hospitalizados en un centro de tercer nivel con gripe con firmada (ARN del virus en muestras respiratorias). El di seño del estudio fue observacional, mediante recogida de los resultados microbiológicos positivos de la temporada de gripe 2016-2017. Se realizó un análisis estadístico comparativo entre los casos de gripe comunitaria y los casos nosocomiales.

          Resultados:

          El 14.3% del total de la muestra (41 casos) se consideró de origen nosocomial. Se observaron diferencias significativas en el porcentaje de vacunados entre los casos de infección nosocomial (34,1%) y comunitaria (50,2%), y en el número de días de ingreso tras diagnóstico (12 ±22 días para los casos nosocomiales y 6 ±8 días para los comunitarios). La tasa de ataque fue del 0,66%.

          Conclusiones:

          La adquisición nosocomial del virus de la gripe se tradujo en una mayor gravedad del cuadro y en el incremento de los días de estancia hospitalaria. El estricto cumplimiento de las medidas de control y vigilancia epidemiológica de los casos de gripe ha permitido lograr una tasa de ataque reducida.

          ABSTRACT

          Background:

          The increase in morbidity and mortality associated the influenza virus infections represents an important global challenge, with particular relevance within health institutions. The aim of the study was to highlight the impact, repercussions and characteristics of the nosocomial transmission of influenza virus.

          Methods:

          A sample of 286 hospitalized patients in a third-level hospital with confirmed influenza (virus RNA in respiratory specimens) is included. The study design was observational, through the collection of positive microbiological results from the 2016-2017 season. A comparative statistical analysis was carried out between cases of community-acquired influenza and hospital-acquired cases.

          Results:

          14.3% of the total sample (41 cases) was considered of nosocomial origin. Significant differences were observed in the percentage of vaccinated between hospital-acquired (34.1%) and community-acquired (50.2%); and in the number of days of hospitalization after diagnosis between both groups. The attack rate was 0.66%.

          Conclusions:

          The nosocomial acquisition of the influenza virus resulted in a greater severity of the process and in the increase of days of hospital stay. Strict adherence to control measures and epidemiological surveillance of influenza cases has allowed to reduce the attack rate.

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          Most cited references17

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          Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis

          The Lancet Infectious Diseases, 12(1), 36-44
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            Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs.

            Influenza vaccination coverage among healthcare workers (HCW) is insufficient despite health authority recommendations in many countries. Numerous vaccination campaigns encouraging HCW to be vaccinated have met with resistance. We reviewed published influenza vaccination programs in healthcare settings to understand the reasons for their success and failure, as well as the attitudes and beliefs of HCW. Relevant articles published up to June 2004 were identified in the MEDLINE/Pubmed database. Thirty-two studies performed between 1985 and 2002 reported vaccination rates of 2.1-82%. Vaccination campaigns including easy access to free vaccine and an educational program tended to obtain the highest uptake, particularly in the USA. Yet, even this type of campaign was not always successful. Two main barriers to satisfactory vaccine uptake were consistently reported: (1) misperception of influenza, its risks, the role of HCW in its transmission to patients, and the importance and risks of vaccination (2) lack of (or perceived lack of) conveniently available vaccine. To overcome these barriers and increase uptake, vaccination campaigns must be carefully designed and implemented taking account of the specific needs at each healthcare institution.
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              Vaccinating healthcare workers against influenza to protect the vulnerable--is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation.

              Influenza causes substantial mortality in high-risk groups despite targeted vaccination programmes. This paper considers whether it is worth vaccinating healthcare workers (HCWs) against influenza to protect high-risk patients in a series of systematic reviews and an economic evaluation. Eighteen studies are included. Vaccination was highly effective in HCWs, with minimal adverse effects. Two trials assessed patient mortality after vaccinating HCWs, both of which showed a reduction. Despite recommendations, less than 25% of HCW in Europe and the UK are vaccinated. Five studies looked at programmes to increase uptake; these produced increases of 5%-45%. Published economic evaluations did not include patient benefit; therefore, an economic evaluation using UK data was undertaken. In the base case, vaccination was cost saving (pounds 12/vaccinee). In the most pessimistic scenario it cost pounds 405/life-year gained. Effective implementation should be a priority.
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                Author and article information

                Journal
                Rev Esp Salud Publica
                Rev Esp Salud Publica
                resp
                Revista Española de Salud Pública
                Ministerio de Sanidad, Consumo y Bienestar social
                1135-5727
                2173-9110
                10 August 2018
                Jan-Dec 2018
                : 92
                : e20180814
                Affiliations
                [1 ] originalServicio de Medicina Preventiva. Hospital Universitario de Salamanca. Castilla y León. España. orgdiv1Servicio de Medicina Preventiva orgnameHospital Universitario de Salamanca Castilla y León España
                [2 ] originalServicio de Microbiología. Hospital Universitario de Salamanca. Castilla y León. España. orgdiv1Servicio de Microbiología orgnameHospital Universitario de Salamanca Castilla y León España
                Author notes
                Correspondencia José Luis Mendoza García Servicio de Medicina Preventiva Hospital Universitario de Salamanca Paseo de San Vicente 58-182, 37007-Salamanca joseluismendoza@ 123456saludcastillayleon.es

                Los autores declaran que no existe conflicto de intereses.

                Article
                e201808014
                11587366
                ce9a74e2-7a8c-427c-b667-e357811e2ebe

                This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. You are free to Share (copy and redistribute the material in any medium or format) under the following terms: Attribution (You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use); NonCommercial (You may not use the material for commercial purposes); NoDerivatives (If you remix, transform, or build upon the material, you may not distribute the modified material); No additional restrictions (You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits).

                History
                : 07 September 2017
                : 15 December 2017
                : 10 August 2018
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 16, Pages: 1
                Categories
                Original Breve

                infección hospitalaria,virus de la influenza a,vacunas contra la influenza,vacunas,control de infecciones,reacción en cadena de la polimerasa,cross infection,influenza a virus,influenza vaccines,vaccines,infection control,polymrase chain reaction

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