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      "titulo" => "Sesión plenaria : Mesa redonda: El papel de la Epidemiología y la Salud Pública en la Prevención de la Violencia."
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    "titulo" => "Comunicaciones orales : Vigilancia epidemiológica II"
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    "textoCompleto" => "<p class="elsevierStylePara"> S&#225;bado 4 de Octubre &#47; Saturday 4&#44; October<br></br> 9&#58;00&#58;00 a&#47;to 11&#58;00&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Matilde Chico Mena</p><p class="elsevierStylePara"><span class="elsevierStyleBold">497 BLOODBORNE SURVEILLANCE&#58; A 3-YEAR FOLLOW-UP PROGRAM IN A NEW HOSPITAL</span></p><p class="elsevierStylePara"> Ricardo Bou&#44; Miguel Peris&#44; Javier Perpi&#241;&#225;n&#44; Angel Aguilar&#44; Pilar Ramos</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Infectious Diseases Unit&#44; Hospital de la Ribera&#44; Alzira&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> To describe the overall and stratum-specific incidence rate of bloodborne exposures &#40;BE&#41; notified to the Infection Control Team &#40;ICT&#41;&#46; To characterise them and to present the results of the follow-up program&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span><span class="elsevierStyleItalic">Design&#58;</span> Prospective study&#46; <span class="elsevierStyleItalic">Setting&#58;</span> A 260-bed community referral center with a catchment population of 232&#44;739 inhabitants &#40;census 2001&#41;&#46; <span class="elsevierStyleItalic">Case definition&#58;</span> BE reported to Hospital de la Ribera &#40;HR&#41; ICT from January 1999 to December 2001&#46; <span class="elsevierStyleItalic">Study population&#58;</span> HR healthcare-workers &#40;HCW&#41;&#44; primary care centers and non healthcare-workers&#46; Patients and sources were tested for viral markers&#44; vaccinated and studied following the CDC Guidelines&#46; Overall and stratum-specific incidence rates &#40;IR&#41; were calculated&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> A total of 367 exposures to blood and body fluids were reported&#44; of which 94&#46;5 &#37; were percutaneous and 5&#46;4 &#37; mucocutaneous&#46; Seven cases were non HCW and 69 corresponded to primary care centers&#46; Among HR-HCW&#44; IR was 0&#46;3 per 1000 HCW-days &#40;291&#47;898048&#41;&#46; The highest category-specific IRs were observed among students &#40;0&#46;5 per 1000 HCW-days&#41;&#44; auxiliary nurses &#40;0&#46;4 per 1000 HCW-days&#41;&#44; nurses and housekeepers &#40;0&#46;2 per 1000 HCW-days&#41;&#46; The highest area-specific IRs were observed in the sterilization unit &#40;0&#46;9 per 1000 HCW-days&#41;&#44; outpatient clinics &#40;0&#46;8 per 1000 HCW-days&#41; and operating rooms &#40;0&#46;5 per 1000 HCW-days&#41;&#46; Among percutaneous exposures&#44; 64&#46;5 &#37; resulted from hollow-bore needlesticks&#44; whereas 13&#46;3 &#37; involved solid needles or sharp instruments&#46; Among mucocutaneous exposures&#44; 76&#46;2 &#37; resulted from direct exposure to patient&#39;s blood or body fluids and 4&#46;8 &#37; involved a broken or spilled body-fluid container&#46; At time of exposure&#44; 1 HCW was positive for HBsAg and 1 for HCV RNA&#44; 78 &#37; had been vaccinated against HBV&#46; Among the known sources involved&#44; 7 &#40;2&#46;7 &#37;&#41; were positive for HBsAg&#44; 24 &#40;9&#46;3 &#37;&#41; for anti-HCV&#44; 3 &#40;1&#46;2 &#37;&#41; for HIV and 217 &#40;84&#46;1 &#37;&#41; were negative for all viral markers&#46; One hundred and fifty-eight patients required post-exposure follow-up and 23 &#37; did not complete it&#46; The 3 HCWs exposed to HIV completed prophylaxis postexposure&#46; There was no seroconversion to any of the viral markers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Exposure risk was related to job tasks as well as to the different areas&#46; These category- and area-specific IRs will permit us to target interventions and control measures throughout next year&#46; There was no transmission of HBV&#44; HCV or HIV&#46; Still&#44; it is necessary to improve HBV vaccine coverage among HCWs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">498 BRUCELOSIS PROFESIONAL EN EL SECTOR DE LA ALIMENTACI&#211;N&#58; UN PROBLEMA PENDIENTE</span></p><p class="elsevierStylePara"> Marta Zimmermann&#44; Mercedes Tejedor&#44; M&#46; Victoria De la Orden&#44; Antonia Almodovar&#44; Pilar Herv&#225;s&#44; M&#46; Angeles De Vicente&#44; Alicia Ar&#233;valo&#44; Aurora Laguarta</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Servicio de Estudios e Investigaci&#243;n&#44; Instituto Nacional de Seguridad y Salud en el Trabajo&#44; Madrid&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> La forma de transmisi&#243;n m&#225;s conocida de la Brucelosis profesional es la adquirida por contacto directo con secreciones y excrementos de los animales y que afecta fundamentalmente a los trabajadores del sector Primario&#46; Sin embargo&#44; es una enfermedad de magnitud creciente en otros colectivos de trabajadores del sector Industrial&#46; El objetivo de este estudio es llegar a un mejor conocimiento de la distribuci&#243;n y tendencias de esta enfermedad profesional&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">M&#233;todos&#58;</span> Fueron analizados los partes de Enfermedad Profesional que correspondieran a brucelosis en el periodo 1996-2000 de todo el territorio nacional&#46; Se realiz&#243; un an&#225;lisis descriptivo de las variables de tiempo &#40;fecha de diagn&#243;stico completa&#41;&#59; lugar &#40;municipio&#44; provincia&#44; actividad de la empresa y plantilla&#41; y persona &#40;edad&#44; antig&#252;edad y ocupaci&#243;n&#41;&#46; Se calcularon incidencias anuales totales y por rama de actividad tomando como denominador trabajadores afiliados&#46; Finalmente&#44; se analizaron de forma pormenorizada los partes de Industrias C&#225;rnicas para detectar agregados temporo-espaciales de la enfermedad&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultados&#58;</span> De los 916 partes de brucelosis analizados 315 &#40;34&#44;4&#37;&#41; se produjeron en Industrias C&#225;rnicas&#59; 220 &#40;24&#37;&#41; en Actividades Agrarias y 67 &#40;7&#44;31&#37;&#41; en la Industria L&#225;ctea&#46; Por distribuci&#243;n territorial destaca Castilla-Le&#243;n con 339 casos &#40;37&#37;&#41;&#59; Arag&#243;n con 141 &#40;15&#44;39&#37;&#41;&#59; Castilla la Mancha con 137 casos &#40;14&#44;9&#37;&#41; y Andaluc&#237;a con 97 &#40;10&#44;6&#37;&#41;&#46; La distribuci&#243;n geogr&#225;fica no fue homog&#233;nea a lo largo del periodo detect&#225;ndose un aumento de casos en 1998 en Murcia &#40;observados 20 frente a 7&#44;2 esperados&#41;&#44; en 1999 en Arag&#243;n &#40;observados 61 frente a 31&#44;7 esperados&#41; y en 2000 en Andaluc&#237;a &#40;observados 24 frente a 13&#44;0 esperados&#41;&#46; La incidencia global de la brucelosis profesional notificada ha disminuido discretamente entre 1996 y 2000&#44; pasando de 1&#44;88 casos por 100&#46;000 afiliados a 1 caso por 100&#46;000&#44; respectivamente&#46; En las ramas de actividad que acumulan m&#225;s casos estas incidencias han pasado de 7&#44;09 a 2&#44;53 en la rama agraria y de 18&#44;9 a 20&#44;4 en la Industria de la Alimentaci&#243;n&#46; Comparando ambas ramas de actividad&#44; el riesgo relativo a favor de la Industria de la Alimentaci&#243;n ha pasado de 2&#44;68 &#40;IC 95&#37;&#58; 1&#44;91-3&#44;76&#41; en 1996 a 8&#44;06 &#40;IC 95&#37;&#58; 5&#44;22-12&#44;43&#41; en 2000&#46; Concretamente&#44; en las Industrias C&#225;rnicas&#44; se detectaron un total de 21 agregados temporo-espaciales que afectaron a 165 trabajadores&#46; La tasa de ataque media&#44; en las empresas afectadas&#44; fue de 21 casos por 100 trabajadores &#40;m&#237;nimo&#58; 11&#44;8&#37; y m&#225;ximo&#58; 37&#44;5 &#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusiones&#58;</span> El perfil de la brucelosis est&#225; cambiando en Espa&#241;a afectando de forma creciente a los trabajadores de Industria&#46; Las campa&#241;as de saneamiento&#44; las condiciones ambientales de las empresas del sector &#40;temperatura&#44; humedad&#41;&#44; las caracter&#237;sticas de las instalaciones y los ritmos de trabajo ser&#237;an mecanismos plausibles involucrados en la aparici&#243;n de brotes que expliquen los cambios en el patr&#243;n cl&#225;sico de la brucelosis profesional&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">499 COMPUTING SOLUTION BASED ON FILEMAKER FOR DE MANAGEMENT OF A LOOKOUT NET FOR SURVEILLANCE OF INFLUENZA</span></p><p class="elsevierStylePara"> Antoni Nicolau&#42;&#44; Arboledas Luis&#42;&#42;&#44; Bosch Catalina&#42;&#44; Portell Maragalida&#42;&#44; Galm&#233;s Ant&#242;nia&#42;&#44; Vanrell Joana&#42;&#44; Mart&#237; Isabel&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servei d&#39;Epidemiologia&#44; Conselleria de Salut i Consum&#46; Govern de les Illes Balears&#44; Palma&#44; Espa&#241;a&#46; &#42;&#42;Inspeccio M&#232;dica&#44; Conselleria d&#39;Educaci&#243; i Cultura&#44; Govern de les Illes Balear&#44; Palma&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Information&#58;</span> In 1999 was introduced the Influenza Lookout Net pilot plan in Mallorca Island&#46; From this time this net has been reinforced in its working so that in 2002-2003 season it is fully established in all the territory of Balearic Islands&#44; and integrated in the pool of nets that is coordinated by the Epidemiology National Center&#46; The peculiarities of such lookout nets&#44; the needs of permanent adaptation to the requirements of the national coordination level and&#44; finally&#44; the high exigencies in its routine management advised to build a computing solution that combine this criteria of power and adaptability&#44; but in conditions of maxim simplicity of programming and use&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> Describe de solution developed in FileMaker Pro for the management of the surveillance of influenza by means a lookout physician net&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methodology&#58;</span> Analysis of the needs of management of information generated by the net&#58; Numeric and individualized &#40;epidemiologic and laboratory&#41; information about cases of influenza detected in the net&#44; laboratory information generated in areas others than the net&#44; information for surveillance of syncitial respiratory virus from the own net&#44; information about response to the information sources and population covering of the net and generation of outputs on paper base and on file base&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span><span class="elsevierStyleItalic">1&#41;</span> Graphic interface data introduction module&#44; with maxim simplicity and minim risk of mistakes thanks to the setting on of validations and connected files&#46; <span class="elsevierStyleItalic">2&#41;</span> Data introduction with validation in order to prevent duplicates&#46; <span class="elsevierStyleItalic"> 3&#41;</span> Easiness to detect introduction mistakes not avoidable by the introduction module&#46; <span class="elsevierStyleItalic">4&#41;</span> Very simple use of consult and modification modules&#46; <span class="elsevierStyleItalic">5&#41;</span> Simple generation of basic statistical exploitation&#46; <span class="elsevierStyleItalic">6&#41;</span> Automatic generation of fundamental epidemiologic information &#40;week incidence taxes&#44; age taxes&#44; standardized taxes&#44; laboratory test performance&#44; population covering&#41;&#46; <span class="elsevierStyleItalic">7&#41;</span> Automatic generation of files&#44; with periodicity&#44; format and structure demanded by the national coordination level&#46; <span class="elsevierStyleItalic">8&#41;</span> Automatic generation of security copies of every database of the solution&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The database software FileMaker Pro allow with very simple elements in the using and programming process to give adapted response to complex requirements and allows&#44; likewise&#44; maximize the performance of the lookout net generated information for influenza surveillance&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">500 &#191;LA TASA DE PETICI&#211;N DE ANT&#205;GENO EN ORINA CONDICIONA LA DISTRIBUCI&#211;N GEOGR&#193;FICA DE NEUMON&#205;A POR LEGIONELLA&#63;</span></p><p class="elsevierStylePara"> Luisa Abraira Garc&#237;a&#42;&#44; M&#170; Jos&#233; Faraldo Valles&#42;&#42;&#44; Laboratorios integrantes del SIMG&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servicio de Informaci&#243;n sobre Sa&#250;de P&#250;blica&#44; DXSP&#44; Santiago de Compostela&#46; &#42;&#42;Servicio de Medicina Preventiva&#44; Hospital Cl&#237;nico Universitario&#44; Santiago de Compostela&#46; &#42;&#42;&#42;Laboratorios de microbiolog&#237;a&#44; Hospitales de la red del SERGAS&#44; Galicia&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> El n&#250;mero de casos aislados de Legionella ha ido en aumento desde el a&#241;o 1996&#44; este hecho podr&#237;a estar asociado a un incremento de la poblaci&#243;n expuesta a fuentes de riesgo&#44; pero tambi&#233;n a la generalizaci&#243;n de la prueba de detecci&#243;n de ant&#237;geno en orina&#46; En Galicia en el a&#241;o 2002&#44; se notificaron un total de 66 casos de neumon&#237;a por Legionella&#44; con distribuci&#243;n desigual entre &#225;reas hospitalarias&#46; El objetivo de este estudio fue determinar si la distribuci&#243;n geogr&#225;fica de casos de Legionella podr&#237;a estar influenciada por la tasa de petici&#243;n de la prueba de ant&#237;geno en orina entre los diferentes hospitales de Galicia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">M&#233;todos&#58;</span> Se solicit&#243; a los laboratorios de microbiolog&#237;a de los hospitales del Sergas que realizan la prueba de la detecci&#243;n de ant&#237;geno en orina&#44; que remitieran el n&#250;mero de pruebas realizadas entre el 1 de enero de 2002 y el 31 de diciembre de 2002&#44; seg&#250;n edad&#44; sexo y fecha de cada una de las peticiones&#46; Se llev&#243; a cabo un an&#225;lisis preliminar que incluy&#243; la comparaci&#243;n de proporciones de casos de neumon&#237;a seg&#250;n edad y sexo en funci&#243;n del n&#250;mero de peticiones de ant&#237;geno Legionella&#59; as&#237; como la correlaci&#243;n entre el n&#250;mero de casos de Legionella y el n&#250;mero de peticiones de ant&#237;geno en orina por hospital mediante el an&#225;lisis no param&#233;trico de Spearman&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultados&#58;</span> La tasa de incidencia de neumon&#237;a por Legionella para el a&#241;o 2002 seg&#250;n &#225;rea hospitalaria vari&#243; entre 0&#44;0 y 5&#44;89 por cien mil habitantes&#46; La incidencia fue menor en mujeres 0&#44;64 vs 4&#44;35 por 100&#46;000&#46; Por edad&#44; el intervalo m&#225;s afectado fue el de 45 a 49 a&#241;os con una tasa de 7&#44;55 por cien mil&#46; Se observ&#243; una clara y significativa distribuci&#243;n estacional de los casos&#44; con una mayor incidencia en los meses de julio y octubre &#40;46&#37; de todos los casos&#41;&#46; Remitieron informaci&#243;n sobre el n&#250;mero de pruebas realizadas 9 de los 11 hospitales en los que se lleva a cabo la detecci&#243;n de ant&#237;geno en orina&#46; Por g&#233;nero&#44; la diferencia en la proporci&#243;n de casos en relaci&#243;n al n&#250;mero de peticiones fue de 2&#44;73 &#40;IC 95&#37; 1&#44;23&#58;4&#44;23&#41;&#59; se observaron tambi&#233;n diferencias significativas por grupos de edad&#46; El coeficiente de correlaci&#243;n entre casos y peticiones por hospital muestra una r &#61; 0&#44;759&#59; p &#60; 0&#44;018&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusiones&#58;</span> De acuerdo con los resultados observados&#44; parece que el n&#250;mero de peticiones de ant&#237;geno en orina podr&#237;a explicar las diferencias geogr&#225;ficas observadas&#46; La homogeneizaci&#243;n de los criterios de petici&#243;n de pruebas diagn&#243;sticas de Legionella ayudar&#237;an a interpretar de forma clara la diferente distribuci&#243;n temporal y espacial de los casos de Legionella&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">501 CONTINUOUS HOSPITALWIDE ACTIVE SURVEILLANCE FOR NOSOCOMIAL INFECTION&#58; 4-YEAR TRENDS IN A NEW HOSPITAL</span></p><p class="elsevierStylePara"> Ricardo Bou&#44; Miguel Peris&#44; Javier Perpi&#241;&#225;n&#44; Angel Aguilar&#44; Pilar Ramos</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Infectious Disease Unit&#44; Hospital de La Ribera&#44; Alzira&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> To describe overall and stratum-specific incidence of nosocomial infections &#40;NI&#41; and to present the trends monitored&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span><span class="elsevierStyleItalic">Design&#58;</span> Prospective study&#46; <span class="elsevierStyleItalic">Setting&#58;</span> A 260-bed community referral center with an open medical-surgical Intensive Care Unit &#40;ICU&#41;&#46; <span class="elsevierStyleItalic">Case definition&#58;</span> NI from January 1999 to December 2002 according to the Centers for Disease Control and Prevention criteria&#46; <span class="elsevierStyleItalic">Study population&#58;</span> All patients admitted to the Hospital de La Ribera &#40;HLR&#41; from January 1999 to December 2002&#46; Data on NI were collected from the microbiology department records and computerized medical and nurse notes&#46; Overall and stratum-specific cumulative incidence &#40;CI&#41; rates were calculated&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Between 1999 and 2002&#44; a total of 70&#46;375 patients were admitted to HLR&#46; During the four year study period&#44; 1947 episodes of NI were identified&#46; Overall&#44; CI rates were constant throughout the study period in every major area &#40;11&#46;8 per 100 admissions for ICU&#44; 5&#46;1 per 100 admissions for surgery&#44; and 1&#46;1 per 100 admissions for medicine&#41;&#46; Overall and site-specific CI marked increases were detected on holiday periods of each year&#46; ICU and medicine areas had higher CI rates on the first year of follow-up&#44; surgery areas had higher CI rates in 2000 and 2001 followed by a slight decrease in 2002&#46; By infection sites&#44; marked decreases were observed in CI rate of bloodstream infections in ICU&#44; medicine and surgery areas &#40;4&#46;5 to 3&#46;1&#44; 1&#46;3 to 0&#46;2 and 1&#46;0 to 0&#46;4 per 100 admissions&#44; respectively&#41; and soft tissue infections in wards and ICU &#40;0&#46;3 to 0&#46;0 and 0&#46;5 to 0&#46;2 per 100 admissions&#44; respectively&#41;&#46; An increase of urinary tract infections was observed in surgery areas &#40;0&#46;7 to 1&#46;5 per 100 admissions&#41;&#46; Surgical site infections were constant over the 4 year period except in neurosurgery &#40;0&#46;5 to 1&#46;7 per 100 admissions&#41;&#46; Additionally&#44; a rise in ventriculitis CI rate was documented &#40;0&#46;0 to 0&#46;5 per 100 admissions&#41;&#46; Changes during the study period such as to recommend intravascular devices&#39; removing as soon as possible&#44; pressure ulcer prevention and patient skin preparation improvements were initiated on January 2001 and January 2002&#44; respectively&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Bloodstream infection was the most frequent&#44; severe and preventable NI observed after 2 years of surveillance&#46; An overall drop in bloodstream infection CI rate was observed since control infection measures were implemented&#46; Surveillance has allowed us to describe NI in terms of time&#44; place and person to identify groups within the population who were at high risk&#46;</p>"
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Comunicaciones orales : Vigilancia epidemiológica II
Surveillance II
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    "textoCompleto" => "<p class="elsevierStylePara"> S&#225;bado 4 de Octubre &#47; Saturday 4&#44; October<br></br> 9&#58;00&#58;00 a&#47;to 11&#58;00&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Matilde Chico Mena</p><p class="elsevierStylePara"><span class="elsevierStyleBold">497 BLOODBORNE SURVEILLANCE&#58; A 3-YEAR FOLLOW-UP PROGRAM IN A NEW HOSPITAL</span></p><p class="elsevierStylePara"> Ricardo Bou&#44; Miguel Peris&#44; Javier Perpi&#241;&#225;n&#44; Angel Aguilar&#44; Pilar Ramos</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Infectious Diseases Unit&#44; Hospital de la Ribera&#44; Alzira&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> To describe the overall and stratum-specific incidence rate of bloodborne exposures &#40;BE&#41; notified to the Infection Control Team &#40;ICT&#41;&#46; To characterise them and to present the results of the follow-up program&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span><span class="elsevierStyleItalic">Design&#58;</span> Prospective study&#46; <span class="elsevierStyleItalic">Setting&#58;</span> A 260-bed community referral center with a catchment population of 232&#44;739 inhabitants &#40;census 2001&#41;&#46; <span class="elsevierStyleItalic">Case definition&#58;</span> BE reported to Hospital de la Ribera &#40;HR&#41; ICT from January 1999 to December 2001&#46; <span class="elsevierStyleItalic">Study population&#58;</span> HR healthcare-workers &#40;HCW&#41;&#44; primary care centers and non healthcare-workers&#46; Patients and sources were tested for viral markers&#44; vaccinated and studied following the CDC Guidelines&#46; Overall and stratum-specific incidence rates &#40;IR&#41; were calculated&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> A total of 367 exposures to blood and body fluids were reported&#44; of which 94&#46;5 &#37; were percutaneous and 5&#46;4 &#37; mucocutaneous&#46; Seven cases were non HCW and 69 corresponded to primary care centers&#46; Among HR-HCW&#44; IR was 0&#46;3 per 1000 HCW-days &#40;291&#47;898048&#41;&#46; The highest category-specific IRs were observed among students &#40;0&#46;5 per 1000 HCW-days&#41;&#44; auxiliary nurses &#40;0&#46;4 per 1000 HCW-days&#41;&#44; nurses and housekeepers &#40;0&#46;2 per 1000 HCW-days&#41;&#46; The highest area-specific IRs were observed in the sterilization unit &#40;0&#46;9 per 1000 HCW-days&#41;&#44; outpatient clinics &#40;0&#46;8 per 1000 HCW-days&#41; and operating rooms &#40;0&#46;5 per 1000 HCW-days&#41;&#46; Among percutaneous exposures&#44; 64&#46;5 &#37; resulted from hollow-bore needlesticks&#44; whereas 13&#46;3 &#37; involved solid needles or sharp instruments&#46; Among mucocutaneous exposures&#44; 76&#46;2 &#37; resulted from direct exposure to patient&#39;s blood or body fluids and 4&#46;8 &#37; involved a broken or spilled body-fluid container&#46; At time of exposure&#44; 1 HCW was positive for HBsAg and 1 for HCV RNA&#44; 78 &#37; had been vaccinated against HBV&#46; Among the known sources involved&#44; 7 &#40;2&#46;7 &#37;&#41; were positive for HBsAg&#44; 24 &#40;9&#46;3 &#37;&#41; for anti-HCV&#44; 3 &#40;1&#46;2 &#37;&#41; for HIV and 217 &#40;84&#46;1 &#37;&#41; were negative for all viral markers&#46; One hundred and fifty-eight patients required post-exposure follow-up and 23 &#37; did not complete it&#46; The 3 HCWs exposed to HIV completed prophylaxis postexposure&#46; There was no seroconversion to any of the viral markers&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Exposure risk was related to job tasks as well as to the different areas&#46; These category- and area-specific IRs will permit us to target interventions and control measures throughout next year&#46; There was no transmission of HBV&#44; HCV or HIV&#46; Still&#44; it is necessary to improve HBV vaccine coverage among HCWs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">498 BRUCELOSIS PROFESIONAL EN EL SECTOR DE LA ALIMENTACI&#211;N&#58; UN PROBLEMA PENDIENTE</span></p><p class="elsevierStylePara"> Marta Zimmermann&#44; Mercedes Tejedor&#44; M&#46; Victoria De la Orden&#44; Antonia Almodovar&#44; Pilar Herv&#225;s&#44; M&#46; Angeles De Vicente&#44; Alicia Ar&#233;valo&#44; Aurora Laguarta</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Servicio de Estudios e Investigaci&#243;n&#44; Instituto Nacional de Seguridad y Salud en el Trabajo&#44; Madrid&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> La forma de transmisi&#243;n m&#225;s conocida de la Brucelosis profesional es la adquirida por contacto directo con secreciones y excrementos de los animales y que afecta fundamentalmente a los trabajadores del sector Primario&#46; Sin embargo&#44; es una enfermedad de magnitud creciente en otros colectivos de trabajadores del sector Industrial&#46; El objetivo de este estudio es llegar a un mejor conocimiento de la distribuci&#243;n y tendencias de esta enfermedad profesional&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">M&#233;todos&#58;</span> Fueron analizados los partes de Enfermedad Profesional que correspondieran a brucelosis en el periodo 1996-2000 de todo el territorio nacional&#46; Se realiz&#243; un an&#225;lisis descriptivo de las variables de tiempo &#40;fecha de diagn&#243;stico completa&#41;&#59; lugar &#40;municipio&#44; provincia&#44; actividad de la empresa y plantilla&#41; y persona &#40;edad&#44; antig&#252;edad y ocupaci&#243;n&#41;&#46; Se calcularon incidencias anuales totales y por rama de actividad tomando como denominador trabajadores afiliados&#46; Finalmente&#44; se analizaron de forma pormenorizada los partes de Industrias C&#225;rnicas para detectar agregados temporo-espaciales de la enfermedad&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultados&#58;</span> De los 916 partes de brucelosis analizados 315 &#40;34&#44;4&#37;&#41; se produjeron en Industrias C&#225;rnicas&#59; 220 &#40;24&#37;&#41; en Actividades Agrarias y 67 &#40;7&#44;31&#37;&#41; en la Industria L&#225;ctea&#46; Por distribuci&#243;n territorial destaca Castilla-Le&#243;n con 339 casos &#40;37&#37;&#41;&#59; Arag&#243;n con 141 &#40;15&#44;39&#37;&#41;&#59; Castilla la Mancha con 137 casos &#40;14&#44;9&#37;&#41; y Andaluc&#237;a con 97 &#40;10&#44;6&#37;&#41;&#46; La distribuci&#243;n geogr&#225;fica no fue homog&#233;nea a lo largo del periodo detect&#225;ndose un aumento de casos en 1998 en Murcia &#40;observados 20 frente a 7&#44;2 esperados&#41;&#44; en 1999 en Arag&#243;n &#40;observados 61 frente a 31&#44;7 esperados&#41; y en 2000 en Andaluc&#237;a &#40;observados 24 frente a 13&#44;0 esperados&#41;&#46; La incidencia global de la brucelosis profesional notificada ha disminuido discretamente entre 1996 y 2000&#44; pasando de 1&#44;88 casos por 100&#46;000 afiliados a 1 caso por 100&#46;000&#44; respectivamente&#46; En las ramas de actividad que acumulan m&#225;s casos estas incidencias han pasado de 7&#44;09 a 2&#44;53 en la rama agraria y de 18&#44;9 a 20&#44;4 en la Industria de la Alimentaci&#243;n&#46; Comparando ambas ramas de actividad&#44; el riesgo relativo a favor de la Industria de la Alimentaci&#243;n ha pasado de 2&#44;68 &#40;IC 95&#37;&#58; 1&#44;91-3&#44;76&#41; en 1996 a 8&#44;06 &#40;IC 95&#37;&#58; 5&#44;22-12&#44;43&#41; en 2000&#46; Concretamente&#44; en las Industrias C&#225;rnicas&#44; se detectaron un total de 21 agregados temporo-espaciales que afectaron a 165 trabajadores&#46; La tasa de ataque media&#44; en las empresas afectadas&#44; fue de 21 casos por 100 trabajadores &#40;m&#237;nimo&#58; 11&#44;8&#37; y m&#225;ximo&#58; 37&#44;5 &#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusiones&#58;</span> El perfil de la brucelosis est&#225; cambiando en Espa&#241;a afectando de forma creciente a los trabajadores de Industria&#46; Las campa&#241;as de saneamiento&#44; las condiciones ambientales de las empresas del sector &#40;temperatura&#44; humedad&#41;&#44; las caracter&#237;sticas de las instalaciones y los ritmos de trabajo ser&#237;an mecanismos plausibles involucrados en la aparici&#243;n de brotes que expliquen los cambios en el patr&#243;n cl&#225;sico de la brucelosis profesional&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">499 COMPUTING SOLUTION BASED ON FILEMAKER FOR DE MANAGEMENT OF A LOOKOUT NET FOR SURVEILLANCE OF INFLUENZA</span></p><p class="elsevierStylePara"> Antoni Nicolau&#42;&#44; Arboledas Luis&#42;&#42;&#44; Bosch Catalina&#42;&#44; Portell Maragalida&#42;&#44; Galm&#233;s Ant&#242;nia&#42;&#44; Vanrell Joana&#42;&#44; Mart&#237; Isabel&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servei d&#39;Epidemiologia&#44; Conselleria de Salut i Consum&#46; Govern de les Illes Balears&#44; Palma&#44; Espa&#241;a&#46; &#42;&#42;Inspeccio M&#232;dica&#44; Conselleria d&#39;Educaci&#243; i Cultura&#44; Govern de les Illes Balear&#44; Palma&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Information&#58;</span> In 1999 was introduced the Influenza Lookout Net pilot plan in Mallorca Island&#46; From this time this net has been reinforced in its working so that in 2002-2003 season it is fully established in all the territory of Balearic Islands&#44; and integrated in the pool of nets that is coordinated by the Epidemiology National Center&#46; The peculiarities of such lookout nets&#44; the needs of permanent adaptation to the requirements of the national coordination level and&#44; finally&#44; the high exigencies in its routine management advised to build a computing solution that combine this criteria of power and adaptability&#44; but in conditions of maxim simplicity of programming and use&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> Describe de solution developed in FileMaker Pro for the management of the surveillance of influenza by means a lookout physician net&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methodology&#58;</span> Analysis of the needs of management of information generated by the net&#58; Numeric and individualized &#40;epidemiologic and laboratory&#41; information about cases of influenza detected in the net&#44; laboratory information generated in areas others than the net&#44; information for surveillance of syncitial respiratory virus from the own net&#44; information about response to the information sources and population covering of the net and generation of outputs on paper base and on file base&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span><span class="elsevierStyleItalic">1&#41;</span> Graphic interface data introduction module&#44; with maxim simplicity and minim risk of mistakes thanks to the setting on of validations and connected files&#46; <span class="elsevierStyleItalic">2&#41;</span> Data introduction with validation in order to prevent duplicates&#46; <span class="elsevierStyleItalic"> 3&#41;</span> Easiness to detect introduction mistakes not avoidable by the introduction module&#46; <span class="elsevierStyleItalic">4&#41;</span> Very simple use of consult and modification modules&#46; <span class="elsevierStyleItalic">5&#41;</span> Simple generation of basic statistical exploitation&#46; <span class="elsevierStyleItalic">6&#41;</span> Automatic generation of fundamental epidemiologic information &#40;week incidence taxes&#44; age taxes&#44; standardized taxes&#44; laboratory test performance&#44; population covering&#41;&#46; <span class="elsevierStyleItalic">7&#41;</span> Automatic generation of files&#44; with periodicity&#44; format and structure demanded by the national coordination level&#46; <span class="elsevierStyleItalic">8&#41;</span> Automatic generation of security copies of every database of the solution&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The database software FileMaker Pro allow with very simple elements in the using and programming process to give adapted response to complex requirements and allows&#44; likewise&#44; maximize the performance of the lookout net generated information for influenza surveillance&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">500 &#191;LA TASA DE PETICI&#211;N DE ANT&#205;GENO EN ORINA CONDICIONA LA DISTRIBUCI&#211;N GEOGR&#193;FICA DE NEUMON&#205;A POR LEGIONELLA&#63;</span></p><p class="elsevierStylePara"> Luisa Abraira Garc&#237;a&#42;&#44; M&#170; Jos&#233; Faraldo Valles&#42;&#42;&#44; Laboratorios integrantes del SIMG&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servicio de Informaci&#243;n sobre Sa&#250;de P&#250;blica&#44; DXSP&#44; Santiago de Compostela&#46; &#42;&#42;Servicio de Medicina Preventiva&#44; Hospital Cl&#237;nico Universitario&#44; Santiago de Compostela&#46; &#42;&#42;&#42;Laboratorios de microbiolog&#237;a&#44; Hospitales de la red del SERGAS&#44; Galicia&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> El n&#250;mero de casos aislados de Legionella ha ido en aumento desde el a&#241;o 1996&#44; este hecho podr&#237;a estar asociado a un incremento de la poblaci&#243;n expuesta a fuentes de riesgo&#44; pero tambi&#233;n a la generalizaci&#243;n de la prueba de detecci&#243;n de ant&#237;geno en orina&#46; En Galicia en el a&#241;o 2002&#44; se notificaron un total de 66 casos de neumon&#237;a por Legionella&#44; con distribuci&#243;n desigual entre &#225;reas hospitalarias&#46; El objetivo de este estudio fue determinar si la distribuci&#243;n geogr&#225;fica de casos de Legionella podr&#237;a estar influenciada por la tasa de petici&#243;n de la prueba de ant&#237;geno en orina entre los diferentes hospitales de Galicia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">M&#233;todos&#58;</span> Se solicit&#243; a los laboratorios de microbiolog&#237;a de los hospitales del Sergas que realizan la prueba de la detecci&#243;n de ant&#237;geno en orina&#44; que remitieran el n&#250;mero de pruebas realizadas entre el 1 de enero de 2002 y el 31 de diciembre de 2002&#44; seg&#250;n edad&#44; sexo y fecha de cada una de las peticiones&#46; Se llev&#243; a cabo un an&#225;lisis preliminar que incluy&#243; la comparaci&#243;n de proporciones de casos de neumon&#237;a seg&#250;n edad y sexo en funci&#243;n del n&#250;mero de peticiones de ant&#237;geno Legionella&#59; as&#237; como la correlaci&#243;n entre el n&#250;mero de casos de Legionella y el n&#250;mero de peticiones de ant&#237;geno en orina por hospital mediante el an&#225;lisis no param&#233;trico de Spearman&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Resultados&#58;</span> La tasa de incidencia de neumon&#237;a por Legionella para el a&#241;o 2002 seg&#250;n &#225;rea hospitalaria vari&#243; entre 0&#44;0 y 5&#44;89 por cien mil habitantes&#46; La incidencia fue menor en mujeres 0&#44;64 vs 4&#44;35 por 100&#46;000&#46; Por edad&#44; el intervalo m&#225;s afectado fue el de 45 a 49 a&#241;os con una tasa de 7&#44;55 por cien mil&#46; Se observ&#243; una clara y significativa distribuci&#243;n estacional de los casos&#44; con una mayor incidencia en los meses de julio y octubre &#40;46&#37; de todos los casos&#41;&#46; Remitieron informaci&#243;n sobre el n&#250;mero de pruebas realizadas 9 de los 11 hospitales en los que se lleva a cabo la detecci&#243;n de ant&#237;geno en orina&#46; Por g&#233;nero&#44; la diferencia en la proporci&#243;n de casos en relaci&#243;n al n&#250;mero de peticiones fue de 2&#44;73 &#40;IC 95&#37; 1&#44;23&#58;4&#44;23&#41;&#59; se observaron tambi&#233;n diferencias significativas por grupos de edad&#46; El coeficiente de correlaci&#243;n entre casos y peticiones por hospital muestra una r &#61; 0&#44;759&#59; p &#60; 0&#44;018&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusiones&#58;</span> De acuerdo con los resultados observados&#44; parece que el n&#250;mero de peticiones de ant&#237;geno en orina podr&#237;a explicar las diferencias geogr&#225;ficas observadas&#46; La homogeneizaci&#243;n de los criterios de petici&#243;n de pruebas diagn&#243;sticas de Legionella ayudar&#237;an a interpretar de forma clara la diferente distribuci&#243;n temporal y espacial de los casos de Legionella&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">501 CONTINUOUS HOSPITALWIDE ACTIVE SURVEILLANCE FOR NOSOCOMIAL INFECTION&#58; 4-YEAR TRENDS IN A NEW HOSPITAL</span></p><p class="elsevierStylePara"> Ricardo Bou&#44; Miguel Peris&#44; Javier Perpi&#241;&#225;n&#44; Angel Aguilar&#44; Pilar Ramos</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Infectious Disease Unit&#44; Hospital de La Ribera&#44; Alzira&#44; Spain&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives&#58;</span> To describe overall and stratum-specific incidence of nosocomial infections &#40;NI&#41; and to present the trends monitored&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span><span class="elsevierStyleItalic">Design&#58;</span> Prospective study&#46; <span class="elsevierStyleItalic">Setting&#58;</span> A 260-bed community referral center with an open medical-surgical Intensive Care Unit &#40;ICU&#41;&#46; <span class="elsevierStyleItalic">Case definition&#58;</span> NI from January 1999 to December 2002 according to the Centers for Disease Control and Prevention criteria&#46; <span class="elsevierStyleItalic">Study population&#58;</span> All patients admitted to the Hospital de La Ribera &#40;HLR&#41; from January 1999 to December 2002&#46; Data on NI were collected from the microbiology department records and computerized medical and nurse notes&#46; Overall and stratum-specific cumulative incidence &#40;CI&#41; rates were calculated&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Between 1999 and 2002&#44; a total of 70&#46;375 patients were admitted to HLR&#46; During the four year study period&#44; 1947 episodes of NI were identified&#46; Overall&#44; CI rates were constant throughout the study period in every major area &#40;11&#46;8 per 100 admissions for ICU&#44; 5&#46;1 per 100 admissions for surgery&#44; and 1&#46;1 per 100 admissions for medicine&#41;&#46; Overall and site-specific CI marked increases were detected on holiday periods of each year&#46; ICU and medicine areas had higher CI rates on the first year of follow-up&#44; surgery areas had higher CI rates in 2000 and 2001 followed by a slight decrease in 2002&#46; By infection sites&#44; marked decreases were observed in CI rate of bloodstream infections in ICU&#44; medicine and surgery areas &#40;4&#46;5 to 3&#46;1&#44; 1&#46;3 to 0&#46;2 and 1&#46;0 to 0&#46;4 per 100 admissions&#44; respectively&#41; and soft tissue infections in wards and ICU &#40;0&#46;3 to 0&#46;0 and 0&#46;5 to 0&#46;2 per 100 admissions&#44; respectively&#41;&#46; An increase of urinary tract infections was observed in surgery areas &#40;0&#46;7 to 1&#46;5 per 100 admissions&#41;&#46; Surgical site infections were constant over the 4 year period except in neurosurgery &#40;0&#46;5 to 1&#46;7 per 100 admissions&#41;&#46; Additionally&#44; a rise in ventriculitis CI rate was documented &#40;0&#46;0 to 0&#46;5 per 100 admissions&#41;&#46; Changes during the study period such as to recommend intravascular devices&#39; removing as soon as possible&#44; pressure ulcer prevention and patient skin preparation improvements were initiated on January 2001 and January 2002&#44; respectively&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Bloodstream infection was the most frequent&#44; severe and preventable NI observed after 2 years of surveillance&#46; An overall drop in bloodstream infection CI rate was observed since control infection measures were implemented&#46; Surveillance has allowed us to describe NI in terms of time&#44; place and person to identify groups within the population who were at high risk&#46;</p>"
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ISSN: 02139111
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