Peruvian Hospitals Research Articles

Alcohol consumption and suicide risk in medical internship: A Peruvian multicentric study.

Suicide and harmful alcohol consumption are major health problems, especially in medical students. This study aimed to evaluate the association between risk for alcohol abuse and suicide risk in medical interns of Peruvian hospitals. We conducted a multicentre cross-sectional study in medical interns from 18 Peruvian hospitals. We measured suicide risk, risk for alcohol abuse, depression and self-esteem using the Plutchik Suicide Risk Scale, CAGE, Zung Self-Rating Depression Scale and Rosenberg Self-Esteem Scale, respectively. We used χ2 and Student t-tests for descriptive analysis. To evaluate the association between risk for alcohol abuse and suicide risk we generated crude and adjusted Poisson regression models with robust variance and estimated prevalence ratios with 95% confidence intervals. We surveyed 433 medical interns. The prevalence of suicide risk and risk for alcohol abuse was 19.6% and 27.5%, respectively. We found significant differences in suicide risk according to age (P < 0.001), region of origin (P = 0.002), with whom the participant lived (P < 0.001), university of origin (P = 0.040), type of hospital (P = 0.042), family history of attempted suicide (P = 0.043), self-esteem level (P < 0.001) and alcohol consumption (P < 0.001). In the adjusted model, age (PRa: 1.11, 95% confidence interval 1.05-1.17) and risk for alcohol abuse (PRa: 7.60, 95% confidence interval 4.46-12, 96) were associated with suicide risk. Two out of 10 medical interns had a positive screening for suicide risk. Age and especially risk for alcohol abuse were the associated variables.

Depression and Abuse During Medical Internships in Peruvian Hospitals

ObjectiveTo estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. MethodsWe conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). ResultsA total of 402 medical interns participated in the study, the median age was 25 [IQR: 21–33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa=1.15), the number of hours they sleep per day (PRa=1.23), being a woman (PRa=3.33), performing the internship in a province (PRa=0.25), studying at a public university (PRa=0.64), living with parents (PRa=0.65) or alone (PRa=0.33), and having perceived some type of abuse (PRa=1.07). ConclusionsA quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

Physical Exertion Immediately Prior to Placental Abruption: A Case-Crossover Study.

While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-crossover study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).

Spare the rod, spoil the child: Bullying during medical internship in three Peruvian hospitals

Dear Editor,Bullying has traditionally been considered normal during health professional training (1). However, it is now recognized as harmful to both academic traiwning and mental and emotional health, with negative consequences such as low career satisfaction, depression, burnout syndrome, and post-traumatic stress symptoms (2,3).The hierarchy observed in the different stages of the medical career facilitates power abuse and makes medical students vulnerable. Likewise, frequently undervaluing abuse leads to less willingness to report bullying cases, and in the continuity of this behavior over time (1,4). During medical internships, students are also considered as workers, which increases the chances of being bullied; in addition, the training environment differs from what they experienced early in their career (3).

Tuberculosis in health workers in Peru, 2013-2015

To describe the characteristics of tuberculosis epidemiology in Peruvian health workers. A descriptive study was performed. It included all health workers with tuberculosis listed in the national epidemiological surveillance system of the Peruvian Ministry of Health, during 2013, 2014, and 2015. A total of 755 cases of tuberculosis in health workers were reported: 60% worked in hospitals, 28% worked in primary-care facilities, and 12% worked in private facilities. In 57% of the cases, they worked in health facilities in Lima Metropolitan area and Callao. The average age of workers was 38 years (ranging from 19 to 89 years), and 63.6% were women. Of the cases, 6.1% were resistant, mainly multidrug-resistant tuberculosis, 67% of the cases had bacteriological confirmation of pulmonary tuberculosis. Health professionals and technicians represented 82.5% of the cases, and 55.2% corresponded to doctor's offices, hospital admissions, and emergency rooms, the areas where they worked. Tuberculosis poses a significant work risk for health workers of both public and private facilities. It mainly affects health professionals and technicians providing direct care and assistance to patients in large Peruvian hospitals.

Extended-spectrum β-lactamase–producing Enterobacteriaceae in cell phones of health care workers from Peruvian pediatric and neonatal intensive care units

Health care workers (HCWs) use their mobile phones during working hours or medical care. There is evidence that the instruments are colonized with pathogenic microorganisms. Here, we describe levels of Enterobacteriaceae contamination (EC) in cell phones and the risk factors associated with EC in Peruvian intensive care units (ICUs). This was a 5-month cohort study among 114 HCWs of 3 pediatric and 2 neonatology ICUs from 3 Peruvian hospitals. A baseline survey collected data on risk factors associated with EC. Swabs were collected from HCWs' phones every other week. Three-quarters of HCWs never decontaminated their phones, and 47% reported using the phones in the ICU >5 times while working. EC was frequent across samplings and sites and was substantially higher in subjects with longer follow-up. Potential risk factors identified did not have strong associations with positive samples (relative risk, 0.7-1.5), regardless of significance. Half of the phones were colonized with an Enterobacteriaceae at least once during the 4 samplings attained on average during the study period. Half of the isolates were multidrug resistant (MDR), and 33% were extended-spectrum β-lactamase producers. EC on HCWs' phones was frequent and apparently randomly distributed through the hospitals without clear clustering or strongly associated risk factors for having a positive sample. Based on the level of EC, phones may be considered as potential bacterial reservoirs of MDR and ESBL bacteria.

Detection of Bordetella pertussis using a PCR test in infants younger than one year old hospitalized with whooping cough in five Peruvian hospitals.

To report the incidence, epidemiology, and clinical features of Bordetella pertussis in Peruvian infants under 1 year old. A prospective cross-sectional study was conducted in five hospitals in Peru from January 2010 to July 2012. A total of 392 infants under 1 year old were admitted with a clinical diagnosis of whooping cough and tested for B. pertussis by PCR. The pertussis toxin and IS481 genes were detected in 39.54% (155/392) of the cases. Infants aged less than 3 months were the most affected, with a prevalence of 73.55% (114/155). The most common household contact was the mother, identified in 20% (31/155) of cases. Paroxysm of coughing (89.03%, 138/155), cyanosis (68.39%, 106/155), respiratory distress (67.09%, 104/155), and breastfeeding difficulties (39.35%, 61/155) were the most frequent symptoms reported. An increase in pertussis cases has been reported in recent years in Peru, despite national immunization efforts. Surveillance with PCR for B. pertussis is essential, especially in infants less than 1 year old, in whom a higher rate of disease-related complications and higher mortality have been reported.

Conocimiento de médicos de 2 hospitales peruanos sobre la relación entre enfermedad periodontal y alteraciones sistémicas

ObjectiveTo determine the level of knowledge of physicians from two Peruvian hospitals on the relationship between periodontal and systemic diseases. MethodsThis cross-sectional and descriptive study was conducted between April and May 2014 and included a total of 77 physicians, 39 from Hospital Belen de Trujillo and 38 from Hospital Victor Lazarte Echegaray (Trujillo, Peru). They were given a questionnaire that was previously submitted for validation by experts and reliability analysis (Cronbach's alpha=0.605). ResultsThe level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1% and moderate in 41.6% of physicians who responded. No differences were found as regards medical specialty (P=.348) or professional experience (P=.403). ConclusionThe results suggest that the level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1% of physicians from Victor Lazarte Echegaray and Belen hospitals in Trujillo, Peru, in 2014.

Abstract 4314: Prediction of chemotherapy response and metabolism for the tailoring of ovarian cancer treatment

Abstract Ovarian cancer patients respond well to first line chemotherapy but present high incidences of toxicity followed by consistent relapse within 18 months. Despite every cancer and patient being unique, generally all cancers are treated by the same chemotherapy regimes and patient metabolism is not considered in treatment selection. Differing metabolism may account for unacceptable toxicity or failures in chemotherapy treatment. It is becoming accepted that the metastatic cell is distinct to those found in the primary tumor and is thus the true target of chemotherapy. Our objectives were to isolate these potential ovarian metastatic cells from patients and correlate their in vitro response to the chemotherapy with clinical response. The single nucleotide polymorphism (SNP) distribution of genes related to chemotherapy metabolism was also analyzed in each patient. Primary cultures and blood samples of ovarian patients were obtained with signed informed consent from a network of Chilean and Peruvian hospitals. Chemotherapy response was assessed by MTS and data correlated with medical follow-up. SNPs were detected using commercial taqman probes from Applied Biosystem. Results. Ovarian cancer patients with clinical follow-up demonstrated a marked separation of progression free survival (PFS) curves according to classification within our in vitro assay. Analysis of exclusively first line patients demonstrated a median PFS of 17 months for patients predicted to respond to treatment showed by our assay, but only an average of 2 months of PFS in patients that the assay predicted no response. Initial analysis of 14 SNPs related to paclitaxel-platinum based chemotherapy demonstrates marked differences in Chilean patients. Conclusion. We demonstrate a clear distinction in time to relapse between the patients predicted or not to respond to treatment by our assay. Ovarian cancer patients demonstrate notably different distributions in SNPs previously correlated with platinum metabolism. Our results highlight the requirement of the medical community to take this research to the stage of randomized clinical trials. CORFO 13CTI21526-P6 &amp; 13IDL2-18608, FONDECYT 1140960, 1140657 &amp; 1120292. Citation Format: Maria Loreto Bravo, Pamela Gonzalez, Sumie Kato, Carolina Ibañez, Marcelo Garrido, Jorge Brañes, Maria Isabel Barriga, Eva Bustamante, Nicanor Barrena, Catalina Alonso, Leonel Muñoz, Erasmo Bravo, Clemente Arab, Alejandro Barra, Paula Jimenez, Patricio Gayan, Fernando Gonzalez, Ignacio Chavez, Alfredo Aguilar, Joseph Pinto, Mauricio Cuello, Gareth Owen, Jaime Cartagena. Prediction of chemotherapy response and metabolism for the tailoring of ovarian cancer treatment. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4314. doi:10.1158/1538-7445.AM2015-4314

Surgical Site Infections Rates in More Than 13,000 Surgical Procedures in Three Cities in Peru: Findings of the International Nosocomial Infection Control Consortium.

Surgical site infections (SSIs) are a threat to patient safety. However, there are not available data on SSI rates stratified by surgical procedure (SP) in Peru. From January 2005 to December 2010, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in four hospitals in three cities of Peru. Data were recorded from hospitalized patients using the U.S. Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) methods and definitions for SSI. Surgical procedures (SPs) were classified into 4 types, according to ICD-9 criteria. We recorded 352 SSIs, associated to 13,904 SPs (2.5%; CI, 2.3-2.8) SSI rates per type of SP were the following for this study's Peruvian hospitals, compared with rates of the INICC and CDC-NHSN reports, respectively: 2.9% for appendix surgery (vs. 2.9% vs. 1.4%); 2.8% for gallbladder surgery (vs. 2.5% vs. 0.6%); 2.2% for cesarean section (vs. 0.7% vs. 1.8%); 2.8% for vaginal hysterectomy (vs. 2.0% vs. 0.9%). Our SSIs rates were higher in all of the four analyzed types of SPs compared with CDC-NHSN, whereas compared with INICC, most rates were similar. This study represents an important advance in the knowledge of SSI epidemiology in Peru that will allow us to introduce targeted interventions.

Estado actual de la mortalidad materna en los hospitales del Perú

OBJETIVO: Actualizar las cifras y la causalidad de muerte materna en los hospitales del Perú. DISEÑO: Se elaboró un Manual de Autoevaluación y se seleccionó 31 hospitales, 7 en Lima y Callao y 24 en las diferentes regiones. Se envió anticipadamente a los hospitales el Manual de Autoevaluacíón y se les solicitó preparar informe. El equipo técnico visitó cada hospital en forma programada y llevó a cabo reunión con los directivos. Se recogió información de indicadores correspondientes a los tres años previos a la encuesta. La información recogida se procesó en computadora utilizando el Programa Fox Pro V2,6. RESULTADOS: Diecisiete hospitales correspondieron a la costa, 10 a la sierra y 4 a la selva; 25 al Ministerio de Salud, 3 al Instituto Peruano de Seguridad Social, 2 hospitales integrados entre las dos instituciones anteriores y 1 privado. El total de partos atendidos el año anterior a la encuesta fue 100 063; de los cuales 66,6% correspondió a partos con 16 más controles prenatales; sólo 43,6% de las parturientas había tenido 4 ó más; hubo 20,5% de cesáreas y 2,2% de partos instrumentados; 15,4% de abortos, 6,7% de niños de peso bajo al nacer y 4,3% de recién nacidos deprimidos. Entre un total de 155 797 partos con nacido vivo reunidos en los tres años anteriores a la encuesta hubo 349 casos de muerte materna, lo que da una tasa de 224,04 por cien mil nacidos vivos. A Lima le correspondió una tasa de 120,14 y al resto del país 255,66. En los hospitales de la costa, la tasa encontrada fue 147,11, en la Sierra 145,36 y en la selva 728,00. Los hospitales integrados presentaron una tasa mayor que los otros; asimismo, la tasa fue mayor en los hospitales más pequeños y en los más grandes. Las causas directas fueron responsables del 84,5% de las muertes y las indirectas del 15,5%. Entre las causas directas, la hemorragia fue la más frecuente, siendo seguida por la hipertensión inducida por el embarazo. CONCLUSIÓN: La tasa de mortalidad materna continúa siendo alta en los hospitales del Perú y es la hemorragia su causa más importante.

Análisis de la tendencia de fracturas de la clavícula en tres hospitales de Lima

Introducción: La tasa de fracturas de clavícula es uno de los indicadores más visibles de la calidad de la atención de parto institucional. Su análisis nos va a permitir evaluar el impacto de nuestras intervenciones, para beneficio directo de los pacientes. Objetivo: Determinar la evolución de la tendencia de la tasa de fracturas de clavícula en los hospitales San Bartolomé, Santa Rosa y el Instituto Especializado Materno Perinatal (IEMP). Diseño: Estudio de tipo ecológico. Instituciones: Hospitales San Bartolomé y Santa Rosa, y el Instituto Especializado Materno Perinatal. Participantes: Recién nacidos. Intervenciones: Análisis individual y global de los reportes mensuales del sistema informático perinatal de cada una de nuestras unidades de análisis (nosocomios), desde enero 2004 hasta diciembre 2008, sobre la evolución cronológica de la tasa de fracturas de clavícula, con el objetivo de evaluar su tendencia y sus patrones característicos. Principales medidas de resultados: Tasa de fracturas de clavícula (total de fracturas de clavícula al mes * 100/ total de partos al mes). Resultados: Durante el periodo de estudio, mientras las mayores tasas de fracturas de clavícula se registraron en el IEMP (2,58% ± 0,32%), los hospitales San Bartolomé (1,03% ± 0,53%, p&lt;0,01) y Santa Rosa (0,72% ± 0,21%, p&lt;0,01) mantuvieron tasas significativamente más bajas. Sin embargo, analizando la progresión anual de estas tasas, se pudo apreciar que, mientras en el IEMP (2,20% [2004], 2,93% [2006], 2,29 [2008]) y en el hospital Santa Rosa la tasa anual de fracturas de clavícula viene disminuyendo sostenidamente en los últimos 3 años, en el San Bartolomé esta tasa se encuentra en franco ascenso, pasando de 0,47% a 1,76%, en los últimos 5 años. Conclusiones: La tasa de fracturas del IEMP es mucho más alta que la de los hospitales Santa Rosa y San Bartolomé; sin embargo, mientras que, en los últimos 3 años, esta tasa viene disminuyendo consistentemente en el IEMP y en el hospital Santa Rosa, en el hospital San Bartolomé se encuentra en franco ascenso.

Repercusión de la preeclampsia/ eclampsia en la mujer peruana y su perinato , 2000-2006

Objetivos: Determinar las características maternas de la preeclampsia (PE) y eclampsia (E) en hospitales del Perú y las repercusiones en las madres y sus recién nacidos. Diseño: Estudio observacional, analítico, de corte transversal. Lugar: Hospitales del Ministerio de Salud (MINSA), Perú. Participantes: Gestantes sin PE/E y con preeclampsia y eclampsia, y sus recién nacidos. Métodos: Se realizó un estudio de los datos del Sistema de Información Perinatal SIP 2000 de 310 795 gestantes y sus 314 078 recién nacidos (RN) atendidos durante los años 2000 a 2006 en 28 hospitales del Ministerio de Salud del Perú. Para el análisis de los datos se usó los paquetes estadísticos SPSS 14.0 y Epi Info 6.0. Principales medidas de resultados: Características maternas y neonatales y repercusiones por la PE/E. Resultados: Del total de gestantes, 295 075 no tuvieron PE/E (94,9%) y 15 720 sufrieron de PE/E (5,1%) [14 993 (4,8%) preeclampsia y 727 (0,24%) eclampsia]. Se asociaron a la PE de manera significativa la edad materna de 35 años o más, el embarazo gemelar, el desprendimiento prematuro de placenta y el parto por cesárea; y se relacionaron a la eclampsia ser menor de 20 años, la soltería, analfabetismo/educación incompleta, el embarazo múltiple, desprendimiento prematuro de placenta y el parto por cesárea. En los recién nacidos de madres con PE/E, hubo significativamente peso bajo para la edad gestacional, Ápgar bajo que requirió reanimación y peso menor a 2 500 g al egreso del RN. Hubo tendencia a mayor mortalidad materna y neonatal en la eclampsia, en relación a las gestantes sin PE/E o con preclampsia sin convulsiones. Conclusiones: En el presente estudio sobre la PE/E en hospitales peruanos del MINSA, la incidencia y la morbimortalidad materna y neonatal fueron similares a la de otros países y se asociaron a factores sociales y etarios. Es indispensable continuar actualizando la información, para conocer la evolución de esta temible complicación del embarazo en nuestro país.

Mortalidad materna de causa obstétrica en el Hospital Materno-infantil de San Bartolomé

Experiencia sobre mortalidad materna, en 25 años de actividad obstétrica, en el Hospital Materno Infantil de San Bartolomé, centro dedicado desde los inicios de su reconstrucción, en 1961, a la docencia en pre y postgrado y a la atención de su comunidad. Fue el primer hospital donde se estableció el residentado de obstetricia y ginecología en la República, con filosofía y tecnología preventivas, ceñidas a la nomenclatura y sugerencias de instituciones de avanzada. La tasa de mortalidad materna de 5,27/10000 partos, con nacidos vivos, en los últimos años está por debajo de la observada en otros nosocomios de iguales características en el país. Es factible disminuir las muertes de causa bstétrica, si se hace conciencia del problema, y se guarda las actitudes técnicas, sobre todo, en las entidades docentes que deben ser rectoras en un país como el nuestro, en proceso de desarrollo (An Fac Med UNMSM 11 Epoca 1989; 1 (1-2): 49-54).

Innovation in Newborn Hearing Screening in Peru: Applying Design Thinking to Improve Health Policy

Objectives: 1) Apply Design Thinking methodology to create an innovative national program for newborn hearing screening (NHS) in Peru. 2) Collaborate with Peruvian Ministry of Health to optimize implementation of a newly mandated national NHS program. 3) Provide a model for expanding NHS throughout the developing world. Methods: Descriptive study with focus groups and guided interviews. Design Thinking is a human-centered approach to interdisciplinary problem solving that tackles complex problems with many stakeholders. Insight is gained through immersion, observation, and engagement. Study dates: June-December 2012. Condition studied: Permanent congenital hearing loss. Subjects: Stakeholders involved in NHS. Policy-makers: officials, politicians, academic physicians. Providers: audiologists, pediatricians, otolaryngologists, health workers. Recipients: neonates, mothers, hearing-impaired children and families. Field sites included community clinics, tertiary care hospitals, ministry of health offices, schools for the deaf, audiology offices, and patient homes. Results: Interviewed 105 individual stakeholders at 14 sites. Data were captured in logbooks, photography, and video. Data obtained from this work were applied in the following ways: creation of a needs assessment tool for use in Peruvian hospitals to facilitate implementation of NHS; inclusion of NHS data in Peru’s national electronic medical record; development of educational resources, both online and classroom-based for providers of NHS. Conclusions: This work represents the first application of Design Thinking to innovate in health policy at a national level. Through publication of these methods, the authors hope to empower providers throughout the developing world to broaden access to NHS.

¿Es útil la amniotomía de rutina en el trabajo de parto de inicio espontáneo? Una revisión de la literatura

La amniotomía de rutina o sistemática, practicada en gestantes con trabajo de parto de inicio espontáneo, se da en gran parte de hospitales del Perú y el mundo, documentándose su prevalencia hasta en 77%. Sin embargo, poco se conoce acerca de los beneficios y daños que puede ocasionar en el feto y en la madre. Se realizó una búsqueda de la literatura médica, con la finalidad de encontrar evidencia científica sólida que respalde o rechace esta práctica. Se llega a la conclusión que la amniotomía practicada sistemáticamente altera la evolución fisiológica del trabajo de parto, acortándolo hasta en 50 minutos en promedio; sin embargo, este acortamiento no tiene trascendencia clínica ni para el feto ni para la madre. Por el contrario, su práctica de rutina puede aumentar el número de partos disfuncionales y el puntaje Ápgar menor de siete a los cinco minutos.

Análisis del dominio desde una perspectiva ontológica: El caso de la Historia Clínica General Peruana

This paper presents the initial results of the research project “Automated Medical Records with Applications to Extrahepatic Obstructive Jaundice,” which has the support of the Science and Technology Program - PCyT - Fund for Innovation, Science and Technology - FINCyT . The project arises from the evidence that the majority of public hospitals only have management systems of medical records in paper, which requires that a patient has a health record in every hospital where he attends. In that sense, the purpose of this project is to develop a socio-technological proposal to manage electronic health records, making possible interoperability between different peruvian hospitals.

Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium

To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals in Peru that are members of the International Nosocomial Infection Control Consortium (INICC). Prospective cohort surveillance of DAIs was conducted in ICUs in four hospitals applying the definitions for nosocomial infections of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS) and National Healthcare Safety Network (NHSN). From September 2003 to October 2007 1 920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0% and 24.9 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1 000 ventilator-days; the central venous catheter-associated bloodstream infections (CVC-BSI) rate was 7.7 cases per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1 000 catheter-days. Extra mortality for VAP was 24.5% (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0% (RR 2.75, P = 0.028). Methicillin-resistant strains accounted for 73.5% of all Staphylococcus aureus DAIs; 40.5% of the Enterobacteriaceae were resistant to ceftriaxone, 40.8% were resistant to ceftazidime, and 32.0% were resistant to piperacillin-tazobactam. Sixty-five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacillin-tazobactam, and 36.1% were resistant to imipenem. The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient safety in the ICUs and throughout hospitals.

Natural Ventilation for Prevention of Airborne Contagion: Conclusions Overgeneralized

This article and editor's summary give the impression that the tuberculosis infection rate was actually reduced by opening windows [1]. A careful reading of the article clearly states that while ventilation rates were measured, infection rates were merely calculated using the Wells-Riley equation. This is old news. While it is important to take into account the adequacy of the ventilation rate provided by mechanical ventilation systems, the ventilation rate through open windows is a function of window size, number, and location in a room as modified by indoor–outdoor temperature differences and wind direction and velocity. Not every case will result in the differences observed in the Peruvian hospitals studied. One must be careful not to overgeneralize the results. A new article, “Role of ventilation in airborne transmission of infectious agents in the built environment—A multidisciplinary systematic review” by Yuguo Li et al., is a thorough review of infectious disease transmission and ventilation just published in the February 2007 issue of the journal Indoor Air, the International Journal of Indoor Environment and Health, available at http://www.blackwell-synergy.com/toc/ina/17/1 [2].

Prospective Study To Evaluate Mechanical Ventilator-Associated Pneumonia Rate in Intensive Care Units in a Peruvian Public Hospital: Benchmark with NNIS American Rates

OBJECTIVES: To measure the incidence of mechanical ventilator-associated pneumonia (VAP) in ICU in Peru and to compare with NNIS rates. METHODS: We performed a prospective nosocomial infection surveillance study during 3 months in one Peruvian ICUs of one public hospital. Nosocomial pneumonias were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance system (NNIS) definitions. Definitions: Criterion 1: A patient has rales or dullness to percussion on physical examination of the chest, and at least one of the following: new onset of purulent sputum or change in character of sputum; organism cultured from blood; isolation of an etiologic agent from a specimen obtained by trans-tracheal aspirate, bronchial brushing, or biopsy. Criterion 2: A patient has a chest radiographic examination that shows a new or progressive infiltrate, consolidation, cavitation, or pleural effusion and at least one of the following: new onset of purulent sputum or change in character of sputum; organism cultured from blood; isolation of an etiologic agent from a specimen obtained by transtracheal aspirate, bronchial brushing, or biopsy. VAP rate was calculated by dividing the number of associated pneumonias by the total number of device days. RESULTS: The VAP rate was 36.14 per 1000 device days (3/82) (benchmark with NNIS rate: 8.7 per 1000 ventilator days, RR: 4.18; CI 95% 1.35–12.97; p= 0.0070). CONCLUSION: When we compare with NNIS rates we found our VAP rate four times the NNIS rate. In Peruvian public hospitals we need to develop interventions to reduce nosocomial infections, especially VAP.