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A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process.

Introduction : There is a subgroup of patients who are admitted to sociosanitary field in which competence is compromised. It is accompanied by healthcare and/or social complexity, including lack of reference person in the family and even the need for a proxy. These patients are transferred to long-stay units as the only resource available. We consider studying the volume of such cases and try to describe the items that affect their complexity as well as the length of hospital stay, whether the patients are deceased or they’ve been finally discharged. Patients and Methods :Retrospective study of hospital discharges that required an Attorney General Office’s statement to seek interim measures of protection during the period 31-12-2014 to 1-01-2012. Results : During this period we have dealt with 14 cases that required this type of intervention. Casuistry of these three years has been 1.3%, 2.7% and 1.5% of discharges respectively. Psychogeriatric or conventional long-stay Unit has been the service of reference in all cases. Gender Distribution: 1: 1 (7 men and 7 women). The average age was 72.4 (SD 4.5) years. Discharge destination: nursing home in 6 cases (four public, two private); discharge to home without resolution: 6 cases and 2 deceases. Designed proxy during the process: 2 cases. Conclusions : - Casuistry represents 1.9% of discharges in long-stay Unit. - Responses from judicial instances are extraordinarily slow and without resolution in some cases. - They generate large amounts of interventions and cause distress to professionals. Proposals for improvements : Case Detection : Prioritize detection of cases before hospital admission. Plan health and social course without the need for distorting the hospital resources. Professional Level : Training in specific skills to adopt the person-centred and not resource-centred model of care. Provide professionals and work teams with specific tools to deal with these cases in order to avoid burn-out. Community level : Create a commission amongst different actors involved in the case on a cross-cutting basis and with equal involvement of institutions (Health, Social Welfare, Municipal-District and Prosecutor’s Office). Ethical level : Ensure principles of Equity and Justice when accessing to resources.

Resumen Fundamento y objetivo la colonizacion por Staphylococcus aureus resistente a meticilina (SARM) es frecuente en centros de media y larga estancia, pero las tasas de infeccion son bajas. Habitualmente se desconoce el estado de portador de un paciente en el momento del ingreso. Nos hemos propuesto estudiar la prevalencia, las caracteristicas clinicas y los factores relacionados con el hecho de ser portador al ingresar en el hospital, asi como la incidencia de colonizacion de los pacientes una vez ingresados durante un periodo de 6 meses. Pacientes y metodo se ha realizado un estudio longitudinal y prospectivo durante un periodo de 6 meses. Se efectuo a todos los pacientes un frotis nasal y de las heridas dentro de las primeras 24 h de ingreso, estudio que se repitio en el momento del alta o de finalizacion del estudio. Resultados la proporcion de pacientes colonizados al ingresar fue del 7,6% (n=25). En el analisis multivariable, la edad, el uso reciente de antibioticos, la colonizacion previa y la presencia de enfermedad vascular periferica fueron las variables asociadas de forma independiente con el estado de portador. Tomando las precauciones estandar solo un 4,2% de los pacientes se colonizaron durante el ingreso. Conclusiones en nuestro centro de media y larga estancia, un numero importante de pacientes presento colonizacion por SARM al ingresar. Fueron pocos los que se colonizaron durante el ingreso y no se describieron episodios de infeccion durante el periodo del estudio. Probablemente las precauciones estandar, entre ellas el lavado de las manos y los metodos de barrera en las curas de heridas, son medidas adecuadas para evitar la diseminacion de la colonizacion por SARM.

Introduction: Decompensation of chronic diseases in patients of advanced age are common. They generate a large consumption of resources, hospital readmissions and require hospitalization for care. Despite various initiatives, it can not be prevented and often require acute hospital care. These patients in most cases have already been studied. Therefore, they do not need further high-tech testing but conventional hospital care. In the Consorci Sanitari Integral, an organization that serves the population of Baix Llobregat we set to implement an Acute and Subacute Geriatric Units to provide health resources to the area's population. In order to achieve this we wanted to make the most of high-tech resources of Hospital General de L’Hospitalet (Ultrasound scan, tomography, MRI -magnetic resonance, and laboratory testing) and Geriatric structure of Hospital Sociosanitari de L’Hospitalet . Objective: To describe the results of the implementation of a Acute and Subacute Geriatric Units as well as the impact on the set of hospital discharges of patients in our area of influence. Patients and Methods: Retrospective analysis of clinical activity during the period 2014-2015, quantifying the number of patients treated, the profile of users and sociodemographic variables, length of stay, mortality, number of readmissions and institutionalization. Results: Subacute Unit (2014-11 beds): Discharges 348; home-discharges 79.5%, lenght of stay 9.59 days, readmissions 10.34% Mortality 10.63% Subacute Unit (2015-11 beds-6 months) Discharges 169; home-discharges 78.5%, lenght of stay 9.94 days, readmissions 7.10% Mortality 10.6%. Acute Care Unit 2015 (16 beds - 6months): Discharges 211; home-discharges 61.5%, lenght of stay 11.06 days, readmissions 13.45% Mortality 15.17% Conclusion: 1. The use of General Hospital technology resources to care for geriatric patients has allowed quality care at a lower consumption of resources and close to home. 2. The most fragile patients benefit from care close to home with similar standards to those of quality literature. (Selection bias to the geriatric dept) 3. This model of care can be very useful in the context of metropolitan areas with large demands and need for acute care hospitalization.

Methicillin-resistant Staphylococcus aureus (MRSA) asymptomatic colonization is common in long-term care facilities, but the burden of symptomatic infection appears to be low. It is not usually known whether a patient is colonized at the time of admission to the geriatric facility. Our purpose was to determine the prevalence, characteristics and factors associated with MRSA colonization on admission, and the cumulative incidence of colonization over the following 6 months.Longitudinal and prospective study conducted over a 6-month period. All patients were screened at admission using nasal and ulcers swabs within the first 24h. Patients were screened also at the end of the study to assess carrier status.The prevalence of MRSA colonization was 7.6% at the entry (25 patients). In the multivariate analysis, advanced age, recent use of antibiotics, prior colonization by MRSA, and peripheral vascular disease were independent risk factors for colonization at admission. With standard precautions, the 6-month cumulative incidence of MRSA colonization was 4.2%.In our long-term care facility, MRSA colonization at the time of admission was frequent. Few patients were colonized during the study and no episodes of infection were reported. Probably, standard precautions, including hand washing and appropriate barrier procedures during the care of wounds, are the most useful control measures.