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Background: Antimicrobial resistance is a disturbing problem in the health system. A relationship between the use of certain antimicrobials and a resistance increase has been proposed. Since this phenomenon is not usually attributed to specific uses of antimicrobials but preferably to its evolution over the years, the analysis of the antimicrobial consumption over time can justify the epidemiological situation of a given region in terms of resistance and possible increases and decreases for specific microorganisms. The objective of this study was to analyze the evolution of the use of antimicrobials in Catalonia during 2008–2018 through the VINCat program (Infection Control and Antimicrobial Stewardship Catalonian Program). Methods: The number of hospitals participating in the VINCat increased from 46 in 2008 to 63 in 2018 (ie, 68.8% and 85.7% of all adult acute-care hospital beds in Catalonia, respectively). Hospitalization days recorded at the participating hospitals increased from 2,991,053 in 2008 to 3,714,938 in 2018. The Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index was used for monitoring antimicrobial consumption. Simple linear regressions were performed, the linear relationship was checked by ANOVA tests, and the Pearson correlation (Pc) coefficients were obtained. Values of P ≤ .05 were considered statistically significant. Results: From 2008 to 2018, there was a statistically significant increase of global antibacterial consumption (65.50 vs 71.73 DDD per 100 bed days; P = .001) and antimycotic consumption (3.09 vs 3.45 DDD per 100 bed days, P = .012) due to an increase of consumption in the surgical units. At the same time, there was a decrease in the consumption of antimycotics in the medical units (4.35 vs 3.90 DDD per 100 bed days; P =.029). Cephalosporins and carbapenem consumption increased both globally (10.88 vs 13.86 DDD per 100 bed days; P < .001) and in medical and surgical units (3.26 vs 5.38 DDD per 100 bed days; P < .001). This increase was mainly associated with ceftriaxone (3.45 vs 5.46 DDD per 100 bed days; P < .001) and meropenem (1.12 vs 3.08 DDD per 100 bed days; P < .001). There was a global decrease in the consumption of penicillins (26.10 vs 24.24 DDD per 100 bed days; P = .012) and quinolones (11.63 vs 9.61 DDD per 100 bed days; P = .004). This trend was observed also in ICUs and medical units but not in surgical units, for which only quinolones showed a significant decrease. Decreases in the use of amoxicillin/clavulanate acid (17.80 vs 14.24 DDD per 100 bed days; P < .001) and ciprofloxacin (5.68 vs 4.01 DDD per 100 bed days; P < .001) were observed. Conclusions: The increase in the use of antimicrobials in Catalonia is concerning. This increase is attributable to the use of these drugs in surgical units. Antibiotic stewardship measures should be aimed primarily at these units. The increasing use of carbapenems should be analyzed.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini as well as speaker honoraria from MSD, Pfizer, and Zambon.

Additional file 1. Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 checklist: recommended items to address in a clinical trial protocol and related documents.

Background Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres. Methods/design A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out. Discussion The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines. Trial registration ClinicalTrials.gov, NCT03931577.

Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

Resumen El proyecto nacional Bacteriemia Zero (BZ) consiste en la aplicacion simultanea de un paquete de medidas para la prevencion de bacteriemias relacionadas con cateteres venosos centrales (B- CVC ) en los pacientes criticos y en el desarrollo de un plan integral en seguridad. El objetivo es presentar los resultados de la aplicacion del proyecto BZ en las unidades de cuidados intensivos (UCI) de la comunidad autonoma de Catalunya. Se han incluido todos los pacientes ingresados en las UCI participantes de Catalunya en el registro ENVIN-HELICS desde enero de 2009 hasta junio de 2010. Han aportado informacion 36 UCI (92,3%) de las 39 posibles. Se han diagnosticado 281 episodios de B-CVC (tasa global de 2,53 episodios por 1.000 dias de CVC). Las tasas han variado significativamente entre las UCI que han participado mas o menos de 12 meses en el proyecto (2,17 frente a 4,27 episodios por 1.000 dias de CVC, respectivamente; p La aplicacion del proyecto BZ en Catalunya ha disminuido la tasa de las B-CVC en las UCI de esta comunidad en mas del 40%, mejorando el objetivo inicial de 4 episodios por 1.000 dias de CVC.

Resumen El objetivo de este articulo es describir los resultados agregados de un sistema de notificacion generico de incidentes relacionados con la seguridad del paciente, implantado en los hospitales catalanes desde 2010 a 2013. Se trata de un estudio observacional, descriptivo de los incidentes notificados desde enero de 2010 a diciembre de 2013, de todos los hospitales de Cataluna adheridos al proyecto de creacion de unidades funcionales de gestion de la seguridad del paciente. Se utilizo el Sistema de Notificacion y Aprendizaje para la Seguridad del Paciente (SiNASP), que permite clasificar los incidentes en funcion del area donde se producen, el tipo de incidente notificado, las consecuencias, la gravedad segun el Severity Assessment Code (SAC) y la profesion del notificante como principales variables. El acceso al sistema se realizo a traves de internet (portal SiNASP), fue voluntario y anonimo o nominativo con posterior anonimizacion. Durante el periodo de estudio notificaron entre 22 y 29 hospitales, con un total de 5.948 incidentes, de los cuales 5.244 fueron gestionados por los centros y son los que se analizan en el estudio. Un 64% (3.380) llego al paciente, un 18% (950) creo una situacion con capacidad de causar un incidente y un 18% (914) no llego al paciente. De los incidentes que llegaron al paciente, un 26% (864) ocasiono algun dano. La mayoria de incidentes ocurrio en hospitalizacion (54%) y urgencias (15%), seguidos de UCI (9%) y bloque quirurgico (8%). Los que mas notificaron fueron los enfermeros (71%), seguidos de los medicos (15%) y de los farmaceuticos (9%). Atendiendo a la gravedad, la mayoria fueron clasificados de riesgo bajo (37%) o que el incidente no llego al paciente (36%). No obstante destacan 40 casos (0,76%) de riesgo extremo. En relacion con el tipo de incidente notificado, la mayoria fue por error en la medicacion (26,8%), seguido por caidas (16,3%) e identificacion del paciente (10,6%). La mayoria de las notificaciones fueron incidentes que llegaron al paciente y de ellos, un 26% ocasiono dano. En general ocurrieron en las unidades de hospitalizacion y fueron los enfermeros los que mas notificaron. El sistema de notificacion de incidentes es una herramienta complementaria a otras para promocionar una cultura de seguridad del paciente y definir el perfil de riesgos de una organizacion sanitaria. La oportunidad para aprender de la propia experiencia es la razon de ser del sistema de notificacion.

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

Resumen La mayoria de las escoliosis son idiopaticas (80%) y ocurren mas frecuentemente en adolescentes y en el sexo femenino. La radiografia simple es el metodo de imagen de eleccion, tanto en el estudio inicial como en el seguimiento evolutivo, pero tiene el inconveniente de utilizar radiaciones ionizantes. Las mamas quedan en el campo de exposicion durante estos estudios repetidos. Los autores presentan una serie de recomendaciones para optimizar la tecnica de las exploraciones y los equipos radiograficos, tanto analogicos como digitales, para evitar dosis de irradiacion innecesarias a los pacientes y reducir el riesgo de cancer de mama en los pacientes con escoliosis. Cuando se utilizan equipos analogicos siempre debe utilizarse protector mamario plomado y, en todos los equipos, sean analogicos o digitales, hay que realizar la radiografia en proyeccion posteroanterior y con tecnicas optimizadas de baja dosis. Hay que seguir siempre el principio ALARA (as low as reasonable achievable) para obtener imagenes diagnosticas de calidad con la dosis lo mas baja posible.

Contains fulltext : 153776.pdf (Publisher’s version ) (Open Access) BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. OBJECTIVE: To present an international framework for patient safety indicators in primary care. METHODS: Literature review and online Delphi-survey, starting from the Catalan model. RESULTS: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. CONCLUSION: The framework can be used to organize indicator development and guide further work in the field.

Most scoliosis are idiopathic (80%) and occur more frequently in adolescent girls. Plain radiography is the imaging method of choice, both for the initial study and follow-up studies but has the disadvantage of using ionizing radiation. The breasts are exposed to x-ray along these repeated examinations. The authors present a range of recommendations in order to optimize radiographic exam technique for both conventional and digital x-ray settings to prevent unnecessary patients' radiation exposure and to reduce the risk of breast cancer in patients with scoliosis. With analogue systems, leaded breast protectors should always be used, and with any radiographic equipment, analog or digital radiography, the examination should be performed in postero-anterior projection and optimized low-dose techniques. The ALARA (as low as reasonable achievable) rule should always be followed to achieve diagnostic quality images with the lowest feasible dose.

The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was mostly given by nurses. The incident notification system is a tool that complements others for promoting a patient safety culture and defining the risk profile of a health organisation. The opportunity for learning from experience is the reason for the existence of the notification system.

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues.

The nationwide Bacteremia Zero (BZ) Project consists in the simultaneous implementation of measures to prevent central venous catheter-related bacteremia (CVC-B) in critically ill patients and in the development of an integral safety plan. The objective is to present the results obtained after the implementation of the BZ project in the ICUs of the Autonomous Community of Catalonia, Spain. All patients admitted to ICUs in Catalonia participating in the ENVIN-HELICS registry between January 2009 and June 2010 were included. Information was provided by 36 (92.3%) of the total possible 39 ICUs. A total of 281 episodes of CVC-B were diagnosed (overall rate of 2.53 episodes per 1000 days of CVC). The rates have varied significantly between ICUs that participated in the project for more or less than 12 months (2.17 vs. 4.27 episodes per 1000 days of CVC, respectively; p.0001). The implementation of the BZ Project in Catalonia has been associated with a decrease greater than 40% in the CVC-B rates in the ICUs of this community, which is much higher than the initial objective of 4 episodes per 1000 days of CVC).