***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the effect of an educational program targeted on modifiable risk factors on  ventilator-associated pneumonia ( VAP ) rates . MATERIAL AND METHOD After a preliminary study on VAP risk factors was conducted at one teaching hospital , a pre- and post-interventional study was then performed on 12 hospitals in Thail and from January 1 , 2002 to June 30 , 2003 . Each hospital r and omly selected 20 patients , who were on mechanical ventilation to be enrolled The study was divided into two phases ; 1 ) pre-intervention , 2 ) post-intervention . Data collected included patients ' demography and risk factors for VAP During pre-interventional phase , data on risk factors for VAP was analyzed and fedback to healthcare providers in the wards by an infection control nurse ( ICN ) of the individual hospital . An educational programme on the prevention of VAP was introduced by the ICN . Ventilator-associated pneumonia rates and their risk factors were continuously monitored during the post-interventionl phase . RESULTS Two hundred and forty four patients in the pre-interventional phase and 254 patients in the post-interventional phase were included . There was no significant difference in the demography between these two patient population s. After the intervetion , there was a significant improvement in h and -hygiene practice s ( p<0.001 ) among healthcare providers and increased use of sucralfate ( p=0.05 ) for stress ulcer prophylaxis . Ventilation-associated pneumonia rate ( 40.5 % vs. 24 % ; p<0.001 ) and crude mortality rate associated with VAP ( 12.3 % vs. 8.7 % ; p<0.001 ) were also reduced CONCLUSION The educational programme targeted on modifiable risk factors for prevention of VAP was effective and should be considered as an intervention to reduce VAP rates in developing countries The authors report the results of a 3-year ( August 1984-May 1987 ) prospect i ve study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego , California . Ninety-three percent ( 666 of 714 ) of the eligible subjects enrolled ; 75 % were women . The mean age of the subjects was 81.6 years .  Lengths of stay ranged from 1 day to 1,025 days , with a mean of 166 days ; the cumulative length of stay for all subjects was 110,746 days ( 303 years ) . Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessment s of all patients to identify infections . The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days . Many of the infections would not have been recognized by persons less skilled than nurse practitioners . Among the 788 nursing home-associated infections identified , 362 ( 47 % ) were in the respiratory tract ( 286 lower respiratory and 76 upper respiratory ) ; 200 ( 25 % ) were associated with skin and subcutaneous and mucous membranes ; 140 ( 18 % ) were symptomatic urinary tract infections ; 13 ( 2 % ) were bacteremia ; and 73 ( 9 % ) were other infections OBJECTIVES To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses , and to reduce the complication rate through changes in CVC management and education . DESIGN A prospect i ve observational study followed by an educational program and a nonr and omized interventional trial . SETTING The Children 's Hospital of Philadelphia , a tertiary , pediatric facility . PATIENTS 268 children with Broviac , Hickman , or Infusaport catheters in place during 58,290 catheter days . INTERVENTIONS Development and implementation of protocol s for cleaning insertion site and hub , use of nonocclusive dressings , and manipulation of access ; formal staff and parental education about protocol s. RESULTS CVC-related infections fell from 4.58/1,000 catheter-days preintervention to 3.83 postintervention ( risk ratio [ RR ] , 0.20 ; 95 % confidence interval [ CI95 ] , 0.89 - 1.622 ; P = .25 ) ; exit-site infections fell from 0.58 to 0.11 ( CI95 , 1.22 - 45.64 ; P = .02 ) ; rates among infants on the surgical service fell from 15.46 to 6.67 ( RR , 2.31 ; CI95 , 1.10 - 4.30 ; P = .02 ) . CONCLUSIONS Education and changes in management protocol s reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical service . Other interventions are needed to decrease further the infectious complications in these children HYPOTHESIS Catheter-related bloodstream infection ( CRBSI ) in critically ill surgical patients with prolonged intensive care unit ( ICU ) stays is associated with a significant increase in health care re source use . DESIGN Prospect i ve cohort study . SETTING Surgical ICU at a large tertiary care center . PATIENTS Critically ill surgical patients ( N = 260 ) with projected surgical ICU length of stay greater than 3 days . INTERVENTIONS Central venous catheters were cultured for clinical suspicion of infection . MAIN OUTCOME MEASURES Increases in total hospital cost , ICU cost , hospital days , and ICU days attributable to CRBSI were estimated using multiple linear regression after adjusting for demographic factors and severity of illness ( APACHE III [ Apache Physiology and Chronic Health Evaluation III ] score ) . RESULTS The incidence of CRBSI per 1000 catheter-days was 3.6 episodes ( 95 % confidence interval [ CI ] , 2.1 - 5.8 episodes ) . Microbiologic isolates were Gram-positive bacteria in 75 % , Gram-negative bacteria in 20 % , and yeast in 5 % . After adjusting for demographic factors and severity of disease , CRBSI was associated with an increase of $ 56 167 ( 95 % CI , $ 11 523-$165 735 ; P = .001 ) ( in 1998 dollars ) in total hospital cost , an increase of $ 71 443 ( 95 % CI , $ 11 960-$195 628 ; P<.001 ) in ICU cost , a 22-day increase in hospital length of stay , and a 20-day increase in ICU length of stay . CONCLUSIONS For critically ill surgical patients , CRBSI is associated with a profound increase in re source use . Prevention , early diagnosis , and intervention for CRBSI might result in cost savings in this high-risk population OBJECTIVE To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection ( CAUTI ) in 1,497 newly catheterized patients . DESIGN Prospect i ve observational and laboratory study . SETTING University hospital . METHODS Data were collected on risk factors for CAUTI  ( defined as > 10(3 ) colony-forming units [CFU]/mL ) , severity of illness , and diagnostic and therapeutic interventions in consenting newly catheterized patients . Daily urine cultures were obtained from each newly catheterized patient , but the results of these cultures were not revealed to his or her physician . During the study , one of the investigators ( DGM ) review ed each patient 's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI . The total hospital costs for each patient were also obtained . RESULTS Overall , 235 patients acquired CAUTIs during the study ; most of the CAUTIs were completely asymptomatic , and only 52 % were diagnosed by the patients ' physicians using the hospital laboratory . Only 1 patient with a CAUTI had a secondary bloodstream infection . Thirty-three ( 13 % ) of the CAUTIs were caused by Escherichia coli ; 63 ( 25 % ) by Klebsiella , Enterobacter , Citrobacter , Pseudomonas aeruginosa , or other antibiotic-resistant , gram-negative bacilli ; 87 ( 35 % ) by enterococci or staphylococci ; and 67 ( 27 % ) by C and ida species . The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $ 20,662 in extra costs of diagnostic tests and $ 35,872 in extra medication costs , a mean of $ 589 ( median , $ 356 ) per CAUTI . CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ( $ 363.3 + /- $ 228.2 vs $ 690.4 + /- $ 783.7 ; P = .02 ) or yeasts ( $ 821.2 + /- $ 2,169.9 ) . There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ( $ 387.1 + /- $ 434.8 ) . CONCLUSIONS The extra direct costs associated with nosocomial CAUTI found in this prospect i ve study , which was done in the era of managed care during the late 1990s , are substantially lower than those reported in the largest comparable studies done more than 15 years ago , most of which were retrospective , reflecting the powerful impact of cost-containment measures that are now implemented in managed care BACKGROUND Control of infection within the long-term care facility is a daunting problem . Elderly patients are at high risk for contracting infection because of reduced innate immunity , malnutrition , and the presence of chronic medical conditions . This small study tested the effect of developing and implementing a comprehensive preventive infection control program in the long-term care setting and examined the result ant incidence of infections . METHODS Eight private , freest and ing , long-term care facilities in urban and suburban setting s were selected for the study . The 4 test sites had a total of 443 beds ; there were 447 beds in 4 matched control sites . Data on infection rates were accrued in both preintervention and intervention years . The control homes maintained their existing infection control policies and procedures . The test homes were provided with an infection control educational program and replaced all currently used germicidal products with single-br and ed products for a 12-month period . A criteria -based st and ardized infection control surveillance system was used to monitor and report infections in all facilities . RESULTS In the preintervention year , the test sites experienced 743 infections ( incidence density rate , 6.33 ) and the control homes experienced 614 infections ( incidence density rate , 3.39 ) . In the intervention year , the test homes reported 621 infections , a decrease of 122 infections ( incidence density rate , 4.15 ) ; in the control homes , the number of infections increased slightly , to 626 ( incidence density rate , 3.15 ) . The greatest reduction in infections in the test homes was in upper respiratory infections ( P = .06 ) . CONCLUSIONS This study provides additional evidence that a comprehensive infection control program that includes h and washing and environmental cleaning and disinfecting may help reduce infections among the elderly residing in long-term care setting OBJECTIVE Our aim was to ascertain the effect of an infection control program , using education and performance feedback on intensive care units , for intravascular device (IVD)-associated bloodstream infection ( BSI ) . METHODS Within 4 level III , adult , intensive care units in Argentina , all admitted , adult patients with a central vascular catheter in place for at least 24 hours were included . This was a prospect i ve before- and -after trial in which rates of IVD-associated BSI determined during a period of active surveillance without education or performance feedback ( phase 1 ) were compared after sequential implementation of an infection control program using education ( phase 2 ) and performance feedback ( phase 3 ) . RESULTS A total of 1219 IVD days were accumulated in phase 1 ; 586 during phase 2 ; and 4140 during phase 3 . Compliance with central vascular catheter -- site care improved significantly from baseline during the study period . Overall rates of IVD-associated BSI were lowered significantly from baseline after sequential implementation of education and performance feedback ( 11.10 vs 46.63 BSI/1000 IVD days ; relative risk=0.25 ; 95 % confidence interval=0.17 - 0.36 ; P<.0001 ) . Rates of IVD-associated BSI decreased significantly after implementation of an educational program ( phase 1 to phase 2 ) ( relative risk 0.37 ; confidence interval 0.19 - 0.73 ; P=.0026 ) and further reductions were seen after implementation of a performance feedback program ( phase 2 to phase 3 ) , although the reduction did not reach statistical significance ( 9.9 vs 17.06 BSI/1000 IVD days ; relative risk 0.58 ; confidence interval 0.29 - 1.18 ; P=.11 ) . Additional analysis of the data using chi2 for trends demonstrated that sequential implementation of an education and performance feedback program result ed 
    Output:
    
The beneficial effect of education was apparent in teaching and nonteaching institutions and in lesser-developed countries and developed nations .
Because of the study design s and limitations of the individual studies , a causal association between educational interventions and reduced HCAI rates can not be made .
The implementation of educational interventions may reduce HCAI considerably .