***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: PURPOSE A pre-post analysis of an antimicrobial stewardship program ( ASP ) involving the use of data -mining software to prospect ively identify cases for ASP intervention was conducted . METHODS The investigators evaluated clinical outcomes and cost metrics before and after implementation of the ASP , which entailed daily physician review of summary reports on all adult in patients receiving antimicrobial therapy . The primary outcome measures were annual antimicrobial expenditures and rates of infections due to common nosocomial pathogens ; secondary outcome measures included patient survival and length of stay ( LOS ) in cases involving the indicator diagnoses of pneumonia and abdominal sepsis . RESULTS Antimicrobial expenditures , which had increased by an average of 14.4 % annually in the years preceding ASP implementation , decreased by 9.75 % in the first year of the program and remained relatively stable in subsequent years , with overall cumulative cost savings estimated at $ 1.7 million . Rates of nosocomial infections involving Clostridium difficile , methicillin-resistant Staphylococcus aureus , and vancomycin-resistant enterococci all decreased after ASP implementation . A pre-post comparison of survival and LOS in patients with pneumonia ( n = 2186 ) or abdominal sepsis ( n = 225 ) showed no significant differences in those outcomes in either patient group , possibly due to the hospital 's initiation of other , concurrent infection-control programs during the study period . CONCLUSION A prospect i ve collaborative ASP employed automated reports to efficiently identify key data for ASP review . After ASP implementation , antimicrobial expenditures and rates of nosocomial infections caused by resistant pathogens dropped without significant changes in patient survival , LOS , and readmissions for the two studied illness categories Objective To evaluate the impact of the Cleanyourh and s campaign on rates of hospital procurement of alcohol h and rub and soap , report trends in selected healthcare associated infections , and investigate the association between infections and procurement . Design Prospect i ve , ecological , interrupted time series study from 1 July 2004 to 30 June 2008 . Setting 187 acute trusts in Engl and and Wales . Intervention Installation of bedside alcohol h and rub , material s promoting h and hygiene and institutional engagement , regular h and hygiene audits , rolled out nationally from 1 December 2004 . Main outcome measures Quarterly ( that is , every three months ) rates for each trust of hospital procurement of alcohol h and rub and liquid soap ; Staphylococcus aureus bacteraemia ( meticillin resistant ( MRSA ) and meticillin sensitive ( MSSA ) ) and Clostridium difficile infection for each trust . Associations between procurement and infection rates assessed by mixed effect Poisson regression model ( which also accounted for effect of bed occupancy , hospital type , and timing of other national interventions targeting these infections ) . Results Combined procurement of soap and alcohol h and rub tripled from 21.8 to 59.8 mL per patient bed day ; procurement rose in association with each phase of the campaign . Rates fell for MRSA bacteraemia ( 1.88 to 0.91 cases per 10 000 bed days ) and C difficile infection ( 16.75 to 9.49 cases ) . MSSA bacteraemia rates did not fall . Increased procurement of soap was independently associated with reduced C difficile infection throughout the study ( adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993 , 95 % confidence interval 0.990 to 0.996 ; P<0.0001 ) . Increased procurement of alcohol h and rub was independently associated with reduced MRSA bacteraemia , but only in the last four quarters of the study ( 0.990 , 0.985 to 0.995 ; P<0.0001 ) . Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia ( 0.86 , 0.75 to 0.98 ; P=0.02 ) and C difficile infection ( 0.75 , 0.67 to 0.84 ; P<0.0001 ) . Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia ( 0.91 , 0.83 to 0.99 ; P=0.03 ) and C difficile infection ( 0.80 , 0.71 to 0.90 ; P=0.01 ) , for at least two quarters after each visit . Conclusions The Cleanyourh and s campaign was associated with sustained increases in hospital procurement of alcohol rub and soap , which the results suggest has an important role in reducing rates of some healthcare associated infections . National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections IMPORTANCE Daily bathing of critically ill patients with the broad-spectrum , topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections . OBJECTIVE To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care-associated infections . DESIGN , SETTING , AND PARTICIPANTS A pragmatic cluster r and omized , crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center in Nashville , Tennessee , from July 2012 through July 2013 . INTERVENTIONS Units performed once-daily bathing of all patients with disposable cloths impregnated with 2 % chlorhexidine or nonantimicrobial cloths as a control . Bathing treatments were performed for a 10-week period followed by a 2-week washout period during which patients were bathed with nonantimicrobial disposable cloths , before crossover to the alternate bathing treatment for 10 weeks . Each unit crossed over between bathing assignments 3 times during the study . MAIN OUTCOMES AND MEASURES The primary prespecified outcome was a composite of central line-associated bloodstream infections ( CLABSIs ) , catheter-associated urinary tract infections ( CAUTIs ) , ventilator-associated pneumonia ( VAP ) , and Clostridium difficile infections . Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms , blood culture contamination , health care-associated bloodstream infections , and rates of the primary outcome by ICU . RESULTS During the chlorhexidine bathing period , 55 infections occurred : 4 CLABSI , 21 CAUTI , 17 VAP , and 13 C difficile . During the control bathing period , 60 infections occurred : 4 CLABSI , 32 CAUTI , 8 VAP , and 16 C difficile . The primary outcome rate was 2.86 per 1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the control bathing periods ( rate difference , -0.04 ; 95 % CI , -1.10 to 1.01 ; P = .95 ) . After adjusting for baseline variables , no difference between groups in the rate of the primary outcome was detected . Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired bloodstream infections , blood culture contamination , or clinical cultures yielding multidrug-resistant organisms . In a prespecified subgroup analysis , no difference in the primary outcome was detected in any individual intensive care unit . CONCLUSION AND RELEVANCE In this pragmatic trial , daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs , CAUTIs , VAP , or C difficile . These findings do not support daily bathing of critically ill patients with chlorhexidine . TRIAL REGISTRATION clinical trials.gov Identifier : NCT02033187 BACKGROUND A paucity of data exists regarding the effectiveness of daily chlorhexidine gluconate ( CHG ) bathing in non-intensive care unit ( ICU ) setting s. OBJECTIVE To evaluate the effectiveness of daily CHG bathing in a non-ICU setting to reduce methicillin-resistant Staphylococcus aureus ( MRSA ) and vancomycin-resistant Enteroccocus ( VRE ) hospital-acquired infections ( HAIs ) , compared with daily bathing with soap and water . DESIGN Quasi-experimental study design ; the primary outcome was the composite incidence of MRSA and VRE HAIs . Clostridium difficile HAI incidence was measured as a nonequivalent dependent variable with which to assess potential confounders . SETTING Four general medicine units , with a total of 94 beds , at a 719-bed academic tertiary-care facility in Providence , Rhode Isl and . PATIENTS A total of 7,102 and 7,699 adult patients were admitted to the medical service in the control and intervention groups , respectively . Patients admitted from January 1 through December 31 , 2008 , were bathed daily with soap and water ( control group ) , and those admitted from February 1 , 2009 , through March 31 , 2010 , were bathed daily with CHG-impregnated cloths ( intervention group ) . RESULTS Daily bathing with CHG was associated with a 64 % reduced risk of developing the primary outcome , namely , the composite incidence of MRSA and VRE HAIs ( hazard ratio , 0.36 [ 95 % CI , 0.2 - 0.8 ] ; P = .01 ) . There was no change in the incidence of C. difficile HAIs ( P = .6 ) . Colonization with MRSA was associated with an increased risk of developing a MRSA HAI ( hazard ratio , 8 [ 95 % CI , 3 - 19 ] ; P < .001 ) . CONCLUSION Daily CHG bathing was associated with a reduced HAI risk , using a composite endpoint of MRSA and VRE HAIs , in a general medical inpatient population OBJECTIVE We aim ed to rigorously evaluate the impact of prospect i ve audit and feedback on broad-spectrum antimicrobial use among critical care patients . DESIGN Prospect i ve , controlled interrupted time series . SETTING Single tertiary care center with 3 intensive care units . PATIENTS AND INTERVENTIONS A formal review of all critical care patients on their third or tenth day of broad-spectrum antibiotic therapy  was conducted , and suggestions for antimicrobial optimization were communicated to the critical care team . OUTCOMES The primary outcome was broad-spectrum antibiotic use ( days of therapy per 1000 patient-days ; secondary outcomes included overall antibiotic use , gram-negative bacterial susceptibility , nosocomial Clostridium difficile infections , length of stay , and mortality . RESULTS The mean monthly broad-spectrum antibiotic use decreased from 644 days of therapy per 1,000 patient-days in the preintervention period to 503 days of therapy per 1,000 patient-days in the postintervention period ( P < .0001 ) ; time series modeling confirmed an immediate decrease ( ± st and ard error ) of 119 ± 37.9 days of therapy per 1,000 patient-days ( P = .0054 ) . In contrast , no changes were identified in the use of broad-spectrum antibiotics in the control group ( nonintervention medical and surgical wards ) or in the use of control medications in critical care ( stress ulcer prophylaxis ) . The incidence of nosocomial C. difficile infections decreased from 11 to 6 cases in the study intensive care units , whereas the incidence increased from 87 to 116 cases in the control wards ( P = .04 ) . Overall gram-negative susceptibility to meropenem increased in the critical care units . Intensive care unit length of stay and mortality did not change . CONCLUSIONS Institution of a formal prospect i ve audit and feedback program appears to be a safe and effective means to improve broad-spectrum antimicrobial use in critical care OBJECTIVE To compare the efficacy of universal gloving with emollient-impregnated gloves with st and ard contact pre caution s for the control of multidrug-resistant organisms ( MDROs ) and to measure the effect on healthcare workers ' ( HCWs ' ) h and skin  health . DESIGN Prospect i ve before-after trial . SETTING An 18-bed surgical intensive care unit . METHODS During phase 1 ( September 2007 through March 2008 ) st and ard contact pre caution s were used . During phase 2 ( March 2008 through September 2008 ) universal gloving with emollient-impregnated gloves was used , and no contact pre caution s.  Patients were screened for vancomycin-resistant Enterococcus ( VRE ) and methicillin-resistant Staphylococcus aureus ( MRSA ) . HCW h and hygiene compliance and h and skin health and microbial contamination were assessed . The incidences of device-associated infection and Clostridium difficile infection ( CDI ) were determined . RESULTS The rate of compliance with contact pre caution s ( phase 1 ) was 67 % , and the rate of compliance with universal gloving ( phase 2 ) was 78 % ( P = .01 ) . H and hygiene compliance was higher during phase 2 than during phase 1 ( before patient care , 40 % vs 35 % of encounters ; P = .001 ; after patient care , 63 % vs 51 % of encounters ; P < .001 ) . No difference was observed in MDRO ac 
    Output:
    
Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates .
Chlorhexidine bathing and intensified h and -hygiene practice s were not effective for reducing CDI rates .
Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals .