***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 perform active targeted prospect i ve surveillance to measure device-associated infection ( DAI ) rates , attributable mortality due to DAI , and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units ( ICUs ) in 9 hospitals in Colombia , all of which are members of the International Infection Control Consortium . METHODS We conducted prospect i ve surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System ( NNIS ) . DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days . RESULTS During the 3-year study , 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs , for an overall DAI rate of 12.2 % , or 18.2 DAIs per 1,000 patient-days . Central venous catheter (CVC)-related bloodstream infection ( BSI ) ( 47.4 % of DAIs ; 11.3 cases per 1,000 catheter-days ) was the most common DAI , followed by ventilator-associated pneumonia ( VAP ) ( 32.3 % of DAIs ; 10.0 cases per 1,000 ventilator-days ) and catheter-associated urinary tract infection ( CAUTI ) ( 20.3 % of DAIs ; 4.3 cases per 1,000 catheter-days ) . Overall , 65.4 % of all Staphylococcus aureus infections were caused by methicillin-resistant strains ; 40.0 % of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3 % were resistant to ceftazidime ; and 40.0 % of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones , 50.0 % were resistant to ceftazidime , 33.3 % were resistant to piperacillin-tazobactam , and 19.0 % were resistant to imipenem . The crude unadjusted attributable mortality was 16.9 % among patients with VAP ( relative risk [ RR ] , 1.93 ; 95 % confidence interval [ CI ] , 1.24 - 3.00 ; P=.002 ) ; 18.5 among those with CVC-associated BSI ( RR , 2.02 ; 95 % CI , 1.42 - 2.87 ; P<.001 ) ; and 10.5 % among those with CAUTI ( RR , 1.58 ; 95 % CI , 0.78 - 3.18 ; P=.19 ) . CONCLUSION The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS . These data show the need for more-effective infection control interventions in Colombia We conducted a prospect i ve study of targeted surveillance of healthcare-associated infections ( HAIs ) in 13 intensive care units ( ICUs ) from 12 Turkish hospitals , all members of the International Nosocomial Infection Control Consortium ( INICC ) . The definitions of the US Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System ( NNISS ) were applied . During the three-year study , 3288 patients for accumulated duration of 37 631 days acquired 1277 device-associated infections ( DAI )  , an overall rate of 38.3 % or 33.9 DAIs per 1000 ICU-days . Ventilator-associated pneumonia ( VAP ) ( 47.4 % of all DAI , 26.5 cases per 1000 ventilator-days ) gave the highest risk , followed by central venous catheter (CVC)-related bloodstream infections ( 30.4 % of all DAI , 17.6 cases per 1000 catheter-days ) and catheter-associated urinary tract infections ( 22.1 % of all DAI , 8.3 cases per 1000 catheter-days ) . Overall 89.2 % of all Staphylococcus aureus infections were caused by methicillin-resistant strains , 48.2 % of the Enterobacteriaceae isolates were resistant to ceftriaxone , 52.0 % to ceftazidime , and 33.2 % to piperacilin-tazobactam ; 51.1 % of Pseudomonas aeruginosa isolates were resistant to  fluoroquinolones  , 50.7 % to ceftazidime , 38.7 % to imipenem , and 30.0 % to piperacilin-tazobactam ; 1.9 % of Enterococcus sp. isolates were resistant to  vancomycin  . This is the first multi-centre study showing DAI in Turkish ICUs . DAI rates in the ICUs of Turkey are higher than reports from industrialized countries OBJECTIVE To assess the efficacy of parental education and use of parents as nursing assistants  on reducing nosocomial infections . DESIGN Prospect i ve study . METHODS Active surveillance for nosocomial infections was performed on two wards . On ward A , parents were educated about infection control practice s and assisted nursing staff with routine tasks , so that nursing personnel could focus their efforts on procedures with higher risk of infection . Parental assistance was not sought on ward B , the comparison ward . RESULTS From October 1990 through September 1991 , 1,081 patients were admitted to wards A ( 470 ) or B ( 611 ) . The over-all nosocomial infection rate was 7.1 per 100 admissions ; the nosocomial infection rate was significantly higher on ward B than ward A ( 63/611 vs 14/470 ; P<.001 ) . Multivariate analysis identified risk factors for nosocomial infection on the two wards as age < 2 years ( P=.01 ) , malnutrition ( P=.005 ) , duration of hospitalization ( P<.001 ) , ward B hospitalization ( P=.003 ) , and ward cleanliness score ( P=.009 ) ; the distribution of patients with these factors was similar on the two wards . CONCLUSIONS Our data suggest that parental infection control education and recruitment to relieve nursing staff of routine low-risk procedures are economical and easily implemented measures to reduce nosocomial infections in hospitals with limited personnel re sources in the developing world 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 Objective To determine epidemiology and risk factors for nosocomial infections in intensive care unit ( ICU ) . Design Prospect i ve incidence survey . Setting An adult general ICU in a university hospital in western Turkey . Patients All patients who stayed more than 48 h in ICU during a 2-year period ( 2000–2001 ) . Measurements and results The study included 434 patients ( 7394 patient-days ) . A total of 225 infections were identified in 113 patients ( 26 % ) . The incidence and infection rates were 56.8 in 1000-patient days and 51.8 % , respectively . The infections were pneumonia ( 40.9 % ) , bloodstream ( 30.2 % ) , urinary tract ( 23.6 % ) and surgical site infections ( 5.3 % ) . Pseudomonas aeruginosa ( 22.6 % ) , methicillin-resistant Staphylococcus aureus ( 22.2 % ) and Acinetobacter spp . ( 11.9 % ) were frequently isolated micro-organisms . Median length of stay with nosocomial infection and without were 13 days ( Interquartile range , IQR , 20 ) and 2 days ( IQR , 2 ) , respectively ( P<0.0001 ) . In logistic regression analysis ,  mechanical ventilation [ odds ratio ( OR ) : 16.35 ; 95 % confidence interval ( CI ) : 8.26–32.34 ; P<0.0001 ) , coma ( OR : 15.04 ; 95 % CI : 3.41–66.33 ; P=0.0003 ) , trauma ( OR : 10.27 ; 95 % CI : 2.34–45.01 ; P=0.002 ) ,  nasogastric tube ( OR : 2.94 ; 95 % CI : 1.47–5.90 ; P=0.002 ) , tracheotomy ( OR : 5.77 ; 95 % CI : 1.10–30.20 ; P=0.04 ) and APACHE II scores 10–19 ( OR : 10.80 ; 95 % CI : 1.10–106.01 ; P=0.04 ) were found to be significant risk factors for nosocomial infection . Rate of nosocomial infection increased with the number of risk factors ( P<0.0001 ) . Mortality rates were higher in infected patients than in non-infected patients ( 60.9 vs 22.1 % ; P<0.0001 ) . Conclusion These data suggest that , in addition to underlying clinical conditions , some invasive procedures can be independent risk factors for nosocomial infection in ICU The aim of this cluster‐r and omized , crossover trial was to compare the efficacy of plain soap and water with an alcohol‐based h and rub for surgical h and preparation and prevention of surgical‐site infection ( SSI ) in a Kenyan rural hospital OBJECTIVE As a measure of the quality of care provided to patients in the intensive care unit , comparison of nosocomial infection rates with those of the National Nosocomial Infection surveillance was completed during a 3-year observation period . DESIGN The study design was a prospect i ve study during 3 years between 1993 and 1995 . During that period , patients at the medical/surgical and neurosurgical intensive care units and the high-risk nursery were surveyed for nosocomial infections . Device use , bloodstream infection , urinary tract infection , and ventilator-associated pneumonia nosocomial infection rates were calculated and compared with the National Nosocomial Infection Surveillance published rates for the same period . SETTING The study setting was the medical/surgical intensive care unit , the neurosurgical intensive care unit , and the high-risk nursery at the Jordan University Hospital . RESULTS Overall infection rates were 17.2 per 100 patients in the medical/surgical intensive care unit , 14.2 to 18.5 per 100 patients in the neurosurgical intensive care unit , and 13.4 to 73.5 per 100 patients in the high-risk nursery . When compared with the weight of the infants , these rates were 61.9 to 94 per 100 in infants weighing < 1500 g , 26 to 30.8 per 100 patients in infants weighing > 1500 g to 2500 g , and 11.7 to 14.4 per 100 in infants weighing > 2500 g. Whereas device use was moderate , bloodstream infection and ventilator-associated pneumonia rates were > 90th percentile for National Nosocomial Infection Surveillance in the high-risk nursery , and urinary tract infection was > 90th percentile in the medical/surgical 
    Output:
    
Gram-negative bacilli represented the most common nosocomial isolates .
INTERPRETATION The burden of health-care-associated infection in developing countries is high .