***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 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 BACKGROUND The purpose of this study was to compare the performance of heat and moisture exchanger filters with heated humidifying systems in the mechanical ventilator circuit on the incidence of ventilator-associated pneumonia ( VAP ) and bacterial colonization . METHOD Two hundred and forty-three consecutive patients who required mechanical ventilation for 48 hours or more in the adult intensive care unit were r and omized to either a heat and moisture exchanger ( HME ) or a heated humidifying breathing circuit . RESULTS The VAP rate among the group with HME was 11.4 % ; the rate among the group with heated humidifying system ( HHS ) was 15.8 % . The difference was not statistically significant . Approximately 68 % of the patients in the HME group had no pathogen isolated compared with 50 % of the patients in the HHS group . This difference was statistically significant ( P = .006 ) . However , the distribution of the pathogens among those patients who had the isolated pathogens was mostly identical in the 2 groups . CONCLUSION Even though the study did not find HME to be significantly advantageous over the HHS , in as much as VAP rate is concerned , other advantages such as reduced nurses workload , reduced financial cost , and better safety made HME a more favorable device for use in our adult intensive care unit BACKGROUND Ventilator-associated pneumonia ( VAP ) is considered to be an important cause of infection-related death and morbidity in intensive care units ( ICUs ) . We sought to determine the long-term effect of an educational program to prevent VAP in a medical ICU ( MICU ) . METHODS A 4-year controlled , prospect i ve , quasi-experimental study was conducted in an MICU , surgical ICU ( SICU ) , and coronary care unit ( CCU ) for 1 year before the intervention ( period 1 ) , 1 year after the intervention ( period 2 ) , and 2 follow-up years ( period 3 ) . The SICU and CCU served as control ICUs . The educational program involved respiratory therapists and nurses and included a self- study module with preintervention and postintervention assessment s , lectures , fact sheets , and posters . RESULTS Before the intervention , there were 45 episodes of VAP ( 20.6 cases per 1000 ventilator-days ) in the MICU , 11 ( 5.4 cases per 1000 ventilator-days ) in the SICU , and 9 ( 4.4 cases per 1000 ventilator-days ) in the CCU . After the intervention , the rate of VAP in the MICU decreased by 59 % ( to 8.5 cases per 1000 ventilator-days ; P=.001 ) and remained stable in the SICU ( 5.6 cases per 1000 ventilator-days ; P=.22 ) and CCU ( 4.8 cases per 1000 ventilator-days ; P=.48 ) . The rate of VAP in the MICU continued to decrease in period 3 ( to 4.2 cases per 1000 ventilator-days ; P=.07 ) , and rates in the SICU and CCU remained unchanged . Compared with period 1 , the mean duration of hospital stay in the MICU was reduced by 8.5 days in period 2 ( P<.001 ) and by 8.9 days in period 3 ( P<.001 ) . The monthly hospital antibiotic costs of VAP treatment and the hospitalization cost for each patient in the MICU in periods 2 and 3 were also reduced by 45%-50 % ( P<.001 ) and 37%-45 % ( P<.001 ) , respectively . CONCLUSIONS A focused education intervention result ed in sustained reductions in the incidence of VAP , duration of hospital stay , cost of antibiotic therapy , and cost of hospitalization BACKGROUND H and hygiene is a fundamental measure for the control of nosocomial infection . However , sustained compliance with h and hygiene in health care workers is poor . We attempted to enhance compliance with h and hygiene by implementing education , training , and performance feedback . We measured nosocomial infections in parallel . METHODS We monitored the overall compliance with h and hygiene during routine patient care in intensive care units ( ICUs ) ; 1 medical surgical ICU and 1 coronary ICU , of 1 hospital in Buenos Aires , Argentina , before and during implementation of a  h and hygiene education , training , and performance feedback program . Observational surveys were done twice a week from September 2000 to May 2002 . Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance ( NNIS ) criteria , with prospect i ve surveillance . RESULTS We observed 4347 opportunities for h and hygiene in both ICUs .  Compliance improved progressively ( h and washing adherence , 23.1 % ( 268/1160 ) to 64.5 % ( 2056/3187 ) ( RR , 2.79 ; 95 % CI : 2.46 - 3.17 ; P < .0001 ) . During the same period , overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days ( 104/2187 ) to 27.93 per 1000 patient days ( 207/7409 ) RR , 0.59 ; 95 % CI : 0.46 - 0.74 , P < .0001 ) . CONCLUSION A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with h and hygiene , coinciding with a reduction in nosocomial infection rates in the ICUs This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients . One hundred and thirty-three patients requiring central venous catheterization were chosen at r and om to receive either an antiseptic-impregnated triple-lumen catheter ( N=64 ) or a st and ard triple-lumen catheter ( N=69 ) . The mean ( SD ) duration s of catheterization for the antiseptic and st and ard catheters were 11.7 ( 5.8 ) days ( median 10 ; range 3 - 29 ) and 8.9 ( 4.6 ) days ( median 8.0 ; range 3 - 20 ) , respectively ( P=0.006 ) . Fourteen ( 21.9 % ) of the antiseptic catheters and 14 ( 20.3 % ) of the st and ard catheters had been colonized at the time of removal ( P=0.834 ) . Four cases ( 6.3 % ) of catheter-related bloodstream infection were associated with antiseptic catheters and one case ( 1.4 % ) was associated with a st and ard catheter ( P=0.195 ) . The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the st and ard catheter group ( P=0.640 ) . The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the st and ard catheter group ( P=0.452 ) . In conclusion , our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients Purpose : To ascertain the effect of an infection control program including process control on intensive care unit ( ICU ) rates of intravascular device (IVD)–associated bloodstream infection ( BSI ) . Setting : Two level III adult ICUs in one public university hospital in Mexico : one medical surgical ICU and one neurosurgical ICU . Population Study : All adult patients admitted to study units who had a central venous catheter ( CVC ) in place for at least 24 hrs . Methods : A prospect i ve before/after trial in which rates of IVD-associated BSI are determined during a period of active surveillance without process control ( phase 1 ) were compared with rates of IVD-associated BSI after implementing an infection control program applying process control ( phase 2 ) . Results : Six hundred five IVD-days were accumulated in phase 1 , and 2824 IVD-days were accumulated during phase 2 . Compliance with CVC site care and h and hygiene improved significantly from baseline during the study period : placing a gauze dressing over the catheter insertion site ( 99.24 % vs. 86.69 % , respectively ; relative risk [ RR ] = 1.14 ; 95 % confidence interval [ CI ] = 1.07–1.22 ; p = .0000 ) , proper use of gauze for vascular catheter insertion site ( 97.87 % vs. 84.21 % , respectively ; RR = 1.16 ; 95 % CI = 1.09–1.24 ; p = .0000 ) , documentation of the duration of the administration set of the vascular catheter ( 93.85 % vs. 40.69 % , respectively ; RR = 2.34 ; 95 % CI = 2.14–2.56 ; p = .0000 ) , and h and hygiene before contact with the patient ( 84.9 % vs. 62 % , respectively ; RR = 1.37 ; 95 % CI = 1.21–1.51 ; p = .0000 ) . Overall rates of IVD-associated BSI were lowered significantly from baseline rates after implementation of process control ( 19.5 vs. 46.3 BSIs per 1000 IVD-days , respectively ; RR = 0.42 ; 95 % CI = 0.27–0.66 ; p = .0001 ) . Overall rates of crude unadjusted mortality were lowered significantly from baseline rates ( 48.5 % vs. 32.8 % 
    Output:
    
Conclusions : Multifaceted interventions including h and -hygiene campaigns , antibiotic stewardship and other elementary infection control practice s are effective in developing countries .