Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: findings of the International Nosocomial Infection Control Consortium

3121-8Objectives: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. Design: A prospective active surveillance before-after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance. Setting: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey. Patients: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals. Interventions: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices. Measurements: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention. Main result: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study. Conclusion: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries

International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009

Q3Artículo original95-106We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 throughDecember 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centersfor Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infec-tion Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective datafrom 155,358 patients hospitalized in the consortium’s hospital ICUs for an aggregate of 923,624 days. Although device utilizationin the developing countries’ ICUs was remarkably similar to that reported from US ICUs in the CDC’s NHSN, rates of device-asso-ciated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter(CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also farhigher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI),6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance ofStaphylococcus aureusisolatesto methicillin (MRSA) (84.1% vs 56.8%, respectively),Klebsiella pneumoniaeto ceftazidime or ceftriaxone (76.1% vs 27.1%, respec-tively),Acinetobacter baumanniito imipenem (46.3% vs 29.2%, respectively), andPseudomonas aeruginosato piperacillin (78.0%vs 20.2%, respectively) were also far higher in the consortium’s ICUs, and the crude unadjusted excess mortalities of device-relatedinfections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP)

Programa de estimulación de lenguaje : 1a parte : para alumnos de educación infantil y primaria

No se trata de un programa terapéutico ni de un método de lectoescritura, simplemente es una estimulación encaminada a conseguir el objetivo propuestoEsta primera parte del Programa Estimulación del Lenguaje está dirigida a niños de educación infantil y primaria como una ayuda más al profesorado que imparte clases en estos ciclos. El programa está formado por un video y una guía para el profesor con fichas explicativas de las actividades a realizar. El objetivo es ayudar a conseguir la madurez psicomotora necesaria para que los alumnos sean capaces de emitir por sí mismos y con la máxima corrección posible los fonemas de nuestra lengua. La realización de las actividades que se proponen es sencilla, para que así pueda ser aplicada en cualquier aula con independencia de los medios disponibles y del número de alumnos. Las actividades se han encuadrado en dos grandes grupos: ejercicios preparatorios y ejercicios de emisión de fonemas. No obstante, en la práctica, como se puede observar en el video, realizado con alumnos y alumnas de preescolar de 4 y 5 años, se utilizaron ambos grupos de actividades conjuntamente, lo que da una solución de continuidad a los ejercicios.AndalucíaCentro del Profesorado de Málaga. Biblioteca; Calle Noé, 3; 29007 Málaga; +34951924214; +34952334092; [email protected]

La educación para la Salud en y desde la escuela

Se propone desarrollar propuestas educativas en todos los ciclos de Primaria que favorezcan la Educación para la Salud. Los objetivos son incluir en el Proyecto Educativo de Centro este tema transversal, reflexionar sobre salud y estilos de vida, y fomentar el cambio de actitudes. Las actividades principales son: curso de formación de profesores en temas de salud, revisión del Proyecto Educativo para incluir objetivos relacionados con la Educación para la Salud, debates y asambleas de alumnos sobre hábitos de alimentación, higiene y deporte y exposición de trabajos plásticos en torno a la Salud. La evaluación y las conclusiones del proyecto señalan aspectos como la formación de los participantes, la intervención educativa, la organización de espacios de ocio y la mejora de los recursos del centro que mejoren hábitos de salud.Madrid (Comunidad Autónoma). Consejería de Sanidad y Servicios SocialesMadridNo disponibleES

Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive careunits of 15 developing countries

Q2Q11264-1272Background The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line–associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership. Methods Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line–days). Process surveillance results at baseline were compared with intervention period data. Results During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line–days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line–days; relative risk, 0.46 [95% confidence interval, 0.33–0.63]; P <.001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P<.001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted Chlorhexidine for antisepsis increased from 7% to 27% (P = .018), and that sought to remove unneeded catheters increased from 37% to 83% (P = .004); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001). Conclusions Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia, the Middle East, and Europe

OBJECTIVE. To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance. DESIGN. An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period. SETTING. Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey. PARTICIPANTS. Healthcare workers at 99 ICU members of the INICC. METHODS. A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods. RESULTS. A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% (P < .01). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; P < .001), physicians versus nurses (62% vs 72%; P < .001), and adult versus neonatal ICUs (67% vs 81%; P < .001), among others. CONCLUSIONS. Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented. Infect Control Hosp Epidemiol 2013;34(4):415-42