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

Author

Rosenthal, V.D., Maki, D.G., Rodrigues, C., Álvarez-Moreno, C., Leblebicioglu, H., Sobreyra-Oropeza, M., Berba, R., Madani, N., Medeiros, E.A., Cuéllar, L.E., Mitrev, Z., Dueñas, L., Guanche-Garcell, H., Mapp, T., Kanj, S.S., Fernández-Hidalgo, R., Viegas, M., Di Núbila, B.M.A., Lanzetta, D., Fernández, L.J., Rossetti, M.A., Romani, A., Migazzi, C., Barolin, C., Martínez, E., Sztokhamer, D., Soroka, L.C., Flynn, L.P., Rausch, D., Spagnolo, A., Forciniti, S., Blasco, M., Lezcano, C.B., Lastra, C.E., Angelieri, D.B., Salomao, R., Da Silva, M.Â.M., Vilins, M., Da Silva, E.H., Blecher, S., Grinberg, G., Linares, C., Gómez, W.V., Vergara, G.R., Arrieta, P., Osorio, L., Guzmán, N.B., Ferrer, M.R., Villa, G.S., Guzmán, A.L., Sussmann, O., Mojica, B.E., Olarte, N., Valderrama, A., Dajud, L., Mendoza, M., Bernate, P.H.A., Calderón, M.E.R., Calzada, J.M.A., Muñoz, G., Argüello, A.R., Pérez, C.M., De Casares, A.C.B., De Machuca, L.J., Hegd, A., Kapadia, F., Todi, S.K., Chakraborty, P., Chatterjee, S., Chakravarthy, M., Jawali, V., Adhikary, R., Singh, S., Kumar, R.K., Radhakrishnan, K., Karlekar, A., Kapoor, P., Pawar, M., Udwadia, F.E., Ansari, R., Poojary, A., Koppikar, G., Bhandarkar, L., Sen, N., Subramani, K., Raj, J.P., Myatra, S.N., Divatia, J.V., Kelkar, R., Biswas, S., Singhal, H., Raut, S., Mahale, N., Dhakate, V., Sampat, S., Ramachandran, B., Zahreddine, N., Sidani, N., Jurdi, L.A., Kanafani, Z., Anguseva, T., Ampova, V., Guroska, S.T., Higuera, F., Hernández, H.T., Gómez, A.C., Morales, J.R., Rodríguez, J.E.V., Serrato, I.P., López, M.S., Ruiz, A.A., Campuzano, R., Brito, J.M., Abouqal, R., Zeggwagh, A.A., Abidi, K., Dendane, T., Alfaro, F.G., Alvarado, C., De León, L.M., Navarro, R., Moreno, J.L., Cerrud, R., Rosales, R., Bravo, L.I.C., Cáceres, M.L., Maldonado, E.F., Espichan, M.J.M., Echenique, L., Sabogal, A.C., Goicochea, I.P., Sanchez, A.A., Alva, G.R., Ventura, J.G., Aguilar, M.R., Plasencia, N.S., Rodríguez, T., Espinoza, T.A., López, F.S., Angelo, G., Genuino, S., Consunji, R.J., Mantaring III, J.B.V., Navoa-Ng, J.A., Villanueva, V.D., Tolentino, M.C.V., Yalcin, A.N., Turhan, O., Keskin, S., Özgültekin, A., Turan, G., Akgün, N., Koksal, I., Yýlmaz, G., Senel, A.C., Sözen, E.E., Akan, Ö.A., Tulunay, M., Oral, M., Ünal, N., Esen, S., Ulger, F., Dilek, A., Aygun, C., Küçüködük, S., Erben, N., Ozgunes, I., Usluer, G., Sardan, Y.C., Yildirim, G., Topeli, A., Ozdemir, D., Guclu, E., Erdogan, N.S., Sirmatel, F., Cengiz, M., Yilmaz, L., Alp, E., Aygen, B., Turgut, H., Sacar, S., Sungurtekin, H., and Uǧurcan, D.

Subjects
health care organization, treatment duration, antisepsis, adult, chlorhexidine, article, bloodstream infection, clinical trial, catheter, intensive care unit, major clinical study, health survey, International Nosocomial Infection Control Consortium, aged, female, multicenter study, male, incidence, health program, controlled study, hospital infection, human
Abstract

BACKGROUND. 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. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.

Published
2010

27. New Polyurethane-based magnetostrictive composites: Dynamical mechanical properties.

Author

Vilas, J.L., Laza, J.M., Rodríguez, C., Rodríguez, M., and León, L.M.

Subjects
POLYURETHANES, MECHANICAL properties of polymers, CALORIMETRY, GLASS transition temperature, CHEMICAL engineering, POLYMERS
Abstract

Polyurethane-based magnetostrictive composites containing between 30 and 70 wt% Terfenol-D have been prepared in order to obtain better and tailored dynamic-mechanical properties. The thermal and mechanical properties of polyurethanes with different chemical compositions were first analyzed to determine the most adequate one to prepare the composite materials. Calorimetric analysis indicates that the amount of crystallites increased in presence of Terfenol-D. Dynamic-mechanical properties have also been determined for the chosen composite, showing that the damping peak at glass transition increased by the addition of the magnetostrictive material while it became simultaneously broader. However, the storage modulus showed a drop with the increase in the filler content from 2200 MPa for pure polyurethane to 400 MPa for polyurethane with 60 %wt Terfenol-D. POLYM. ENG. SCI. 2013. © 2012 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Published
2013
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29. Thermal Degradation of Copolymers of N‐Vinylcarbazole with Acrylic and Methacrylic Monomers.

Author

Bilbao, E., Laza, M., Vilas, J.L., Garay, M.T., Rodríguez, M., and León, L.M.

Subjects
THERMAL analysis, METHACRYLIC acid, MONOMERS, METHYL methacrylate, POLYMERS
Abstract

The thermal stability of several series of N‐vinylcarbazole and a methacrylic or acrylic monomer has been studied. The copolymers are more stable the higher the content of N‐vinylcarbazole, a few units of this monomer being capable of appreciably enhancing the thermal stability of the acrylic or methacrylic homopolymer. The degradation products have been analyzed by FTIR, and a degradation mechanism similar to that for the homopolymers has been proposed. The kinetic analysis based on a differential theoretical model, has allowed an estimate of the activation energy of the degradation process. [ABSTRACT FROM AUTHOR]

Published
2006
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31. Study of Polymer–Polymer Complexes of Poly(N-Isopropylacrylamide) with Hydroxyl-Containing Polymers.

Author

Garay, M.T., Rodriguez, M., Vilas, J.L., and León, L.M.

Subjects
POLYMERS, METHANOL, TEMPERATURE, MIXTURES, CALORIMETRY
Abstract

Interpolymer complexation between poly(N-isopropylacrylamide) (PNIPAAM) and the hydroxyl-containing polymers poly(p-vinylphenol) (PVPh) and poly(2-hydroxypropyl methacrylate) (PHPMA) has been studied. A common solvent for PNIPAAM and PHPMA has been selected from phase behavior studies of these polymers in aqueous–methanolic solutions. Precipitates of PNIPAAM/PVPh in methanol at room temperature and PNIPAAM/PHPMA in a mixture methanol/water (56/44) at −11°C have been isolated. The compositions of the resulting complexes have been determined. Calorimetric measurements indicate that all PNIPAAM/PVPh complexes present a similar Tg, which does not depend on feed composition, and is higher than that of the component polymers, whereas PNIPAAM/PHPMA complexes present an intermediate composition-dependent Tg. Thermal stability of all complexes has also been studied. [ABSTRACT FROM AUTHOR]

Published
2004
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32. Thermal properties of copolymers of N-vinylcarbazole with acrylic and methacrylic monomers.

Author

Isusi, M., Rodríguez, M., Garay, T., Vilas, J.L., and León, L.M.

Subjects
THERMAL analysis, COPOLYMERS, ACRYLIC acid, MONOMERS
Abstract

The copolymerization of N-vinylcarbazole (NVC) with several acrylic and methacrylic monomers (butyl acrylate (BuA), ethyl-, butyl-, and cyclohexyl methacrylate) has been studied and the thermal properties of the copolymers have been analyzed. The reactivity ratios calculated by a statistical method known as the error in variables method indicate that NVC–BuA copolymers are predominantly alternating, the rest of the systems having a moderate alternating character. The dependence of the glass transition temperature on copolymer composition has been analyzed by using different theories; those taking into account the sequence distribution in the copolymer are the ones that best fit the experimental data. Analysis of the copolymers' thermal stability reveals high values of the initial degradation temperature even for those samples with a low content in NVC. [ABSTRACT FROM AUTHOR]

Published
2002
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