Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

Utilización nutritiva de hierro en el transcurso de la ferrodeficiencia / Nutritive utilization of iron during the evolution of a iron deficiency

Se ha estudiado la utilización digestiva y metabólica de hierro durante la evolución (20,30, 40 días) de una ferrodeficiencia nutricional en ratas en periodo de crecimiento. Se han usado 48 ratas (Ratusnovergicus, raza Wistar albina) con un peso inicial aproximado de 45-50. Los animales se dividieron en 6 grupos: tres grupos controles (C) y tres grupos ferrodeficientes (FD) que recibieron una dieta AIN93G con contenido normal (45 mg Fe/kg dieta) o con un bajo contenido de hierro (5 mg/Fe Kg dieta)respectivamente durante 20, 30 ó 40 días. Los resultados obtenidos indican que la utilización nutritiva de hierro aumenta progresivamente en todos los periodos, siendo esta diferencia significativa, si comparamos el día 40 con el 20, esto es debido a que dicha patología produce una depleción de los depósitos corporales de Fe, lo cual favorece la entrada a favor de gradiente de concentración por difusión simple de dicho mineral(AU)

The digestive and metabolic utilization of iron during the evolution (20, 30, 40 days) of a nutritional Fe-deficiency has been studied in growing rats. 48 rats (Ratus novergicus, Wistar albino breed) wereused with an initial approximate weight of 45-50g. The animals were divided in 6 groups: three groups control (C) and three groups Fe-deficient (FD) receiving a diet AIN 93G with normal-Fe content (45mg/kg diet) or with a low-Fe content (5 mg/Kg diet) respectively during 20, 30 ó 40 days. The results obtained indicate that the nutritive utilization of iron increases progressively in all the periods, being this difference significant, if we compare the day 40 with 20, due to the above mentioned pathology produces a depletion of the Fe body stores, which favours the up take in favour of gradient of concentration by simple diffusion(AU)

Utilización nutritiva de fósforo en el transcurso de la anemia ferropénica nutricional / Nutritive utilization of phosphorus during the course of nutritional ferropenic anaemia

Se ha estudiado el efecto de la evolución de la anemia ferropénica nutricional sobre la utilización digestiva y metabólica de fósforo en tres periodos 20, 30 y 40 días. Los animales de experimentación han sido 48 ratas macho de la raza Wistar albina que se dividieron en 6 grupos: tres grupos controles(C) y tres grupos ferrodeficientes (FD) que recibieron una dieta AIN 93G con contenido normal (45mg Fe/kg dieta) o con un bajo contenido de hierro (5 mg/Fe Kg dieta) respectivamente durante 20, 30 ó 40 días. Se ha encontrado un aumento significativo en la utilización digestiva y metabólica de fósforo en el transcurso de la anemia ferropénica nutricional, efecto que se va haciendo más patente a medida que evoluciona la ferrodeficiencia. Este incremento en la utilización nutritiva de fósforo es debido principalmente al mecanismo pasivo de absorción de fósforo que opera principalmente en el yeyuno-íleon y es predominante en situación de anemia ferropénica nutricional(AU)

The evolution of the nutritional iron deficiency anemia on the digestive and metabolic utilization of phosphorus has been studied during three periods: 20, 30 and 40 days. 48 male Wistar albino breedrats were divided in 6 groups: three control groups (C) and three Fe-deficient groups (FD) receiving AIN 93G with normal-Fe content (45 mg /kg diet) or with a low-Fe content (5 mg/Kg diet) respectively during 20, 30 ó 40 days. A significant increase in the digestive and metabolic utilization of phosphorus has been found in the course of the nutritional iron deficiency anemia, effect that become more pronounced as the ferrodeficiency is instaured. This increase in the nutritive utilization of phosphorus is due mainly to the passive mechanism of phosphorus absorption which operates principally in the jejunum-ileum and is predominant in situation of nutritional iron deficiency anemia(AU)

Utilización nutritiva de magnesio durante el desarrollo de la anemia ferropénica nutricional / Nutritive utilization of magnesium during the development of nutritional iron deficiency anaemia

Dada la alta prevalencia de la anemia ferropénica y la diversidad de población a la que afecta es de interés conocer durante el desarrollo de la anemia las repercusiones de la deficiencia de hierro sobre el aprovechamiento nutritivo de otros minerales como el magnesio, para ello se ha determinado la utilización digestiva y metabólica a los 20, 30 y 40 días de suministrar una dieta con bajo contenido en hierro en ratas en crecimiento. La anemia incrementa la utilización nutritiva de magnesio en el día 30 del estudio. En los tres periodos estudiados, la utilización digestiva de magnesio en ratas controles presenta valores similares; en cambio, la relación magnesio retenido respecto al ingerido se eleva significativamente dadas las menores pérdidas urinarias de este mineral hacia el final del estudio. En ratas anémicas, el aprovechamiento digestivo y metabólico de magnesio aumenta en los últimos periodos estudiados debido al incremento del componente pasivo de la absorción de magnesio, ya que en situación de ferrodeficiencia la energía metabólica está disminuida y por tanto el componente activo de la absorción se encuentra reducido considerablemente(AU)

Taking into account the high prevalence of the iron deficiency anemia and the diversity of population affected, it is of great interest to know the repercussions of the iron deficiency during the development of the pathology on the nutritive utilization of other minerals such as magnesium, therefore we decided to study the digestive and metabolic utilization to 20, 30 and 40 days of supplying a diet with low content in iron in growing rats. The anemia increases the nutritive utilization of magnesium in the day 30 of the study. In the three studied periods, the digestive utilization of magnesium in control rats shows similar values; on the other hand, the relation magnesium retained with regard to the intake rises significantly because of the lower urinary losses of this mineral towards the end of the study. In anaemic rats, the digestive and metabolic utilization of magnesium increases in the last periods studied due to the increase of the passive component of the absorption of this mineral, since in situation of Fe-deficiency the metabolic energy is diminished and therefore the active component of the absorption is reduced considerably(AU)