Implementing a multifaceted intervention to decrease central line-associated bloodstream infections in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience.

OBJECTIVE To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line-associated bloodstream infections. DESIGN Prospective cohort collaborative. SETTING AND PARTICIPANTS Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi. INTERVENTIONS A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line-associated bloodstream infections. RESULTS Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line-associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line-associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods. CONCLUSION A significant reduction in the global morbidity and mortality associated with central line-associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.

Enhanced arsenic sorption by hydrated iron (III) oxide-coated materials--mechanism and performances.

Mechanism and performances of arsenic(III) [As(III)] and arsenic(V) [As(V)] sorption onto hydrated iron(III) oxide (HFO)-coated materials were investigated at neutral pH where arsenic occurs in both molecular and ionic forms. Arsenic sorption by HFO-coated materials was proven to be a multistage process consisting of both macropore and intraparticle diffusion. Higher mass-transfer velocities were obtained for As(III), which is attributed to the beneficial features of HFO. Equilibrium studies revealed the spontaneous and favorable nature of the arsenic sorption process. The maximum sorption capacity and the Gibbs free energy values indicated that HFO-coated materials exhibit more affinity towards As(III). The Langmuir and Freundlich isotherm models revealed both the chemical and physical nature of the sorption process, while the Dubinin-Radushkevich model indicated that physical sorption is a more dominant process with HFO-coated materials.

Determination of inorganic arsenic species in natural waters--benefits of separation and preconcentration on ion exchange and hybrid resins.

A simple method for the separation and determination of inorganic arsenic (iAs) species in natural and drinking water was developed. Procedures for sample preparation, separation of As(III) and As(V) species and preconcentration of the total iAs on fixed bed columns were defined. Two resins, a strong base anion exchange (SBAE) resin and a hybrid (HY) resin were utilized. The inductively-coupled plasma-mass spectrometry method was applied as the analytical method for the determination of the arsenic concentration in water. The governing factors for the ion exchange/sorption of arsenic on resins in a batch and a fixed bed flow system were analyzed and compared. Acidity of the water, which plays an important role in the control of the ionic or molecular forms of arsenic species, was beneficial for the separation; by adjusting the pH values to less than 8.00, the SBAE resin separated As(V) from As(III) in water by retaining As(V) and allowing As(III) to pass through. The sorption activity of the hydrated iron oxide particles integrated into the HY resin was beneficial for bonding of all iAs species over a wide range of pH values from 5.00 to 11.00. The resin capacities were calculated according to the breakthrough points in a fixed bed flow system. At pH 7.50, the SBAE resin bound more than 370 microg g(-1) of As(V) while the HY resin bound more than 4150 microg g(-1) of As(III) and more than 3500 microg g(-1) of As(V). The high capacities and selectivity of the resins were considered as advantageous for the development and application of two procedures, one for the separation and determination of As(III) (with SBAE) and the other for the preconcentration and determination of the total arsenic (with HY resin). Methods were established through basic analytical procedures (with external standards, certified reference materials and the standard addition method) and by the parallel analysis of some samples using the atomic absorption spectrometry-hydride generation technique. The analytical properties of both procedures were similar: the limit of detection was 0.24 microg L(-1), the limit of quantification was 0.80 microg L(-1) and the relative standard deviations for samples with a content of arsenic from 10.00 to 300.0 microg L(-1) ranged from 1.1 to 5.8%. The interference effects of anions commonly found in water and some organic species which can be present in water were found to be negligible. Verification with certified reference materials proved that the experimental concentrations found for model solutions and real samples were in agreement with the certified values.

[The role of certain Campylobacter types in the etiology of enterocolitis]. / Ucesce pojedinih vrsta kampilobaktera u etiologiji enterokolitisa.

BACKGROUND: In recent decades, medical community has increasingly been calling attention to the importance of Campylobacter as an disease-causing agent in humans. Nowadays, Campylobacter jejuni (C. jejuni) is known as the most frequent bacterial cause of diarrhea worldwide. Epidemiological differences of the infections caused by Campylobacter, present in the developed and the developing countries, are attributed to the differences of the types of virulence. Due to the specificity, and the demanding features of Campylobacter, as well as poorly equipped microbiological laboratories, campylobacteriosis is insufficiently studied in our country. This investigation aimed to determine the participation of some Campylobacter species in the etiology of diarrheal diseases in our population. METHODS: The four-years continuous monitoring of Campylobacter presence was performed in the faeces of 12,605 patients with enterocolitis. The control group included 5,774 examinees of healthy children and youth. Faeces samples were cultivated on Skirrow's selective medium, and further incubated according to effective methodology for Campylobacter. Identification of strains was based on morphological, cultural and physiologic features of strains (oxidase test, catalase test, susceptibility to nalidixic acid, and hypurate hydrolysis). As a statistical method, for data processing, chi 2 test and Fisher's exact test were used. RESULTS: Campylobacter was proven in 3.86% of enterocolitis patients, and in 0.71% of healthy population. Out of 518 Campylobacter isolates, 86.48% belonged to enterocolitis outpatients, and 13.51% to inpatients. Predominant symptoms of the disease were diarrhea (81.83%), increased temperature (34.71%), vomiting (19.77%), and stomach pain (15.17%). The diseased were predominantly infants in the first year of life. Out of 300 Campylobacter isolates, 75% were identified as Campylobacter jejuni, 23% as Campylobacter coli (C. coli), and 2% as Campylobacter lari (C. lari). CONCLUSION: Species of Campylobacter genus participate in the etiology of enterocolitis at 3.86%. According to numerous parameters the infection in our population coincides with the infection in the population of European countries. Frequent findings of C. coli in our region are in discrepancy with the results of numerous studies conducted in the developed countries.