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To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.
This prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.
During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).
Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.
This chapter discusses the current knowledge of hormonal suppression as a means to preserve or restore fertility in males. The seminiferous tubules contain the germ cells, which consist of stem and differentiating spermatogonia, spermatocytes, spermatids and sperm and the sertoli cells, which support and regulate germ cell differentiation. The eventual recovery of sperm production depends on the survival of the spermatogonial stem cells and their ability to differentiate after exposure to cytotoxic agents. Several studies support the conclusion that gonadotropin suppression does not protect spermatogenesis in mice from damage. Seven clinical trials have been performed in attempts to demonstrate protection of spermatogenesis in humans by hormone suppression treatment before and during cytotoxic therapy, but six indicated no protection. One contribution to the difference in the stimulation of recovery by hormone suppression after cytotoxic treatment may be the interspecies differences in the block in differentiation of spermatogonia.