Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines /
Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines /
Christopher J. Gill [and seven others]
Background. The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in
the developing world creates an urgent need for cost-effective infection-control measures in resource-limited
settings.
Methods. Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance,
colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative
bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction
of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila,
The Philippines.
Results. Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with
drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized
with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with
gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drug-resistant
gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species)
and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention
period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95%
confidence interval 1.1–1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4–2.0) and that overall mortality
decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4–0.6; NICU 2: relative risk, 0.8; 95% confidence
interval, 0.7–0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change
significantly at either NICU.
Discussion. Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines;
transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible
and are possibly effective in resource-limited hospital settings. https://pubmed.ncbi.nlm.nih.gov/19025496/
In: Clinical Infectious Disease, 2009 vol. 48 (1) pages 13-21
Anti-Bacterial Agents --pharmacology
Bacteria--isolation and purification
Bacterial Infections--prevention and control
Cross Infection--prevention and control
Infant, Newborn
Sepsis--prevention and control
Intensive Care Units, Neonatal
Background. The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in
the developing world creates an urgent need for cost-effective infection-control measures in resource-limited
settings.
Methods. Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance,
colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative
bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction
of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila,
The Philippines.
Results. Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with
drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized
with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with
gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drug-resistant
gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species)
and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention
period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95%
confidence interval 1.1–1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4–2.0) and that overall mortality
decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4–0.6; NICU 2: relative risk, 0.8; 95% confidence
interval, 0.7–0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change
significantly at either NICU.
Discussion. Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines;
transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible
and are possibly effective in resource-limited hospital settings. https://pubmed.ncbi.nlm.nih.gov/19025496/
In: Clinical Infectious Disease, 2009 vol. 48 (1) pages 13-21
Anti-Bacterial Agents --pharmacology
Bacteria--isolation and purification
Bacterial Infections--prevention and control
Cross Infection--prevention and control
Infant, Newborn
Sepsis--prevention and control
Intensive Care Units, Neonatal