Impact of Enhanced Infection Control at 2 Neonatal Intensive Care Units in The Philippines

Abstract

Background The growing burden of neonatal mortality due to hospital acquired neonatal sepsis in the developing world creates an urgent need for low cost effective infection control measures in low resource settings. Methods Using a pre/post comparison design, we measured how rates of staff hand hygiene compliance, colonization with resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative rods (GNRs) and resistant gram-positive cocci), bacteremia, and overall mortality changed following the introduction of a simplified package of infection control measures at two neonatal intensive care units (NICUs) in Manila, the Philippines. Results Of 1828 NICU neonates admitted, 45.6% became newly colonized with resistant bacteria, 19.6% became bacteremic (78.2% from GNRs), and 33.6% died. 2903 resistant colonizing bacteria were identified of which 85% were resistant GNRs (predominantly Klebsiella spp., Pseudomonas spp., and Acinetobacter spp.) and 14% were Methicillin-resistant Staphylococcus aureus. Contrasting control vs. intervention periods at each NICU, staff hand hygiene compliance improved (At NICU 1 RR=1.3, 95% CI 1.1–1.5; At NICU 2 RR=1.6, 95% CI 1.4–2.0) and overall mortality declined (NICU 1 RR=0.5, 95%CI 0.4–0.6; NICU 2 RR=0.8, 95% CI 0.7–0.9). However, colonization with resistant pathogens and sepsis rates did not change significantly at either NICU. Discussion Nosocomial transmission of resistant pathogens was intense at these two Philippines NICUs and dominated by resistant GNRs. Infection control interventions are feasible and possibly effective in resource limited hospital settings.

Brief communication (Original). Trends in neonatal sepsis in a neonatal intensive care unit in Thailand before and after construction of a new facility

“…The rates of sepsis in this study are comparable to those in units in Taiwan that reported rates ranging from 3% to 4% [18,19], but lower compared with data from other countries such as the Philippines, The Netherlands, and Nigeria, where sepsis rates have been reported to range from 15.1% to 19.6% [20][21][22]. Furthermore, at 2.68 cases per 1,000 live births, the rate of sepsis for inborn infants was lower than that reported in other countries including Korea (5.9 cases per 1,000 live births) [23], the USA (6.1 cases per 1,000 live births) [4], and India (14.8 cases per 1,000 live births) [24].…”

Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis

“…However, Picheansathian et al [35] and Gill et al [38] reported no improvement in HCAI, but mortality was reduced in the study by Gill et al [38]. Won et al [36] reported an improvement in the total infection rate (bloodstream, surgical, urinary tract, gastrointestinal tract, skin and respiratory tract) from 15.13±0.98 to 10.69±0.88 (p=0.003).…”

“…Nine of the included studies reported on blood culturepositive HCAIs [29,[32][33][34][35][36][37][38] or colonisation by pathogens [34]; seven of these reported a decrease in the incidence of HCAI following implementation of interventions to improve HHC. However, Picheansathian et al [35] and Gill et al [38] reported no improvement in HCAI, but mortality was reduced in the study by Gill et al [38].…”

Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting. A BEME systematic review: BEME Guide No. 22

“…Eleven studies solely measured a change in healthcare professionals' behaviour (Kirkpatrick level 3) as an outcome measure (Muto et al 2000;Huang et al 2002;Sharek et al 2002;Rosenthal et al 2003;Won et al 2004;Danchaivijitr et al 2005 The remainder looked at the broadly defined change in nosocomial infection rates (Helder et al 2010;Zhang et al 2010), risk of death per 1000 ICU admissions (Gill et al 2009), catheter-related blood stream infections (Lobo et al 2005;Bhutta et al 2007;Lobo et al 2010) and changes in rates of MRSA, vancomycin-resistant enterococci (VRE) and Clostridium difficile (Doron et al 2011). …”

“…Infections can be transmitted from a colonised healthcare professional (a qualified individual who delivers professional health care in a systematic way to any individual in need of healthcare services) to a susceptible patient as a result of direct physical contact, such as when bathing or caring for a patient (direct-contact transmission) or transmitted from a colonised object to a susceptible patient, such as needles or gloves (indirect-contact transmission). The most common organisms transmitted via direct-contact transmission are Clostridium difficile (Whitaker et al 2007) and methicillin-resistant Staphylococcus aureus (MRSA; Larson et al 2000;Gill et al 2009). The most commonly acquired HCAI are urinary tract infections, surgical site infections (including MRSA) and pneumonias (including ventilator-associated pneumonia; Reilly et al 2007).…”