Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

Abstract

Background. The rate of central-line-associated bloodstream infection (CLABSI) in South African (SA) public sector neonatal intensive care units (NICUs) is unknown. Tygerberg Children's Hospital (TCH), Cape Town, introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives. To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods. A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors, using stepwise forward logistic regression analysis. Results. A total of 706 central lines were inserted in 530 neonates during the study period. Nineteen CLABSI events were identified, with a CLABSI rate of 5.9/1 000 line days. CLABSI patients were of lower gestational age (28 v. 34 weeks; p=0.003), lower median birth weight (1 170 g v. 1 975 g; p=0.014), had longer catheter dwell times (>4 days) (odds ratio (OR) 5.1 (95% confidence interval (CI) 1.0 -25.4); p=0.04) and were more likely to have had surgery during their NICU stay (OR 3.5 (95% CI 1.26 -10); p=0.01). Significant risk factors for CLABSI were length of stay >30 days (OR 20.7 (95% CI 2.1 -203.2); p=0.009) and central-line insertion in the operating theatre (OR 8.1 (95% CI 1.2 -54.7); p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates (10/12; 83%) exhibiting multidrug resistance. Conclusion. The TCH NICU CLABSI rate is similar to that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key to reducing CLABSI rates.

A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective

“…Further, more than half ( n = 21, 60%) of the synthesised articles were from East Africa, whereas the rest were shared across northern, western, southern and central Africa (Figure 3). Only one article reported an incidence study, 14 whereas the rest were prevalence studies (retrospective or prospective). Five (14.3%) of the reviewed articles based their categorisation on specific microorganisms isolated, 15,16,17,18,19 whereas some others were based on specific HCAI.…”

“…Five (14.3%) of the reviewed articles based their categorisation on specific microorganisms isolated, 15,16,17,18,19 whereas some others were based on specific HCAI. 14,16,17,20,21,22,23,24,25,26,35,37,38,39,44,45,46,47,48 Only eight studies (22.9%) 28,29,30,31,32,33,34,35 covered HCAI in entirety and conducted full surveillance of the different types enumerated by previous published protocols. 8,36 Eight articles (22.9%), however, did perform HCAI surveillance without the mention of the microorganisms implicated.…”

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

“…As highlighted by Rosenthal (2009), high CLABSI rates suggest that LMICs face significant barriers for CLABSI reduction including resources, appropriate medical supplies and adequate numbers of skilled personnel. Additional examples include inadequate and (Geldenhuys et al, 2017;Assis et al, 2018;Ider et al, 2012;The Joint Commission, 2012). outdated technologies, lines used without sterile dressings, single dose vials used multiple times covered with contaminated tape, cotton balls impregnated with contaminated antiseptic solutions and semi-rigid plastic containers used for intravenous infusate preparation.…”

Feasibility and Safety of Peripheral Intravenous Administration of Vasopressor Agents in Resource-limited Settings

“…Bai et al (2014) reported that with every hour's delay in noradrenaline initiation after the onset of septic shock, mortality increased by 5.3% [13]. Although CVC has long been considered necessary by clinicians for initiating vasopressors, delay in placement due to non-availability of skilled personnel may be associated with prolonged hemodynamic instability and its related complications [14]. It is possible to initiate vasopressors early if the infusion is initiated through a PVC and even forestall the use of a CVC.…”