Background
Annually, infections contribute to approximately 25% of the 2.8 million neonatal deaths worldwide. Over 95% of sepsis‐related neonatal deaths occur in low‐ and middle‐income countries. Hand hygiene is an inexpensive and cost‐effective method of preventing infection in neonates, making it an affordable and practicable intervention in low‐ and middle‐income country settings. Therefore, hand hygiene practices may hold strong prospects for reducing the occurrence of infection and infection‐related neonatal death.
Objectives
To determine the effectiveness of different hand hygiene agents for preventing neonatal infection in both community and health facility settings.
Search methods
Searches were conducted without date or language limits in December 2022 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulated Index to Nursing and Allied Health Literature (CINAHL), clinicaltrials.gov and International Clinical Trials Registry Platform (ICTRP) trial registries. The reference lists of retrieved studies or related systematic reviews were screened for studies not identified by the searches.
Selection criteria
We included randomized controlled trials (RCTs), cross‐over trials, and cluster trials that included pregnant women, mothers, other caregivers, and healthcare workers who received interventions within either the community setting or in health facility settings, and the neonates in the neonatal care units or community settings.
Data collection and analysis
We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. Primary outcomes were incidence of suspected infection (author‐defined in study) within the first 28 days of life, bacteriologically confirmed infection within the first 28 days of life, all‐cause mortality within the first seven days of life (early neonatal death), and all‐cause mortality from the 8th to the 28th day of life (late neonatal death).
Main results
Our review included six studies: two RCTs, one cluster‐RCT, and three cross‐over trials. Three studies involved 3281 neonates; the remaining three did not specify the actual number of neonates included in their study. Three studies involved 279 nurses working in neonatal intensive care units (NICUs). The number of nurses included was not specified by one study. A cluster‐RCT included 103 pregnant women of over 34 weeks gestation from 10 villages in a community setting (sources of data: 103 mother‐neonate pairs) and another community‐based study included 258 married pregnant women at 32 to 34 weeks of gestation (the trial reported adverse events on 258 mothers and 246 neonates). Studies examined the effectiveness of different hand hygiene practices for the incidence of suspected infection (author‐defined in study) within the first 28 days of life. Three studies ...