Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings

Dramowski, Angela; Aucamp, Marina; Beales, Emily R.; Bekker, Adrie; Cotton, Mark F.; Fitzgerald, Felicity; Russell, Neal; Strysko, Jonathan; Whitelaw, Andrew; Coffin, Susan

doi:10.3389/fped.2022.919403

Cited by 16 publications

(10 citation statements)

References 137 publications

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“…Compared to other WHO regions, the Africa region has the lowest HHSAF scores (mean 281, SD 127), possibly owing to poor healthcare infrastructure, lack of infection prevention resources, and a limited knowledge of HH implementation and sustainability [ 55 ]. Our post-intervention neonatal unit HHSAF score of 262 (intermediate level) is in keeping with scores reported from other LMIC settings with median HHSAF survey scores ranging from 233 in low-income countries to 395 in high-income countries [ 53 , 56 ]. The disparity between the HHSAF and the HH compliance and other related variables highlights the fact that institutional progress and commitment to HH does not always achieve behavior change at the level of the individual.…”

Section: Discussionsupporting

confidence: 83%

“…High neonatal bed occupancy rates (85–91%) and suboptimal staff-to-patient ratios contributed to the challenges in ensuring compliance with HH recommendations and other infection best practices. This highlights the need to implement multimodal infection prevention strategies in LMIC neonatal units, where the causal pathway from colonisation to infection is particularly complex [ 56 ]. The study was not designed to explain differences in the effectiveness of the intervention in healthcare workers versus mothers.…”

Section: Discussionmentioning

confidence: 99%

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SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit

Dramowski

Erasmus

Aucamp³

et al. 2022

TropicalMed

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Background: Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. Methods: We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). Results: A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was ‘basic’ (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to ‘intermediate’ level (262). There was no change in the neonatal unit HA-BSI rate. Conclusion: Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit

Dramowski

Erasmus

Aucamp³

et al. 2022

TropicalMed

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“…In addition, we may not have captured the medical staff quality, including hygiene and insight about nosocomial infection and antibiotic resistance that is related to resistant pathogen infection in other general studies. 17,18 In conclusion, invasive procedures, central access insertion, and the provision of parenteral nutrition have a significant correlation with the…”

Section: Discussionmentioning

confidence: 98%

Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants

Ratridewi

Winaputri

Sulistijono

et al. 2023

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Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.

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“…Smit et al (2018) demonstrated that ESBL- K. pneumoniae were transmitted between humans and 22% of neonate infections were due to environmental source (19). Furthermore, Dramowski et al (2022) emphasized the importance of WASH and IPC in the early and heavy bacterial colonization of neonates in resource-limited settings and recommended sustained neonatal IPC and surveillance programs in neonatal units in these settings (20). Healthcare workers colonized with MDR-ESBL isolates could thus contribute to the ongoing transmission of resistant bacteria to neonates where they could subsequently cause life-threatening neonatal infections such as sepsis, meningitidis or pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Neonatal Colonization with Multidrug Resistant and Extended Spectrum ß-Lactamase ProducingEscherichia coliandKlebsiella pneumoniaein a Cameroonian Labour Ward

Njeuna,

Founou,

Founou

et al. 2024

Preprint

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Background: Escherichia coli and Klebsiella pneumoniae rank among the primary bacterial culprits in neonatal infections and fatalities in sub-Saharan Africa. This study sought to characterize the phenotypic and genotypic features of Escherichia coli and Klebsiella pneumoniae in a labour ward in Yaounde, Cameroon. Methods: A prospective and cross-sectional study spanning five months, from February 21 to June 30, 2022. Recto-vaginal swabs were obtained from expectant mothers, and nasopharyngeal swabs were collected from their babies. The samples were cultured on eosin methylene blue agar and isolates identified using the Enterosystem 18R kit. Extended-spectrum beta-lactamase (ESBL) production was assessed using CHROMAgar ESBL and the double disc synergy test. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Polymerase chain reaction (PCR) was employed to detect beta-lactamase genes blaSHV, blaCTX-M and blaTEM. ERIC-PCR was used to assess the clonal relatedness of isolates. Results: E. coli was predominantly found in pregnant women (81%) and neonates (55%) while K. pneumoniae predominated in healthcare workers. Almost all pregnant women (90%) were colonized by one or more multi-drug resistant (MDR) isolates with 52% being concomitantly ESBL producers. Altogether, 22 neonates were positive for E. coli and/or K. pneumoniae and 19 (91%) were colonized by a MDR isolate. The blaCTX-M (75%) was the leading beta-lactamase gene detected. Conclusion: Our study suggests that MDR- and ESBL-E. coli and K. pneumoniae are circulating at high prevalence in labour Yaounde. It emphasizes the necessity for strict infection prevention and control measures in conjunction with effective antimicrobial stewardship in the country.

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Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings

Cited by 16 publications

References 137 publications

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit

Risk factors of late onset sepsis caused by extended spectrum beta-lactamase (ESBL) - producing bacteria in preterm infants

Maternal and Neonatal Colonization with Multidrug Resistant and Extended Spectrum ß-Lactamase ProducingEscherichia coliandKlebsiella pneumoniaein a Cameroonian Labour Ward

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