Healthcare-associated Infections in Very Low Birth–weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes

Lloyd, Lizel G; Bekker, Adrie; Weissenbruch, Mirjam M. van; Dramowski, Angela

doi:10.1097/inf.0000000000003666

Cited by 5 publications

(5 citation statements)

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“…In our unit, presumed HAI is equally as prevalent as proven HAI. 22 The retrospective nature of the data used for the IPS development and validation is a study limitation. Ideally, this IPS should be validated prospectively in an external setting.…”

Section: Open Accessmentioning

confidence: 99%

“…In the original study, electronic patient records (Tygerberg Hospital Enterprise Content Management system) and the National Health Laboratory Service Trakcare Results viewer were used to retrospectively collect clinical and laboratory data from VLBW infants admitted between 1 January 2016 and 31 December 2017 for >72 hours, using REDCap, a secure online electronic data capture tool. 21 22 …”

Section: Introductionmentioning

confidence: 99%

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Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Lloyd,

van Weissenbruch,

Dramowski

et al. 2023

bmjpo

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Background and objectivesEarly diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight (VLBW; <1500 g) infants is 20%; and the mortality in low-resource settings can be as high as 70%. This study aimed to develop an Infection Prediction Score to diagnose bacterial HAIs.MethodsA retrospective cohort of VLBW infants investigated for HAI was randomised into two unmatched cohorts. The first cohort was used for development of the score, and the second cohort was used for the internal validation thereof. Potential predictors included risk factors, clinical features, interventions, and laboratory data. The model was developed based on logistic regression analysis.ResultsThe study population of 655 VLBW infants with 1116 episodes of clinically suspected HAIs was used to develop the model. The model had five significant variables: capillary refill time >3 s, lethargy, abdominal distention, presence of a central venous catheter in the previous 48 hours and a C reactive protein ≥10 mg/L. The area below the receiver operating characteristic curve was 0.868. A score of ≥2 had a sensitivity of 54.2% and a specificity of 96.4%.ConclusionA novel Infection Prediction Score for HAIs among VLBW infants may be an important tool for healthcare providers working in low-resource settings but external validation needs to be performed before widespread use can be recommended.

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Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Lloyd,

van Weissenbruch,

Dramowski

et al. 2023

bmjpo

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“…Organisms that usually cause HA-BSI include coagulase-negative Staphylococci, Staphylococcus aureus, Gram-negative bacilli, and fungi [12]. A retrospective study conducted in South Africa indicated that the majority of HA-BSI infections were caused by Gram-negative bacteria, with Staphylococcus aureus and Acinetobacter baumannii as the most common organisms [92].…”

Section: Hospital-acquired Bloodstream Infectionmentioning

confidence: 99%

A Narrative Review of the Tale of the Dysbiotic Microbiome in the Preterm Neonate

Sowden,

van Niekerk,

Bulabula

et al. 2023

Dietetics

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Background: Researchers have established that the preterm neonate is born with an immature gastrointestinal tract. The preterm neonate is thus susceptible to various complications often seen in the neonatal intensive care unit, e.g., feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. These complications can be life-threatening, and if survived, can have an unfavorable effect on the neonate’s growth and development. Aim: The aims of this narrative review article were to provide an in-depth understanding of the various factors contributing to the development of the preterm neonatal microbiome. Further, we reviewed gastrointestinal microbiome dysbiosis and its potential role in the development of feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. Lastly, we described the potential role of probiotics in this vulnerable population. Methods: A PubMed database search was conducted identifying articles that describe the development and function of the neonatal microbiome, the role of gastrointestinal dysbiosis, and the development of neonatal complications as well as the role of probiotics in gastrointestinal dysbiosis. Results: Various maternal, neonatal, and environmental factors play a role in the development of gastrointestinal dysbiosis in the preterm neonate. This can lead to feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. Discussion: The pathogenesis of the development of short-term complications in the preterm neonate can be linked to the immaturity of the host immune system as well as alterations seen in the intestinal microbiome. There is a growing body of evidence that probiotics can play a role in preventing dysbiosis and thus complications observed in the preterm neonate. However, the optimal combination of probiotic strains and dosage still needs to be identified.

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“…In South Africa, the overall occurrences of HAIs at one hospital over a period of one month in 2018 was 7.67% [3] compared to Ethiopia (16.940), China (3.12%), Morocco (10.3%), and Botswana (13.54%) [4]. Lloyd, Bekker, Van Weissenbruch, et al [5] found that HAIs are main causes of neonatal diseases and deaths in South Africa. An estimated 6.5% of patients in acute care hospitals had at least one HAI in the European Union and European Economic Area (EU/EEA) [6].…”

Section: Introductionmentioning

confidence: 99%

Case Study Protocol to Evaluate the Impact of Training Intervention on Cleaners’ Knowledge Level, Perceptions and Practices regarding Correct Cleaning Techniques at Selected Care Facilities in Limpopo Province, South Africa

Tshitangano

2024

Nursing Reports

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Despite being preventable, healthcare-associated infections are known primary causes of patient mortality and morbidity, threatening global public health. Though it is believed that one competent and dedicated cleaning staff member given the right tools and enough time can prevent more health-care-associated infectious diseases than a room full of doctors and nurses can cure, it was discovered in Letaba Hospital of the Limpopo Province, South Africa, that knowledge and practices of infection control among cleaning staff were not optimal. The proposed study aims to evaluate the impact of training interventions on cleaners’ knowledge levels and practices. In Phase 1, cleaners’ pre-training knowledge level, practices, and perceptions regarding correct cleaning techniques will be assessed through qualitative, individual, in-depth interviews. The initial question will read, “Describe the steps you follow when cleaning at this health facility and why?” In Phase 2a, a cleaning training program will be developed based on the South African Qualification Authority ID 118730 Healthcare Cleaner: Occupational Certificate Curriculum and the Center for Diseases Control and ICAN’s Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. In Phase 2b, a cleaning training intervention will be implemented. In Phase 3, cleaners’ post-training knowledge level, practices, and perceptions will be reassessed and compared to pre-training findings. The Standard Protocol Items: Recommendations for an Interventional Trial, commonly known as SPIRIT, guided the development of this protocol. This protocol received ethical clearance number FHS/22/PH/04/3005 in August 2023 from the University of Venda Human and Clinical Trials Research Ethics Committee. The protocol approval was granted by the Limpopo Provincial Department of Health (LP_2022-05-028) in October 2023. This protocol is registered with the South African National Clinical Trial Registry. The findings of this study may provide baseline data upon which healthcare facilities’ cleaner training qualification curriculum may be developed. In addition, this protocol contributes to the application of qualitative methodology in an intervention trial.

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Healthcare-associated Infections in Very Low Birth–weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes

Cited by 5 publications

References 52 publications

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

A Narrative Review of the Tale of the Dysbiotic Microbiome in the Preterm Neonate

Case Study Protocol to Evaluate the Impact of Training Intervention on Cleaners’ Knowledge Level, Perceptions and Practices regarding Correct Cleaning Techniques at Selected Care Facilities in Limpopo Province, South Africa

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