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Clin Infect Dis. 2018 Dec 28. doi: 10.1093/cid/ciy1114. [Epub ahead of print]

Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle.

Author information

1
Right to Care-Zambia, Lusaka, Zambia.
2
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
3
Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA.
4
Department of Pathology and Microbiology University Teaching Hospital and Lusaka Apex Medical University Lusaka, Zambia.
5
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
6
Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
7
Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia.
8
Department of Pathology and Microbiology University Teaching Hospital, Lusaka, Zambia.
9
School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.

Abstract

Background:

Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased.

Methods:

We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multi-faceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation.

Results:

Most enrolled neonates had a birthweight ≥1.5 kg (2131/2669, 79.8%). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549, 74.5%), predominantly Klebsiella pneumoniae (289/409, 70.1%). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birthweight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period.

Conclusions:

A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. Clinical Trials Registration. NCT02386592.

PMID:
30596901
DOI:
10.1093/cid/ciy1114

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