Send to

Choose Destination
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

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



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.


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.


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.


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.


Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center