TY - JOUR
T1 - Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines
AU - Gill, Christopher J.
AU - Mantaring, Jose B.V.
AU - Macleod, William B.
AU - Mendoza, Myrna
AU - Mendoza, Sookee
AU - Huskins, W. Charles
AU - Goldmann, Donald A.
AU - Hamer, Davidson H.
PY - 2009/1/1
Y1 - 2009/1/1
N2 - Background. The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in the developing world creates an urgent need for cost-effective infection-control measures in resource-limited settings. Methods. Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance, colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila, The Philippines. Results. Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drugresistant gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species) and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95% confidence interval 1.1-1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4-2.0) and that overall mortality decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4-0.6; NICU 2: relative risk, 0.8; 95% confidence interval, 0.7-0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change significantly at either NICU. Discussion. Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines; transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible and are possibly effective in resource-limited hospital settings.
AB - Background. The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in the developing world creates an urgent need for cost-effective infection-control measures in resource-limited settings. Methods. Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance, colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila, The Philippines. Results. Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drugresistant gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species) and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95% confidence interval 1.1-1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4-2.0) and that overall mortality decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4-0.6; NICU 2: relative risk, 0.8; 95% confidence interval, 0.7-0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change significantly at either NICU. Discussion. Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines; transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible and are possibly effective in resource-limited hospital settings.
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U2 - 10.1086/594120
DO - 10.1086/594120
M3 - Article
C2 - 19025496
AN - SCOPUS:57749097798
SN - 1058-4838
VL - 48
SP - 13
EP - 21
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -