Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines

Christopher J. Gill, Jose B V Mantaring, William B. Macleod, Myrna Mendoza, Sookee Mendoza, W Charles Huskins, Donald A. Goldmann, Davidson H. Hamer

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34 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)13-21
Number of pages9
JournalClinical Infectious Diseases
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2009

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ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Gill, C. J., Mantaring, J. B. V., Macleod, W. B., Mendoza, M., Mendoza, S., Huskins, W. C., Goldmann, D. A., & Hamer, D. H. (2009). Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines. Clinical Infectious Diseases, 48(1), 13-21. https://doi.org/10.1086/594120