Journal Article

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 and Davidson H. Hamer

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 1, pages 13-21
Published in print January 2009 | ISSN: 1058-4838
Published online January 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/594120
Impact of Enhanced Infection Control at 2 Neonatal Intensive Care Units in The Philippines

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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 drug-resistant 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.

Journal Article.  4293 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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