Infection control practices reduce nosocomial infections and mortality in preterm infants in Bangladesh.
OBJECTIVE
The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial months of the study, the infection and mortality rates were noted to be unacceptably high. Therefore, an infection control program was introduced early in the trial to reduce the rate of nosocomial infections.


METHODS
After a comprehensive review of neonatal care practices and equipment to identify sources of nosocomial infections, a simple but comprehensive infection control program was introduced that emphasized education of staff and caregivers about measures to decrease risk of contamination, particularly hand-washing, proper disposal of infectious waste, and strict asepsis during procedures, as well as prudent use of antibiotics.


RESULTS
Infection control efforts resulted in declines in episodes of suspected sepsis (47%), cases of culture-proven (61%) sepsis, patients with a clinical diagnosis of sepsis (79%), and deaths with clinical (82%) or culture-proven sepsis (50%).


CONCLUSIONS
The infection control program was shown to be a simple, low-cost, low-technology intervention to reduce substantially the incidence of septicemia and mortality in the nursery.
Darmstadt
Gary L
GL
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Nawshad Uddin Ahmed
A S M
AS
Saha
Samir K
SK
Azad Chowdhury
M A K
MA
Alam
Muhammad Asif
MA
Khatun
Mahamuda
M
Black
Robert E
RE
Santosham
Mathuram
M
D001459:Bangladesh; D002423:Cause of Death; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D017053:Infection Control / Q000458:organization & administration*; D007363:Intensive Care Units, Neonatal; D008297:Male; D011336:Probability; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016019:Survival Analysis