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


CONCLUSIONS
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.
Gill
Christopher J
CJ
Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA. cgill@bu.edu
Mantaring
Jose B V
JB
Macleod
William B
WB
Mendoza
Myrna
M
Mendoza
Sookee
S
Huskins
W Charles
WC
Goldmann
Donald A
DA
Hamer
Davidson H
DH
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D002353:Carrier State / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D024881:Drug Resistance, Bacterial; D019983:Guideline Adherence; D006235:Hand Disinfection; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D010679:Philippines; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission
D000900:Anti-Bacterial Agents