title: Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks.
abstract: BACKGROUND
  Despite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity.
  
  
  METHODS
  We searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance.
  
  
  RESULTS
  Thirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries.
  
  
  CONCLUSIONS
  Systematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.
authors.affiliation: Public Health England, Manor Farm Road, Porton Down SP4 0JG, UK Manchester University, Oxford Rd, Manchester M13 9PL, UK.
authors.forename: J
authors.initials: J
authors.lastname: Birt
authors.affiliation: Public Health England, Manor Farm Road, Porton Down SP4 0JG, UK St George's University of London, Blackshaw Road, London SW17 0TE, UK Centre for International Child Health, Imperial College London, Norfolk Place, London W2 1PG, UK K.mehring-le-doare@ic.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Le Doare
authors.affiliation: St George's University of London, Blackshaw Road, London SW17 0TE, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kortsalioudaki
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
authors.forename: J
authors.initials: J
authors.lastname: Lawn
authors.affiliation: St George's University of London, Blackshaw Road, London SW17 0TE, UK.
authors.forename: P T
authors.initials: PT
authors.lastname: Heath
authors.affiliation: St George's University of London, Blackshaw Road, London SW17 0TE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Sharland
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D055317:Evidence-Based Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D018571:Sentinel Surveillance
keywords: Hospital-acquired infection; Neonates; Outbreaks; Prevention
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