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Infection Control Practices Reduce Nosocomial Infections and Mortality in Preterm Infants in Bangladesh

Journal of Perinatology volume 25, pages 331–335 (2005)Cite this article

Abstract

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.

STUDY DESIGN:

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%).

CONCLUSION:

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.

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References

  1. Ahmed A, Chowdhury M, Hoque M, Darmstadt G . Clinical and bacteriological profile of neonatal septicaemia in a teriary level paediatric hospital in Bangladesh. Indian Pediatr 2002;39:1034–1039.

    Google Scholar 

  2. Ahmed A, Chowdhury M, Saha S, Darmstadt GL . Skin colonization of newborns with multiply resistant bacteria: implications in outbreak of sepsis in the nursery. Proceedings of the Third National Annual Conference on Scientific Session Bangladesh Neonatal Forum 2002.

  3. Ahmed A, Saha S, Chowdhury M, Law P, Ahmed S, Darmstadt G . Topical skin barrier therapy and infection control measures improve survival of hospitalized very low birth weight neonates. 10th Asian Conference on Diarrhoeal Disease Nutrition 2003;89 (Abstract 134).

  4. Sharma A, Kutty K, Sabharwal U, Rathee S, Mohan H . Evaluation of sepsis screen for diagnosis of neonatal septicemia. Indian J Pediatr 1993;60:559–563.

    Article  CAS  Google Scholar 

  5. Puri J, Revathi G, Faridi M, Talwar V, Kumar A, Parkash B . Role of body surface cultures in prediction of sepsis in a neonatal intensive care unit. Ann Trop Pediatr 1995;15:307–311.

    Article  CAS  Google Scholar 

  6. Bhakoo O . Neonatal bacterial infections at Chandigarh — a decade of experience. Indian J Pediatr 1980;47:419–424.

    Article  CAS  Google Scholar 

  7. Bhutta Z, Naqvi S, Muzaffar T, Farooqui B . Neonatal sepsis in Pakistan. Acta Paediatr Scand 1991;80:596–601.

    Article  CAS  Google Scholar 

  8. Stoll B . The global impact of neonatal infection. Clin Perinatol 1997;24:1–21.

    Article  CAS  Google Scholar 

  9. Das B, Mishra R, Mishra O, Bhargava V, Prakash A . Comparative outcome of low birth weight babies. Indian Pediatr 1993;30:15–21.

    CAS  PubMed  Google Scholar 

  10. Singh M, Paul VK, Deorari A, Ray D, Murali M, Sundaram K . et al. Strategies which reduce sepsis related neonatal mortality. Indian J Pediatr 1988;55:955–960.

    Article  CAS  Google Scholar 

  11. Bartlett A, Paz de Bocaletti M, Bocaletti M . Neonatal and early postneonatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management. Pediatr Infect Dis J 1991;10:752–757.

    Article  CAS  Google Scholar 

  12. Ponce-de-Leon S . The needs of developing countries and the resources required. J Hosp Inf 1991;18 (Suppl A):376–381.

    Article  Google Scholar 

  13. Saez-Llorens XCd, Wong M, Castano E, De Suman O, De Moros D, De Atencio L . Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country. Pediatr Infect Dis J 2000;19:200–206.

    Article  CAS  Google Scholar 

  14. Darmstadt G, Saha S, Ahmed A, Chowdhury M, Law P, Ahmed S . et al. Topical therapy with skin-barrier enhancing emollients prevents nosocomial infections in preterm infants in Bangladesh: a randomized, controlled clinical trial. Lancet 2005; in press.

  15. Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, et al. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr 2002;91:1–9.

    Article  Google Scholar 

  16. Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I . et al. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J 2004;23:719–725.

    Article  Google Scholar 

  17. Darmstadt GL, Saha S, Ahmed A, Khatun M, Chowdhury M . The skin as a potential portal of entry for invasive infections in neonates. Perinatol 2003;5:205–212.

    Google Scholar 

  18. Ballard J, Khoury J, Wedig K, Wang L, Ellers-Walsman B, Lipp R . New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991;119:417–423.

    Article  CAS  Google Scholar 

  19. Dubowitz L, Dubowitz V, Goldberg C . Clinical assessment of gestational age in the newborn infant. J Pediatr 1970;77:1–10.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by the Thrasher Research Fund, the Johns Hopkins Family Health and Child Survival Cooperative Agreement with the United Sates Agency for International Development, the Society for Pediatric Dermatology and Save the Children USA through a grant from the Bill and Melinda Gates Foundation. We thank the members of the Data Safety and Monitoring Board (DSMB) for the parent intervention trial for their encouragement to pursue infection control measures in the nursery. DSMB members included Kim Mulholland, University of Melbourne, Barbara Stoll, Emory University, and William Blackwelder (retired), National Institutes of Health (USA). We thank Rachel Haws for editorial assistance in preparation of the manuscript, and Maksuda Islam for microbiological technical assistance.

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Authors and Affiliations

  1. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Gary L Darmstadt MD, MS, Robert E Black MD, MPH & Mathuram Santosham MD, MPH

  2. Saving Newborn Lives Initiative, Save the Children USA, Washington, DC, USA

    Gary L Darmstadt MD, MS

  3. Department of Neonatology, Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh

    A S M Nawshad Uddin Ahmed MBBS, FRCP & M A K Azad Chowdhury MBBS, FRCP

  4. Department of Microbiology, Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh

    Samir K Saha PhD, Muhammad Asif Alam MBBS, MS & Mahamuda Khatun MBBS

Authors
  1. Gary L Darmstadt MD, MS
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  2. A S M Nawshad Uddin Ahmed MBBS, FRCP
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  3. Samir K Saha PhD
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  4. M A K Azad Chowdhury MBBS, FRCP
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  5. Muhammad Asif Alam MBBS, MS
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  6. Mahamuda Khatun MBBS
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  7. Robert E Black MD, MPH
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  8. Mathuram Santosham MD, MPH
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Additional information

Presented in part at 10th Asian Conference on Diarrhoeal Diseases and Nutrition, Dhaka, Bangladesh, 2004; and Third National Annual Conference and Scientific Session, Bangladesh Neonatal Forum, Dhaka, Bangladesh, 2002.

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Darmstadt, G., Nawshad Uddin Ahmed, A., Saha, S. et al. Infection Control Practices Reduce Nosocomial Infections and Mortality in Preterm Infants in Bangladesh. J Perinatol 25, 331–335 (2005). https://doi.org/10.1038/sj.jp.7211283

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