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.
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.
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%).
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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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.
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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