Reducing Neonatal Mortality via Intensified Infection Prevention
Post on 14-Apr-2018
225 Views
Preview:
Transcript
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
1/29
Hospital Acquired Infections inDeveloping Countries.
Dr Chungu.Dr Nchimba.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
2/29
Neonatal Mortality
Global situation 40% of all under-five child deaths are among newborn
neonates.
Estimated 4 million annual neonatal deaths worlwide
More than 50% of these deaths are clustered in only six
countries: China, Democratic Republic of the Congo, Ethiopia, India,
Nigeria, and Pakistan
India contributes the highest: 25% attributed to LBW 25%
Up to two thirds of newborn deaths can be prevented ifknown.
Effective health measures are provided at birth and duringthe first week of life
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
3/29
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
4/29
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
5/29
Local Situation.
Zambian IMR stands at 70/1000
NMR 30/1000
This constitutes 43% of IMR More than 50% of births delivered at home
23% assisted by TBA, 25% by relative 5% no
assistance.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
6/29
UTH
NICU: 40% mortality
Septicaemia: 32%
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
7/29
Perinatal-neonatal period carries the highest
risk of mortality and morbidity in the lifespan
of a human being
126 DALYs annually, or 8.3 % of the global
disease burden (63million DALYs for ischemic
heart disease)
Rates are unacceptably high and more needs
to be done to reduce HAI
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
8/29
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
9/29
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
10/29
Gram negative sepsis (klebsiella, Pseudomonas,Acinobacter) causes 50% of infections.
Associated with outbreaks because these water bugs
can thrive in multi-use medicine containers, liquidsoaps, antiseptic & disinfectant solutions.
Even though Klebsiella believed to be maternal florainvestigators in Karachi found resistance patternsconflicting as Swedish isolates were sensitive.
In SAA. Baumanniiemerging problem & stressimportance of ongoing Microbiological surveillance.
C di i l di hi h
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
11/29
Conditions leading to higher HAI
Burden in
Developing Countries Inadequate hygiene conditions
Poor infrastructure
Inadequate / insufficient equipment
Lack of microbiological information Understaffing
Overcrowding
Lack of knowledge and low staff preparedness
Inappropriate use of antibiotics
More diseased population Unfavorable social background
Lack of national policies and programs
Costs falling on individual patients
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
12/29
ANTIMICROBIAL RESISTANCE
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
13/29
The powerful selective pressure of
inappropriate and prolonged antimicrobial use
favours the emergence and amplification of
resistance in hospital nurseries.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
14/29
CAUSES OF HAI IN DEVELOPING COUNTRIES
PERIPARTUM
Lack of essential equipment and supplies (soap, washbasin, cleanwater, obstetric instruments, gloves,sterilisers, medications, cordclamps)
Failures in sterilisation/disinfection or handling/storage of multi-use resuscitation instruments, equipment and supplies, deliverysurfaces, leading to contamination
Re-use of disposable supplies without safe disinfection/sterilisationprocedures
Inadequate hand hygiene and glove use
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
15/29
Excessive vaginal examinations
Lack of aseptic technique for invasive procedures and cordcutting and care
Overcrowded and understaffed labour and delivery rooms
Lack of knowledge, training, and competency regardinginfection control practice and identification andmanagement of risk factors for maternal and neonatalinfection
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
16/29
POSTNATAL
Lack of essential equipment and supplies (soap, cleanwater, wash-basins, gloves, incubators, topicalmedications for eye and cord care)
Failures in sterilisation/disinfection or handling/storageof multi-use instruments, equipment and supplies,leading to contamination
Inadequate environmental cleaning and disinfection
Re-use of disposable supplies without safedisinfection/sterilisation procedures
Inadequate hand hygiene and glove use
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
17/29
Failures in isolation procedures/inadequateisolation facilities for babies infected withantibiotic-resistant or highly transmissible
pathogens Overcrowded and understaffed nurseries
Unhygienic bathing and skin care
Lack of early and exclusive breastfeeding
Contaminated bottle feedings
Absence of mother-baby cohorting
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
18/29
Lack of aseptic technique for invasiveprocedures
Overuse of invasive devices and venous cut-
downs Pooling or multiple use of single-use vials
Lack of knowledge, training, and competency
regarding infection control practice Inappropriate and prolonged use of
antibiotics
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
19/29
Standard Infection Control Practices.
Handwashing
Low cost handrub can be prepared by hospital
pharmacies (Glycerin, Sorbitol, Isopropylene)
Addition of 0.5% chlorhexidine prolongs
bactericidal action, though expensive
Studies have shown impressive colonisation
reduction in late onset infection when used by
NICU personnel.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
20/29
Routine gowning: No benefit
Appropriate cleaning and disinfection ofreusable items.
Reprocessing errors (chemicals, timing )associated with high pseudomonas species
Phillipines: Local handrub. Bedside infection
prevention checklist Argentina: NICU guidelines on suctioning, IV
catheters and infusions
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
21/29
OBSTETRIC
ANC: Identifies risk factors. Appropriate addressof which reduce prematurity & infection.
INTRAPARTUM:
Reduced VEs
Vulval swabbing/douching: No data.
Hand washing between patients
Cleaning beds.
Regular ward swabs & microbiological liason
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
22/29
Postpartum
Prophylaxis against Ophthalmia neonatorum
Early exclusive breast feeding
Kangaroo Topical umbilical antiseptics: Egypt sunflower
seed oil.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
23/29
A study in Panama showed lower antibiotic
resistance rates by discontinuing empiric
antimicrobial treatment for early onset
infection after 3 days if
Infants doing well
Cultures negative
Lab markers of infection were normal.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
24/29
HEALTH SYSTEMS ORIENTED
SOLUTIONS
Translation of evidence into reliable sustainablepractice challenging
Sad because most effective interventions
inexpensive Multi-faceted behaviour change.
Best solutions locally driven e.g participatoryintervention in Nepal
Random safety audits by front line staff beneficialin the US & can be adapted to our setting
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
25/29
Need to strengthen primary care
Primary care to work closely with tertiary
centres
Infection prevention principles are hallmark
Commitment needed by every stake holder.
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
26/29
Microbiological surveillance in close
association with the lab
In India IMCI is IMNCI a deliberate initiative in
2003 to equip primary level to manage
neonates.
1st level hospitals equipped with skill to
manage uncomplicated neonates
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
27/29
Link between Primary & Tertiary
centre
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
28/29
Referral flow chart for Neonatal care
7/30/2019 Reducing Neonatal Mortality via Intensified Infection Prevention
29/29
DISCUSSION
WAY FORWARD ?CONCLUSION?
top related