Small patients, big challengesDr.Angela Dramowski, Stellenbosch University, Cape Town, South Africa A Webber Training Teleclass Hosted by Paul Webber [email protected] 4 2011

InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica

AWebberTrainingTeleclass

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InfectionpreventionforhospitalizedchildrenandneonatesinAfrica

Photo:MarchofDimes

Smallpatients,bigchallenges

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www.webbertraining.com October31,2017

Presenter: DrAngelaDramowski

Affiliation: StellenboschUniversity,SouthAfricaInfectionControlAfricaNetwork(ICAN)

Specialty: Paediatric InfectiousDiseases

Disclosures: Ihavenothingtodisclose.

InfectionpreventionchallengesamonghospitalizedchildrenandneonatesinAfrica

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ApopulationvulnerabletoHAI

Immatureimmunity(innate,acquiredandvaccine-derived)

Rapidlycolonisedwithantibiotic-resistantbacteria

Uniquebehavioursandincontinence

Manycaregivers,morehandling

Predominanceofrespiratory andgastrointestinalviruses

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RotheJHospInfect2013

What’sdifferentaboutinfectionpreventioninAfrica?



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2011ReportontheburdenofHAI:neonatesNeonatalinfectionratesindevelopingcountries3-20xhigherthaninindustrializedcountries

HAIcause4-56%ofdeathsintheneonatalperiod(majorityinSSAfricaandSEAsia)

HAIratesinneonatalICUsareveryhighwithpredominanceofHA-bloodstreaminfectionsanddevice-associatedinfections.

VAPandCR-BSIdensitieswereparticularlyhighVAP=109- 143episodes/1000ventilator-daysCR-BSI=21- 600episodes/1000catheter-days.

HighratesofAMRinfections:- 70%ofneonatalBSInotsusceptibletoanempiricregimenofampicillinandgentamicin.

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Hospitalizedneonatesarevulnerabletoinfection,withpathogen

exposuresoccurringinutero,intrapartum,andpostnatally.

Africanneonatalunitsareathighriskofoutbreaksowingto

overcrowding,understaffing,andsharedequipment.

Highincomeneonatalunitexperience10outbreaks/year;

BurdenofneonatalunitoutbreaksinAfricaisunknown.

AfricanneonatalunitHAIoutbreaks

IJID2016

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Tygerberghospitalneonatalunit Africanneonatal units

13outbreaksover8years 20outbreaks over20years

148babies

(11deaths;7%mortality)

524babies

(177deaths;34%mortality)

Viruses:rotavirus,influenza,measles

MDRbacteria:S.marcescens,A.

baumannii,MRSA,VRE

50%ofoutbreakswerecaused

byESBL-producing

K.pneumoniae.

Sourceseldomidentified;mostoutbreakshadbreachesinIPpractices.

Outbreakscontainedwith:stringenttransmission-basedprecautions,

staff/parenteducation,andchangestoclinicalpractices.

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Hospital–acquired

pneumonia

(HAP)

Bloodstreaminfection

(BSI)

Urinarytractinfection

(UTI)

Surgicalsiteinfection

(SSI)

Device-associatedinfection

Others:ENT

GastroBone/joint

HAIpointprevalencestudiesinAfrica:

- HAIprevalence10– 19%- Profileofpaediatric infectionsdiffers- HAP,BSIandUTIpredominate- Lessfocusondevice-associated

infections- Verylimitedevidencebase– more

researchneeded!

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Paediatric HA-BSI:

Aiken(Kenya) 1.0/1000patientdays(PD)Dramowski(S.Africa) 1.6/1000PD

NeonatalHA-BSI:

Maoulainine (Morocco) 18/1000PDGadallah (Egypt) 14/1000PDBallot(S.Africa) 14/1000PDSpicer(S.Africa) 7/1000PDDramowski(S.Africa) 4/1000PDLandre-Peigne (Senegal) 3/1000PD

Mortalityvariesbystudy20– >70%

Hospital-acquiredbloodstreaminfections(BSI) 14



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Device-associatedinfectionsinLMICcountries 18



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Tygerbergpaediatric HAIprevalencevsEuropeanCDC

24.1%(95%CI21.9-26.5%)296childrenwith417healthcare-associatedinfections

TygerbergZA

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Healthsystemimpact

Directcosts* Hospitalizationdays

Antimicrobialuse

Laboratoryinvestigations

HAP,BSI,UTI,SSI

=R5.6million

Extrapolationtoall

TCHwardsannually

=R60million

2275excessdays

overcrowding

inabilitytoadmit

pathogenreservoir

2365excessRxdays

95%ofHAIevents=

newantimicrobial/s

prescription

61%carbapenems

3575excesstests

*Costcalculation=#HAIeventsxmedianexcessstayxunitcostperpatientday(fixed+variablecosts:laboratory,radiology,pharmacy)

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Proportionalutilizationofisolationbed-days

*missedisolation=laboratoryidentificationofpathogensrequiringisolation butpatientnotisolated

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Source:http://www.slideshare.net/WCETConference2010/the-tip-of-the-iceberg-10009379?related=1

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WhatisknownaboutpaediatricandneonatalHAIinAfrica

Whatisyettoberesearched!

HAI



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Small patients, big challengesDr.Angela Dramowski, Stellenbosch University, Cape Town, South Africa A Webber Training Teleclass Hosted by Paul Webber [email protected] 4 2011

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