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Background <p>Neonates admitted to neonatal intensive care units (NICUs) are particularly susceptible to acquiring healthcare-associated infections because of factors such as prematurity, prolonged hospital stays, and need for invasive support devices. A longitudinal study in a Bangladeshi NICU demonstrated a high burden of bloodstream infections (BSIs) and rectal colonization with carbapenem-resistant organisms (CROs). We aimed to assess the impact of infection prevention and control (IPC) interventions on BSIs and CRO colonization in this NICU.</p> Methods <p>We conducted a quasi-experimental study in a 38-bed NICU of a tertiary care referral hospital in Dhaka, Bangladesh. Following a baseline assessment in December 2023-January 2024, an IPC intervention was carried out during February-September 2024, with a pause during June-August because of political instability. NICU staff, including environmental cleaners, received multimodal IPC training with an emphasis on hand hygiene and environmental cleaning. Compliance was monitored through covert observation of hand hygiene and use of fluorescent markers on environmental surfaces. Colonization with CROs was evaluated through twice monthly point prevalence surveys using rectal swabs plated on selective media followed by Vitek 2 confirmatory testing. BSIs were assessed based on recovery of pathogenic organisms from blood cultures, and mortality rates were determined based on the number of deaths per 100 admissions. We assessed for trends in process and outcome measures over time using the Mann-Kendall test.</p> Results <p>Over the course of the IPC intervention, hygiene compliance improved from 13% to 69% (<i>p</i> &lt; 0.001) while environmental cleaning improved from 10% to 87% (<i>p</i> &lt; 0.001). We sampled 363 neonates across 12 point prevalence surveys. CRO colonization was similar at the beginning of the intervention compared with the endline (88% vs. 81%, <i>p</i> = 0.45). However, BSI incidence decreased from 28 to 4 per 100 admissions (<i>p</i> = 0.034), representing an 86% reduction. Similarly, mortality decreased from 26 to 4 per 100 admissions (<i>p</i> = 0.064), though this change was not statistically significant.</p> Conclusions <p>Enhancing basic IPC practices may be effective in reducing adverse outcomes in low-resource settings with a high burden of multidrug-resistant organisms (MDROs). However, the lack of impact on CRO colonization suggests the need for additional IPC and/or antibiotic stewardship interventions to further mitigate MDRO transmission and the selective pressures driving MDRO proliferation in this NICU.</p>

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Impact of targeted infection prevention and control interventions on bloodstream infections and colonization with carbapenem-resistant organisms among hospitalized neonates, Bangladesh, 2023–2024

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  • 发表日期：

    2026年5月20日

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  • Ashley Styczynski,
  • Amelia Keaton,
  • Gazi Md. Salahuddin Mamun,
  • Sanzida Khan,
  • Shariful Amin Sumon,
  • Tanzir Ahmed Shuvo,
  • Shabrina Sharmin,
  • Md. Aminul Islam,
  • Aninda Rahman,
  • Tahsinul Amin,
  • Jesmin Akter,
  • Kakali Halder,
  • Sazzad Bin Shahid,
  • Gemma Parra,
  • Lisa P. Oakley,
  • Katie Wilson,
  • Molly Patrick,
  • Md Golam Dostogir Harun,
  • Fahmida Chowdhury

摘要

Background

Neonates admitted to neonatal intensive care units (NICUs) are particularly susceptible to acquiring healthcare-associated infections because of factors such as prematurity, prolonged hospital stays, and need for invasive support devices. A longitudinal study in a Bangladeshi NICU demonstrated a high burden of bloodstream infections (BSIs) and rectal colonization with carbapenem-resistant organisms (CROs). We aimed to assess the impact of infection prevention and control (IPC) interventions on BSIs and CRO colonization in this NICU.

Methods

We conducted a quasi-experimental study in a 38-bed NICU of a tertiary care referral hospital in Dhaka, Bangladesh. Following a baseline assessment in December 2023-January 2024, an IPC intervention was carried out during February-September 2024, with a pause during June-August because of political instability. NICU staff, including environmental cleaners, received multimodal IPC training with an emphasis on hand hygiene and environmental cleaning. Compliance was monitored through covert observation of hand hygiene and use of fluorescent markers on environmental surfaces. Colonization with CROs was evaluated through twice monthly point prevalence surveys using rectal swabs plated on selective media followed by Vitek 2 confirmatory testing. BSIs were assessed based on recovery of pathogenic organisms from blood cultures, and mortality rates were determined based on the number of deaths per 100 admissions. We assessed for trends in process and outcome measures over time using the Mann-Kendall test.

Results

Over the course of the IPC intervention, hygiene compliance improved from 13% to 69% (p < 0.001) while environmental cleaning improved from 10% to 87% (p < 0.001). We sampled 363 neonates across 12 point prevalence surveys. CRO colonization was similar at the beginning of the intervention compared with the endline (88% vs. 81%, p = 0.45). However, BSI incidence decreased from 28 to 4 per 100 admissions (p = 0.034), representing an 86% reduction. Similarly, mortality decreased from 26 to 4 per 100 admissions (p = 0.064), though this change was not statistically significant.

Conclusions

Enhancing basic IPC practices may be effective in reducing adverse outcomes in low-resource settings with a high burden of multidrug-resistant organisms (MDROs). However, the lack of impact on CRO colonization suggests the need for additional IPC and/or antibiotic stewardship interventions to further mitigate MDRO transmission and the selective pressures driving MDRO proliferation in this NICU.