Impact of infection prevention interventions on neonatal bloodstream infections and mortality in Ethiopia.

INTRODUCTION

Bloodstream infections (BSIs) are a major cause of neonatal morbidity and mortality in low-resource settings, yet most are preventable. However, few studies evaluated the effectiveness of multimodal interventions in preventing healthcare-associated BSIs (HA-BSIs) in neonatal intensive care units (NICUs) in low- and middle-income countries (LMICs).

METHODS

We conducted an implementation study in a NICU in Northern Ethiopia from January to June 2024, using a pre-and post-intervention design. Multimodal prevention strategies consisted of infection prevention and control (IPC) training, the appointment of an IPC expert, in-house production of alcohol-based hand rub (ABHR), HA-BSI surveillance, and online IPC meetings. Follow-up interventions were implemented based on feedback from these meetings. Logistic regression analysis was used to assess the associations between variables.

RESULTS

Among 151 clinically suspected HA-BSI episodes, 58.3 % were culture-positive. The baseline rate of HA-BSI was 333 episodes per 1000 hospital admissions. This rate significantly declined to 74 within two months (p < 0.0001) and 96 episodes per 1000 by the end of the study (p < 0.0001). HA-BSI-associated mortality decreased by 80 % (p < 0.0001). Each additional hospital day increased HA-BSI risk by 10.5 % (odds ratio [OR]: 1.105, 95 % confidence interval [CI]: 1.018-1.200; p < 0.05), while a 100-g increase in birth weight improved the odds of successful antibiotic treatment by 15.2 % (OR: 1.152, 95 % CI: 1.055-1.257; p < 0.01).

CONCLUSION

Cost-effective, multimodal IPC interventions can significantly reduce HA-BSIs and associated mortality in NICUs in low-resource settings. Further research is needed to evaluate the long-term sustainability of these measures in LMICs.