Time, Space and Sociodemographic Factors Related to Neonatal Healthcare-associated Infection Rates in Brazil.

BACKGROUND

Healthcare-associated infections (HAI) are a limiting factor for survival of high-risk newborns, especially in low-and middle-income countries. This study aimed to associate time, space, hospital characteristics and sociodemographic factors with the rates of HAI in neonatal intensive care units in the State of São Paulo, Brazil.

METHODS

We conducted an ecologic study based on annual rates of central-line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) in high-risk nurseries of hospitals included in a statewide surveillance system in Brazil, from 2009 to 2019. We used Poisson regression models to investigate time-space trends of those rates, as well as their association with socioeconomic indexes and hospital care complexity. We represented the space distribution of CLABSI and VAP with Kernel density maps.

RESULTS

A total of 294 hospitals reported neonatal data to São Paulo State Program for Infection Control, amounting to 2345 year-hospitals. The median rates of device-related infections were VAP 1.49 (0-3.91), confirmed CLABSI 6.82 (5.9-9.4) and clinical CLABSI 2.47 (0-6.29), with a significant decrease in all HAI rates over time. Hotspots were detected in metropolitan and coastal areas, especially for CLABSI rates.

CONCLUSIONS

The establishment of a surveillance system, as well as quality improvement measures, can promote a reduction in neonatal HAI rates, even in low-resource scenarios. The impact of socioeconomic factors on infection rates can be associated with the availability of diagnostic resources.