Developing a care bundle for neonatal sepsis prevention in low-resource settings

项目总结 尽管全球儿童死亡率大幅下降，但新生儿死亡率取得了同样的进展 还没有实现削减。严重的细菌感染影响了690万新生儿，并导致 据估计，中低收入国家(LMIC)每年有75万人死亡，大大超过其他国家 与传染病相关的死亡。住院和早产儿脓毒症预防的新途径 由于抗菌素耐药性威胁到仅存的几种治疗方法，LMIC中的新生儿迫切需要 选择。新生儿败血症流行病学数据的缺乏是发展新生儿败血症的另一个障碍。 针对低资源环境的感染预防干预措施。 护理捆绑包是针对医疗保健相关感染的循证策略；捆绑包广泛- 在高收入国家采用并有效，特别是在成人重症监护人口中。一种关怀 在LMIC中捆绑预防新生儿败血症有很大的潜力；它可能是经济有效的， 在文化上可以接受，赋予母亲权力，并可能适用于医院和社区- 基于设置。可能的捆绑元素包括润肤剂、洗必泰葡萄糖酸酯 洗涤、促进清洁的新生儿环境、安全的静脉通道和改善手部卫生 在新生儿照顾者中。 我们的研究计划需要一个初步的监测阶段，以更好地描述流行性感冒的流行病学特征 南非住院新生儿的细菌性败血症。一系列的观察性研究将建立 新生儿细菌定植和感染的动态和决定因素。可接受性、可行性和 《新生儿败血症预防护理包》中至少五个潜在要素的遵从性指标将是 下定决心。最后阶段将通过两次观察来衡量捆绑的可行性和可接受性。 医院队列中每名婴儿50名。这项研究的总体影响将包括高级 南非新生儿院内脓毒症流行病学及发病情况的了解 “新生儿败血症预防护理包”，适用于低资源环境。

PROJECT SUMMARY Despite substantial global decline in childhood mortality rates, equivalent progress in neonatal mortality reduction has not been achieved. Severe bacterial infection affects 6.9 million neonates and causes an estimated 750 000 deaths in low-middle income countries (LMIC) annually, substantially exceeding other infectious disease-related deaths. New approaches to sepsis prevention for hospitalized and preterm newborns in LMIC are urgently needed as antimicrobial resistance threatens the few remaining therapeutic options. The paucity of data on neonatal sepsis epidemiology is an additional obstacle to development of infection prevention interventions for low-resource settings. Care bundles are evidence-based strategies targeting healthcare-associated infections; bundles are widely- adopted and effective in high-income countries, especially in adult intensive care populations. A care bundled approach for neonatal sepsis prevention in LMIC has great potential; it is likely to be cost-effective, culturally-acceptable, empowering for mothers and potentially applicable in both hospital and community- based settings. Possible bundle elements could include emollient application, chlorhexidine gluconate body washing, promotion of a clean newborn environment, safe intravenous access and improved hand hygiene among neonatal caregivers. Our research programme entails an initial surveillance phase to better characterize the epidemiology of bacterial sepsis in hospitalized South African neonates. A series of observational studies will establish the dynamics and determinants of neonatal bacterial colonization and infection. The acceptability, feasibility and compliance indicators for at least five potential elements of a ‘neonatal sepsis prevention care bundle' will be determined. A final phase will measure the feasibility and acceptability of the bundle in two observational hospital cohorts of 50 infants each. The overall impact of this research will include an advanced understanding of the epidemiology of hospital-onset sepsis in South African neonates and development of a ‘neonatal sepsis prevention care bundle’ for low-resource settings.