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

开发资源匮乏地区预防新生儿败血症的护理包

• 批准号: 9906287
• 负责人: Angela Dramowski
• 金额: $ 11.34万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-22 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906287
• 关键词: 37 weeks gestation; Adopted; Adult; Affect; Antimicrobial Resistance; Bacterial Infections; Bathing; Caregivers; Caring; Cause of Death; Cessation of life; Childhood; Chlorhexidine; Communicable Diseases; Communities; Country; Data; Development; Elements; Emollients; Environment; Epidemiology; Exclusive Breastfeeding; Exposure to; Gluconates; HIV; Hand; Health care facility; Hospitals; Hygiene; Income; Individual; Infant; Infection; Infection prevention; Integumentary system; Intensive Care; Intervention; Intravenous; Kangaroo-Mother Care; Low Birth Weight Infant; Measurement; Measures; Methods; Microbiology; Modeling; Mothers; Neonatal; Neonatal Mortality; Newborn Infant; Observational Study; Oral; Outcome; Outpatients; Phase; Population; Pregnancy; Prevention; Prevention Measures; Preventive Intervention; Provider; Research; Resources; Risk Factors; Sepsis; Series; Site; Skin; South African; Testing; Therapeutic; antimicrobial; base; burden of illness; cohort; community based care; cost; cost effective; empowered; evidence base; healthcare-associated infections; improved; low and middle-income countries; mortality; neonatal sepsis; neonate; novel strategies; pathogen; preterm newborn; programs; prospective; tool

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.

项目摘要 尽管全球儿童死亡率大幅度下降，但新生儿死亡率也取得了同样的进展 没有实现削减。严重的细菌感染影响690万新生儿， 据估计，中低收入国家每年有75万人死亡，大大超过其他国家。 传染病相关死亡。预防住院和早产儿败血症的新方法 由于抗生素耐药性威胁到少数剩余的治疗药物， 选项.新生儿败血症流行病学数据的缺乏是发展的另一个障碍， 在资源匮乏的环境中采取预防感染的干预措施。 护理包是针对医疗保健相关感染的循证战略;护理包广泛- 在高收入国家，特别是在成人重症监护人群中采用并有效。护理 LMIC中新生儿败血症预防的捆绑方法具有很大的潜力;它可能具有成本效益， 文化上可接受的，赋予母亲权力，并可能适用于医院和社区- 基于设置。可能的捆绑元素可能包括润肤剂应用，葡萄糖酸氯己定体 清洗，促进清洁的新生儿环境，安全的静脉注射和改善手部卫生 在新生儿护理者中。 我们的研究计划需要一个初步的监测阶段，以更好地描述流行病学， 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力学和决定因素。可接受性、可行性和 “新生儿败血症预防护理包”的至少五个潜在要素的依从性指标将被 测定最后一个阶段将在两个观察阶段衡量捆绑的可行性和可接受性。 医院队列，每组50名婴儿。这项研究的整体影响将包括一个先进的 了解南非新生儿院内败血症的流行病学，并制定一项 “新生儿败血症预防护理包”为低资源设置。

项目成果

Healthcare-Associated Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in a Neonatal Unit: The Importance of Universal Masking, Hand Hygiene, and Symptom Screening in Containment.

• DOI: 10.1093/jpids/piaa160
• 发表时间: 2021-05-28
• 期刊: Journal of the Pediatric Infectious Diseases Society
• 影响因子: 3.2
• 作者: Holgate SL;Dramowski A;van Niekerk M;Hassan H;Prinsloo Y;Bekker A
• 通讯作者: Bekker A

Impact of a multi-strain probiotic administration on peri-rectal colonization with drug-resistant Gram-negative bacteria in preterm neonates.

• DOI: 10.3389/fped.2022.1002762
• 发表时间: 2022
• 期刊: Frontiers in pediatrics
• 影响因子: 2.6

Performance Comparison of Infection Prediction Scores in a South African Neonatal Unit: A Retrospective Case-Control Study.

• DOI: 10.3389/fped.2022.830510
• 发表时间: 2022
• 期刊: Frontiers in pediatrics
• 影响因子: 2.6
• 作者: Lloyd LG;Dramowski A;Bekker A;Malou N;Ferreyra C;Van Weissenbruch MM
• 通讯作者: Van Weissenbruch MM

A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009-2018 at Tygerberg Hospital, South Africa.

• DOI: 10.1371/journal.pone.0245089
• 发表时间: 2021
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Reddy K;Bekker A;Whitelaw AC;Esterhuizen TM;Dramowski A
• 通讯作者: Dramowski A

Epidemiology of clinically suspected and laboratory-confirmed bloodstream infections at a South African neonatal unit.

南非新生儿病房临床疑似和实验室确诊的血流感染的流行病学。

• DOI: 10.3855/jidc.13971
• 发表时间: 2021
• 期刊: Journal of infection in developing countries
• 影响因子: 1.9
• 作者: Dramowski,Angela;Bekker,Adrie;Cotton,MarkFrederic;Whitelaw,AndrewChristopher;Coffin,Susan
• 通讯作者: Coffin,Susan