In Ghana, neonatal sepsis and other neonatal infections account for 31% of all neonatal deaths. At the KBTH it accounts for 15.7% of all neonatal intensive care unit (NICU) admissions and was implicated in 12.8% of all neonatal deaths. Previous studies of neonatal bloodstream infections at the KBTH have shown a preponderance of multi-drug resistant(MDR) Gram negative bacteria; with enterobacteria being the most commonly isolated organisms. These organisms anecdotally are responsible for mini-outbreaks at the NICU. There is evidence that adherence to hand hygiene practices in the unit is on the decline. In the year 2009 it was observed that averagely 22% of staff performed hand hygiene before contact with patient, whilst in 2013 adherence had declined to an average of 16%.
To study the epidemiology of neonatal sepsis and evaluate the effect of multimodal infection control interventions on the incidence of neonatal sepsis and MDR Gram negative colonization.
1. To determine the incidence of neonatal sepsis and antibiograms of responsible microorganisms at the NICU of the KBTH.
2. To determine the risk factors and clinical outcomes associated with neonatal sepsis during hospitalization.
3. To determine the role of Gram negative environmental flora in the colonization of neonates and the development of neonatal sepsis, as well as the transmission patterns of colonizing MDR Gram negative bacteria among neonates in the NICU
4. To determine the impact of infection control interventions on the incidence of onset neonatal sepsis and colonization by MDR Gram negative bacteria.
Neonatal sepsis is a major contributor to global under five mortality. In developing countries a major proportion of neonatal sepsis is thought to emanate from the healthcare setting, due to challenges in infection prevention practices. Hospital acquired infections (HAIs) are associated with multi-drug resistant (MDR) bacteria, which increases the risk of therapeutic failure due to the limited choice of available antibiotics. HAIs also lead to extended duration of admission, increased medical costs, morbidity and mortality.
This work package seeks to investigate neonatal sepsis in two major referral hospitals in Ghana, with emphasis on the role of multi-drug resistant gram negative bacteria. It also sets out to investigate the WHO multimodal hand hygiene strategy in improving infection prevention and control practices in the two hospitals.
Hypothesis: In this study we are hypothesizing that the hospital environment serves as a source of multi-drug resistant Gram negative bacteria responsible for neonatal colonization and sepsis among patients admitted to the NICU; and increased infection control interventions will lead to reduction in the incidence of neonatal sepsis and colonization by MDR Gram negative bacteria.
Study plan. We will conduct a controlled before and after interventional trial comprising a 7 month pre-intervention phase, 5 month intervention phase and 7 months post-intervention phase. Neonates admitted at the Neonatal Intensive Care Unit (NICU) at Korle-Bu Teaching Hospital (KBTH) will be enrolled prospectively and followed up for diagnosis of sepsis and outcome of admissions. Signs and symptoms of neonatal sepsis as well as results from blood cultures will be collected to describe the epidemiology of neonatal sepsis. Swabs will be collected from a subpopulation of included neonates at intervention site (KBTH) and control site (37 Military Hospital) NICUs to assess colonization of neonates with MDR Gram Negative bacteria. Environmental swabs will be collected from incubators and surfaces at the NICU to assess Gram negative contamination of the environment. Surveillance of neonatal sepsis will also be instituted over the lifespan of the study at both control and intervention sites. The intervention comprise infection prevention and control strategies including implementation of the WHO multimodal hand hygiene strategy. The primary endpoint is incidence of neonatal sepsis. Secondary outcome measures is the rate of Gram negative colonization of neonates and the environment. Data collected will be used in evaluating the impact of interventions on the primary and secondary outcomes.
Expected Outcome: It is expected that findings from this study will contribute to improved infection prevention and control practices in the NICU. It will further highlight lessons which other national and sub-regional NICUs may learn from, and help to reduce the burden of hospital acvquired infections (HAIs) in newborns.
Progress made so far
The project is in its 1st year of implementation. Ethical approval for project commencement has been received. The work package is currently at the stage of patient recruitment.
The following activities are currently ongoing for patient recruitment, specimen collection and laboratory analysis.
1. Surveillance of sepsis and conduct of blood cultures continued at both KBTH and 37 Military Hospital
2. Second set of swabs of all babies on admission have been taken to determine Gram negative colonisation. This was done at both study sites. All the isolates are currently in Denmark awaiting identification, susceptibility testing and further analysis.
3. We have conducted a second sampling of water from the KBTH NICU equipment. As well as a third sampling of the NICU environment. All the samples have been cultured and all isolates stored for future analysis.
4. Databases have been created and data entry is underway for all the datasets.
The following activities are planned for the next 4 months
1. Complete course and labwork in Denmark.
2. Complete Baseline data collection at Korle-Bu Teaching Hospital.
3. Plan and start intervention phase of the study at Korle-Bu Teaching Hospital.
4. Draft manuscript for Gram negative colonization of neonates at Korle-Bu Teaching Hospital.
Dr Appiah-Korang Labi-shared some findings from the recent multi-centre point prevalence survey with delegates at the 7th Infection Control African Network in Capetown South Africa.
Dr. Labi won a partial bursary for original African scientific work
Dr. Labi networking with some delegates at ICAN
Dr. Labi with Professor Didier Pittet of WHO
Dr. Labi with another award winner from Nigeria
Neonatal Sepsis Work Package launces alcohol based hand hygiene promotion campaign at the Neonatal Intensive Care Unit (NICU) of the Korle-Bu Teaching Hospital.
As part of efforts to improve care for our newborns and reduce hospital acquired infections at the NICU of the Korle-Bu Teaching Hospital; the neonatal sepsis work package under the HAI-Ghana project is embarking on a campaign to improve hand hygiene practices at the unit. The campaign was launched at the unit on 12th September 2018 with the slogan “use alcohol hand rub, save a neonate today”. The launch was attended by the Medical Director of the hospital Dr.Daniel Asiamah, Director of Nursing Mrs. Rita Aryee, the acting Head of the Department of Child Health Prof. Bamenla Goka, the head of unit, Dr. Agyiri Sackey, Prof. Christabel Enweronu-Laryea co-supervisor neonatal sepsis work package, Prof. Mercy J Newman, the PI of the HAI Ghana project as well as staff from the department of child health and other departments.
Participants were introduced to the importance of hand hygiene in neonatal care and the components of the WHO multi-modal hand hygiene strategy. There was also a demonstration session on the appropriate use of alcohol hand rub.
The current hand hygiene promotion campaign is based on the WHO multi-modal hand hygiene strategy including components of: system change, improved communication in the form of reminders (posters) at the workplace, education on hand hygiene, audit and feedback of practices and outcomes, and fostering a safety climate in the unit. Activities in the current campaing include provision of alcohol hand rub at the bedside of each neonate, augmenting the number of cotton hand towels, increasing the number of reminders on hand hygiene in the unit, monitoring of alcohol consumption volumes as well as hand hygiene compliance; with feedback provided via a notice board.
The campaign will be running for approximately 6 months and will provide continuously feedback on the results obtain on hand hygiene practices as well as on the effect on infections and clinical outcomes of our babies.
Join the campaign!