Interventions to prevent neonatal healthcare-associated infections in low-resource settings: a systematic review

BackgroundClinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control (IPC) interventions for neonates in low-and-middle-income countries (LMIC) are unknown. AimTo identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. MethodsMedline, PUBMED, The Cochrane Database of Systematic Reviews, EMBASE, and PsychInfo (January 2003 - October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. ResultsOur initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and ICROMS assessment criteria and were summarised in the final analysis. No studies were carried out in low-income countries, only one in sub-Saharan Africa and just two in multiple countries. Of the 18 single intervention studies, most targeted skin (n=4) and gastrointestinal mucosal integrity (n=5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-centre studies. Of the nine studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. ConclusionThere is a limited evidence-base for the effectiveness of IPC interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multi-site studies with robust study designs are needed to inform IPC intervention strategies in low-resource neonatal units. Sources of SupportFF is supported by the Academy of Medical Sciences, the funders of the Starter Grant for Clinical Lecturers scheme and UCL Great Ormond Street NIHR Biomedical Research Centre. AD is supported by the Fogarty International Center of the National Institutes of Health, Emerging Global Leader Award Number K43-TW010682.