110 Frequency and spectrum of healthcare associated infections in neonatal care unit of a teaching hospital in North India

Abstract

<h3>Aims</h3> Health care-associated infections (HCAIs) are infections that patients acquire while receiving treatment for medical or surgical conditions and are the most frequent adverse event during Health care delivery. s. The risk to acquire HCAI is universal and pervades every health-care facility and system worldwide, but the true burden remains unknown in many nations, particularly in developing countries. Neonates are particularly susceptible to infection because of abnormalities of the immune system and extrinsic risk factors, such as the use of central venous catheters (CVC), ventilators and surgical procedures. So, the present study was undertaken to assess the frequency &amp; spectrum of HCAI in Level-4 nursery of a tertiary care hospital. <h3>Methods</h3> A prospective observational study was conducted in neonatal ward, from December 2019 to March 2021. All neonates, from birth to 28 days of either sex, admitted in neonatal ward due to any underlying condition then having diagnosis compatible with HCAI as per CDC/WHO criteria were included in the study. Collected data was tabulated in an excel sheet, under the guidance of statistician. Difference between two groups was determined using student t-test as well as chi square test and the level of significance was set at p &lt; 0.05. <h3>Results</h3> Incidence of HCAI was found to be 21.79% (n=78). Overall infection rate was 19.9 cases per 1000 patient days. Incidence of HCAI was directly related to prematurity (&lt;27 weeks [100%], 27-34 weeks [61.5%], 34-37 weeks [24.14%] &amp; ³37 weeks [5.88%]) and low birth weight (&lt;750g [100%], 751-1000g [100%], 1001-1500g [71.43%], 1501-2500g [5.13%] &amp; &gt;2500g [4.76%]). The most common HAI was pneumonia (47.06%) followed by bacteremia (17.65%) and CLABSI (11.76%) (table 1). Most common organism revealed in the study subjects was Klebsiella species (29.41%) followed by Enterobacter species (23.53%) (figure 1). Ventilator-DAIR (Device Associated Infection Rate), central catheter-DAIR and Urinary Catheter DAIR per 1000 invasive device exposure days were 28.3, 16.8 and 18.4 respectively. Mean hospital stay was 33.92±19.04 and 14.63±12.48 days among the subjects affected with and without HAI (p&lt;0.01). Mortality rate was 70.59% among subjects affected with HCAI (p&lt;0.01). <h3>Conclusion</h3> We can conclude that hospital associated infection rate is very high among neonates. One of the major factors is prematurity and low birth weight, that ultimately requires prolong hospital stay with respiratory &amp; feeding supports. This will require higher antibiotics and increase chances of developing drug resistant organisIncrease hospital stay and mortality is also a major concern among neonates affected with HAI, which ultimately leads to increased financial burden over family and country. India is a low-income country, with dense population and over-burdened health infrastructure. In last few decades things are continuously improving with increase in numbers of neonatologist and availability of level-III &amp; level-IV neonatal facilities in both government and private sector. Neonatal HCAI is major concern among premature deliveries and low birth weight babies. We need further improvement and development of new policies to reduce HAIs among neonates.