Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia
Introduction: Sepsis is the leading cause of infectious morbidity and mortality among hospitalized neonates. In high-resource pediatric and adult intensive care units, use of aqueous chlorhexidine (CHG) solution has been associated with reduced risk of bloodstream infections (BSI). Objectives: To as...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-07-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971220301752 |
| _version_ | 1818693231463890944 |
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| author | T. Westling C. Cowden L. Mwananyanda M.L. Kapasa S. Machona C. Pierre N. Mitra D.H. Hamer S.E. Coffin |
| author_facet | T. Westling C. Cowden L. Mwananyanda M.L. Kapasa S. Machona C. Pierre N. Mitra D.H. Hamer S.E. Coffin |
| author_sort | T. Westling |
| collection | DOAJ |
| description | Introduction: Sepsis is the leading cause of infectious morbidity and mortality among hospitalized neonates. In high-resource pediatric and adult intensive care units, use of aqueous chlorhexidine (CHG) solution has been associated with reduced risk of bloodstream infections (BSI). Objectives: To assess the impact of bathing of neonates with 2% CHG on BSI, suspected sepsis, and mortality in a low-income country neonatal care unit. Methods: We conducted a secondary analysis of data from the Sepsis Prevention in Neonates in Zambia (SPINZ) study, a prospective observational cohort study performed at a large public referral hospital in Lusaka, Zambia. The SPINZ study assessed the impact of an infection control bundle (consisting of alcohol hand rub, SMS hygiene reminders, enhanced environmental cleaning, and CHG baths for babies ≥1.5 kg) on sepsis, BSI, and all-cause mortality. Episodic shortages in study staffing resulted in some enrolled babies not receiving a CHG bath. Using Longitudinal Targeted Maximum Likelihood Estimation and Cox proportional hazards regression to adjust for observed confounding, we estimated the causal effect of receiving a CHG bath within the first 3 days of life on suspected sepsis, BSI, and death among inborn babies enrolled during the study implementation and intervention phases. Results: The majority of inborn, enrolled babies ≥1.5 kg received a CHG bath within 3 days of NICU admission (864 of 1233, 70%). We found that CHG bathing reduced the hazard rate of BSI among inborn babies ≥1.5 kg by a factor of 0.58 (p = 0.10, 95% CI: 0.31, 1.11), corresponding to an absolute risk reduction of 9.6 percentage points within a week of admission (p = 0.002, 95% CI: 3.4–15.7 percentage points). We did not find a statistically significant effect of CHG bathing on culture-negative sepsis (p = 0.54) or death (p = 0.85). Conclusion: In our single center study, CHG bathing at admission was associated with a reduced risk of BSI due to a pathogenic organism after adjusting for potential confounding. Our results suggest that CHG may be an effective intervention for preventing neonatal sepsis in high-risk, low-income country settings. |
| first_indexed | 2024-12-17T13:10:24Z |
| format | Article |
| id | doaj.art-95520fa4023248c1a4b5692cc8cad72a |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-17T13:10:24Z |
| publishDate | 2020-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-95520fa4023248c1a4b5692cc8cad72a2022-12-21T21:47:08ZengElsevierInternational Journal of Infectious Diseases1201-97122020-07-01965460Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in ZambiaT. Westling0C. Cowden1L. Mwananyanda2M.L. Kapasa3S. Machona4C. Pierre5N. Mitra6D.H. Hamer7S.E. Coffin8Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA; Corresponding author.Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USARight to Care-Zambia, Lusaka, Zambia; Department of Global Health, Boston University School of Public Health, Boston, MA, USANeonatal Intensive Care Unit, University Teaching Hospital, Lusaka, ZambiaNeonatal Intensive Care Unit, University Teaching Hospital, Lusaka, ZambiaSection of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USADepartment of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USADepartment of Global Health, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USADivision of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USAIntroduction: Sepsis is the leading cause of infectious morbidity and mortality among hospitalized neonates. In high-resource pediatric and adult intensive care units, use of aqueous chlorhexidine (CHG) solution has been associated with reduced risk of bloodstream infections (BSI). Objectives: To assess the impact of bathing of neonates with 2% CHG on BSI, suspected sepsis, and mortality in a low-income country neonatal care unit. Methods: We conducted a secondary analysis of data from the Sepsis Prevention in Neonates in Zambia (SPINZ) study, a prospective observational cohort study performed at a large public referral hospital in Lusaka, Zambia. The SPINZ study assessed the impact of an infection control bundle (consisting of alcohol hand rub, SMS hygiene reminders, enhanced environmental cleaning, and CHG baths for babies ≥1.5 kg) on sepsis, BSI, and all-cause mortality. Episodic shortages in study staffing resulted in some enrolled babies not receiving a CHG bath. Using Longitudinal Targeted Maximum Likelihood Estimation and Cox proportional hazards regression to adjust for observed confounding, we estimated the causal effect of receiving a CHG bath within the first 3 days of life on suspected sepsis, BSI, and death among inborn babies enrolled during the study implementation and intervention phases. Results: The majority of inborn, enrolled babies ≥1.5 kg received a CHG bath within 3 days of NICU admission (864 of 1233, 70%). We found that CHG bathing reduced the hazard rate of BSI among inborn babies ≥1.5 kg by a factor of 0.58 (p = 0.10, 95% CI: 0.31, 1.11), corresponding to an absolute risk reduction of 9.6 percentage points within a week of admission (p = 0.002, 95% CI: 3.4–15.7 percentage points). We did not find a statistically significant effect of CHG bathing on culture-negative sepsis (p = 0.54) or death (p = 0.85). Conclusion: In our single center study, CHG bathing at admission was associated with a reduced risk of BSI due to a pathogenic organism after adjusting for potential confounding. Our results suggest that CHG may be an effective intervention for preventing neonatal sepsis in high-risk, low-income country settings.http://www.sciencedirect.com/science/article/pii/S1201971220301752Bloodstream infectionChlorhexidineNeonatal intensive care unitLow-income country |
| spellingShingle | T. Westling C. Cowden L. Mwananyanda M.L. Kapasa S. Machona C. Pierre N. Mitra D.H. Hamer S.E. Coffin Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia International Journal of Infectious Diseases Bloodstream infection Chlorhexidine Neonatal intensive care unit Low-income country |
| title | Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia |
| title_full | Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia |
| title_fullStr | Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia |
| title_full_unstemmed | Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia |
| title_short | Impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in Zambia |
| title_sort | impact of chlorhexidine baths on suspected sepsis and bloodstream infections in hospitalized neonates in zambia |
| topic | Bloodstream infection Chlorhexidine Neonatal intensive care unit Low-income country |
| url | http://www.sciencedirect.com/science/article/pii/S1201971220301752 |
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