Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect (original) (raw)
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Effectiveness of birthing kits for clean childbirth: a systematic review
International Health, 2019
Poor infection control practices during childbirth are recognised as a critical factor leading to life-threatening maternal and newborn sepsis. Therefore, this paper assesses the effectiveness of clean birth kits (CBKs) to ensure a safe birthing environment. We searched PubMed, Cochrane Library and CINAHL, as well as Google Scholar, to identify both qualitative and quantitative studies on CBKs published in English up to November 2018. Studies were included if the pregnant women or women giving birth intended to use or used a CBK. The methodological quality of included papers was assessed. A total of 37 studies, 26 quantitative and 11 qualitative studies, were included. Quantitative studies showed a positive impact of CBKs on reducing the incidence of puerperal sepsis and neonatal tetanus. The review also identified CBK use to be associated with a reduction in perinatal, neonatal and young infant mortality. Qualitative studies suggested that a lack of awareness of the importance of C...
F1000Research, 2023
Background: Neonatal healthcare-associated infection (HAI) globally is the leading preventable cause of neonatal mortality. Neonatal mortality in India is also very high. Considering that HAIs can be prevented globally, there are disparities in resources; the current study aimed at developing locally feasible and effective prevention bundles for neonatal HAIs. Methods: A mixed-method study was conducted at one tertiary care teaching hospital's level IV Neonatal Intensive Care Unit. The study explores the causes of neonatal HAIs, current processes, benchmark practices, gaps in current practices with HAIs, root-cause analysis and system process mapping, and failure mode effect analysis. Observations, interviews, brainstorming activities, and a survey were conducted. Written and audio-video recorded prevention bundle was developed and implemented using a quasi-experimental study design. Results: Process standardisation, healthcare worker training, hand hygiene practices, nursing care process and vascular access process were identified as key improvement areas to prevent neonatal HAIs. Out of eighteen identified processes, three processes were standardised. All the healthcare providers were trained at three-time intervals of three months each. After implementing the prevention bundle, there was a significant decline in the rate of HAIs, reducing it
BMC Public Health, 2011
Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. Funding This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.
2020
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 s...
The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial months of the study, the infection and mortality rates were noted to be unacceptably high. Therefore, an infection control program was introduced early in the trial to reduce the rate of nosocomial infections.
Cord Care Practices Among Neonatal Tetanus Cases In the Community
Cord care practice is one of the most important practice for prevention ofNeonatal Tetanus including other practices are safe delivery, mother's immunization, early diagnosis and management of Neonatal Tetanus.In 2008, Bangladesh achieved " Maternal and Neonatal Tetanus " (MNT) elimination,but still cases of neonatal tetanus is being reported frequently. This study aims to assess the cord care practices among the neonatal tetanus cases and to assess further scopes of interventionto reduce its incidence.A cross-sectional descriptive type of study carried out atInfectious Disease Hospital(IDH), Dhaka duringJanuary 2004 to October 2005 A total number of sixty-threeneonatal tetanus caseswere assessed by interviewing mothers and examining cases. Among the cases of NNT 96% was home deliveries, 97% deliveries were by unskilled birth attendants, 78% of the mothers were not immunized against tetanus,77% of cases the umbilical cords were cut by unsterilized instruments, only 12% by attained sterile methods to tie the cord, 54% cases used nothing to the umbilical cord, but37% cases used the traditional unhealthy and unsterile methods to keep the cord clean.The respondents were both from the urban and rural settings, 38% and 62% respectively. The mean age of the neonate on the day of admission was approximately 10 days withcommonly reported symptoms of developingdifficulty in sucking (98%), convulsion (62%) and risussardonicus(46%). Only 35% of symptomatic cases were treated by doctors at the hospital with only discharge (38%) and with inflammation additional to discharge (35%) at the site of the umbilical stump and rest 65% were treated and referred by other than doctors. Establishing long-term elimination of neonatal tetanus requires the health care system to be yet more scrutinized to effectively encourage institutional delivery, improving immunization status of the mothers and to detect vulnerable households and mothers, so that, the unhealthy delivery and cord care practices can be prevented as a result, reduce exposure to tetanus.
Topical Umbilical Cord Care for Prevention of Infection and Neonatal Mortality
The Pediatric Infectious Disease Journal, 2013
Umbilical cord care varies often reflecting community or health-worker beliefs. We undertook a review of current evidence on topical umbilical cord care. Study quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluation system, and a metaanalysis was conducted for comparable trials. Available moderate-quality to high-quality evidence indicate that cord cleansing with 4% chlorhexidine may reduce the risk of neonatal mortality and sepsis (omphalitis) in low-resource settings. Keywords cord care; chlorhexidine; neonatal mortality; sepsis; neonates Annually about 3.3 million neonatal deaths occur around the world; 1 of these, more than 30% are caused by infections. 2,3 Some of these infections start as umbilical cord infection. The umbilical cord area supports growth of some innocuous or beneficial microorganisms (commensals) whereas others are harmful (eg, Clostridium tetani). Sources of these bacteria include the mother's birth canal, the environment in which the neonate is delivered and hands of the person assisting with the delivery. Cord infection may be localized to the umbilical cord (omphalitis) or, after entry into the blood stream, become systemic (eg, neonatal sepsis). Data on the incidence of omphalitis in low-income countries is generally scarce, the available data estimate the risk to range between 2 and 77 per 1000 live births in hospital settings, with fatality rates of between 1% and 15% depending on the definition of
Journal of Infection Prevention, 2012
Peer reviewed article nfection prevention is a cornerstone of good neonatal care. There are, however, few research data to support infection control approaches in this population. Through a structured telephone interview we surveyed all neonatal units in the United Kingdom to identify infection control issues, practices and policies. Eighty seven percent of the 198 neonatal units participated. Twenty one units (12.2%) had closed with infection control issues in the last year; 14.1% had current infection control concerns; 81.5% of units decolonised MRSA positive infants, but over 15 regimens were used. Wide variations in hygiene measures were identified; 22.1% of units used theatre scrubs for all staff, 7.6% used aprons and 5.8% required gloves to be worn when entering clinical areas. Only 54% required hand washing and alcohol gel before entry to a patient care area; 11.6% required only the use of alcohol gel.