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Updated: Jun 27, 2026
A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines
Christopher J Gill1, Jose B V Mantaring, William B Macleod
1Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA. cgill@bu.edu
Insights
Implementing simplified infection control measures in Philippine neonatal intensive care units (NICUs) improved staff hand hygiene and reduced overall mortality. However, rates of drug-resistant pathogen colonization and sepsis remained unchanged, highlighting ongoing challenges in resource-limited settings.
Area of Science:
- Infectious Diseases
- Public Health
- Neonatal Care
Background:
- Neonatal mortality from hospital-acquired sepsis is a significant global health challenge, particularly in developing countries.
- Resource-limited settings urgently require cost-effective infection control strategies to combat neonatal sepsis.
Purpose of the Study:
- To evaluate the impact of simplified infection control measures on hand hygiene, pathogen colonization, bacteremia, and mortality in two neonatal intensive care units (NICUs) in Manila, Philippines.
- To assess the feasibility and effectiveness of infection control interventions in resource-limited hospital environments.
Main Methods:
- A before-and-after comparison study design was employed.
- Key metrics measured included staff hand-hygiene compliance, colonization with drug-resistant pathogens, bacteremia rates, and overall mortality.
- Interventions were implemented in two NICUs, followed by post-intervention data collection.
Main Results:
- Staff hand-hygiene compliance significantly improved in both NICUs post-intervention.
- Overall mortality decreased in both NICUs following the implementation of infection control measures.
- Despite improvements in hand hygiene and mortality, rates of colonization with drug-resistant pathogens and sepsis did not change significantly.
Conclusions:
- Nosocomial transmission of drug-resistant pathogens, primarily gram-negative bacilli, was prevalent in the studied NICUs.
- Infection control interventions are feasible in resource-limited settings and show potential effectiveness, particularly in improving hand hygiene and reducing mortality.
- Further research and sustained efforts are needed to address the persistent challenge of drug-resistant pathogen colonization and sepsis in neonatal intensive care units.
Background:
The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in the developing world creates an urgent need for cost-effective infection-control measures in resource-limited settings.
Methods:
Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance, colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila, The Philippines.
Results:
Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drug-resistant gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species) and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95% confidence interval 1.1-1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4-2.0) and that overall mortality decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4-0.6; NICU 2: relative risk, 0.8; 95% confidence interval, 0.7-0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change significantly at either NICU.
Discussion:
Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines; transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible and are possibly effective in resource-limited hospital settings.
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