Time, Space and Sociodemographic Factors Related to Neonatal Healthcare-associated Infection Rates in Brazil

Area of Science:

• Neonatal intensive care
• Infectious disease epidemiology
• Public health surveillance

Background:

• Healthcare-associated infections (HAI) significantly impact high-risk newborn survival, particularly in low- and middle-income countries.
• Neonatal intensive care units (NICUs) are critical settings where HAI prevention is paramount.
• Understanding factors influencing HAI rates is crucial for targeted interventions.

Purpose of the Study:

• To analyze time, space, hospital characteristics, and sociodemographic factors associated with HAI rates in Brazilian NICUs.
• To investigate trends and spatial distribution of central-line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP).

Main Methods:

• Ecologic study utilizing annual HAI rates (CLABSI, VAP) from a statewide surveillance system (2009-2019).
• Poisson regression models to assess associations with socioeconomic indexes and hospital complexity.
• Kernel density maps to visualize spatial distribution of infections.

Main Results:

• A total of 294 hospitals reported data, contributing 2345 hospital-years.
• Median infection rates: VAP 1.49, confirmed CLABSI 6.82, clinical CLABSI 2.47.
• Significant decrease in all HAI rates observed over time; hotspots identified in metropolitan and coastal areas, particularly for CLABSI.

Conclusions:

• Effective surveillance systems and quality improvement initiatives can lower neonatal HAI rates, even in resource-limited settings.
• Socioeconomic factors, potentially linked to diagnostic resource availability, influence neonatal infection rates.
• Targeted interventions in identified hotspots may further reduce HAI burden.