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Time, Space and Sociodemographic Factors Related to Neonatal Healthcare-associated Infection Rates in Brazil
Ludmila Gerios1, Lucas Martins Liporaci2, Geraldine Madalosso3
1From the Division of Neonatology, Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.
Insights
A surveillance system and quality improvements reduced neonatal healthcare-associated infections (HAI) in Brazil. Socioeconomic factors, like diagnostic resource availability, influenced infection rates in neonatal intensive care units.
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.
Background:
Healthcare-associated infections (HAI) are a limiting factor for survival of high-risk newborns, especially in low-and middle-income countries. This study aimed to associate time, space, hospital characteristics and sociodemographic factors with the rates of HAI in neonatal intensive care units in the State of São Paulo, Brazil.
Methods:
We conducted an ecologic study based on annual rates of central-line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) in high-risk nurseries of hospitals included in a statewide surveillance system in Brazil, from 2009 to 2019. We used Poisson regression models to investigate time-space trends of those rates, as well as their association with socioeconomic indexes and hospital care complexity. We represented the space distribution of CLABSI and VAP with Kernel density maps.
Results:
A total of 294 hospitals reported neonatal data to São Paulo State Program for Infection Control, amounting to 2345 year-hospitals. The median rates of device-related infections were VAP 1.49 (0-3.91), confirmed CLABSI 6.82 (5.9-9.4) and clinical CLABSI 2.47 (0-6.29), with a significant decrease in all HAI rates over time. Hotspots were detected in metropolitan and coastal areas, especially for CLABSI rates.
Conclusions:
The establishment of a surveillance system, as well as quality improvement measures, can promote a reduction in neonatal HAI rates, even in low-resource scenarios. The impact of socioeconomic factors on infection rates can be associated with the availability of diagnostic resources.
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