Central line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit
Thesis (MMed)--Stellenbosch University, 2016.
ENGLISH SUMMARY: Background: The rate of central line-associated bloodstream infection (CLABSI) in South African public sector neonatal intensive care units (NICU) is unknown. Tygerberg Children’s Hospital (TCH) introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives: To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods: A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors using stepwise forward logistic regression analysis. Results: Seven hundred and six central lines were inserted in 530 neonates during the first two years of the programme. Nineteen CLABSI events were identified with a CLABSI rate of 5.9/1000 line days. CLABSI cases were of lower gestational age (28 vs 34 weeks; p=0.003), lower median birth weight (1170g vs 1975g; p=0.014), had longer catheter dwell times (> 4 days) (OR 5.1 [95% CI 1.0-25.4]; p=0.04) and were more likely to have surgery during their NICU stay (OR 3.5 [95% CI 1.26-10]; p=0.01). Significant risk factors for CLABSI were length of stay > 30 days (OR 20.7 [95% CI 2.1-203.2]; p=0.009) and central line insertion in the operating theatre (OR 8.1; [95% CI 1.2-54.7]; p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates 10/12 (83%) exhibiting multi-drug resistance. Conclusion: The TCH NICU CLABSI rate is similar to that reported from resource-limited settings but far exceeds that of high-income countries. Prolonged NICU stay and central line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene is key to reducing CLABSI rates.
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