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. 2016 Feb;110(2):98-106.
doi: 10.1093/trstmh/trv116.

Lack of Evidence for the Efficacy of Enhanced Surveillance Compared to Other Specific Interventions to Control Neonatal Healthcare-Associated Infection Outbreaks

Free PMC article

Lack of Evidence for the Efficacy of Enhanced Surveillance Compared to Other Specific Interventions to Control Neonatal Healthcare-Associated Infection Outbreaks

J Birt et al. Trans R Soc Trop Med Hyg. .
Free PMC article


Background: Despite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity.

Methods: We searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance.

Results: Thirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries.

Conclusions: Systematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.

Keywords: Hospital-acquired infection; Neonates; Outbreaks; Prevention.


Figure 1.
Figure 1.
Flowchart of study selection process (based on PRISMA flowchart). This figure is available in black and white in print and in color at Transactions online.
Figure 2.
Figure 2.
Outbreak duration (months) and (%) case fatality ratio by pathogen by country classification.

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