Objective: To determine the incidence and risk factors for neonatal nosocomial infections.
Design: Cohort study.
Setting: Tertiary care Teaching Hospital.
Methods: Hospital born neonates transferred to the neonatal unit after birth and available in the unit 48 hours later comprised the cohort for the surveillance. Detailed maternal, intrapartum and neonatal variables were recorded. Risk factors for nosocomial infection were analyzed by both univariate and multiple logistic regression methods.
Results: One hundred and thirty-four neonates were enrolled in the cohort. The overall nosocomial infection rate was 16.8/1000 patient days. Device associated infection rate was 11.9/1000 device days. Multidrug resistant Klebsiella species was the commonest organism causing nosocomial septicemia and pneumonia followed by Pseudomonas aeruginosa. The risk factors detected to be significantly associated with infection on multiple logistic regression analyses were a birth weight < 1500 g (OR 3.3) and assisted ventilation > 72 h (OR 14.2).
Conclusions: Very low birth weight (VLBW) neonates, especially those undergoing interventions such as mechanical ventilation are at the greatest risk for infection and death. Therefore, strict protocol for asepsis must be adhered to when handling these high risk infants.
PIP: The incidence and risk factors for neonatal nosocomial infection were investigated in a cohort study of 134 hospital-born infants transferred to a neonatal unit in New Delhi, India, after birth and observed for up to 72 hours. 22 of the 134 infants developed nosocomial infections. The median age at diagnosis was 184 hours. In 16 of these infants, both sepsis screen and blood culture were positive. Septicemia was diagnosed in 21 neonates; 11 had associated pneumonia and four had soft tissue infection. Multiresistant Klebsiella species was the infectious agent in 68% of cases. The overall nosocomial infection rate was 16.8/1000 patient-days and the device-associated infection rate was 11.9/1000 device-days. Factors significantly associated with neonatal nosocomial infection in the univariate analysis were low birth weight, prematurity, vaginal delivery, hyaline membrane disease, assisted ventilation, and use of peripheral venous and umbilical vascular catheters. In the final multivariate analysis, only birth weight under 1500 g (odds ratio, 3.3) and assisted ventilation for more than 72 hours (odds ratio, 14.2) remained significant risk factors. It was observed in 122 random observations in this hospital that 15-18% of nurses and residents failed to adhere to adequate hand-washing techniques. Strict adherence to aseptic protocols in neonatal units is essential to keep infection rates under control.