small patients, big challengesdr.angela dramowski, stellenbosch university, cape town, south africa...
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionpreventionforhospitalizedchildrenandneonatesinAfrica
Photo:MarchofDimes
Smallpatients,bigchallenges
www.webbertraining.com October31,2017
Presenter: DrAngelaDramowski
Affiliation: StellenboschUniversity,SouthAfricaInfectionControlAfricaNetwork(ICAN)
Specialty: Paediatric InfectiousDiseases
Disclosures: Ihavenothingtodisclose.
InfectionpreventionchallengesamonghospitalizedchildrenandneonatesinAfrica
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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ApopulationvulnerabletoHAI
Immatureimmunity(innate,acquiredandvaccine-derived)
Rapidlycolonisedwithantibiotic-resistantbacteria
Uniquebehavioursandincontinence
Manycaregivers,morehandling
Predominanceofrespiratory andgastrointestinalviruses
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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RotheJHospInfect2013
What’sdifferentaboutinfectionpreventioninAfrica?
InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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2011ReportontheburdenofHAI:neonatesNeonatalinfectionratesindevelopingcountries3-20xhigherthaninindustrializedcountries
HAIcause4-56%ofdeathsintheneonatalperiod(majorityinSSAfricaandSEAsia)
HAIratesinneonatalICUsareveryhighwithpredominanceofHA-bloodstreaminfectionsanddevice-associatedinfections.
VAPandCR-BSIdensitieswereparticularlyhighVAP=109- 143episodes/1000ventilator-daysCR-BSI=21- 600episodes/1000catheter-days.
HighratesofAMRinfections:- 70%ofneonatalBSInotsusceptibletoanempiricregimenofampicillinandgentamicin.
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Hospitalizedneonatesarevulnerabletoinfection,withpathogen
exposuresoccurringinutero,intrapartum,andpostnatally.
Africanneonatalunitsareathighriskofoutbreaksowingto
overcrowding,understaffing,andsharedequipment.
Highincomeneonatalunitexperience10outbreaks/year;
BurdenofneonatalunitoutbreaksinAfricaisunknown.
AfricanneonatalunitHAIoutbreaks
IJID2016
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Tygerberghospitalneonatalunit Africanneonatal units
13outbreaksover8years 20outbreaks over20years
148babies
(11deaths;7%mortality)
524babies
(177deaths;34%mortality)
Viruses:rotavirus,influenza,measles
MDRbacteria:S.marcescens,A.
baumannii,MRSA,VRE
50%ofoutbreakswerecaused
byESBL-producing
K.pneumoniae.
Sourceseldomidentified;mostoutbreakshadbreachesinIPpractices.
Outbreakscontainedwith:stringenttransmission-basedprecautions,
staff/parenteducation,andchangestoclinicalpractices.
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Hospital–acquired
pneumonia
(HAP)
Bloodstreaminfection
(BSI)
Urinarytractinfection
(UTI)
Surgicalsiteinfection
(SSI)
Device-associatedinfection
Others:ENT
GastroBone/joint
HAIpointprevalencestudiesinAfrica:
- HAIprevalence10– 19%- Profileofpaediatric infectionsdiffers- HAP,BSIandUTIpredominate- Lessfocusondevice-associated
infections- Verylimitedevidencebase– more
researchneeded!
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Paediatric HA-BSI:
Aiken(Kenya) 1.0/1000patientdays(PD)Dramowski(S.Africa) 1.6/1000PD
NeonatalHA-BSI:
Maoulainine (Morocco) 18/1000PDGadallah (Egypt) 14/1000PDBallot(S.Africa) 14/1000PDSpicer(S.Africa) 7/1000PDDramowski(S.Africa) 4/1000PDLandre-Peigne (Senegal) 3/1000PD
Mortalityvariesbystudy20– >70%
Hospital-acquiredbloodstreaminfections(BSI) 14
InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Device-associatedinfectionsinLMICcountries 18
InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Tygerbergpaediatric HAIprevalencevsEuropeanCDC
24.1%(95%CI21.9-26.5%)296childrenwith417healthcare-associatedinfections
TygerbergZA
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Healthsystemimpact
Directcosts* Hospitalizationdays
Antimicrobialuse
Laboratoryinvestigations
HAP,BSI,UTI,SSI
=R5.6million
Extrapolationtoall
TCHwardsannually
=R60million
2275excessdays
overcrowding
inabilitytoadmit
pathogenreservoir
2365excessRxdays
95%ofHAIevents=
newantimicrobial/s
prescription
61%carbapenems
3575excesstests
*Costcalculation=#HAIeventsxmedianexcessstayxunitcostperpatientday(fixed+variablecosts:laboratory,radiology,pharmacy)
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Proportionalutilizationofisolationbed-days
*missedisolation=laboratoryidentificationofpathogensrequiringisolation butpatientnotisolated
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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Source:http://www.slideshare.net/WCETConference2010/the-tip-of-the-iceberg-10009379?related=1
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WhatisknownaboutpaediatricandneonatalHAIinAfrica
Whatisyettoberesearched!
HAI
InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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InfectionPreventionForHospitalizedChildrenandNeonatesinAfricaDr. AngelaDramowski,StellenboschUniversity,CapeTown,SouthAfrica
AWebberTrainingTeleclass
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