الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
Neonates admitted to the NICU are at a risk of developing healthcare- associated infections (HCAIs) which are either of EOS or LOS. Developing countries, including Egypt, account for the majority of reported worldwide neonatal deaths. The risk for LOS increases with decreasing gestational age and birth weight and excessive use of invasive medical devices. Healthcare environment can provide a source of pathogens, either by indirect transmission on the hands of healthcare workers (HCWs) or by direct transfer from environmental contamination.
The present cross sectional study was carried out over a period of 4 months from January through April 2018. The study was carried out at NICU of Elshatby University Hospital, Alexandria.
The study aimed to:
1. Isolate and identify organisms causing health care associated infections in neonates with identification of their antibiotic resistance.
2. Assess possible risk factors associated with neonatal infections.
3. Isolate and identify organisms from the environment and surroundings.
4. Identify the relatedness of isolates from environment, HCW hands and neonates.
5. To design and implement hand hygiene interventional training program.
6. To assess the state of hand hygiene compliance of health care workers before and after an educational program.
7. To assess the infection rate before and after implementation of hand hygiene program.
This study was across 3 phases. The first (pre-interventional) phase was over a period of one month, and was conducted as a baseline for evaluation of HCWs hand hygiene compliance, environmental microbial contamination and neonatal HCAIs. The second (interventional) phase was also over a period of one month and aimed at the implementation of hand hygiene multimodal intervention program among HCWs.The third (post- interventional) phase lasted for 2 months and was conducted to evaluate the impact of the hand hygiene multimodal intervention program on the HCWs hand hygiene compliance, environmental contamination and rate of neonatal HCAI.
Throughout the three phases, neonatal and environmental samples were collected and their bacterial isolates were identified. Moreover, fingerprinting of HCWs (physicians and nurses) was done in the second phasebefore and after using soap and ABHR.
The role of the environment and HCWs in propagating infections in the NICU setting was also evaluated by comparing the genotypes of their microbial isolates to those isolated from neonates.
The results of this study revealed that:
1. Gram negative bacteria were the most prevalent microorganisms (47.3%) and comprised mainly of K. pneumoniae(32.6%) followed by Candida spp. which was the second commonest group (28.4%). among the total neonatal infection isolates.
2. The relative risk (RR) of death among those with positive cultures was 1.84 times that among those with negative cultures.
3. There was no statistically significant difference in colony count of hands (of either physicians or nurses) before versus after soap and ABHR use.
4. There was no difference in the distribution of bacteria from hands of physicians and nurses.
5. There was a significant improvement between pre-test versus post-test scores among both physicians and nurses (p=0.046).
6. Interventional hand hygiene program improved the knowledge of the HCWS and thus improving their hand hygiene compliance rate (compliance rate increased from 44% to 63%).
7. Higher hand hygiene compliance rate improvement was achieved by the physicians (from 28% to 71%) compared to the nurses (from 50% to 54%).
8. The rate of respiratory infections was markedly changed over the 3 phases, with particular decrease between the pre- and post-interventional (from 70.6% to 27.6%) (p=0.009).
9. Out of the total 330 environmental samples, 77% showed no growth while 23% were culture positive.
10. Similar bacterial isolates were identified from different sources (neonates, environment and hands of HCWs) emphasizing the role of environment and hands of HCWs in transmitting infection to neonates in NICUs.
11. Forty nine percent of the total neonatal isolates were MDR.
12. Gentamycin and Cefoperazone which areroutinely used in the protocol of this unit, showed poor results against K. pneumoniae, Acinetobacter and MRSA.
It can be concluded from this study that:
1. K. pneumoniaeand Candida spp. were the commonest pathogens isolated from neonates at the NICU.
2. The environment and hands of HCWs may play an important role in transmitting infection to neonates.
3. Knowledge and compliance to infection control measures improved after implementing a multimodal interventional program.
4. The antimicrobial protocol of the unit should be reconsidered to replace the antibiotics routinely used with other effective drugs.
from the results of the present study, the following recommendations are suggested:
1. Continuous supply of resources as alcohol and disinfectants should be provided in every setting in the NICU.
2. Periodic surveillance for nosocomial microorganisms.
3. Continuous Multimodal Educational programs are recommended for overcoming obstacles that lead to improper compliance to infection control measures.
4. Further studies should be done on the effect of ABHR on transient and resident flora of the hands.
5. Higher sample size is recommended in tracking the source of infection across the environment, HCWs and neonates.
6. Future studies to elaborate on the role of the inanimate environment must include measures of when the environment was contaminated and patients acquired organisms; where the patients were located during acquisition, with respect to contaminated rooms; and how well hand hygiene and environmental cleaning were practiced.
7. Adopting proper antimicrobial stewardship to reduce the inappropriate use of antibiotics.