Routine blood cultures are critical to improving infection surveillance in newborn and neonate units, experts say.
According to microbiologists and infectious disease specialists’, newborn units contribute to a lot of antimicrobial resistance especially Klebsiella which is resistant to up to 70 percent of antibiotics we use in the country.
The experts cite frequency of outbreaks in neonatal units to be higher due to overcrowding, understaffing, and the sharing and reuse of equipment.
However, despite of these risk factors, identification of the resistant bugs is hindered by limited microbiology laboratory access, an absence of Healthcare-Associated Infection (HCAI) surveillance programs and infection prevention resources.
This happens in the back drop of a fact that neonatal sepsis is one of the major cause of neonatal morbidity and mortality and accounts for nearly half of all the neonatal deaths.
“With our data showing that neonatal mortality is still high caused by prematurity, prenatal asphyxia and sepsis, we need to act to break the chain of newborn unit infections,” the experts observed.
According to Dr Loice Achieng Ombajo, an Infectious Disease specialist, approaches to neonatal sepsis management incorporate a combination of measures beyond technology and include clinical suspicion, coordination between laboratory staff and healthcare providers, robust infection control, and strong antimicrobial stewardship.
She says that newborn care units should invest in microbiology diagnostics to help them to get a better understanding of the kind of infections they are seeing in newborns in hospitals, the bugs causing them, and the treatments that are being used.
“We should use culture and sensitivity test to help us in prudent use of antibiotics and therefore we need to invest in microbiology diagnostics,” Dr Ombajo said.
While Dr Emmanuel Tanui, National AMR Focal Point, Ministry of Health the infection in hospital environment can be better managed by simple things such as hand hygiene, sterilization of equipment’s proper cleaning, disinfection and sterilization and ensure environment cleanliness.
He adds that apart from early detection and correct treatment of microorganisms by rational use of antibiotics it is also important to sensitize everyone in the hospital environment from the cleaners, mothers and healthcare workers the importance of hygiene.
“We need to sensitize the mothers, cleaners’ healthcare workers and everyone in the hospital setting that they should wash their hands before handling babies, before and after breastfeeding and also sensitize the cleaning staff and healthcare workers how to decontaminate equipment’s and medical devices if they require cleaning, cleaning and disinfection and or cleaning and sterilization.”
He added “The hospitals should also sensitize everyone on waste management and the importance of segregating wastes according to type.”
According to Prof Gunturu Revathi, Section Head of Clinical Microbiology, Department of Pathology, Aga Khan University Medical College, East Africa, neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life early-onset neonatal sepsis or late-onset neonatal sepsis.
“The early onset sepsis transmitted vertically as it is acquired from the mother or mother colonized by gut or vaginal flora and late onset sepsis transmitted horizontally from the community and or a hospital environment,” she said adding that, “We are also seeing sepsis from postmortem of still birth babies from an ongoing study we are conducting in western Kenya and the mother has to be the source and uterus may have acquired organism in sterile environment in the uterus.”
She added that for late onset sepsis the solution is very simple prevent infections by practicing absolute hygiene safe and clean birth practices, hand hygiene, umbilical cord care, early exclusive breastfeeding, and disinfection of equipment observing one meter distancing and not sharing cots, and the surrounding clinical environment like good ventilation in NBU, breaches of these protocols will cause late onset sepsis, she explained.
With the early onset sepsis, the mothers especially those who exhibit fever less than 38 degrees Celsius had PROM more than 18 hours and have foul smelling liquor can be given a prophylaxis of one shot of a simple antibiotic crystalline penicillin and gentamycin but with the AMR era this is complicated because the mother’s birth canal is harboring resistant microbials so the baby can pick up resistant bugs, which can be monitored through antimicrobial stewardship and swabbing the mothers birth canal for resistant bugs.
While Dr Hillary Kagwa AMR focal person Kiambu County said that counties should invest in AMR by incorporating its budget in the County Integrated Development Plan (CIDP).
The experts were speaking at an event to mark world Antimicrobial Awareness week which is observed every year from 18th to 24th November every year to raise awareness and understanding of AMR and promote best practices among One Health stakeholders to reduce the emergence and spread of drug-resistant infections.
