Strengthening Antibiotics Stewardship At Mowbray Maternity – Neonatal Unit

Mkony, Martha

Strengthening Antibiotics Stewardship At Mowbray Maternity – Neonatal Unit

Thesis / Dissertation

2023

Abstract

Objective To assess antimicrobial usage, prescription practices, sensitivity patterns, hand hygiene (HH) practices and adherence to antibiotic stewardship principles in the neonatal unit at Mowbray Maternity Hospital (MMH). Study design: Mixed method observational study was done at MMH. A point of prevalence survey to assess antibiotic stewardship and HH audits were conducted using the WHO tools in two phases, a baseline in December 2020 and post-intervention from March to May 2021. Results: 246 Neonatal unit patient folders were reviewed between December 2020 and May 2021. At baseline, compliance with treatment guidelines was 90% which improved to 100% post-intervention. We found 37(15.0%) babies were on antibiotics, with 64.9 % of those on first-line antibiotics (Access group). Using multivariate logistic regression, extremely preterm infants were more likely to be on antibiotics with an odds ratio of 11, which was statistically significant. We found eight organisms (18.9%), which included one Carbapenem-resistant enterococci -Klebsiella pneumoniae. For HH, a total of 444 opportunities were observed. Moment 5 had the lowest overall mean compliance of (57.4%), which was statistically significant with a p-value =0.0172. The overall HH compliance was 83.7% at baseline and 80.9% post-intervention; however, this was not statistically significant (p-value = 0.909). Conclusion: Strict adherence to treatment guidelines and good HH are essential factors for the good antibiotic stewardship seen at the MMH neonatal unit. This was reflected by low antibiotic usage, good HH compliance and low HAI rate. Further improvement requires ongoing HH audits and training, especially focusing on HH moment 5, after touching the patient's surroundings.

Keywords

Neonatology

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