Abstract
Background: Hospital-acquired infections (HAIs) remain a leading cause of mortality and morbidity among preterm infants in neonatal intensive care units (NICUs). Evidence regarding the effectiveness of multifaceted infection prevention bundles in reducing these adverse outcomes, particularly in resource-limited settings, remains limited.
Objective: To evaluate the impact of a comprehensive infection prevention bundle on HAI incidence, neonatal mortality, and major morbidity among preterm infants admitted to a tertiary NICU.
Methods: This prospective observational study included 1042 neonates was conducted in the Neonatal Intensive Care Unit (NICU) of Al-Azhar University Hospital during the study period. The study included two groups as Group (I): included 487 neonates pre-intervention group and Group (II): included 555 neonates post-intervention group.
Results: Overall, HAI incidence decreased significantly from 20.1% to 12.1% (adjusted OR 0.52; 95% CI: 0.36–0.75; P < 0.001). CLABSI rates declined by 61.9% (IRR 0.38; P < 0.001), ventilator-associated pneumonia by 54.0% (IRR 0.46; P < 0.001), and late-onset sepsis by 50.0% (IRR 0.50; P = 0.006). Neonatal mortality decreased from 10.7% to 6.8% (adjusted OR 0.58; 95% CI: 0.37–0.91; P = 0.028). Compliance with all 13 infection prevention indicators improved significantly (all P < 0.001), with absolute gains ranging from 18.4 to 55.7 percentage points. HAI was independently associated with moderate-to-severe BPD (OR 2.01), severe IVH (OR 1.84), and NEC ≥ Stage II (OR 2.14). In multivariate analysis, HAI was the strongest predictor of the composite outcome of death or severe morbidity (OR 3.24; 95% CI: 2.08–5.05; P < 0.001), while the post-intervention period was independently protective (OR 0.62; P = 0.024).
Conclusion: Implementation of a comprehensive, multifaceted infection prevention bundle significantly reduced HAI incidence, device-associated infection rates, and neonatal mortality among preterm infants. These findings support the integration of structured infection prevention protocols as a standard of care in NICUs and underscore the critical role of primary prevention in improving outcomes for vulnerable preterm neonates.