Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements).
Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively.
3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection, (3) Case management, and Implementation (3 + I). The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control.
Evidence before this study
Health care-associated infections (HCAI) are a major cause of neonatal morbidity and mortality in low- and middle-income countries (LMIC) and of increasing concern owing to their associated antimicrobial resistance. Infection prevention and care bundles have expanded to neonatal care settings and proven effective in reducing HCAI. Consequently, the creation of a Classification Framework for the care bundles’ components (elements) will provide a basis for a uniform nomenclature for the creation of future care bundles. EMBASE, Pubmed, Global Health, CINAHL, and Web of Science were searched for studies published between January 2001 and July 2020 with the search terms: “neonate”, “care bundles”, “health care-associated infections”, and “low- and middle-income countries”.
Added value of this study
This is the first scoping review synthesising all published literature on neonatal infection prevention and care bundles addressing HCAI in LMIC. From 56 bundles 295 individual elements were identified. A novel 3 + I Classification Framework was created into which these elements were classified, covering: (1) Primary prevention, (2) Detection, (3) Case management + Implementation (3 + I). Almost half the bundle elements were for infection primary prevention, notably targeting central line catheters and mechanical ventilators. Importantly we found almost a total lack of elements aimed at HCAI detection. Case management elements focused on the supportive care of neonates with HCAI were scarce.