Optimizing Accessibility of a Hand-Wash Gel to Infant's Cradle: Effect on Neonatal Conjunctivitis.

BACKGROUND: In our recent study in 2015, we showed a significant relationship between increased rate of clinical neonatal conjunctivitis (CNC) and performance of eye red reflex (RR) examination. Our study aim was to assess whether improved accessibility of staff to disinfectant gel (via attaching the gel bottle to infant's cradle) will increase the caring staff compliance with hand hygiene and decrease the rate of CNC.

METHODS: Our intervention included attaching bottles of alcohol-based gel to newborns' cradles to insure full availability and accessibility of hand-wash disinfectant. We included all newborn infants who were born beyond 35 weeks' gestation and stayed in the well-baby nursery. We compared two periods: pre-intervention period (n=9380) vs. an intervention period (n=8087). Three variables were recorded: (a) rate of CNC: number of conjunctival swabs sampled /1000 newborns whenever an eye discharge was noted, (b) rate of bacterial conjunctivitis: number of positive swabs/1000 newborns, (c) percentage of positive swabs out of all sampled swabs.

RESULTS: Compared to pre-intervention period, the rate of CNC dropped significantly during the intervention period: 28.6/1,000 vs. 21.3/1,000, respectively, p<0.01. However, the number of positive bacterial swabs/1000 newborns (3.2 vs. 2.5) and the percentage of positive bacterial swabs of all sent samples (11.6% vs. 10.8%) were not different between the two periods. The majority of pathogens in swabs were gram-negative sp. without difference between study periods (77.4% versus 80%), respectively. Univariate analysis showed significant association between rate of CNC and longer length of stay> 5days (p<0.001) and vaginal delivery (VD). Logistic stepwise regression analysis showed that 4 variables were significantly and independently associated with higher rate of clinical conjunctivitis. These include birth during pre-intervention period (p=0.018, OR 1.27, 95% CI 1.04-1.54), length of stay 4-5 days (p<0.001, OR 2.23 CI 1.63-3.06), length of stay > 7 days (p<0.001, OR 6.51 CI 4.24-10.02), vaginal delivery (p=0.004, OR 1.6 CI 1.17-2.2) and male gender (p=0.006, OR 1.31 CI 1.08-1.59).

CONCLUSIONS: Accessibility of a disinfectant gel within each newborn's cradle raised hygiene awareness among the caring staff and contributed to reduction of CNC rate in the newborn nursery.