A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaemia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.
PIP: From January 1, 1986 to December 31, 1991, data were collected on neonatal septicemia at the Maternity Hospital, Kuala Lumpur, Malaysia, to monitor the trend of the infection and to determine whether any remedial steps reduced the infection rate. Of the 155,935 live births during this period, 8.8% were admitted to the special care nursery (SCN). Septicemia accounted for 5.2-10.2/100 admissions. 392 neonates (2.5/1000 live births) died from bacteriologically proven septicemia during this period, accounting for 11% (1991) to 30.4% (1989) of all neonatal deaths. Case rates of septicemia were highest in the very low birth weight babies who constituted 28.2% of the septicemia cases (low birth weight babies constituted 55.5%). During 1986 and the early part of 1987, disposable endotracheal tubes and mucus extraction suction catheters were reused in the labor rooms and the SCN after being soaked in Hibitane, and there were only 3 mucus suction systems available in the SCN. Septicemia outbreaks reduced in late 1987 after 4 new mucus suction systems were acquired, and the practice of reusing disposables was abandoned. During 1989, constant use of the mucus suction apparatus caused frequent breakdowns, and the water supply for hand washing was interrupted frequently; therefore, septicemia increased again. A reduction was accomplished in 1991 with the establishment of a regular water supply, disposable hand towels, and the purchase of new suction systems. Thus, the varying annual septicemia rates in the SCN ran parallel to the availability of infection control facilities. Staphylococcus epidermidis and staphylococcus aureus were the most common causative organisms in 1986 and 1987, and the Klebsiella series became the most common after 1988. More than half of the neonatal septicemia occurred after the age of 2 days; the low birth weight babies who remained in the SCN the longest were the most susceptible. This study shows that simple control measures can be very effective in reducing the incidence of septicemia.