1. BCA at a glance
2. Lessons from Adult BCA
3. Why focus on the newborn
4. BCA for the newborn

3
1.Healthcare
Associated
Infections
3.BCA…for the newborn
2.Antimicrobial
Stewardship

10 LESSONS FROM ADULT BCA

5

6

7

8

9

1
0

1
1

1
2

1
3

10.
EATING THE ELEPHANT ONE BITE AT A
TIME

Why focus on the newborn?

Determinants of Infant Mortality
0thers
30%
Neonatal
31%
LRTI
17%
Diarrhoea
22%
16

Congential
Abnormalities
14%
Determinants of Neonatal Deaths
Prematurity
Sepsis
25%
Birth Asphyxia
25%
38%
17

• Neonatal Sepsis
• Chronic Lung Disease
• Necrotising Enterocolitis
• Periventricular-Intraventricular
Haemorrhage
• Retinopathy of Prematurity

1.Screening bundle
2.Drivers of
Mortality &
Morbidity
3. Sepsis bundle

1. Antenatal steroid compliance
2. HIV screening
3. HIV PMTCT compliance
4. Syphilis screening
5. Early NCPAP compliance
6. Cranial Ultrasound compliance
7. Retinal exam compliance
8. Caesarean section rate

CLD
PIH
NEC
DRIVERS OF
MORBIDITY &
MORTALITY
ROP

• Early Bacterial Sepsis (EBS)
 Vertical transmission
 Within 72 hours of birth
• Late Onset Infections (LOI)
 Healthcare Associated Infection
 Bacteria, fungal or viral
 After 72 hours of birth

Screening bundle
Data
Collection
M & M drivers
Bundles EBS
Obstetric
Sepsis
Surveillance
LO I
ICP &
CLABSI bundle

RETINOPATHY OF PREMATURITY
ROP

ROP BUNDLE
1.
Pulse oximetry on an infant receiving oxygen.
2.
Saturation probe to be placed on the Right or Left hand.
3.
Saturation aimed at 86-92%
4.
Monitor alarm to be set at 85
(low) and 93 (high).
5.
Fundoscopy screening done or booked before discharge.
ROP

CHRONIC LUNG DISEASE

CLD BUNDLE
1.
Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2.
Neopuff use in neonatal resuscitation.
3.
Gentle ventilation (NCPAP) vs
(HFO) vs (CV).
4.
Permissive hypercapnia of more than 45mmHg.
5.
Administration of systemic steroids to the infant to prevent or treat CLD.
CLD

NECROTISING ENTEROCOLITIS

NEC BUNDLE
1.
Breastmilk or pasteurised EBM as a modality of feeding.
2.
Trophic feeds within 24 hours of birth.
3.
Adherence to “volume per day” protocol.
4.
Adherence to “frequency of feeds” protocol.
NEC

PERIVENTRICULAR-INTRAVENTRICULAR
HAEMORRHAGE

PIH BUNDLE
1.
Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.
2.
Delayed cord clamping for 45 seconds to a minute.
3.
Neopuff use in neonatal resuscitation.
4.
Maintain infant temperature to more than 36 degrees Celsius.
5.
Developmental care: dim lights, low levels of noise and minimal handling.
PIH