Strengthening Antibiotics Stewardship at Mowbray Maternity Hospital– Neonatal Unit.

Abstract Objective To assess antimicrobial usage, prescription practices, sensitivity patterns, hand hygiene (HH) practices and adherence to antibiotic stewardship principles in the neonatal unit at Mowbray Maternity Hospital (MMH). Study design: A mixed method observational study was performed at MMH. A point of prevalence survey to assess antibiotic stewardship and HH audits was conducted using the WHO tools in two phases, a baseline in December 2020. The findings of this baseline audit were presented to the Health Care Workers (HCW) and small-group HH training was done with all HCWs (day- and night-shift), representing the intervention. This was followed by a post-intervention audit from March to May 2021. Results: A total of 246 neonatal unit patient folders were reviewed between December 2020 and May 2021. At baseline, compliance with treatment guidelines was 90%, which improved to 100% postintervention. We found that 37 (15.0%) babies were on antibiotics, with 64.9% of those on first-line antibiotics (Access group). Using multivariate logistic regression, extremely preterm infants were more likely to be on antibiotics, with an odds ratio of 11, which was statistically significant. We found eight positive blood cultures (18.9%), which included one carbapenem-resistant enterococci, Klebsiella pneumoniae. For HH, a total of 444 opportunities were observed. Moment 5 had the lowest overall mean compliance of 57.4%, which was statistically significant with a p-value =0.0172. Conclusion: Strict adherence to treatment guidelines and good HH are essential factors for the good antibiotic stewardship seen at the MMH neonatal unit. This was reflected by low antibiotic usage, good HH compliance and a low HAI rate. Further improvement requires ongoing HH audits and training, especially focusing on HH moment 5, after touching the patient's surroundings.