Prevention of Nosocomial Infections (CleanKids)
Condition: Severe Acute Malnutrition; Health Care Associated Infection; Multi Drug Resistant Organisms
MeSH terms: Infections; Communicable Diseases; Cross Infection; Malnutrition; Severe Acute Malnutrition
Study type: Interventional

Summary: 
      While the standardization of treatment protocols for Severe Acute Malnutrition (SAM) has
      helped to reduce historically high mortality, mortality in inpatient settings remains
      substantial, likely due to the severity of complications associated with late presentation
      and health-care associated infection (HCAI).

      The purpose of this study is to serve as an important stand-alone description to inform the
      understanding of the magnitude of the problem and help guide implementation of measures to
      reduce the risk of nosocomial infection and multi-drug resistance.
    

Detailed description: 
      This study is designed as a cross-sectional, non-randomized, two-site, four-phase study: an
      initial baseline period, two intervention periods, and a final interruption period.

      This is a descriptive study to collect information on the risk of HCAIs in the MSF-supported
      inpatient nutritional treatment centers. Information on key clinical indicators will be
      collected regularly according to the routine program procedures from the time of admission to
      discharge. All children will undergo a blood draw for culture at time of admission and at the
      time of any suspected hospital-acquired bloodstream infection. As part of active surveillance
      for bacterial colonization, including multi-drug resistant organisms, all children will
      undergo nasal and rectal swabs at the time of admission, suspected infection, and discharge.
      Data will provide an estimate of nosocomial infection incidence under routine circumstances
      and inform sample size calculations if further study is warranted.
    

Intervention name(s): Health-care associated infection (HCAI)
Intervention type(s): Other
Intervention description(s): Cleaning of the child with soap and water administered by the child's accompanying person in a structure or - a cleaning of the child with chlorhexidine gluconate administered by the child's accompanying person in the other structure
Intervention model: Single Group Assignment
Intervention model description: The initial 8-month baseline period will be used to collect data on the evaluation criteria of interest prior to the administration of any intervention of the study and will develop appropriate pedagogical tools to support the uptake of each cleaning strategy during subsequent intervention periods. After the reference period, a one-month introductory period will allow the organization of the first intervention at each site (ie - a soap and water cleansing administered by the carers in a structure or - a cleaning HCG administered by caregivers in the other facility) followed by eight months of active follow-up of the study with the first intervention. Following the eight months of active follow-up with the first intervention, there will be a crossover with an introductory period of one month and eight months of active follow-up with the other intervention. A final period of interruption will occur during the last eight months of the study.
Masking: None (Open Label)
Primary purpose: Prevention