Background : In 2022, a study in the maternity and neonatology units of Franceville Hospital revealed high risk of carbapenemase-producing Enterobacterales (CPE) acquisition in parturients and newborns potentially linked to suboptimal hand hygiene (HH) compliance, environmental contamination, and extensive use of broad-spectrum antibiotics in newborns. To address this, a three-pronged intervention-HH promotion via hand rubbing, sink trap replacement, and restricted antibiotic use-was implemented.Methods We conducted a prospective post-intervention study. HH compliance was assessed in February 2023, before the intervention. From July to September 2023, HH compliance, CPE carriage in parturients and newborns, neonatal infections, environmental contamination, and antibiotic use were evaluated post-intervention. The impact on asymptomatic CPE carriage in parturients and newborns, neonatal CPE infections, and environmental contamination was assessed by comparing post-intervention results with pre-intervention data from 2022.

Results : HH compliance improved significantly (2.9% vs. 70.6%; p < 0.001), and neonatal antibiotic use declined (74.9% vs. 15.3%, p < 0.001). ESBLE carriage rates decreased among parturients, (15.8% vs. 40.1%; p < 0.001), and among newborns (0.5% vs. 5.4%; p = 0.007). CPE carriage rates decreased among parturients (4.6% vs. 1.0%; p = 0.059). No neonatal CPE infections occurred post-intervention. Despite sink trap replacement, contamination persisted. Genomic analysis of CPE strains suggested reduced parturient-to-parturient transmission and CPE acquisition from the environment.

Conclusions : Our findings suggest a reduction in the risk of CPE acquisition among parturients and neonates after implementing the intervention. Our findings strongly support the need for sustained HCW training, ensuring the availability of hand rub solutions, and campaigns promoting proper HH practices and rational antibiotic use to prevent nosocomial infections caused by hypervirulent CPE clones circulating in Gabon.