article · Antimicrobial Resistance and Infection Control
A hospital-based joint programme combining infection prevention and control with antimicrobial stewardship was implemented in the obstetrics and gynaecology department of a Tanzanian tertiary hospital. The intervention comprised staff training on infection control together with evidence-based education on antimicrobial resistance and good prescribing practices. Following the intervention, pre-operative antibiotic prophylaxis administration rose from 2 percent to 98 percent. The proportion of caesarean deliveries performed by qualified operators increased, as did the adoption of Pfannenstiel skin incisions and absorbable continuous intradermic sutures. Overall, post-caesarean surgical site infections declined significantly from 48 percent prior to the programme to 17 percent after implementation. Post-intervention testing also recorded a low prevalence of gram-positive bacterial isolates and methicillin-resistant Staphylococcus aureus.
Surgical site infections are a major source of illness and mortality following caesarean deliveries, especially in low- and middle-income countries. Demonstrating that combined infection control and prescribing education significantly reduces infections provides hospital administrators and maternity units with a practical approach to improving maternal health outcomes and tackling drug resistance in resource-limited settings.
The findings represent an applied and tested hospital workflow intervention rather than a manufactured product. The training materials, clinical protocols, and surgical practice guidelines could be packaged by healthcare consultants, non-governmental organisations, or public health bodies into operational quality-improvement toolkits for adoption across resource-constrained maternity departments.
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BACKGROUND: Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control with antimicrobial stewardship joint program would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital. METHODS: The intervention included: 1. formal and on-job trainings on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was post-caesarean section surgical site infections prevalence and secondary outcome the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were ascertained. RESULTS: Total 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p < 0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p = 0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p < 0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p < 0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention and 95 (17%) in the post intervention group (p < 0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey. CONCLUSIONS: Further researches are needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.
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DOI: 10.1186/s13756-020-00740-7
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