Reducing Infections Among Women Undergoing Cesarean Section in Colombia by Means of Continuous Quality Improvement Methods

Weinberg, Michelle; Fuentes, J. M.; Ruiz, A.; Lozano, Fred Wilson; Angel, Edith; Gaitán, Hernando; Goethe, Brunhilde; Parra, S. Pérez; Hellerstein, Susan; Ross‐Degnan, Dennis; Goldmann, Donald A.; Huskins, W. Charles

doi:10.1001/archinte.161.19.2357

Cited by 81 publications

(72 citation statements)

References 41 publications

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“…Patients who received antibiotics 2 hours before surgery were found to be less prone to SSI as compared to those who did not receive it in a timely fashion. This association was found to be statistically significant which is in accordance with other studies [23,26,27].…”

Section: Discussionsupporting

confidence: 93%

Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section

Saxena

Mehta

et al. 2013

International Journal of Antibiotics

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Background. Lower segment caesarean section (LSCS) is a common mode of delivery now and surgical site infection is the second most common infectious complication in these patients. This study was planned with this background to have a comprehensive approach to SSI following LSCS. Methods. 500 consecutive patients undergoing LSCS, irrespective of indication, were studied. A questionnaire was developed to assess the risk factors associated with development of SSI. All patients were followed up from day one of surgery till discharge and then up till the postoperative day 30 after discharge. Results. SSI was identified in 121 (24.2%) out of 500 patients. In all age groups, Gram-negative bacilli were the commonest finding. The commonest isolate was Acinetobacter species (32.03%) followed by Staphylococcus aureus and coagulase negative Staphylococcus (21.09%). 23.8% of Staphylococcus aureus strains were MRSA. By multivariate logistic regression premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be significant. Conclusions. A proper assessment of risk factors that predispose to SSI and their modification may help in reduction of SSI rates. Also, frequent antimicrobial audit and qualitative research could give an insight into the current antibiotic prescription practices and the factors affecting these practices.

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Section: Discussionsupporting

confidence: 93%

Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section

Saxena

Mehta

et al. 2013

International Journal of Antibiotics

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“…This process can create an environment that is conducive for implementing a quality improvement plan and for building teamwork. [19][20][21] Third, the introduction of selfevaluation checklists, in general, can improve compliance with best clinical practice. 22 And finally, the HBB QIC progress boards placed in each unit provided a constant reminder to the staff of the quality improvement effort.…”

Section: Discussionmentioning

confidence: 99%

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

et al. 2016

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BACKGROUND AND OBJECTIVE: Newborns are at the highest risk of dying around the time of birth, due to intrapartum-related complications. Our study’s objective was to improve adherence to the Helping Babies Breathe (HBB) neonatal resuscitation protocol and reduce perinatal mortality by using a quality improvement cycle (QIC) in a tertiary hospital in Nepal. METHODS: The HBB QIC was implemented through a multifaceted approach, including the formation of quality improvement teams; development of quality improvement goals, objectives, and standards; HBB protocol training; weekly review meetings; daily skill checks; use of self-evaluation checklists; and refresher training. A cohort design, including a nested case-control study was used to measure changes in clinical outcomes and adherence to the resuscitation protocol through video recording, before and after implementation of the QIC. RESULTS: The intrapartum stillbirth rate decreased from 9.0 to 3.2 per thousand deliveries, and first-day mortality from 5.2 to 1.9 per thousand live births after intervention, demonstrating a reduction of approximately half in the odds of intrapartum stillbirth (adjusted odds ratio [OR] 0.46, 95% confidence interval [CI] 0.32–0.66) and first-day mortality (adjusted OR 0.51, 95% CI 0.31–0.83). After intervention, the odds of inappropriate use of suction and stimulation decreased by 87% (OR 0.13, 95% CI 0.09–0.17) and 62% (OR 0.38, 95% CI 0.29–0.49), respectively. Before intervention, none of the infants received bag-and-mask ventilation within 1 minute of birth, compared with 83.9% of infants after. CONCLUSIONS: The HBB QIC reduced intrapartum stillbirth and first-day neonatal mortality and led to use of suctioning and stimulation more frequently. The HBB QIC requires further testing in primary settings across Nepal.

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“…It has been widely studied in obstetrics and has shown to be effective in reducing postoperative puerperal morbidity after Caesarean section [10]. Nevertheless, surveys suggest inconsistent and variable application of recommendations for its use [11]. Moreover, widespread use of antibiotics may contribute to the development of antibiotic-resistant bacteria as well as adverse reactions such as rash or antibiotic-related diarrhea [10].…”

Section: Introductionmentioning

confidence: 99%

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

et al. 2009

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In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.

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Reducing Infections Among Women Undergoing Cesarean Section in Colombia by Means of Continuous Quality Improvement Methods

Abstract: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

Cited by 81 publications

References 41 publications

Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section

Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section

Reducing Perinatal Mortality in Nepal Using Helping Babies Breathe

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

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