Reducing obstetrical infections in colombian hospitals using Quality Improvement (QI) methods

Infection is a major complication of childbirth in developing countries. Hospital care processes that affect the risk of infection are often not optimal, but improvement is viewed as extremely difficult given Limited resources. Challenging this perception, we used QI methods to achieve sustained improvements in obstetrical care processes with existing resources in two non-profit hospitals in Colombia. Multidisciplinary teams were given "just-in-time" basic training in rapid cycle QI methods. They used cause-effect diagrams and priority matrices to focus initially on administration of perioperative antimicrobial prophylaxis (PAP) in cesarean section (CS). Flowcharts of existing systems targeted areas for changes. At HSB, data for a 3 month pre- and a 10 month post-intervention period showed the % of CS receiving PAP increased from 70% to 96% (X², p < 0.001) and receipt of PAP within 1 hour of delivery increased from 31% to 87% (X², p < 0.001). Rates of post-CS endometritis decreased from 4.1 to 0.8 (Fisher exact test, p = 0.002) and surgical site infection decreased from 6.2 to 1.4 (X², p < 0.001). Increased utilization and timely receipt of PAP were associated with decreased overall infection rates (multiple linear regression, R² = 0.60, p = 0.011). At IMI, data for a 3 month pre-intervention period and two periods (8 & 4 months) after separate interventions showed the % of high-risk CS receiving PAP increased from 32% to 53% to 82% (X², p < 0.001) and receipt of PAP within 1 hour of delivery increased from 70% to 79% to 92% (X², p < 0.001). Infection rates at IMI did not change significantly. QI methods identified areas where improvement in the administration of PAP were critically needed, achievable, and sustainable, despite limited resources. These methods can be used to optimize other care processes to improve patient outcomes in hospitals with limited resources.