Evidence-based interventions to reduce obstetric-related infections at an army training facility - 23/04/19
Abstract |
Background |
Objective |
Obstetric-related infections are a major cause of maternal morbidity and mortality worldwide. Our team implemented an evidence-based infection control bundle aimed at reducing obstetric-related infections at our facility.
Methods |
A multidisciplinary team at Tripler Army Medical Center developed, implemented, and evaluated an evidence-based maternal safety infection control bundle (MSICB) on labor and delivery aimed at reducing the incidence of surgical site infections (SSI) and chorioamnionitis. Adenosine triphosphate testing of patient care–related surfaces was performed while behavioral and environmental interventions were implemented. Incidence rates for chorioamnionitis, SSI, and endometritis were compared between pre- and during-MSICB implementation using Fisher exact test and Poisson regression, adjusting for year and quarter. The decision science analysts at US Army Medical Command, Fort Sam Houston, Texas responsible for our facility utilized diagnosis-related group and ICD-10 Procedure Coding to determine infection-related costs.
Results |
Prior to implementation of the MSICB, the rates of chorioamnionitis, SSI, and endometritis in the first half of 2016 were 6.3%, 3.4%, and 0.4%, respectively. After implementation of the MSICB, in the first 6 months of 2017, the rates of chorioamnionitis and SSI decreased to 1.7% and 1.0%, respectively, with no change in the rate of endometritis. The rate was significantly lower after implementation for chorioamnionitis (P < .001), and there was a statistically nonsignificant decrease for SSI (P = .060) and no difference for postpartum endometritis (P = 1.00). These reductions resulted in an estimated net cost savings of $671,218.
Conclusions |
A multidisciplinary approach with evidence-based strategies resulted in a significant decrease (P < .001) in chorioamnionitis and a statistically nonsignificant decrease (P = .060) in the SSI rate, which resulted in a significant cost savings for the hospital. There was no change in our postpartum endometritis rate.
Le texte complet de cet article est disponible en PDF.Key Words : Chorioamnionitis, Endometritis, Surgical site infection
Plan
Previous presentation: Preliminary data were presented orally at the Asia-Pacific Military Health Exchange, Singapore, May 23-26, 2017. Completed data were presented orally at the ACOG Armed Forces District Meeting, San Antonio, TX, September 24-27, 2017. Poster presentations were made to the Pacific Coast Obstetrical and Gynecological Society, Palm Desert, CA, November 2-5, 2017, and the American Medical Association Scientific Assembly, Honolulu, HI, November 10, 2017. |
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Conflicts of interest: None to report. |
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The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States government. |
Vol 47 - N° 5
P. 558-564 - mai 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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