New Hospital Systems Help Cut C-Section Infection

NEW YORK (Reuters Health) - Physicians working in countries where money and medicine are limited may be able to improve patient care by borrowing performance improvement techniques from the business world, the results of a study suggest.

Dr. W. Charles Huskins of the Mayo Clinic in Rochester, Minnesota, and

colleagues found that new guidelines on giving antibiotics to women undergoing Cesarean sections at two hospitals in Bogota, Colombia, were successful in bringing down the rate of infection in these patients.

The hospital teams implementing the new guidelines used ''continuous quality improvement''--a strategy frequently used by businesses to improve performance--to establish the new system and monitor its effectiveness. The strategy was based on four steps: plan the change; implement it; study its effects; and then accept, adapt, re-test or abandon the change.

The approach is particularly attractive for settings like Colombia, the authors note, because it is based on using existing resources.

Traditionally, a woman who has a C-section is given antibiotics as a precautionary measure soon after the baby's umbilical cord is clamped or cut to reduce her chances of developing an infection.

But before the guidelines were put in place, in one of the hospitals antibiotics were given to 71% of women undergoing C-sections, with 24% receiving the medicine in a timely fashion. At the other hospital, only 36% of the women received antibiotics and half of them got the drug at the optimal time to fight infection, the report indicates.

In one of the hospitals, each obstetrician decided on a case-by-case basis whether a woman undergoing a C-section would be given antibiotics, and which medication to use. Because the availability of antibiotics at the hospital was limited, a woman's family often had to buy the drug for her outside the hospital. The situation was similar in the second hospital.

The improvements implemented at the hospitals included establishing a universal requirement for women undergoing C-section to have preventive antibiotic treatment and increasing the availability of antibiotics in the operating rooms.

After the new systems were put in place, both hospitals saw significant downward trends in the rates of infection in women undergoing C-sections, the investigators report in the October 22nd issue of the Archives of Internal Medicine (news - web sites). Ninety-five percent of C-section patients were given antibiotics in one hospital, while 89% received the drugs at the second hospital. At both hospitals, 96% of women received the drugs in a timely fashion.

``This is a quasi-experimental study so this finding was not 'proven' with the highest degree of scientific rigor,'' Huskins told Reuters Health. ``However, the association between improved use and timing of (antibiotics) and fewer infections was strong and temporally correlated.''

The study shows that ``quality improvement methods to improve care in a resource limited setting'' can improve patient outcomes, he added.

Although Huskins noted that these methods were applied to women undergoing C-sections ``because improving outcomes of pregnancy and childbirth is a major international public health priority,'' he pointed out that ``the same approach could be used to improve key aspects of care for other conditions.''

SOURCE: Archives of Internal Medicine 2001;161:2357-2365.