Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design

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dc.contributor.authorWanyoro, A. K.
dc.contributor.authorAiken, Alexander M.
dc.contributor.authorMwangi, Jonah
dc.contributor.authorJuma, Francis
dc.contributor.authorMugoya, Isaac K.
dc.contributor.authorScott, J. Anthony G
dc.date.accessioned2014-10-17T14:00:40Z
dc.date.available2014-10-17T14:00:40Z
dc.date.issued2013
dc.descriptionDOI: 10.1371/annotation/6506cc0b-2878-4cf8-b663-23a2f32a199aen_US
dc.description.abstractAbstract Introduction In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. Methods We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. Results From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Conclusion Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.en_US
dc.identifier.citationAiken AM, Wanyoro AK, Mwangi J, Juma F, Mugoya IK, et al. (2013) Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design. PLoS ONE 8(11): e78942. doi:10.1371/journal.pone.0078942en_US
dc.identifier.issn1932-6203
dc.identifier.other1932-6203
dc.identifier.urihttp://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0078942
dc.identifier.urihttp://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0078942&representation=PDF
dc.identifier.urihttp://ir-library.ku.ac.ke/handle/123456789/11492
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.titleChanging Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Designen_US
dc.typeArticleen_US
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