A Multicomponent Intervention to Improve Maternal Infection Outcomes.
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Lissauer David, Gadama Luis, Waitt Catriona, Whyte Sonia, Burnside Girvan, Anilkumar Aiswarya, Makuluni Regina, Okwaro Peace, Yang Liu, Waitt Peter, Musopole Owen, Bilesi Rosemary, Maseko Bertha, Lwasa Joel, Mugahi Richard, Olaro Charles, Lamorde Mohammed, Makuta Mirriam, Kachiwaya Chimwemwe, Mkandawire Tionge, Malunga Adrian, Chitsulo Nyadani, Abitimo Prisca, Ayabo Tabitha, Weeks Andrew, Martin James, Hemming Karla, Gallos Ioannis, Monk Edward J M, Riches Jennifer, Chapuma Chikondi, Nanyondo S Judith, Lorencatto Fabiana, Monahan Mark, Allegranzi Benedetta, Dunlop Catherine, Atkins Lou, Rosala-Hallas Anna, Roberts Tracy, Gamble Carrol, Malata Address, Desmond Nicola, Kommwa Edward, Merriel Abi, Parry-Smith William, Smith Rebecca, Ndumu Ivy, Williams Eleanor, Faque Bob, Banda Gertrude, Nyondo-Mipando Alinane L, Twimukye Adelline, Chater Tim, Diplas Aristotelis, Brizuela Vanessa, Souza Joao Paulo, Rylance Jamie, Cheshire James, Hawker Lydia, Coomarasamy Arri, Bonet Mercedes
Аннотация
METHODS: We conducted a cluster-randomized trial to assess a multicomponent intervention, the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program. This program was designed to support health care providers in achieving three goals: adherence to World Health Organization (WHO) hand-hygiene standards; adoption of evidence-based practices for maternal infection prevention and management; and early detection of sepsis and use of the FAST-M (fluids, antibiotics, source control, transfer if required, and monitoring) treatment bundle. Usual care was provided in the control group, along with dissemination of guidelines. The primary outcome was a composite of infection-related maternal death, infection-related near-miss event (events in which women survived a life-threatening complication), or severe infection-related illness (deep surgical-site, deep perineal, or body-cavity infection) among women who were pregnant or had recently been pregnant.
RESULTS: We randomly assigned 59 health facilities (where 431,394 women gave birth during the trial) in Malawi and Uganda to the intervention group (30 clusters) or the usual-care group (29 clusters). A primary-outcome event occurred in 1.4% of the patients in the intervention group and in 1.9% of those in the usual-care group (risk ratio, 0.68; 95% confidence interval, 0.55 to 0.83; P<0.001). This effect was generally consistent between countries and among facilities of difference sizes and was sustained over time.
CONCLUSIONS: Implementation of the APT-Sepsis program led to a significantly lower risk of a composite of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care. (Funded by the Joint Global Health Trials scheme and others; APT-Sepsis ISRCTN number, ISRCTN42347014.).