Transcript Introduction

Surgical antibiotic prophylaxis at
Moi Teaching & Referral Hospital
Rose Kakai1, Barrack Ayumba2, Damaris Lagat2,
Eveline Wesangula3, Sam Kariuki4
1Maseno
University,
2Moi University,
3Ministry of Health
4Kenya Medical Research Institute
Introduction
• Worldwide, over 230m operations performed annually
• SSIs one of the most important causes of healthcare
associated infections
• SSI is an infection occurring at the operation site within 30 dys
of the procedure
• In GARP-Kenya situation analysis (2011), hospital antibiotic
use was one of the critically important areas of policy action
• Rationale is, in order to control AMR in hospitals, the most
important steps are to reduce and rationalize hospital
prescribing
Introduction -------Why give pre-operative antibiotics?
• The operation is the major period of bacterial
contamination of the site
• There is a strong evidence base for single dose from
– Experimental (animal) studies
– Clinical research in East Africa
– International research + recommendations
• National Clinical Guidelines recommend it
Introduction -------Potential benefits of single dose regimen
• Reduce rate of wound infections
• Reduce costs to pts + hospital
• Reduce overall usage of antibiotics cf. R
• Better injection safety
• Less nursing time giving antibiotics in wards
Introduction -------Statement of the problem:
• Surgical prophylaxis is beneficial in prevention of SSIs
• identified as one of the areas where antibiotics are often overused
Objective:
• To rationalize use of surgical AP at MTRH
Specific objectives:
Determine:
• Use of antibiotics in surgical pts
• Rate of SSI
• Pathogens
• AMR in pts with SSI
Outcome measure:
• Proportion of pts receiving rational (correctly timed and dosed) AP
Methods
Study site:
• MTRH surgical patients
Design:
• Longitudinal observational study
Inclusion criteria:
• Surgical wound class I (clean) and II (clean/contaminated)
Dependent variable:
• Pre-operative single dose regimen
Independent variables:
• Use of antibiotics in surgical pts, Rate of SSI, Pathogens and AMR in pts with SSI
Limitation:
• Failure to follow up and detect post operative infections after pts were discharged
Ethical consideration:
• Approval obtained from IREC
Methods -- Data collection procedure
First seminar for planning
• Immediately after ethical and other relevant approvals
• Review of:
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research findings
Kenya national clinical guidelines (2009)
Kenya national IPC guidelines (2010)
Experiences of other hospitals e.g. Thika Level 5 (June 2010 – Feb 2011)
• Show strong evidence to support pre-operative single-dose (AP), using similar
antibiotics
• Agreed that there was need for locally appropriate AP policy at MTRH, hence
develop a process chart and drug regime for the proposed policy
• Process chart describes; rresponsibilities’ for different hospital staff, materials
needed and sequence of events
• Collection of lab and bio data from date of 1st seminar to end of study is
ongoing to monitor antibiotic use, changes in SSIs, pathogens and resistance
rates
Methods -- Data collection procedure
Second seminar for Planning
• 2 months after 1st seminar
• Process chart and drug regime drafts presented and discussed
• Main drug for AP is Ampicillin because it
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Has good bacterial coverage
Is (relatively) cheap
Has no major side-effects or interactions
Is safe in high doses
• Formal application to Hospital Director requesting approval to
implement use of the proposed process chart and drug regime
• Approval granted to proceed with the implementation and it is
ongoing
Methods -- Data collection procedure
Third seminar for Monitoring and Evaluation
• Expected to be held 11 months after
implementation of proposed surgical AP policy
• To evaluate effects of the change in the policy
with regard to;
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Use of antibiotics in surgical pts
Rate of SSI
Pathogens
AMR in pts with SSI
Methods -- Data collection procedure
Fourth final seminar for Sustainability
• 3 months write up
• Discuss:
– Final results and challenges
– Hence long term sustainability of the policy
Preliminary results
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Total of 446 surgical pts sampled
160 (58.35) females
193 (43%) aged 40 – 65 yrs old
Most common surgeries were 164 (36.8%)
general and 147 (32.9%) CS
• SSI reported in 8 (1.8%) pts
• Post operative AP prescribed for 136 (30.5%) pts
ranging from 3 – 5 days duration
• Inconsistent access to ampicillin
Conclusion
• Pre-operative single dose beneficial
• Main challenges
– Drug stock outs
– Prescription of post-operative antibiotics
Recommendation
• Measures e.g. CME on AMR aimed at rational
use of surgical prophylactic drugs is necessary
to strengthen sustainable practices regarding
AP
Acknowledgement
• Ramanan Laxminarayan, CDDEP
Thank you