Implementing a Combined Infection Prevention and Control with Antimicrobial Stewardship Joint Programme to Prevent Caesarean Section Surgical Site Infections and Antimicrobial Resistance: a Tanzanian Tertiary Hospital Experience
Abstract Background Surgical site infections after caesarean section are a leading cause of morbidity and mortality, especially in Low and Middle Income Countries. We hypothesized that combining infection prevention and control with an antimicrobial stewardship programme would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital. Methods A first survey was conducted to assess the burden of post-CS SSI. Thereafter, an intervention was introduced including: 1. formal on-the-job training on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was information on the prevalence of post-caesarean section surgical site infections whereas the secondary outcome was the identification of the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were also established. Results A total of 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p <0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p =0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p <0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p <0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention group and 95 (17%) in the post intervention group ( p <0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey. Conclusions Further research is needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.