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Antimicrobial Stewardship & Maternal Sepsis

Summary

Antimicrobial Resistance is one of the biggest threats to global health, food security and development in the world today and has the potential to reverse decades of medical progress. Multi-drug resistant bacteria don’t respect national borders; what happens in one country affects us all. Low- and Middle-Income Countries (LMICs) such as Uganda are particularly hard hit. Infectious diseases still cause a high proportion of deaths and, as many of the most commonly used antibiotics fail to work, resource-poor settings struggle to cover the costs of newer and more expensive antibiotics. Sepsis is a major cause of maternal mortality in Uganda and is often a result of poor Infection Prevention and Control (IPC) during c-sections, leading to surgical site infections.

K4C has facilitated ongoing work, capacity-building efforts and interventions targeting AMR and Maternal Sepsis, that have their origins in the funded The Antimicrobial Stewardship (AMS) research project.

The Antimicrobial Stewardship (AMS) Project

Objectives

The Antimicrobial Stewardship (AMS) research project was funded by the Commonwealth Pharmacy Association through the Tropical Health Education Trust. £60,000 was received and the project ran from November 2018 to April 2020, in partnership with the University of Salford and Tameside and Glossop NHS Trust. Its key objectives were to improve the prescribing practices of pharmacists and clinical staff through training and mentoring, restart the Medicine Therapeutic Committee (MTC), improve staff skills in treating maternal sepsis and to develop appropriate new and existing tools and protocols within the hospital.

Activities

This action research project followed a mixed methods approach and was conducted at Fort Portal Regional Referral Hospital. Several professional volunteer doctors, nurses and midwives were placed in Fort Portal Regional Referral Hospital (FPRRH) to conduct training sessions and project evaluation alongside our Ugandan staff.

Over the course of the project, over 70 staff were trained in prescribing practices, the management of sepsis and/or IPC measures. One senior hospital pharmacist, Mr Simon Sseguya, was awarded a British Commonwealth funded fellowship and travelled the UK for 3 months from March-June 2020 to complete further training placements at Tameside and Glossop NHS Trust and the University of Salford.

One core element of the AMS project was a Maternal Sepsis Intervention (MSI) which focused on two key contributors to AMS; reducing the incidence of infections (especially those acquired from hospitals) and improving the use of antibiotics to fight the infections that do occur.

 

 

 

The project activities were subject to ongoing extensive evaluation which enabled us to make continuous improvements to activities and processes over the course of the

project in line with the findings. The MSI was highly successful in fostering multi-disciplinary teamworking to improve IPC, wound swabbing and management and the laboratory analysis of swab results to identify the bacteria responsible and target the most effective antibiotic. We observed transformational change on the wards with major improvements in all of these areas, resulting in improved patient outcomes, reduced morbidity and mortality, reduced length of stay on the wards and major financial savings to the hospital.

Since the beginning of the project, the percentage of suspected sepsis cases being tested for culture and sensitivity rose from 0% to 95%. Furthermore, the hospital’s score on the WHO’s IPC Infrastructure Audit Tool rose from 58.7% to 96.8%.

Most impressively, the number of sepsis related maternal deaths at FPRRH reduced from 24 in 2018 (prior to the project starting) to 0 in 2019, and numbers have remained below 4 in each of the years since the official project ended in 2020 which demonstrates sustainability. The MTC was also restarted and the hospital has a fully functional ‘Rx system’ which has had a positive impact on Antimicrobial Stewardship and the procurement of appropriate antibiotics.

Due to the success of this project, we have continued to upscale it over recent years to include other wards (paediatrics, medical and surgical wards) and also launched a new project in 2024 focusing on reducing sepsis related morbidity and mortality for neonates at FPRRH, Kasangati Health Centre (Kampala, Uganda) and Mnazi Mmoja Hospital (Zanzibar, Tanzania).