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.
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 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.
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 to conduct training sessions and project evaluation alongside our Ugandan staff. Over the course of the project, over XXX staff have been 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 2020, to complete 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.
Results so far
The project activities were continuously updated and refined over the course of the project in line with findings. This project has only recently ended, and the full evaluation is still ongoing, however we have already seen evidence that the MSI has fostered 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. Since the beginning of the project, the percentage of suspected sepsis cases being tested for culture and sensitivity has risen from 0% to 95%. Furthermore, the hospital’s score on the WHO’s IPC Infrastructure Audit Tool has risen from 58.7% to 96.8%.
The MSI has seen transformational change on the wards with major improvements in all of the above areas. This has resulted in improved patient outcomes, reduced mortality, reduced length of stay on the wards and major financial savings to the hospital. The MTC has been restarted and the hospital now has a fully functional ‘Rx system’ which will have a positive impact on AMS and the procurement of appropriate antibiotics.
A full project evaluation and associated publications are currently being written. Check back here soon to find out more!