Increasing evidence-based interventions in patients with acute infections in a resource-limited setting

A before-and-after feasibility trial in Gitwe, Rwanda

Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and Main Results: Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (preintervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed. Conclusions: Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population.

Original languageEnglish (US)
Pages (from-to)1357-1366
Number of pages10
JournalCritical care medicine
Volume46
Issue number8
DOIs
StatePublished - Jan 1 2018

Fingerprint

Rwanda
Infection
District Hospitals
Education
Therapeutics
Cross Infection
Acute Kidney Injury
Blood Transfusion
Respiratory Insufficiency
Malaria
Hospital Emergency Service
Hypersensitivity
Demography
Safety
Incidence

Keywords

  • Africa
  • Bundle
  • Education
  • Evidence-based intervention
  • Infection
  • Safety
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Increasing evidence-based interventions in patients with acute infections in a resource-limited setting : A before-and-after feasibility trial in Gitwe, Rwanda. / Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign.

In: Critical care medicine, Vol. 46, No. 8, 01.01.2018, p. 1357-1366.

Research output: Contribution to journalArticle

Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign. / Increasing evidence-based interventions in patients with acute infections in a resource-limited setting : A before-and-after feasibility trial in Gitwe, Rwanda. In: Critical care medicine. 2018 ; Vol. 46, No. 8. pp. 1357-1366.
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title = "Increasing evidence-based interventions in patients with acute infections in a resource-limited setting: A before-and-after feasibility trial in Gitwe, Rwanda",
abstract = "Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and Main Results: Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15{\%}, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15{\%}, p = 0.58). No differences in the incidence of blood transfusion (preintervention, 6{\%}; intervention I, 7{\%}; intervention II, 7{\%}) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2{\%}; intervention I, 0{\%}; intervention II, 0{\%}; respiratory failure: pre-intervention, 2{\%}; intervention I, 2{\%}; intervention II, 2{\%}; acute renal failure: pre-intervention, 2{\%}; intervention I, 2{\%}; intervention II, 1{\%}) were observed. Conclusions: Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population.",
keywords = "Africa, Bundle, Education, Evidence-based intervention, Infection, Safety, Sepsis",
author = "{Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign} and Olivier Urayeneza and Pierre Mujyarugamba and Zacharie Rukemba and Vincent Nyiringabo and Polyphile Ntihinyurwa and Baelani, {John I.} and Arthur Kwizera and Danstan Bagenda and Mervyn Mer and Ndidiamaka Musa and Hoffman, {Julia T.} and Ashok Mudgapalli and Porter, {Austin M.} and Niranjan Kissoon and Hanno Ulmer and Harmon, {Lori A.} and Farmer, {Joseph C.} and D{\"u}nser, {Martin W.} and Patterson, {Andrew J}",
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T1 - Increasing evidence-based interventions in patients with acute infections in a resource-limited setting

T2 - A before-and-after feasibility trial in Gitwe, Rwanda

AU - Sepsis in Resource-Limited Nations Workgroup of the Surviving Sepsis Campaign

AU - Urayeneza, Olivier

AU - Mujyarugamba, Pierre

AU - Rukemba, Zacharie

AU - Nyiringabo, Vincent

AU - Ntihinyurwa, Polyphile

AU - Baelani, John I.

AU - Kwizera, Arthur

AU - Bagenda, Danstan

AU - Mer, Mervyn

AU - Musa, Ndidiamaka

AU - Hoffman, Julia T.

AU - Mudgapalli, Ashok

AU - Porter, Austin M.

AU - Kissoon, Niranjan

AU - Ulmer, Hanno

AU - Harmon, Lori A.

AU - Farmer, Joseph C.

AU - Dünser, Martin W.

AU - Patterson, Andrew J

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and Main Results: Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (preintervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed. Conclusions: Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population.

AB - Objective: To evaluate whether a focused education program and implementation of a treatment bundle increases the rate of early evidence-based interventions in patients with acute infections. Design: Single-center, prospective, before-and-after feasibility trial. Setting: Emergency department of a sub-Saharan African district hospital. Patients: Patients > 28 days of life admitted to the study hospital for an acute infection. Interventions: The trial had three phases (each of four months). Interventions took place during the second (educational program followed by implementation of the treatment bundle) and third (provision of resources to implement treatment bundle) phases. Measurements and Main Results: Demographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 hours after hospital admission; and at discharge. A total of 1,594 patients were enrolled (pre-intervention, n = 661; intervention I, n = 531; intervention II, n = 402). The rate of early evidence-based interventions per patient during Intervention Phase I was greater than during the pre-intervention phase (74 ± 17 vs. 79 ± 15%, p < 0.001). No difference was detected when data were compared between Intervention Phases I and II (79 ± 15 vs. 80 ± 15%, p = 0.58). No differences in the incidence of blood transfusion (preintervention, 6%; intervention I, 7%; intervention II, 7%) or severe adverse events in the first 24 hours (allergic reactions: pre-intervention, 0.2%; intervention I, 0%; intervention II, 0%; respiratory failure: pre-intervention, 2%; intervention I, 2%; intervention II, 2%; acute renal failure: pre-intervention, 2%; intervention I, 2%; intervention II, 1%) were observed. Conclusions: Our results indicate that a focused education program and implementation of an infection treatment bundle in clinical practice increased the rate of early evidence-based interventions in patients with acute infections (mostly malaria) admitted to a sub-Saharan African district hospital. Provision of material resources did not further increase this rate. While no safety issues were detected, this could be related to the very low disease severity of the enrolled patient population.

KW - Africa

KW - Bundle

KW - Education

KW - Evidence-based intervention

KW - Infection

KW - Safety

KW - Sepsis

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DO - 10.1097/CCM.0000000000003227

M3 - Article

VL - 46

SP - 1357

EP - 1366

JO - Critical Care Medicine

JF - Critical Care Medicine

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