TY - JOUR
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
N1 - Funding Information:
This study was funded by the Life Priority Fund, the Hellman Foundation, Copyright © 2018 by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.
Funding Information:
and the King Baudouin Foundation. The research project was supported by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine through the Surviving Sepsis Campaign.
Funding Information:
Dr. Mujyarugamba’s institution received funding from Gitwe Hospital. Dr. Nyiringabo received funding from the Society of Critical Care Medicine (SCCM). Dr. Kwizera received travel and accommodation to assist in the training portion of the study. Dr. Bagenda received funding from SCCM and the European Society of Intensive Care Medicine (ESICM); he received support for article research from SCCM and ESICM, and he disclosed having two shares in Mylan NV. Dr. Mer received funding (honoraria for advisory boards and education talks delivered) from Pfizer, AstraZeneca, MSD, Gilead, Aspen, Sun, and 3M. Ms. Harmon’s institution received funding from King Baudouin Foundation ($25,000), Hellman Foundation ($50,000), and BD Corporation (provided supplies of $5,000 utilized for sepsis carts at Gitwe Hospital in Rwanda and a donation to the project of $2,500, which was used for the cart purchases and instructional materials). Dr. Farmer received support for article research from the Hellman Foundation. Dr. Patterson received funding from American Board of Anesthesiology, Accreditation Council for Graduate Medical Education, SCCM, Society of Academic Anesthesiology Associations (paid partial expenses after inviting him to give presentations at the Annual Meeting in 2016), and Dickie McCamey LLC (paid expert witness for the defense); he disclosed that his son (Ryan) and daughter (Julia) both received grant funding for projects in Gitwe, Rwanda from the Hellman Foundation (which partially supported this current project via a grant to SCCM); and he received support for article research from the Hellman Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, Email: Martin.Duenser@i-med.ac.at
PY - 2018
Y1 - 2018
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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U2 - 10.1097/CCM.0000000000003227
DO - 10.1097/CCM.0000000000003227
M3 - Article
C2 - 29957715
AN - SCOPUS:85056544756
VL - 46
SP - 1357
EP - 1366
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 8
ER -