Increasing Evidence-Based Interventions in Patients with Acute Infections in a Resource-Limited Setting: A Before-and-After Feasibility Trial in Gitwe, Rwanda.
Crit Care Med
; 46(8): 1357-1366, 2018 08.
Article
en En
| MEDLINE
| ID: mdl-29957715
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 MAINRESULTS:
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 (pre-intervention, 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 (www.clinicaltrials.gov NCT02697513).
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
/
3_ND
Problema de salud:
1_geracao_evidencia_conhecimento
/
3_malaria
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3_neglected_diseases
Asunto principal:
Enfermedades Transmisibles
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Países en Desarrollo
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Servicio de Urgencia en Hospital
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Paquetes de Atención al Paciente
/
Capacitación en Servicio
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
/
Adult
/
Child
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Child, preschool
/
Female
/
Humans
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Infant
/
Male
/
Middle aged
País/Región como asunto:
Africa
Idioma:
En
Revista:
Crit Care Med
Año:
2018
Tipo del documento:
Article
País de afiliación:
Ruanda