Reinforcing measures to reduce post cesarean section endometriosis and hysterectomy cases at Queen Elizabeth Central Hospital, Malawi
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Patricia Khisi, Queen Elizabeth Central Hospital, Blantyre, Malawi; Isaac Mphande, Queen Elizabeth Central Hospital, Blantyre, Malawi; Prof. Ellen Chirwa, Kamuzu College of Nursing, Blantyre, Malawi
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- Non-member
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- Queen Elizabeth Central Hospital, Blantyre, Malawi
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BACKGROUND: Endometriosis is the inflammation of the endometrium and myometrium, usually caused by infections after cesarean section. Queen Elizabeth Central Hospital’s (QECH) records showed that from January to July 2018, 2400 cesarean sections were conducted, and 2.8% (n=68) developed endometriosis. Of these, 42% (n=29) underwent total abdominal hysterectomy. Contributing factors might have been lack of adherence to infection prevention standards in the wards and theaters and inadequate resources. In view of this, this project was conducted in theater, labor and postnatal ward.
PURPOSE: The qualitative improvement project aimed at reducing endometriosis cases by 90%, and thereby reducing hysterectomies due to endometriosis to less than 5% through strict adherence of infection prevention practices in the targeted wards.
METHODS: An inter-professional team comprising of hospital management, doctors, domestic staff, nurses/midwives, formed the quality improvement team. The following interventions were implemented:
- Developed infection prevention protocols on cleaning of the environment, traffic control, vaginal examinations in labor ward, patient and hand hygiene
- Mobilized resources like: scrubbing materials, patient’s linen, shoe rack for theater staff’s shoes, trolleys for vaginal examination, mopping pails and bins
- Obtained extra cleaning staff for the labor unit, postnatal ward and theater, and a security guard for the postnatal ward
- Conducted training on infection prevention to targeted sites
- Provided health education to patients and guardians on infection prevention
- Initiated intensified supportive supervision of the implemented strategies
- Monitoring was done through monthly review of records and gaps identified were addressed accordingly
RESULTS: Preliminary results showed that there were 2,011 cesarean sections cases from August 2018 to February 2019. Out of those cases, endometriosis cases were 2.7% (n=62) and the total abdominal hysterectomies were 45% (n=28), but the interventions are ongoing and the results will be reported on until the end of June 2019.
CONCLUSION: The targets for reducing endometriosis cases post cesarean section at this hospital is expected to be achieved. Following of infection prevention protocols is expected to reduce cesarean section complications and strict adherence to infection prevention measures should be a commitment by all. There is a need for continued management support and inter-professional collaboration to combat infection risks after cesarean sections.
IMPLICATIONS: Infection prevention standards are integrated into practice by inter-professional healthcare professionals and support staff. Eventually this will contribute to Sustainable Development Goal of reducing maternal mortality.
Type | Poster |
Acquisition | Proxy-submission |
Review Type | Faculty/Mentor Approved: Sigma Academy Participant Presentation |
Format | Text-based Document |
Evidence Level | Quality Improvement |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | Maternal-Child Health; Endometriosis; Cesarean section; Infection prevention standards; Inter-professional healthcare quality improvement; Leadership Development |
Name | Inter-professional Education and Collaborative Practice for Africa Conference |
Host | Sigma Theta Tau’s International Tau Lambda at-Llarge Chapter; Amref International University; WHO-FIC Collaborating Centre for the African region; Africa Interprofessional Education Network (AfrIPEN); WHO Regional Office for Africa |
Location | Nairobi, Kenya |
Date | 2019 |
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