Increasing evidence based interventions in patients with acute infections in a resource limited setting: a before and after feasibility trial in Gitwe, Rwanda
AbstractObjectiveTo 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.DesignSingle center, prospective, before and after feasibility trial.SettingEmergency department of a sub Saharan African district hospital.PatientsPatients 28 days of life admitted to the study hospital for an acute infection.InterventionsThe trial had three phases (each of 4 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 resultsDemographic, clinical, and laboratory data were collected at study enrollment; 24, 48, and 72 h after hospital admission; and at discharge. A total of 1594 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 h (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.ConclusionsOur 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 (http:/www.clinicaltrials.gov: NCT02697513)
Intensive Care Medicine