Combating post-cesarean section infections at Kibagabaga Hospital

This was the highest rate recorded at the hospital in over 12 months. The hospital's maternity unit staff, under the supervision of the Head of Maternity and Midwifery, conducted general cleaning of the operating theatre. However, the hospital's infection prevention and control (IPC) measures were inadequate, leading to the high infection rate. A rapid response team, formed by IPC and maternal health specialists from USAID Ingobyi Activity, visited the hospital to assess compliance with IPC policies and determine the root causes of the high infections. The team found several gaps, including the absence of critical IPC policies and checklists, inadequate cleaning of the operating theatre, inadequate orientation of newly hired staff on IPC implementation, lack of involvement of hospital leadership and clinicians in supervising the cleaning of theatres and maternity rooms, lack of clear delineation of the operating theatre to bar unauthorized personnel, and non-adherence to prophylactic antibiotic administration protocols. The team held discussions to find solutions to these gaps, including delineating the operating theatre, conducting refresher training of maternity staff on IPC, the head of maternity supervising the cleaning of the theatres, the weekly general cleaning supervised by the head of nursing and midwifery, and providing IPC protocols and checklists to aid in IPC implementation. These proposed actions were to be implemented using USAID Ingobyi Activity's continuous quality improvement approach, in which measurable small-scale changes are applied and continually built upon to bring about long-lasting and sustainable improvement in health service delivery. Through supportive supervision and mentorship, IPC officers from USAID Ingobyi Activity continued to support the hospital in adhering to the six-month action plan. The efforts resulted in a sharp decline in the post-cesarean section infection rate from 3.8% in February 2021 to only 0.9% in September 2021. The efforts also had other positive impacts, including a sharp decline in maternal deaths, as complications from post-caesarean section infections were accounting for almost 40% of all deaths related to delivery. USAID Ingobyi Activity has continued to support 26 hospitals and 356 health centers to implement IPC measures through training, mentorship, and supportive supervision in IPC to strengthen provider capacity in infection control. The project is also supporting the Ministry of Health to develop national guidelines and protocols that will harmonize the implementation of IPC nationwide.