Reducing Surgical Infections in Rwanda
Reducing Surgical Infections in Rwanda
The National Accreditation Program at Bushenge Provincial Hospital
Tucked in the outermost region of the Western Province of Rwanda, Bushenge Provincial Hospital serves a population of over 171,000 people, including expectant mothers referred by neighboring health centers for pregnancy complications that require Cesarean section. Cesarean section (C-section) delivery is one of the most frequent surgeries performed at health facilities worldwide. At Bushenge Provincial Hospital, it accounts for approximately 48% of annual births. As with any surgical procedure, there are a number of complications that could occur during or post-operation. Surgical site infections (SSI) are a common complication following Cesarean section procedures that do not adhere to infection prevention and control principles. Such infections place a great deal of physical and emotional burden on the mother and family and present substantial costs for health facilities.
Because of the Accreditation Program, I work with an objective and not just out of routine as I did before. I always ask myself what can I do to contribute to the quality of care at Bushenge? If there is an infection risk, I ask myself, what can I do to help?
—Noëlla Benemariya, Environmental Health Officer at Bushenge Hospital
Since 1998, Rwanda has been on a journey to improve the quality of healthcare services nationwide. In 2012, the Rwandan Ministry of Health established the National Healthcare Accreditation Program in partnership with Rwanda Health Systems Strengthening Project (RHSS Project), supported by USAID and implemented by Management Sciences for Health. The Accreditation Program, as a strategy to improve the quality of health care services in the Rwandan health system, addresses five main areas for risk reduction: Leadership process and accountability; competent and capable workforce; safe environment for patients and staff; clinical care of patients; and improvement of quality and safety. The Accreditation Program began with 5 hospitals, including Bushenge Provincial Hospital, and has since expanded to all 42 public hospitals in Rwanda.
The program directly addresses maternal and child health, among other critical health areas, and includes standards for the prevention of infections resulting from Cesarean delivery. When a woman gives birth by C-section with no complications, she spends 3 days in the hospital so that doctors and nurses can monitor her and her newborn baby before they go home to their family. However, when a woman develops an infection at the site of her C-section incision, she often experiences fever, discharge from the incision, and pain; she and her newborn baby may spend anywhere from 7 to 14 days in the hospital as doctors treat her infection. The patient’s family also must walk long distances every day to deliver meals to the mother and newborn who cannot go home.
With the support of the RHSS Project, Bushenge Hospital developed and followed patient-centered quality improvement policies, procedures, and protocols to ensure that hospital staff washed their hands frequently, sterilized equipment, monitored antibiotics prophylaxis, and ensured safe and adequate water to patients on a daily basis. The RHSS Project trained hospital staff on infection prevention and control (IPC) and patient education so patients can actively mitigate the spread of infection post-operation. After each procedure, clinicians at Bushenge Hospital take time to inform women how to take care of their incision and avoid developing an infection. Simple steps such as periodically cleaning the incision with clean water and wearing clean clothes can save a mother from the pain and anxiety associated with surgical site infections.
On its journey of Accreditation, Bushenge Hospital has leveraged simple, cost-effective quality improvement techniques to create a safer environment and ultimately reduce the number of mothers developing infections after Cesarean delivery. The hospital has successfully reduced the rate of mothers developing infections post-Cesarean from 8.0% in quarter 1 of 2014 to 1.8% at quarter 4 of 2016, which marked three years of implementing quality standards.
To safeguard and enhance the successes at Bushenge Hospital, the RHSS Project has supported the facility in the establishment of IPC and quality improvement committees which continue to steer Bushenge on its journey to full accreditation as a hospital that delivers high-quality, patient-centered care.