Reducing infections among women undergoing cesarean section in Colombia bymeans of continuous quality improvement methods

Background: Improving obstetric care in resource-limited countries is a maj or international health priority. Objective: To reduce infection rates afte r cesarean section by optimizing systems of obstetric care for low-income w omen in Colombia by means of quality improvement methods. Methods: Multidisciplinary teams in 2 hospitals used simple methods to impr ove their systems for prescribing and administering perioperative antibioti c prophylaxis. Process indicators were the percentage of women in whom prop hylaxis was administered and the percentage of these women in whom it was a dministered in a timely fashion. The outcome indicator was the surgical sit e infection rate. Results: Before improvement, prophylaxis was administered to 71% of women i n hospital A; 24% received prophylaxis in a timely fashion. Corresponding f igures in hospital B were 36% and 50%. Systems improvements included implem enting protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements we re associated with increases in overall and timely administration of prophy laxis (P < .001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administrat ion of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospita l B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P < .001). In hospital B, the infection rate began a downward trend before the improvements that continued after their impleme ntation (P=.04). Conclusion: Simple quality improvement methods can be used to optimize obst etric services and improve outcomes of care in resource-limited settings.