Dismayed by the incidence of post-surgery sepsis among patients, especially following cesarean sections, Dr. Martin Buhamizo and a team of co-workers set out to rid the operating room and maternity ward of infection. They received a powerful assist from a General Electric Foundation-funded quality assurance project that has a record of preventing infection and saving lives.
Pioneered by Jhpiego, the Standards-Based Management and Recognition (SBM-R) approach offered Dr. Buhamizo a systematic and innovative way to improve conditions at the Kabuyanda Health Center IV, a government-owned facility that serves a sub-district of about 200,000 Ugandans. Through SBM-R, Dr. Buhamizo and his infection control team have developed standards of care, identified gaps in services and devised solutions to the problems. In two years, the hospital’s operating room infection rate fell to nearly zero from about 30–40 percent, Dr. Buhamizo said. The team’s use of SBM-R earned the facility recognition as the best in quality assurance improvements.
Kabuyanda’s SBM-R-supported achievements continue today, and thousands of Ugandans who use the facility are benefiting from it, said Dr. Buhamizo. Ten additional health centers in Isingiro district and Mbarara Regional Referral Hospital have followed Kabuyanda’s lead and have improved the quality of health care in the district. Because of the success of this Ministry of Health-supported project, the GE Foundation has committed additional funding to improve the quality of maternal and newborn health services in Isingiro district.
In 2008, Kabuyanda was struggling to maintain minimum standards of infection prevention and control. Dr. Buhamizo and his team had their work cut out for them.
“We had lots of accidental blood exposures (ABEs) through splashes of blood and needle pricks. We had lots of infections between clients. We had infections after operations,” said the 30-year-old medical director.
It didn’t take the team long to identify the likely causes of the problems.
Facility staff often left syringes and sharps on a table in an examining room instead of disposing them in a puncture-resistant sharps container—simply because these containers were too full or out of reach. Hospital workers didn’t always wear protective clothing and safety goggles when examining and performing procedures on patients, which left them at risk of exposure to blood and other infectious material. At the same time, clean safety gear wasn’t always available. The team also found that waste wasn’t properly segregated and disposed of.
Dr. Buhamizo said staff attitudes about health and safety issues had to change, and a campaign to educate 65 hospital workers about infection prevention measures and control was begun. The infection control team started with the basics: instructing staff on safe methods of handwashing and sterilization of instruments. “We also integrated infection prevention and control programs in other activities,” said Dr. Buhamizo. “During our general monthly meetings, we make sure we say something about infection prevention and control. When we are having outreach to the community, such as immunization activities, we mention something to do with health education and good practices in the home to prevent infection.”
The collaborative aspect of SBM-R gave health workers a stake in resolving these issues. Workers were recognized for their achievements with awards ranging from a hearty “thank you,” to certificates, to pairs of gumboots, goggles and heavy-duty protective gloves.
With education and encouragement, staff reluctance eventually gave way to cooperation and support. The improvement in the operating room was so great that officials at the regional referral hospital noticed that they were no longer receiving serious cases from Kabuyanda. When Dr. Buhamizo got a call inquiring about the lack of referrals, he said that was the biggest compliment he could have received. “In 2008, we had, in a whole year, 500 operations and 11 accidental blood exposures at Kabuyanda. Last year (2010), we had 800 operations with only two cases of accidental blood exposures,” said Dr. Buhamizo, speaking of the progress made at Kabuyanda.
After the operating room, the infection prevention team reviewed the maternity ward, where they identified an excessive amount of traffic, beds too close together and unsanitary practices brought from home. Next on their agenda was the supply area.
“We held a meeting to make sure everyone was updated on our findings, gaps and how to address them. Within three weeks we saw a very big difference,” said Dr. Buhamizo. “First and foremost we marked all the doors that had to be closed during the time of operations. As the rate of infection went down, we used less antibiotics and sundries. We established IP [infection prevention] teams in all departments and they are functional.”
Kabuyanda area health facilities have followed the hospital’s lead. As a result, health systems have been strengthened, health care has improved and more Ugandans—and even clients from neighboring countries like Tanzania and Rwanda—are coming to the health facilities for care, Dr. Buhamizo says.