Development and Evaluation of a Continuous Quality Improvement Programme for Antimicrobial Stewardship in Six Hospitals in Uganda
Development and Evaluation of a Continuous Quality Improvement Programme for Antimicrobial Stewardship in Six Hospitals in Uganda
By: Reuben Kiggundu, J.P. Waswa, Hilma N Nakambale, Francis Kakooza, Hassan Kassuja, Marion Murungi, Harriet Akello, Seru Morries, Mohan P. Joshi, Andy Stergachis, Niranjan Konduri
Publication: BMJ Open Quality; 2023;12:e002293. DOI: 10.1136/bmjoq-2023-002293
Abstract
Appropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.
Six Ugandan hospitals implemented AMS interventions between June 2019 and July 2022. The authors used the World Health Organization AMS toolkit to set-up hospital AMS programs and implemented interventions using continuous quality improvement (CQI) techniques, targeting conditions commonly associated with antibiotic misuse, such as urinary tract infections (UTIs), upper respiratory tract infections (URTIs), and surgical antibiotic prophylaxis. The interventions included training, mentorship, and provision of clinical guidelines to support clinical decision making. Quarterly antibiotic use surveys were conducted.
Using CQI approaches to focus on specific causes of inappropriate antibiotic use led to desirable overall reductions in antibiotic use for URTIs and UTIs. This study adds lessons suitable for other resource constrained, low-income countries on how to use CQI approaches to improve antibiotic use.