ffll a UNIVERSITY OF

t:7 LIVERPOOL

THINK SEPSIS, ACT FAST-M

The urgent need to improve infection prevention and control in maternity care

The intersection of WASH, IPC and AMR

David Lissauer

NIHR Professor of Global Maternal Health Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi

A positive and safe birth for all

Health workers in maternal and newborn care are committed to making childbirth a positive, life-affirming experience for women,

their babies and their birth partners

Water, sanitation and hygiene

Sanitation 35% facilities lack appropriate water 20% facilities lack toilets/latrines

(WHO,UNICEF 2015)

Hand Hygiene Challenges:

Infrastructure Staffing, crowding, time Compliance

But evidence of successful programs (WHO, 2015)

Water, sanitation and hygiene infrastructure

• Water, sanitation and hygiene (WASH) infrastructureis essential for effective infection prevention

• Factors to be assessed: • access to running or flowing water from a high-

quality source • sanitation services • toileting facilities, including menstrual hygiene

requirements in maternity areas • hand hygiene resources like soap and alcohol-

based handrub • safe health-care waste disposal facilities

• Tools such as WHO WASHFIT can help to assess and monitor WASH infrastructure

Source: Water and Sanitation for Health Facility Improvement Tool (WASH FIT). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/25491.0).

'S THE

PROBLEM?

0 0 Q 0 C,

-e

1 I N 10 PATIENTS ge an infectia while rece, ng core

UP TO S2% OF SURGICAL PATI ENTS get a past-op mlectio , up o 61 antibiotic resiSto nc

UP TO 90% OF HEALTH CARE WORKERS do no cleon t r hands in some acilities

I NFECTIONS CAUSE UP TO 56% OF DEATHS among llospJta l- t>orn babies

UP TO 20% OF AFRICAN WOMEN get o wound infection o tter a caesorean section

50-70% OF INJ IECTIONS given 1n some developing countries are unsafe

I NFECTIONS con lead to disobility, ANTIBIOTIC RESISTANCE, increased llosp11a1 time and death

HAVE ACTIVE INFECTION PREV£NTION AND CONTROL PROGRAMMES and arget antibiouc resistance

USE CLEAN PRACTICES and aseps1s for interventions

PRACTICE HAND HYGIENE to preven Infections o nd reduce the spread of antibio 1c resistance

HAVE ENOUCH STAFF, a clean and hygienic enviro ment and don·1 overcrowd lleaUh core f0<::IIU1es

MONITOR I NFECTIONS and make action pla ns to reduce th ir freq ency

NEVER RE- USE needles and syr inc;ies

Only dispense antibiotics wtien TRULY NEE.OED to REDUCE THE RISK OF RESISTANCE

Infection prevention

REVENT INFECT ONS I REGNANCY & CHILDBIRTH FAST-m

STOP SEPSIS! PATHWAY

• FollOft' th WHO MOMENTS FOR .-ND H't'GEN rGtructions

lilEFORE • DONCJT the rine I nd pubic ar s fore vagina\ births - DB.NERY

• PERFORM VAGINALEXAMINUIONS ERY 4 HOURS in rcutin V.UNAL se m ntof sta

DliUVERY • DO NOT PER NAL N nth chlorhexidine,

n In Group B Strep ococcus IGBSI coton ation

• CLEAN TH VA NA Ith povidone-4 i lmmedia b fore proc dure Cil~ • Use an AN PTICA EMT FOR N nn::t"JU'UlTION

SlCllON • fl P PHYlACTIC ANTIIUOTICS for n el r,.• or em rg ncy

s in incision.

GIVE ANTIBIOTIC PROPHYLAXIS CORRECTLY

1STTRIMESTER

2NDOR3RD TRl4E'STER

1ST,12ND STAG& OF LA80UR

3RDST.AGE OFLHIOUR

CAliSAREAN SliCTION

Abortion or Miscarriage Surgery IMVA/EVA('JO&CI

Premrm prelabour rupture of membranes IPPR0 MI

Uncomplicated second or third trimester

Premrm Labour w;tt, int.act amniotic membranes

Prelabour rupture of membranes IPROMI at or near term

Vaginal Group B Streptococcus (GBSI colonisation

Meconi um-stained amniotic fluid

Uncomplicated vaginal birth

Operative vaginal birth lforceps or vacuum-assisted delivery I

M nual removal of the placenta

3rd or 4th degree perineallears ltorn analsphincler, anus or rectum)

Electiw or emergency caesarean section (antibiotics should be giwn BEFORE skin incision!

UNITED AGAINST MATERNAL SEPSIS

YES NO

X

X

X

X

X

X

X

X

X

X

X

X

Antibiotic overuse and misuse are common in maternity

Avoiding overcrowding and adequate staffing

Facility overcrowding can:

• Increase the risk of HAIs, nosocomial outbreaks and the spread of antimicrobial resistance

• Lead to inadequate health-care worker staffing levels

To avoid overcrowding on admission and throughout the hospital stay, the facility should ensure:

• No more than one patient per bed

• Spacing of at least 1 metre between the edges of beds

• Overall occupancy that does not exceed the designed total bed capacity of the facility

• A referral system in case the facility reaches full capacity

WHO recommends adequate bed occupancy, avoiding overcrowding and adequate staffing as a core component of effective IPC programmes

Source: Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241549929).

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1 11 11 1 1

I I I I I

I I I I I I I I I I I I I

I I I I I I I I I I I I I

I I I I I I I I I I I I I

, I I I I II II II 1111 I I I I I I I I I I I I I I

I I I I I I I I I I I I I I I I I I I I I I I I I

MODIFIED EARLY OBSTETRIC WARNING CHART (MEOWS CHART)

Date

Time

WRITE VALUES IN BOXES PROVIDED Initials

Respiratory rate

(breaths per minute)

25 or more RED

21 - 24 YELLOW

11 - 20 NORMAL

10 or less RED

Temperature (˚C)

38 or more YELLOW

36.0 to 37.9 NORMAL

35.9 or less YELLOW

Heart rate (beats per minute)

120 or more RED

100 - 119 YELLOW

50 - 99 NORMAL

40 - 49 YELLOW

39 or less RED

Systolic blood

pressure (mmHg)

160 or more RED

140 -159 YELLOW

100 -139 NORMAL

90 - 99 YELLOW

89 or less RED

Diastolic blood

pressure (mmHg)

110 or more RED

90 -109 YELLOW

40 - 89 NORMAL

39 or less RED

Urine output Hours since

patient passed urine

(tick box)

12 hours or less NORMAL

12 - 18 hours YELLOW

18 hours or more OR less than

0.5 ml/kg/hour RED

Mental State (tick box)

Alert NORMAL

Not Alert RED

Looks unwell (tick box)

No NORMAL

Yes YELLOW

TOTAL YELLOW FLAGS

TOTAL RED FLAGS

ACTION TAKEN (IF REQUIRED) Yes (Y) / No (N)

ACT NOW if patient triggers ONE RED or TWO YELLOW flags at any time. Escalate to clinical decision maker and start FAST-M decision tool.

Patient Patient ID DOB/AgeContact clinical decision maker if patient triggers ONE RED or TWO YELLOW flags at any one time.

UNITED AGAINST MATERNAL SEPSIS THINK SEPSIS, ACT FAST-M

TREAT SEPSIS

GIVE IV FLUIDS

GIVE IV ANTIBIOTICS

IDENTIFY &TREAT THE SOURCE OF INFECTION

CONSIDER TRANSFER TO SPECIALIZED CARE

MONITOR VITAL SIGNS OF THE MOTHER AND FETUS

TACKLING ANTIMICROBIAL

RESISTANCE: Supporting national

measures to address infection prevention

and control ancfwa er, sanitation and hygiene in

health care settings

World Health un·1cefttf'litOrganization ~

Antimicrobial resistance (AMR) presents asignificant threat to human health. World leaders have agreed that tackling AMR will require addressing both health and agriculture concerns with afocus on prevention. Improving infection prevention and control (IPC) and water, sanitation, and hygiene (WASH) is one of the five objectives in the World Health Organization's (WHO) AMR Global Action Plan. Nowhere is reducing infection more important than in health care facilities.Joint, immediate action to address IPC and WASH is essential.

3 lnaused burden ofexpensive, hanl-to-trut and llfe-thrHtenlng

Addressing these challenges will require accelerating joint efforts to improve WASH, IPC and AMR in health care settings.

reslstlnt Infections ==::::i lnaused use of antllllotlcs to trNt pmentallle InfectionsCempn11111sed

4 Deaease In patient confidence InIPCpractkes health are

lnaused reslstlnce