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Michelle Weinberg, MD, MPH; Jose Maria Fuentes, MD; Ariel I. Ruiz, MD; Fred Wilson Lozano, MD; Edith Angel, MD; Hernando Gaitan, MD; Brunhilde Goethe, RN; Sonia Parra, RN; Susan Hellerstein, MD, MPH; Dennis Ross-Degnan, ScD; Donald A. Goldmann, MD; W. Charles Huskins, MD, MS

Arch Intern Med. 2001;161:2357-2365.

Background  Improving obstetric care in resource-limited countries is a major international health priority.

Objective  To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods.

Methods  Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate.

Results  Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital 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 implementation (P = .04).

Conclusion  Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

From the Division of Infectious Diseases, Children's Hospital, Boston, Mass (Drs Weinberg, Goldmann, and Huskins); Department of Medicine, Hospital Simón Bolívar (Drs Fuentes and Lozano and Ms Goethe), Escuela Colombiana de Medicina (Drs Fuentes and Lozano), Instituto Materno Infantil (Drs Ruiz, Angel, and Gaitan and Ms Parra), and Departamento de Ginecologia y Obstetricia, Universidad Nacional de Colombia (Drs Ruiz, Angel, and Gaitan), Santafé de Bogotá, Colombia; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston (Dr Hellerstein); Department of Ambulatory Care and Prevention Drug Policy Research Group, Harvard Medical School and Harvard Pilgrim Health Care, Boston (Dr Ross-Degnan); and Department of Pediatrics, Harvard Medical School, Boston (Drs Goldmann and Huskins). Dr Weinberg is now with the Division of Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Dr Huskins is now with the Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minn.

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