An International Collaboration to Implement and Evaluate at Scale the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis Programme)

大规模实施和评估孕产妇脓毒症积极预防和治疗的国际合作（APT-脓毒症计划）

• 批准号: MR/V005782/1
• 负责人: David Lissauer
• 金额: $ 437.5万
• 依托单位: University of Liverpool
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FV005782%2F1
• 关键词: International; Collaboration; Implement; Evaluate; Scale

MATERNAL SEPSIS - AN URGENT RESEARCH NEED"Maternal sepsis" is a life threatening condition caused by infection during or after pregnancy. It occurs if the body's response to a developing infection causes damage to its own organs. Maternal sepsis contributes to half of all maternal deaths. Internationally, organisations such as the World Health Organisation and United Nations are committed to reducing the numbers of women who die due to pregnancy and childbirth. Tackling maternal sepsis is an important part of this effort. However, there has been inadequate international focus on this issue, and there is an urgent need to identify effective ways to combat this problem.A POTENTIAL SOLUTION"The Active Prevention and Treatment of Maternal Sepsis" or APT-sepsis is a carefully developed programme designed specifically to be used in countries and facilities where there are limited resources available. It aims to change health care workers behaviours to ensure mothers get the best care possible to better prevent and manage infections. In particular the programme will improve care by ensuring that health care workers: 1) always wash their hands to prevent the transmission of infections, 2) prevent infections by following all the World Health Organisation guidelines on infection prevention during pregnancy and birth 3) carry out regular vital sign monitoring and act rapidly to ensure women with suspected sepsis are given all the correct initial treatments using a specially developed maternal sepsis treatment "bundle".This programme is based on an understanding that changing behaviours of health care workers required a carefully planned approach. Our approach helps provide the information, motivation and tools needed. This includes training delivered at the site, paper based checklists and reminders, a network of site champions who can help encourage change and provide ongoing feedback and coaching, involvement of the site management, re-organising sharing of tasks between staff and helping motivate sites and individuals.WORK PREPARING FOR THE TRIALWe have been working over several years with the World Health Organisation and healthcare workers in low resource countries to develop ATP-sepsis. We have tested all parts of the programme in multiple hospitals and shown that it improves the quality of care given to women, and that it is acceptable and that change in practice can be maintained. However, to show that it improves the most important outcomes such as women dying or having very severe infections needs a large trial involving many centres and women and this is what we now plan to do.THE APT-SEPSIS TRIALTo carefully answer the question if the APT-sepsis programme reduces mothers dying or having the most severe infections will involve a clinical trial. This will be done in Malawi and Uganda.We will work across 30 hospitals in each country. After a period where the outcomes will be carefully measured across all facilities, half of the hospitals will then test the APT-sepsis intervention and half will continue their usual practices. Which hospitals will use APT-sepsis will be decided by chance, but making sure that there is a balance in the facilities between both groups.For the next 20 months we will then compare the outcomes in those hospitals taking part in APT-sepsis and those where usual practice is occurring. We will also look in detail at the way the programme is being carried out. This aspect will involve measuring what is happening at the facilities and also detailed interviews to understand the opinions of staff.This research will tell us if the APT-sepsis programme can reduce bad outcomes and stop deaths from maternal sepsis in low resource settings. It will also help us understand how APT-sepsis is used in the study sites so that we can plan further implementation if it is shown to be useful. We also will discover if the APT-sepsis programme is cost effective.

孕产妇败血症 - 紧急研究需要“孕产妇败血症”是由怀孕期间或怀孕后感染引起的威胁生命的疾病。如果人体对发育中的感染的反应会损害其自身器官，就会发生这种情况。孕妇败血症造成了所有孕产妇死亡的一半。在国际上，世界卫生组织和联合国等组织致力于减少因怀孕和分娩而死亡的妇女人数。应对孕产妇败血症是这项工作的重要组成部分。但是，国际上的关注不足，因此迫切需要确定解决此问题的有效方法。潜在的解决方案“积极预防和治疗孕产妇脓毒症”或Apt-Sepsis是一项精心开发的计划，该计划专门设计在可用资源有限的国家和设施中。它旨在改变医疗保健工作者的行为，以确保母亲获得最好的护理，以更好地预防和管理感染。特别是，该计划将通过确保医疗保健工作者来改善护理：1）始终洗手以防止感染传播，2）遵循所有世界卫生组织预防预防感染的指南，在怀孕和出生期间预防预防感染指南3）进行常规的生命体征监测并迅速采取行动，以确保妇女对seps的妇女进行所有适当的治疗方法，以实现所有的治疗方法，以实现特定的治疗方法。卫生保健工作者需要精心计划的方法。我们的方法有助于提供所需的信息，动力和工具。这包括在网站上提供的培训，基于纸质的清单和提醒，这是一个网站冠军网络，可以帮助鼓励变革，并提供持续的反馈和教练，参与现场管理，重新组织员工之间的任务共享并帮助激励站点和个人的工作。我们已经在多家医院测试了该计划的所有部分，并表明它提高了给予女性的护理质量，并且可以接受，并且可以维持实践的变化。但是，为了证明它可以改善诸如女性死亡或患有非常严重的感染的最重要结果，需要进行许多中心和妇女的大型试验，这是我们现在打算做的。这将在马拉维和乌干达完成。我们将在每个国家的30家医院工作。在将结果仔细测量所有设施的时期之后，一半的医院将测试APT-SEPSIS干预，一半将继续其通常的做法。哪些医院将使用APT-SEPSIS将由偶然决定，但是请确保两组之间的设施之间存在平衡。在接下来的20个月中，我们将比较参加APT-Sepsis的医院和通常实践的医院的结果。我们还将详细介绍程序的执行方式。这一方面将涉及衡量设施中发生的事情，并详细的访谈以了解员工的意见。这项研究将告诉我们，Apt-Sepsis计划是否可以减少不良结果并停止在低资源环境中产妇败血症的死亡。它还将帮助我们了解研究站点中如何使用Apt-Sepsis，以便我们可以计划进一步实施，如果证明有用。我们还将发现APT-SEPSIS计划是否具有成本效益。

项目成果

Avoidable Factors Associated with Maternal Death from Postpartum Haemorrhage: A National Malawian Surveillance Study

与产后出血导致孕产妇死亡相关的可避免因素：马拉维全国监测研究

• DOI: 10.2139/ssrn.4726184
• 发表时间: 2024
• 作者: Riches J