Hussein Julia, Ramani K V, Kanguru Lovney, Patel Kalpesh, Bell Jacqueline, Patel Purvi, Walker Leighton, Mehta Rajesh, Mavalankar Dileep
Immpact, University of Aberdeen, Aberdeen, Scotland.
Indian Institute of Management, Ahmedabad, India.
PLoS One. 2014 Jan 30;9(1):e87378. doi: 10.1371/journal.pone.0087378. eCollection 2014.
To evaluate the effects of an intervention comprising surveillance and an organisational change called Appreciative Inquiry on puerperal infections in hospitals in Gujarat state, India.
This longitudinal cohort study with a control group was conducted over 16 months between 2010 and 2012. Women who delivered in six hospitals were followed-up. After a five month pre-intervention period, the intervention was introduced in three hospitals. Monthly incidence of puerperal infection was recorded throughout the study in all six hospitals. A chi-square test and logistic regression were used to examine for associations, trends and interactions between the intervention and control groups.
Of the 8,124 women followed up, puerperal infections were reported in 319 women (3.9%) over the course of the study. Puerperal sepsis/genital tract infections and urinary tract infections were the two most common puerperal infections. At the end of the study, infection incidence in the control group halved from 7.4% to 3.5%. Levels in the intervention group reduced proportionately even more, from 4.3% to 1.7%. A chi-square test for trend confirmed the reduction of infection in the intervention and control groups (p<0.0001) but the trends were not statistically different from one another. There was an overall reduction of infection by month (OR = 0.94 95% CI 0.91-0.97). Risk factors like delivery type, complications or delivery attendant showed no association with infection.
Interruption of resource flows in the health system occurred during the intervention phase, which may have affected the findings. The incidence of infection fell in both control and intervention groups during the course of the study. It is not clear if appreciative inquiry contributed to the reductions observed. A number of practical and methodological limitations were faced.
Controlled-Trials.com ISRCTN03513186.
评估一项包括监测和名为“欣赏式探询”的组织变革在内的干预措施对印度古吉拉特邦医院产褥感染的影响。
这项设有对照组的纵向队列研究于2010年至2012年期间进行了16个月。对在六家医院分娩的妇女进行随访。在为期五个月的干预前期之后，在三家医院引入了干预措施。在整个研究过程中记录了所有六家医院产褥感染的月度发病率。采用卡方检验和逻辑回归来检验干预组与对照组之间的关联、趋势和相互作用。
在随访的8124名妇女中，在研究过程中有319名妇女（3.9%）报告发生了产褥感染。产褥期败血症/生殖道感染和尿路感染是两种最常见的产褥感染。在研究结束时，对照组的感染发生率从7.4%减半至3.5%。干预组的感染水平下降幅度更大，从4.3%降至1.7%。趋势卡方检验证实了干预组和对照组感染率的降低（p<0.0001），但两组趋势在统计学上并无差异。逐月来看，感染总体呈下降趋势（比值比=0.94，95%置信区间0.91-0.97）。分娩类型、并发症或接生人员等风险因素与感染无关联。
在干预阶段，卫生系统出现了资源流动中断的情况，这可能影响了研究结果。在研究过程中，对照组和干预组的感染发生率均有所下降。尚不清楚欣赏式探询是否促成了所观察到的感染率降低。研究面临一些实际和方法学上的局限性。
Controlled-Trials.com ISRCTN03513186
