A collaboration led by the University of Liverpool has received more than £3m funding for a new intervention that will actively prevent, treat and evaluate maternal sepsis.
Every four minutes, a mother dies from a sepsis-related cause somewhere in the world, with the greatest burden borne by women in low and income countries.
The APT-Sepsis intervention aims to address this issue in Malawi and Uganda through an integrated programme with three interventional domains. APT-Sepsis is a complex intervention, developed to target care provider behaviours across the care continuum, culminating in adherence to best practice in prevention and management of maternal sepsis.
Programme lead Professor David Lissauer said: “The recent WHO GLOSS (Global Sepsis) study suggested maternal sepsis may contribute to over half of all maternal deaths.
Despite this, there has been little international focus on the issue. Reducing maternal mortality to reach the Sustainable Development Goal (SDG) target of less than 70 deaths per 100,000 births will require a comprehensive response.
“Although maternal death due to sepsis is the final devastating event, the origins of the problem often lie in multiple areas of poor quality of care including inconsistent infection prevention, poor infection treatment, delayed diagnosis of sepsis, and inadequate sepsis management. The APT-Sepsis intervention brings together evidence-based practice to address these issues via a integrated, scaleable and sustainable approach.”
The three interventional domains are:
- ‘Hand hygiene’: ensuring compliance with the WHO 5 moments of hand hygiene.
- Infection prevention and management: ensuring adoption of evidence based practices for infection prevention in maternity, including appropriate antibiotic prophylaxis for high-risk women and improved surgical practices.
- Better sepsis management: ensuring consistent measurement of patient vital signs and when there is suspected sepsis the triggering of the FAST-M maternal sepsis bundle (which includes fluids, antibiotics, source control, transfer and monitoring).
Senior Research Nurse Laura Munthali said: “Having worked in one of the busiest maternity units in Malawi, it is quite evident we have high numbers of maternal sepsis cases however lack a standardized approach to prevention, early identification, treatment and management resulting mostly to death. It is interesting to have the APT study for this cause, and for the benefit of our mothers not just in Malawi but in all low middle-income countries.”
This work has been developed with colleagues at the University of Birmingham.
Professor Arri Coomarasamy from the University of Birmingham said: “An apparently innocent infection can quickly turn into the catastrophe of sepsis. Sepsis is associated with multiple organ failure, which is often the prelude to a mother’s death. The right patient, receiving the right treatment at the right time can make the difference between life and death. The APT-Sepsis intervention is designed to make it easy to do the right thing quickly and consistently. This research programme will evaluate if the intervention is effective, and give policy-makers and healthcare practitioners the confidence to implement and scale-up the intervention.”
This project is funded by the MRC, NIHR, Wellcome and UK Aid Direct, and managed by the MRC.
Professor David Lissauer is also leading a related programme, LACTATE, which will show the accuracy of blood lactate in the diagnosis of maternal. This will be tested in in pregnant mothers and those who have recently had their babies and suffer with infections, in Malawi, Uganda and Pakistan.
Measurement of blood lactate forms a key part of sepsis management and risk stratification in current international guidelines from both NICE and the Surviving Sepsis Campaign, however these guidelines were developed for non-pregnancy populations in high income countries.
The trial will investigate if lactate measurement, available as a point-of-care test, has incremental benefit over conventional maternal vital sign assessment in the diagnosis of sepsis and identification of women at risk of severe morbidity and mortality in Malawi, Pakistan and Uganda. The study will also investigate how this testing can be incorporated in current clinical practice.