Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study.

Background: Prophylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices. Aim: This study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH). Methods: The observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach. Result: Surgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds. Conclusion: Deeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks.

Prevalence and determinants of work related injuries among small and medium scale industry workers in Bahir Dar Town, north west Ethiopia.

OBJECTIVES: To assess the prevalence and determinants of work-related injuries among small and medium scale industrial workers in Bahir Dar town, northwest Ethiopia. METHOD: Cross sectional comparative study design was used. Purposive sampling method was used to choose the specific Kebele 14 of the study area, for its relatively high number of industries. The study units were stratified into small and medium scale industries. All workers who were available at the time of interview were included in the study. A pre-tested questionnaire was used to collect data. Data was analyzed using SPSS for windows 16.0. RESULT: A total of 328 and 655 workers from small and medium-scale industries respectively participated in the study. Seven hundred sixty nine (78.2%) were males. Three hundred thirty six workers (34.2%) reported that they had experienced work-related injuries. Sex, monthly salary, age, work experience and use of personal protective equipment were found to be different in the small and medium industries (P < 0.05). CONCLUSION: There was a high prevalence of work related injuries. Sociodemographic, socioeconomic, personal work behavior and the working environment have contributed for the injuries. Work-related injuries are assumed to be preventable with the provision of occupational health programs in workplaces. Thus it is recommended that the owners of industries need to focus on training and installing safer work environment and Further studies with large-scale coverage and prospective study designs are warranted.