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Conclusion: Melatonin could revert the effects of continuous light and pinealectomy under the ovary of adult rats.

P1.16 QUALITY ASSURANCE

P1.16.01 IMPROVING INFECTION PREVENTION PRACTICES IN REPRODUCTIVE HEALTH SERVICES M. Barone (l), M. Guimei (2), N. Goma (3) (1) AVSC International, New York, New York, USA. (2) University of Alexandria, Alexandria, Egypt. (3) High Institute of Nursing, Ain Shams University, Cairo, Egypt.

Objectives: From 1993 to 1998, Egypt’s Safe Reproductive Health (SRH) Program worked to establish hospital-based reproductive health services in public health systems. One aspect of the program was an effort to improve infection prevention practices. Study Methods: In April 1995, staff knowledge and practice of infection prevention were assessed at three university hospitals. Between April 1995 and December 1997 SRH Program inputs to improve infection prevention were ongoing. Workshops were held at each site; on-going, on-site inputs to identify and resolve problems were provided, and Arabic training and reference materials were developed. Follow-up evaluations occurred in October/November 1997. Results: Results of baseline assessments revealed problems with, and low knowledge of, infection prevention (mean score f S.E.M. 60.6% f 1.3). The mean score on the follow-up knowledge assessment was significantly (p=O.OO) improved (78.3% f 2.1) and practices had improved greatly at the sites. Impact of the infection prevention activities was widespread. For example, proper practices had been adopted throughout the hospitals; infection prevention had been incorporated into curricula at the High Institute of Nursing at each site; and supplies were purchased with hospital funds. Conclusions: Going beyond one-time training of selected staff, to ensuring that all staff - including cleaners - participated in training and other activities, was critical to the improvements. Regular monitoring visits using facilitative approaches, on-the-job training, supervisory involvement and support, and availability of reference materials and supplies also contributed to the program’s success. Fostering ownership among site staff facilitated improvements and will contribute to sustainability of efforts to improve infection prevention.

P1.16.02 AUDIT OF STILLBIRTHS THROUGH THE CONFIDENTIAL ENQUIRY APPROACH K.H. Tan, C.S. Tee, S.H. Yeo, Dept. of Maternal Fetal Medicine, KK Women’s & Children’s Hospital, Singapore.

Objective: To identify suboptimal factors in the management of pregnancies resulting in stillbirths. Study Methods: Over the 4 years (19951998) in KKH, all 231 stillbirths (28 weeks or more) out of 61,284 births were studied in detail by a panel of obstetricians through the confidential enquiry approach. Results: The stillbirth rate was 3.711000 births. More than half of stillbirths have suboptimal factors of which optimum management may have made a difference to the outcome if they were instituted. The majority of theses factors involved suboptimal practice of the patients themselves. Other factors include those related to primary care givers, specialist caregivers and the antenatal care system. A key area identified for stillbirth reduction lies with public and patient education of the importance of seeking early antenatal care. Patients’ poor compliance with management, another important suboptimal factor can be improved by increased effective use of day care facilities, education and social support. Conclusions: Patient education on the importance of early antenatal care and antepartum fetal surveillance, heightened appreciation of antenatal risk factors and adherence to good well formulated management protocols as well as the multidisciplinary cooperative involvement and approach to high risk pregnancies are key elements in closing the stillbirth audit loop.

P1.16.03 OPERATOR-DEPENDANT VARIATION IN MODE OF OPERATIVE DELIVERY OF ‘STANDARD’ NULLIPAROUS WOMEN - DEVELOPING AN OPERATOR PROFILE R. Settatree, N. Varawalla, Department of Obstetrics & Gynaecology, Birmingham Heartlands and Solihull Hospitals, U.K.

Objectives: The study aimed to investigate the scale of variation and characteristics of individual operators in their choice of operative mode of delivery of nulliparous women allowed to labour at term with a singleton cephalic presentation (‘standard’ nullipara’). Study Methods: Data entered on computer at the time of delivery from consecutive deliveries in a single maternity unit over a period of three years were analysed. Parous women, multiple pregnancy, pre-term delivery, non-cephalic delivery and Caesarean Section (CS) planned before the onset of labour were excluded in order to identify a homogeneous group uninfluenced by obstetric history or malpresentation. Responsibility for conduct of an assisted delivery was assigned to the most senior obstetrician present. Results: Of the 3459 births to ‘standard’ nullipara, 1410 required some kind of operative assistance, of which 1110 were carried out by one of 12 senior trainee obstetricians (registrars) and 138 by one of a number of ‘locum’ registrars. Important characteristics of women and their babies appeared randomly distributed among deliveries by these trainees and the remaining analysis was confined to these cases. There were several highly significant differences (O.Ol<P<O.OOl) between the modes of delivery by some trainees compared to the group as a whole. The largest differences were in CS in the second stage of labour, particularly after a failed attempt at vaginal delivery, and the smallest differences were in CS in the first stage of labour. A higher likelihood of CS in the second stage was associated with fewer years of relevant experience and not yet having passed the UK higher professional training examination. Conclusions: The distribution of modes of operative delivery by an individual contributes to an operator ‘profile’. These profiles may vary greatly without awareness by the individual or by those responsible for maternity unit performance. Frequent profile updates would provide objective evidence of the scale and statistical validity of this variation and early warning of features requiring investigation, supervision or other remedial action.

P1.16.04 SCOTTISH HORMONAL CONTRACEmIVE PILL KNOWLEDGE AUDIT D. Raiasekar, A. Bigrigg, Glasgow Center for Family Planning & Sexual Health, Glasgow, Scotland.

Quality assurance implies the definition of standards, the measurement of their achievement and the mechanism to improve performance. Contraceptive Audit Project of Scotland (CAPS) coordinated this National Pill Knowledge Audit to draw national consensus about the pill teaching, what has been practiced by staff and to quantify the quality of pill knowledge among users. Objectives: To set National Standards for current pill users knowledge. To measure the effectiveness of current pill teaching by the health professional in 161 Scottish family planning clinics To determine whether oral contraceptive pill users had understood and retained the required knowledge. Study Methods: This is a criteria based audit using 3 separate questionnaires to estimate the senior staff agreement of the criteria set by a multidisciplinary expert panel, actual routine clinical practice and user knowledge. Two thousand one hundred and thirty pill users participated in this National survey. Results: Five out of the 15 criteria, there was a discrepancy of greater than 30% in what clinicians did in practice compared to what senior staff thought they ought to do. For further 5 criteria, there was over 30% deficiency between the number f clients who understood criteria & the number of clients the clinicians thought they had taught. Conclusion: Improvement in user knowledge levels is required to achieve effective reliable use of oral contraceptive pills. There is a need to develop new intervention strategies to improve the pill users’ knowledge. Two new interventions are being evaluated in Scotland.