Development of a Surgical Infection Surveillance Program at a Tertiary Hospital in Ethiopia: Lessons Learned from Two Surveillance Strategies

Forrester, Jared A.; Koritsanszky, Luca; Parsons, Benjamin D; Hailu, Menbere; Amenu, Demisew; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas

doi:10.1089/sur.2017.136

Cited by 22 publications

(30 citation statements)

References 33 publications

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“…Among these, four of the studies were conducted in countries other than Ethiopia: Nigeria [23], China [24], India [25] and England [26]. The remaining nine studies were conducted in different regions of Ethiopia [27–35] and excluded because of the study population and unreported outcome of interest. Finally, 13 eligible studies were included in the review (Fig.…”

Section: Resultsmentioning

confidence: 99%

Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis

et al. 2019

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BackgroundSurgical site infection is a common complication in women undergoing Caesarean section and the second most common cause of maternal mortality in obstetrics. In Ethiopia, prevalence and root causes of surgical site infection post-Caesarean section are highly variable. This systematic review and meta-analysis estimate the overall prevalence of surgical site infection and its root causes among women undergoing Caesarean section in Ethiopia.MethodSystematic review and meta-analysis were conducted to assess the prevalence and root causes of surgical site infection in Ethiopia. The articles were searched from the databases such as Medline, Google Scholar and Science Direct. A total of 13 studies from different regions of Ethiopia reporting the prevalence and root causes of surgical site infection among women undergoing Caesarean section were included. A random effect meta-analysis model was computed to estimate the overall prevalence. In addition, the association between risk factor variables and surgical site infection related to Caesarean section were examined.ResultsThirteen studies in Ethiopia showed that the overall prevalence of surgical site infection among women undergoing Caesarean section was 8.81% (95% CI: 6.34–11.28). Prolonged labor, prolonged rupture of membrane, presence of anemia, presence of chorioamnionitis, presence of meconium, vertical skin incision, greater than 2 cm thickness of subcutaneous tissue, and general anesthesia were significantly associated with surgical site infection post-Caesarean section.ConclusionPrevalence of surgical site infection among women undergoing Caesarean section was relatively higher in Ethiopians compared with the report of center of disease control guideline. Prolonged labor, prolonged rupture of membrane, presence of anemia, chorioamnionitis, presence of meconium, vertical skin incision, greater than 2 cm thickness of subcutaneous tissue and/or general anesthesia were significantly associated with surgical site infection post-Caesarean section.

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Section: Resultsmentioning

confidence: 99%

Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis

et al. 2019

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“…Second, the prospective study design and data collection through direct observation will allow for the collection of high-quality primary data, avoiding the pitfalls of retrospective chart review and reliance on secondary data. As echoed by Forrester et al direct observation is a more effective postoperative surveillance method than chart review 52. Third, baseline and endline data will be collected over 3 months to reduce the impact of monthly variation 53.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

et al. 2019

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IntroductionEffective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term.Methods and analysisOur design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania’s Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance.Ethics and disseminationThe study has received ethical approval from Harvard Medical School and Tanzania’s National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania’s Lake Zone region and other similar contexts.

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“…1 Depending on the degree of intraoperative contamination, baseline patient risk and other infection control measures, as many as 50% of patients can suffer surgical wound infections within the 30-days after an operation. 2 As a result, SSI has been the focus of several recent global initiatives including randomised controlled trials of health technologies, 3 quality improvement bundle studies, [4][5][6] and prospective cohort studies. 2,7 Regimens of antibiotic prophylaxis are a key component in the SSI prevention pathway.…”

Section: Editorialmentioning

confidence: 99%

Antibiotic prophylaxis in a global surgical context

Glasbey

2020

Southern African Journal of Anaesthesia and Analgesia

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Surgical site infection (SSI) is a global problem, and has been highlighted as the foremost research priority for perioperative researchers across high-, middle- and low-income settings. Depending on the degree of intraoperative contamination, baseline patient risk and other infection control measures, as many as 50% of patients can suffer surgical wound infections within the 30-days after an operation. As a result, SSI has been the focus of several recent global initiatives including randomised controlled trials of health technologies, quality improvement bundle studies, and prospective cohort studies.

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Development of a Surgical Infection Surveillance Program at a Tertiary Hospital in Ethiopia: Lessons Learned from Two Surveillance Strategies

Cited by 22 publications

References 33 publications

Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis

Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis

Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

Antibiotic prophylaxis in a global surgical context

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