Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya

Abstract

SummaryBackgroundIn low-income countries, surgical site infections (SSIs) are a very frequent form of hospital-acquired infection. Surveillance is an important method for controlling SSI but it is unclear how this can best be performed in low-income settings.AimTo examine the epidemiological characteristics of various components of an SSI surveillance programme in a single Kenyan hospital.MethodsThe study assessed the inter-observer consistency of the surgical wound class (SWC) and American Society of Anesthesiologists (ASA) scores using the kappa statistic. Post-discharge telephone calls were evaluated against an outpatient clinician review ‘gold standard’. The predictive value of components of the Centers for Disease Control and Prevention – National Healthcare Safety Network (CDC-NHNS) risk index was examined in patients having major obstetric or gynaecological surgery (O&G) between August 2010 and February 2011.FindingsAfter appropriate training, surgeons and anaesthetists were found to be consistent in their use of the SWC and ASA scores respectively. Telephone calls were found to have a sensitivity of 70% [95% confidence interval (CI): 47–87] and a specificity of 100% (95% CI: 95–100) for detection of post-discharge SSI in this setting. In 954 patients undergoing major O&G operations, the SWC score was the only parameter in the CDC-NHNS risk index model associated with the risk of SSI (odds ratio: 4.00; 95% CI: 1.21–13.2; P = 0.02).ConclusionsSurveillance for SSI can be conducted in a low-income hospital setting, although dedicated staff, intensive training and local modifications to surveillance methods are necessary. Surveillance for post-discharge SSI using telephone calls is imperfect but provides a practical alternative to clinic-based diagnosis. The SWC score was the only predictor of SSI risk in O&G surgery in this context.

Surgical Site Infections at a Saudi Hospital: The Need for a National Surveillance Program

“…It is worth noting that > 80% of Staphylococci isolates in the present study were methicillin-resistant and > 50% of Gramnegative pathogens were resistant to the commonly prescribed antibiotics such as cephalosporins, quinolones and trimethoprim/sulfamethoxazole. These findings, similar to previous reports from developing countries, 20,21,28 This study has some limitations. The first limitation is the absence of individual patient follow-up after discharge.…”

“…20,21 These measures include: maintaining perioperative blood glucose levels of less than 200 mg/dL; avoiding hair removal except when hair could interfere with an operation or, when hair removal is necessary, removing it with clippers; using appropriate antibiotics for antimicrobial prophylaxis ; conducting antimicrobial prophylaxis for the appropriate time (and discontinuing the prophylaxis within 24 h after the procedure); and requiring a chlorhexidine bath before the operation. 22 20,21,23,24 Perioperative antimicrobial prophylaxis is a well-established strategy for reducing the risk of SSI. However, in the present study, there were no significant differences in the rate of SSI between patients who received antibiotic prophylaxis and those who didn't.…”

Fact-finding Survey of Nosocomial Infection Control in Hospitals in Kathmandu, Nepal—A Basis for Improvement

“…The average number of beds in the surveyed hospitals was as follows: national hospitals; 372 (150-497), private hospitals; 206 (50-750), other hospitals 328 (156-500). The average number of clinical departments was as follows: national hospitals (excluding the two specialized hospitals); 18.0 (14-22), private hospitals 9.7 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15); other hospitals 17.5 (15)(16)(17)(18)(19)(20). TUTH, which is one of the national hospitals, had 468 beds and 22 clinical departments.…”

“…In developing countries, where the incidence of infectious diseases is high and environmental conditions of healthcare facilities are poor, nosocomial infections may frequently occur, and some studies have reported a high incidence at healthcare facilities in these countries [4][5][6]. Effective nosocomial infection control is crucial in the healthcare facilities of developing countries, but in actual fact, attention to it is still limited and control measures are not functioning well in many facilities.…”

Compliance to Intraoperative Basic Hygiene and Patient Safety Culture in Mozambique

“…However, thousands of infections are recorded nationally every year post surgery, making surgical site infections commonly occurring in healthcare, ranging from superficial skin infections to much more severe conditions some in fact life-threatening [1]. A review studying surgical site infections in low-income countries and Africa in particular found that the frequency of surgical site infections were shockingly high in comparison to high-income countries [2].…”