Multimodal approach for surgical site infection prevention – results from a pilot site in Kenya

Ntumba, P; Mwangi, Caroline; Barasa, Jack; Aiken, Alexander M.; Kubilay, Zeynep; Allegranzi, Benedetta

doi:10.1186/2047-2994-4-s1-p87

Cited by 11 publications

(6 citation statements)

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“…Good compliance to agreed guidelines is increasingly used across sectors and countries as demonstrating good quality care [ 18 , 61 , 62 ]. There have been concerns with adherence rates to published guidelines among African countries [ 18 , 21 , 60 , 69 , 70 , 71 , 72 ]; however, this is not always the case [ 56 , 58 , 61 ]. In addition, the percentage of patients prescribed antibiotics by their international non-proprietary name is important to reduce costs; however, there can be concerns with their quality across countries (INN) [ 73 , 74 , 75 , 76 , 77 ].…”

Section: Methodsmentioning

confidence: 99%

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

et al. 2022

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Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of ‘Access’ over ‘Watch’ and ‘Reserve’ antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of ‘Watch’ antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.

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Section: Methodsmentioning

confidence: 99%

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

et al. 2022

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“…There have been a number of interventions that have effectively reduced SAP duration, and increase appropriate selection of antimicrobials, through compliance to STG and local guidelines, with some also reducing SSI rates, among African countries (Table S2 ). 11 , 17 , 68–71 Some of these interventions, which the antimicrobial stewardship team in this hospital in Ghana can take forward as future quality improvement projects, include education and training and conducting leadership programmes for front-line staff. These interventions can be implemented either alone or in combination with other approaches including regular audit and feedback meetings with the entire clinical team, dose optimization and the use of prior authorization for restricted antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications

Sefah

Denoo

Bangalee

et al. 2022

JAC-Antimicrobial Resistance

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Background Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Methods A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5 month duration from January to May 2021 in Ho Teaching Hospital. A data collection form was designed to collect key information including the age and gender of patients, type and duration of surgery, choice and duration of SAP. The collected data was assessed for the proportion of SAP compliance with Ghana Standard Treatment Guidelines (STGs) and any association with various patient, surgical wound and drug characteristics. Results Of the 597 medical records assessed, the mean age of patients was 35.6 ± 12.2 years with 86.8% (n = 518) female. Overall SAP compliance with the STG was 2.5% (n = 15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n = 400) and duration at 8.7% (n = 52). SAP compliance was predicted by duration of SAP (P < 0.000) and postoperative hospitalization duration (P = 0.005). Conclusions SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates.

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“…Establishing safe and effective surgical care for children is a critical but neglected area within global surgery [7]. Simple preventive measures, such as optimal surgical hand and skin preparation and appropriate antibiotic prophylaxis have shown to significantly lower the rate of SSI independent of available resources and surgical procedure [39,40]. Implementing and investigating standardized perioperative management programs in children does not only reduce postoperative morbidity and associated health-care costs.…”

Section: Discussionmentioning

confidence: 99%

Systematic literature review on surgical site preparation in paediatric surgery

2022

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Background Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age. Methods A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections. Results In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted. Conclusion Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children. Trial registration Prospero registration (CRD42020166193).

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Multimodal approach for surgical site infection prevention – results from a pilot site in Kenya

Cited by 11 publications

References 0 publications

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications

Systematic literature review on surgical site preparation in paediatric surgery

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