Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study

A Bediako-Bowan; E Owusu; S Debrah; A Kjerulf; M J Newman; J A L Kurtzhals; K Mølbak

doi:10.1016/j.jhin.2020.01.004

Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study

J Hosp Infect. 2020 Mar;104(3):321-327. doi: 10.1016/j.jhin.2020.01.004. Epub 2020 Jan 10.

Authors

A Bediako-Bowan¹, E Owusu², S Debrah³, A Kjerulf⁴, M J Newman⁵, J A L Kurtzhals⁶, K Mølbak⁷

Affiliations

¹ Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana; Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana; Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark; Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark. Electronic address: abediako-bowan@ug.edu.gh.
² Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Science, University of Ghana, Accra, Ghana.
³ Department of Surgery, University of Cape Coast, Cape Coast, Ghana.
⁴ National Centre for Infection Control, Department of Infectious Disease Epidemiology and Prevention, Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
⁵ Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana.
⁶ Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital (Righospitalet), Copenhagen, Denmark.
⁷ Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark; Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.

PMID: 31931045
DOI: 10.1016/j.jhin.2020.01.004

Abstract

Background: Surveillance systems for surgical site infections (SSIs), as a measure of patient safety, help health institutions devise strategies to reduce or prevent them. No surveillance systems exist to monitor SSIs in Ghana.

Aim: To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs.

Methods: An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1^st, 2017 to December 31^st, 2018 to identify SSI. It involved a daily inpatient surveillance of patients who had had a surgical procedure, followed by post-discharge surveillance by means of a healthcare personnel-based survey and a patient-based telephone survey. We supplied quarterly feedback of results to surgeons.

Findings: Among the 3267 patients included, 331 were identified with an SSI, a 10% incidence risk. Patients who acquired an SSI experienced increased morbidity including nine extra days in hospital and an adjusted relative mortality risk of 2.3 (95% confidence interval: 1.3 - 4.1; P=0.006) compared to patients without SSI. Forty-nine per cent (161/331) of SSIs were diagnosed post discharge using the healthcare personnel-based survey. The patient-based telephone survey contributed 12 additional cases. SSI incidence risk decreased from 12.8% to 7.5% during the study period.

Conclusion: Post-discharge surveillance is feasible using existing healthcare personnel, and the results highlight the high risk and burden of SSIs in Ghana. A surveillance system with feedback for monitoring SSIs may contribute to reducing SSIs; however, firm conclusions regarding the impact need longer observation time.

Keywords: Ghana; Monitoring; Surgical site infections; Surveillance; Surveillance system.

MeSH terms

Adolescent
Adult
Aged
Child
Cohort Studies
Cross Infection / epidemiology*
Female
Ghana
Hospitals, Teaching
Humans
Male
Middle Aged
Patient Safety*
Population Surveillance
Prospective Studies
Risk Factors
Surgical Wound Infection / epidemiology*
Surgical Wound Infection / prevention & control
Young Adult