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

• Published in: The Journal of hospital infection 2020-03, Vol.104 (3), p.321-327
• Main Authors: Bediako-Bowan, A., Owusu, E., Debrah, S., Kjerulf, A., Newman, M.J., Kurtzhals, J.A.L., Mølbak, K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Cohort Studies; Cross Infection - epidemiology; Female; Ghana; Hospitals, Teaching; Humans; Male; Middle Aged; Monitoring; Patient Safety; Population Surveillance; Prospective Studies; Risk Factors; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Surveillance; Surveillance system; Young Adult
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2020.01.004

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. To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs. An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1st, 2017 to December 31st, 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. 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. 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.