Interventional studies for preventing surgical site infections in sub-Saharan Africa - A systematic review

Alexander M Aiken, David M Karuri, Anthony K Wanyoro, Jana Macleod, Alexander M Aiken, David M Karuri, Anthony K Wanyoro, Jana Macleod

Abstract

Background: There is a great need for safe surgical services in sub-Saharan Africa, but a major difficulty of performing surgery in this region is the high risk of post-operative surgical site infection (SSI).

Methods: We aimed to systematically review which interventions had been tested in sub-Saharan Africa to reduce the risk of SSI and to synthesize their findings. We searched Medline, Embase and Global Health databases for studies published between 1995 and 2010 without language restrictions and extracted data from full-text articles.

Findings: We identified 24 relevant articles originating from nine countries in sub-Saharan Africa. The methodological quality of these publications was diverse, with inconsistency in definitions used for SSI, period and method of post-operative follow-up and classification of wound contamination. Although it was difficult to synthesise information between studies, there was consistent evidence that use of single-dose pre-operative antibiotic prophylaxis could reduce, sometimes dramatically, the risk of SSI. Several studies indicated that alcohol-based handrubs could provide a low-cost alternative to traditional surgical hand-washing methods. Other studies investigated the use of drains and variants of surgical technique. There were no African studies found relating to several other promising SSI prevention strategies, including use of checklists and SSI surveillance.

Conclusions: There is extremely limited research from sub-Saharan Africa on interventions to curb the occurrence of SSI. Although some of the existing studies are weak, several high-quality studies have been published in recent years. Standard methodological approaches to this subject are needed.

Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Search items used for systematic review.
Fig. 2
Fig. 2
Flow diagram for selection of articles.

References

    1. Allegranzi B., Nejad S.B., Combescure C., Graafmans W., Attar H., Donaldson L. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–241.
    1. Bagheri Nejad S., Allegranzi B., Syed S.B., Ellis B., Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89(10):757–765.
    1. Bagratee J.S., Moodley J., Kleinschmidt I., Zawilski W. A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. BJOG. 2001;108(2):143–148.
    1. Osuigwe A.N., Ekwunife C.N., Ihekowba C.H. Use of prophylactic antibiotics in a paediatric day-case surgery at NAUTH, Nnewi, Nigeria: a randomized double-blinded study. Trop Doct. 2006;36(1):42–44.
    1. Ansaloni L., Brundisini R., Morino G., Kiura A. Prospective, randomized, comparative study of Misgav Ladach versus traditional cesarean section at Nazareth Hospital, Kenya. World J Surg. 2001;25(9):1164–1172.
    1. Nthumba P.M., Stepita-Poenaru E., Poenaru D., Bird P., Allegranzi B., Pittet D. Cluster-randomized, crossover trial of the efficacy of plain soap and water versus alcohol-based rub for surgical hand preparation in a rural hospital in Kenya. Br J Surg. 2010;97(11):1621–1628.
    1. Begg C., Cho M., Eastwood S., Horton R., Moher D., Olkin I. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637–639.
    1. Adjoussou S., Ble R.K., Seni K., Fanny M., Toure-Ecra A., Koffi A. Value of hand disinfection by rubbing with alcohol prior to surgery in a tropical setting. Med Trop. 2009;69(5):463–466. [in French]
    1. Saxer F., Widmer A., Fehr J., Soka I., Kibatala P., Urassa H. Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact. Ann Surg. 2009;249(2):322–326.
    1. Culver D.H., Horan T.C., Gaynes R.P., Martone W.J., Jarvis W.R., Emori T.G. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):152S–157S.
    1. Reggiori A., Ravera M., Cocozza E., Andreata M., Mukasa F. Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa. Br J Surg. 1996;83(3):356–359.
    1. Kayihura V., Osman N.B., Bugalho A., Bergstrom S., Kayihura V., Osman N.B. Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost–benefit study in Mozambique. Acta Obstet Gynecol Scand. 2003;82(7):636–641.
    1. Opoku B.K. Prophylactic antibiotic during Caesarean sections at Komfo Anokye Teaching Hospital, Kumasi. Ghana Med J. 2007;41(2):48–51.
    1. Alekwe L.O., Kuti O., Orji E.O., Ogunniyi S.O. Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities. J Matern Fetal Neonatal Med. 2008;21(9):638–642.
    1. Mulu M., Biruk T., Aytenfisu H.G. Antibiotic use in obstetric fistula repair: single blinded randomized clinical trial. Ethiop Med J. 2010;48(3):211–217.
    1. Usang U.E., Sowande O.A., Adejuyigbe O., Bakare T.I.B., Ademuyiwa O.A. The role of preoperative antibiotics in the prevention of wound infection after day case surgery for inguinal hernia in children in Ile Ife, Nigeria. Pediatr Surg Int. 2008;24(10):1181–1185.
    1. Meier D.E., Nkor S.K., Aasa D., OlaOlorun D.A., Tarpley J.L. Prospective randomized comparison of two preoperative skin preparation techniques in a developing world country. World J Surg. 2001;25(4):441–443.
    1. Malomo O., Kuti O., Orji E., Ogunniyi S., Sule S. A randomised controlled study of non-closure of peritoneum at caesarean section in a Nigerian population. J Obstet Gynaecol. 2006;26(5):429–432.
    1. Bjorklund K., Kimaro M., Urassa E., Lindmark G. Introduction of the Misgav Ladach caesarean section at an African tertiary centre: a randomised controlled trial. BJOG. 2000;107(2):209–216.
    1. van Bogaert L.J., Misra A. Peritoneal closure or non-closure at caesarean section. J Obstet Gynaecol. 2009;29(3):217–219.
    1. Warf B.C. Comparison of 1-year outcomes for the Chhabra and Codman-Hakim micro precision shunt systems in Uganda: a prospective study in 195 children. J Neurosurg. 2005;102(4):358–362.
    1. Lagarde E., Taljaard D., Puren A., Auvert B. High rate of adverse events following circumcision of young male adults with the Tara KLamp technique: a randomised trial in South Africa. S Afr Med J. 2009;99(3):163–169.
    1. Maharaj D., Bagratee J.S., Moodley J. Drainage at caesarean section – a randomised prospective study. S Afr J Surg. 2000;38(1):9–12.
    1. Ezeome E.R., Adebamowo C.A. Closed suction drainage versus closed simple drainage in the management of modified radical mastectomy wounds. S Afr Med J. 2008;98(9):712–715.
    1. Musa A.A., Agboola O.J., Banjo A.A., Oyegunle O. The use of drains in thyroid surgery. Niger Postgrad Med J. 2010;17(1):15–18.
    1. Horan T.C., Andrus M., Dudeck M.A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–332.
    1. Owens C.D., Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infect. 2008;70(Suppl. 2):3–10.
    1. National Collaborating Centre for Women’s and Children’s Health . National Institute for Clinical Excellence; UK: 2008. Prevention and treatment of surgical site infection.
    1. Kirby J.P., Mazuski J.E. Prevention of surgical site infection. Surg Clin North Am. 2009;89(2):365–389. viii.
    1. Anderson D.J., Kaye K.S., Classen D., Arias K.M., Podgorny K., Burstin H. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl. 1):S51–S61.
    1. Reichman D.E., Greenberg J.A. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009;2(4):212–221.
    1. Gogoua R.D., Mambo M., Anoumou M., Kouame M., Fal A., Kone B. Pefloxacin compared with oxacillin in short term antibiotic prophylaxis in orthopaedic surgery and traumatology unit at the Treichville university teaching hospital. Medecine d’Afrique Noire. 2003;50(1):17–21. [French]
    1. Ward H.R., Jennings O.G., Potgieter P., Lombard C.J. Do plastic adhesive drapes prevent post caesarean wound infection? Journal of Hospital Infection [Clinical Trial Randomized Controlled Trial] 2001 Mar;47(3):230–234.
    1. Fasubaa O.B., Ogunniyi S.O., Dare F.O., Isawumi A.I., Ezechi O.C., Orji E.O. Uncomplicated Caesarean section: is prolonged hospital stay necessary? East African Medical Journal. 2000 Aug;77(8):448–451.

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