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

A M Aiken, A K Wanyoro, J Mwangi, P Mulingwa, J Wanjohi, J Njoroge, F Juma, I K Mugoya, J A G Scott, A J Hall, A M Aiken, A K Wanyoro, J Mwangi, P Mulingwa, J Wanjohi, J Njoroge, F Juma, I K Mugoya, J A G Scott, A J Hall

Abstract

Background: In 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.

Aim: To examine the epidemiological characteristics of various components of an SSI surveillance programme in a single Kenyan hospital.

Methods: The 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.

Findings: After 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).

Conclusions: Surveillance 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.

Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

References

    1. Allegranzi B., Bagheri Nejad S., Combescure C. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241.
    1. Gaynes R., Richards C., Edwards J. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis. 2001;7:295–298.
    1. Aiken A.M., Karuri D.M., Wanyoro A.K., Macleod J. Interventional studies for preventing surgical site infections in sub-Saharan Africa – a systematic review. Int J Surg. 2012;10:242–249.
    1. Haley R.W. The scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates. J Hosp Infect. 1995;30(Suppl):3–14.
    1. Rosenthal R., Weber W.P., Marti W.R. Surveillance of surgical site infections by surgeons: biased underreporting or useful epidemiological data? J Hosp Infect. 2010;75:178–182.
    1. Petherick E.S., Dalton J.E., Moore P.J., Cullum N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis. 2006;6:170.
    1. Culver D.H., Horan T.C., Gaynes R.P. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991;91:152S–157S.
    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;36:309–332.
    1. Fehr J., Hatz C., Soka I. Risk factors for surgical site infection in a Tanzanian district hospital: a challenge for the traditional National Nosocomial Infections Surveillance system index. Infect Control Hosp Epidemiol. 2006;27:1401–1404.
    1. Eriksen H.M., Chugulu S., Kondo S., Lingaas E. Surgical-site infections at Kilimanjaro Christian Medical Center. J Hosp Infect. 2003;55:14–20.
    1. Nthumba P.M., Stepita-Poenaru E., Poenaru 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;97:1621–1628.
    1. Whiting P., Rutjes A.W., Reitsma J.B., Bossuyt P.M., Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.
    1. Taye M. Wound infection in Tikur Anbessa hospital, surgical department. Ethiop Med J. 2005;43:167–174.
    1. Woodfield J.C., Beshay N.M., Pettigrew R.A., Plank L.D., van Rij A.M. American Society of Anesthesiologists classification of physical status as a predictor of wound infection. Aust NZ J Surg. 2007;77:738–741.
    1. Kesah C.N., Egri-Okwaji M.T., Iroha E., Odugbemi T.O. Aerobic bacterial nosocomial infections in paediatric surgical patients at a tertiary health institution in Lagos, Nigeria. Niger Postgrad Med J. 2004;11:4–9.
    1. Koigi-Kamau R., Kabare L.W., Wanyoike-Gichuhi J. Incidence of wound infection after caesarean delivery in a district hospital in central Kenya. East Afr Med J. 2005;82:357–361.
    1. Ameh E.A., Mshelbwala P.M., Nasir A.A. Surgical site infection in children: prospective analysis of the burden and risk factors in a sub-Saharan African setting. Surg Infect (Larchmt) 2009;10:105–109.

Source: PubMed

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