Reliability and validity of using telephone calls for post-discharge surveillance of surgical site infection following caesarean section at a tertiary hospital in Tanzania

Boniface Nguhuni, Pasquale De Nardo, Elisa Gentilotti, Zainab Chaula, Caroline Damian, Paola Mencarini, Emanuele Nicastri, Arnold Fulment, Alessandro Piscini, Francesco Vairo, Alexander M Aiken, Giuseppe Ippolito, Boniface Nguhuni, Pasquale De Nardo, Elisa Gentilotti, Zainab Chaula, Caroline Damian, Paola Mencarini, Emanuele Nicastri, Arnold Fulment, Alessandro Piscini, Francesco Vairo, Alexander M Aiken, Giuseppe Ippolito

Abstract

Background: Surgical site infection (SSI) is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved.

Methodology: We conducted an observational cohort study in Dodoma, Tanzania to examine the sensitivity and specificity of telephone calls to detect SSI after discharge from hospital in comparison to a gold standard of clinician review. Women undergoing caesarean section were enrolled and followed up for 30 days. Women providing a telephone number were interviewed using a structured questionnaire at approximately days 5, 12 and 28 post-surgery. Women were then invited for out-patient review by a clinician blinded to the findings of telephone interview.

Results: A total of 374 women were enrolled and an overall SSI rate of 12% (n = 45) was observed. Three hundred and sixteen (84%) women provided a telephone number, of which 202 had at least one telephone interview followed by a clinical review within 48 h, generating a total of 484 paired observations. From the clinical reviews, 25 SSI were diagnosed, of which telephone interview had correctly identified 18 infections; telephone calls did not incorrectly identify SSI in any patients. The overall sensitivity and specificity of telephone interviews as compared to clinician evaluation was 72 and 100%, respectively.

Conclusion: The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.

Keywords: Caesarean section; Phone call interview; Post-discharge surveillance; Resource limited settings; Surgical site infection.

References

    1. Bagnall NM, Vig S, Trivedi P. Surgical-site infection. Surgery. 2009;27(10):426–30.
    1. Smyth ET. Emmerson a M. Surgical site infection surveillance. J Hosp Infect. 2000;45(3):173–184. doi: 10.1053/jhin.2000.0736.
    1. Nejad SB, Allegranzi B, Syed S, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ. 2011;89(10):757–765. doi: 10.2471/BLT.11.088179.
    1. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries : systematic review and meta-analysis. Lancet. 2011;377(9761):228–241. doi: 10.1016/S0140-6736(10)61458-4.
    1. Rothe C, Schlaich C, Thompson S. Healthcare-associated infections in sub-Saharan Africa. J Hosp Infect. 2013;85(4):257–267. doi: 10.1016/j.jhin.2013.09.008.
    1. Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014;3:25. doi: 10.1186/2047-2994-3-25.
    1. Hadiati DR, Hakimi M, Nurdiati DS. Skin preparation for preventing infection following caesarean section. Cochrane Database of Systematic Reviews. 2012;(9). Art. No: CD007462. doi:10.1002/14651858.CD007462.pub2.
    1. Conroy K, Koenig AF, Yu Y, Courtney A, Lee HJ, Norwitz ER. Delivery: 10 strategies to reduce risk. Rev Obstet Gynecol. 2012;5(2):69–77.
    1. Lyimo FM, Massinde AN, Kidenya BR, Konje E, Mshana SE. Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial. Trials. 2012;13:89. doi: 10.1186/1745-6215-13-89.
    1. Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):91–100. doi: 10.4314/ejhs.v21i2.69049.
    1. Brown J, Thompson M, Sinnya S, Jeffery A, de Costa C, Woods C, et al. Pre-incision antibiotic prophylaxis reduces the incidence of post-caesarean surgical site infection. J Hosp Infect. 2013;83(1):68–70. doi: 10.1016/j.jhin.2012.08.014.
    1. Fehr J, Hatz C, Soka I, Kibatala P, Urassa H, Smith T, et al. 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(12):1401–1404. doi: 10.1086/509855.
    1. Cardoso Del Monte MC, Pinto Neto AM. Postdischarge surveillance following cesarean section: the incidence of surgical site infection and associated factors. Am J Infect Control. 2010;38(6):467–472. doi: 10.1016/j.ajic.2009.10.008.
    1. Aiken AM, Wanyoro AK, Mwangi J, Mulingwa P, Wanjohi J, Njoroge J, et al. Evaluation of surveillance for surgical site infections in Thika hospital. Kenya J Hosp Infect. 2013;83(2):140–145. doi: 10.1016/j.jhin.2012.11.003.
    1. Petherick ES, Dalton JE, Moore PJ, Cullum N. Methods for identifying surgical wound infection after discharge from hospital: A systematic review. BMC Infect Dis. 2006;6:170. doi: 10.1186/1471-2334-6-170.
    1. Halwani MA, Turnbull AE, Harris M, Witter F, Perl TM. Postdischarge surveillance for infection following cesarean section: a prospective cohort study comparing methodologies. Am J Infect Control. 2016:455–7.
    1. Koek MB, Wille JC, Isken MR, Voss A, Van Benthem BH. Post-discharge surveillance ( PDS ) for surgical site infections : a good method is more important than a long duration. 2015.
    1. Ng W, Brown A, Alexander D, Ho MF, Kerr B, Amato M, et al. A multifaceted prevention program to reduce infection after cesarean section: interventions assessed using an intensive postdischarge surveillance system. Am J Infect Control. 2015;43(8):805–809. doi: 10.1016/j.ajic.2015.04.001.
    1. Staszewicz W, Eisenring M-C, Bettschart V, Harbarth S, Troillet N. Thirteen years of surgical site infection surveillance in Swiss hospitals. J Hosp Infect. 2014;88(1):40–47. doi: 10.1016/j.jhin.2014.06.003.
    1. Leonne J, Almeida D De, Cristina H, Souza D, Clemente WT, Maia R, et al. American journal of infection control surveillance of surgical site infection after cesarean section and time of notification. AJIC Am J Infect Control 2016;44(3):273–277.
    1. Petrosillo N, Drapeau CMJ, Nicastri E, Martini L, Ippolito G, Moro ML. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis. 2008;8:34. doi: 10.1186/1471-2334-8-34.
    1. Horan TC, Andrus M, Dudeck MA. 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. doi: 10.1016/j.ajic.2008.03.002.
    1. Srun S, Sinath Y, Seng AT, Chea M, Borin M, Nhem S, et al. Surveillance of post-caesarean surgical site infections in a hospital with limited resources. Cambodia J Infect Dev Ctries. 2013;7(8):579–585.
    1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20(4):247–78. doi: 10.1086/501620.
    1. Eriksen HM, Chugulu S, Kondo S, Lingaas E. Surgical-site infections at Kilimanjaro Christian medical center. J Hosp Infect. 2003;55(1):14–20. doi: 10.1016/S0195-6701(03)00225-1.
    1. De Nardo P, Gentilotti E, Nguhuni B, Vairo F, Chaula Z, Nicastri E, et al. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study. J Hosp Infect. 2016;93(4):355–9. doi: 10.1016/j.jhin.2016.02.021.
    1. Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG. 2012;119(11):1324–1333. doi: 10.1111/j.1471-0528.2012.03452.x.
    1. Farret TCF, Dallé J, da Silva MV, Riche CVW, Antonello VS. Risk factors for surgical site infection following cesarean section in a Brazilian Women’s hospital: a case–control study. Brazilian J Infect Dis. 2015;19(2):113–117. doi: 10.1016/j.bjid.2014.09.009.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner