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