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

Aiken, AM; Wanyoro, AK; Mwangi, J; Mulingwa, P; Wanjohi, J; Njoroge, J; Juma, F; Mugoya, IK; Scott, JA; Hall, AJ; (2013) Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya. The Journal of hospital infection, 83 (2). pp. 140-5. ISSN 0195-6701 DOI: https://doi.org/10.1016/j.jhin.2012.11.003

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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.<br/> AIM: To examine the epidemiological characteristics of various components of an SSI surveillance programme in a single Kenyan hospital.<br/> 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.<br/> 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).<br/> 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 23332563
Web of Science ID: 314355600011
URI: http://researchonline.lshtm.ac.uk/id/eprint/611214


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