Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya
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 character...
| Hauptverfasser: | , , , , , , , , , |
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| Format: | Journal article |
| Sprache: | English |
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2013
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| _version_ | 1826273900232704000 |
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| author | Aiken, A Wanyoro, A Mwangi, J Mulingwa, P Wanjohi, J Njoroge, J Juma, F Mugoya, I Scott, J Hall, A |
| author_facet | Aiken, A Wanyoro, A Mwangi, J Mulingwa, P Wanjohi, J Njoroge, J Juma, F Mugoya, I Scott, J Hall, A |
| author_sort | Aiken, A |
| collection | OXFORD |
| description | 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 (OandG) 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 OandG 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 OandG surgery in this context. © 2012 The Healthcare Infection Society. |
| first_indexed | 2024-03-06T22:35:15Z |
| format | Journal article |
| id | oxford-uuid:59ad38c2-2adc-4fee-b157-965e543459bd |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T22:35:15Z |
| publishDate | 2013 |
| record_format | dspace |
| spelling | oxford-uuid:59ad38c2-2adc-4fee-b157-965e543459bd2022-03-26T17:11:09ZEvaluation of surveillance for surgical site infections in Thika Hospital, KenyaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:59ad38c2-2adc-4fee-b157-965e543459bdEnglishSymplectic Elements at Oxford2013Aiken, AWanyoro, AMwangi, JMulingwa, PWanjohi, JNjoroge, JJuma, FMugoya, IScott, JHall, ABackground: 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 (OandG) 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 OandG 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 OandG surgery in this context. © 2012 The Healthcare Infection Society. |
| spellingShingle | Aiken, A Wanyoro, A Mwangi, J Mulingwa, P Wanjohi, J Njoroge, J Juma, F Mugoya, I Scott, J Hall, A Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title | Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title_full | Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title_fullStr | Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title_full_unstemmed | Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title_short | Evaluation of surveillance for surgical site infections in Thika Hospital, Kenya |
| title_sort | evaluation of surveillance for surgical site infections in thika hospital kenya |
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