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.
Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Science, University of Ghana, Accra, Ghana.
J Hosp Infect. 2020 Mar;104(3):321-327. doi: 10.1016/j.jhin.2020.01.004. Epub 2020 Jan 10.
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.
To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs.
An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1, 2017 to December 31, 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.
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.
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.
作为患者安全措施之一的手术部位感染（SSI）监测系统有助于医疗机构制定减少或预防 SSI 的策略。目前，加纳还没有监测 SSI 的系统。
建立监测趋势和发现暴发的系统，以提高对 SSI 的认识并加以控制。
2017 年 7 月 1 日至 2018 年 12 月 31 日，在Korle Bu 教学医院普通外科病房进行了为期 30 天的主动监测，以确定 SSI。这包括对接受过手术的住院患者进行日常监测，然后通过医务人员为基础的调查和患者为基础的电话调查进行出院后监测。我们每季度向外科医生提供结果反馈。
在纳入的 3267 名患者中，有 331 名患者发生 SSI，发病率为 10%。发生 SSI 的患者发病率增加，包括住院时间延长 9 天，调整后的相对死亡风险为 2.3（95%置信区间：1.3-4.1；P=0.006），与未发生 SSI 的患者相比。使用医务人员为基础的调查，49%（161/331）的 SSI 在出院后诊断。电话调查又增加了 12 例。在研究期间，SSI 发病率从 12.8%降至 7.5%。
使用现有的医务人员进行出院后监测是可行的，结果突出表明了加纳 SSI 的高风险和高负担。具有反馈的监测系统可能有助于减少 SSI，但需要更长的观察时间才能确定其对 SSI 的影响。
