Surgical Site Infection (SSI) is the most frequent type of health care-associated infection in low– and middle–income countries affecting, in some settings, up to one third of patients who are operated on. This problem causes a substantial risk to patients and financial losses for health systems. The problem is multifactorial, and achieving a measureable and sustained reduction in SSI risk is challenging.
From 2013 to 2015 the WHO Clean Care is Safer Care programme, in collaboration with the Johns Hopkins Armstrong Institute for Patient Safety and Quality, supported the implementation of an SSI prevention and quality improvement intervention in Surgical Departments in five African hospitals (AIC Kijabe Hospital, Kenya; Mulago Hospital, Uganda; Church of Uganda Kisiizi Hospital, Uganda; Ndola General Hospital, Zambia; Parirenyatwa Hospital, Zimbabwe). This is the Surgical Unit-based Safety Programme (SUSP) in Africa.
Amongst these African hospitals the AIC Kijabe Hospital in Kijabe, Kenya, has been awarded by WHO as being the most successful at improving Patient Safety in general, and in preventing SSI in particular in the context of the SUSP project. Over an 18–month period, the team at Kijabe Hospital individually followed up over 1,000 patients pre- and post-operatively as part of their SSI surveillance, using an innovative combination of inpatient reviews, outpatient clinic appointments and telephone calls.
On 4 August 2014 a multimodal intervention to reduce SSI occurrence was launched in Kijabe Hospital, comprising improvements in the following evidence-based infection control elements
- Pre-operative patient bathing
- Avoiding pre-operative hair removal
- Appropriate surgeon hand cleaning
- Appropriate patient skin preparation
- Appropriate antibiotic prophylaxis
- Improving discipline in the operating room
Further SUSP work also took place to improve the institutional culture of patient safety, especially focusing on teamwork and communication. Regular patient safety rounds with senior executives were used to highlight current ‘on the ground’ infection control challenges. Posters and leaflets developed for use in the SUSP project are now being made available as an open resource for others.
Woman Trial This entails the use of tranexamic acid for the treatment of postpartum hemorrhage; An international, randomized, double blind, placebo controlled trial since 2012 in collaboration with The London school of Hygiene & Tropical medicine (LSHTM)
Another international study we are currently undertaking is International orthopaedic multicenter study in fracture care (INORMUS) in collaboration with the George Institute for global Health -Australia