Implementing a surveillance and prevention program for post-caesarean surgical site infections in Kenya

Surgical Site Infection (SSI) surveillance efforts in sub-Saharan Africa have largely been documented in research settings. Such programs need to be institutionalized within routine healthcare settings for sustainability. We evaluate the feasibility of setting up an SSI surveillance and prevention program within public settings in Kenya.

Facility infection prevention and control (IPC) committees were established, trained, and resourced on SSI surveillance and prevention in two large hospitals in Kenya. A surgical checklist and monitoring form assessing surgical care bundle implementation and wound status before discharge was included in the medical charts of women who had cesarean section (CS) deliveries. Post-discharge wound assessment interviews were targeted for completion 14-30 days after surgery. Data were analyzed using descriptive statistics and chi-square tests (χ²) for differences.

The program enrolled 1,039 women undergoing CS. Only 65% (675/1039) were reached for any post-discharge wound assessment, with 28% (186/675) reached within the targeted 30 days. Of these, 7% (12/186) had an SSI. Six of these women (6/37 = 16%) were identified within 14 days post-operatively while the remaining six (6/149 = 4%) were identified 15-30 days post-operatively. Surgical care bundle implementation differed by site, with pre-operative antibiotic use at 100% in Thika vs. 66% in Kitale, with variation in the antibiotics used. Blood glucose monitoring at 23 vs. 32% respectively. Hair removal was low overall at 2%.

While setting up an SSI surveillance and prevention program is feasible, efforts and resources targeting post-discharge follow-up and case finding should be prioritized. National guidelines standardizing surgical antibiotic prophylaxis are needed as part of antimicrobial stewardship programs.