The Ghana HAI project is an international multicentre and interdisciplinary research network that brings together academia (PhD students and Post-Doctoral fellows supervised by Ghanaian and Danish team of experts in the fields of clinical microbiology, interventional studies, cost analysis and ethnographic research), hospitals, policy makers, and civil society groups who work in infection prevention and control. The project is hosted by the Department of Microbiology, University of Ghana with institutional partners from the Institute of Statistical, Social and Economic Research, University of Ghana; Institutional Care Division, Ghana Health Service; Department of Public Health, Aarhus University; Department of Clinical Microbiology at Rigshospitalet, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. The Ghana HAI project is at the present time conducting a prospective surveillance of neonatal sepsis, surgical site infections and puerperal infections in line with health care priorities of the Ghana Health Service.

Project Overview

 Healthcare-associated infections (HCAIs) comprise one of the most common, significant and preventable patient safety issue worldwide. The challenge of HCAIs in Ghana and other developing countries is estimated to be high but scarcely addressed. We postulate that a high prevalence of HCAIs in Ghanaian healthcare settings leads to high patient morbidity and mortality, prolonged hospital stay, reduced quality of life as well as increased economic costs to patients and the health sector. This project aims to improve patient safety by reducing and preventing HCAIs through surveillance and effective infection control. This requires an interdisciplinary approach and the project involves collaboration and research capacity building within the fields of surveillance, clinical research, microbiology, ethnographic health facility research and cost-analysis. We have conducted a nationwide point prevalence survey to assess the burden of HCAIs and related antibiotic use among a representative sample of hospitals in Ghana. A prospective survey focusing on surgical site infections, healthcare associated neonatal sepsis and puerperal infections is being conducted in the selected to generate data on the epidemiology, socioeconomic impact of HCAIs and socio-cultural barriers to infection control.

The project is also piloting a surveillance system for surgical site infections. On the basis of this evidence we will identify cost-effective interventions to reduce HCAIs in partnership with Ghana Health Service and Ministry of Health. Overall, the project is expected to reduce morbidity and mortality from HCAIs through effective infection control, surveillance and rational use of antimicrobials. There is a great need to intervene against HCAIs in Ghana to avoid jeopardizing the benefits of the increased uptake of facility-based healthcare services experienced in the country over the past decade. Prevention of HCAIs among mothers and neonates could further accelerate progress towards the attainment of the United Nations Millennium Development Goals 4 & 5. Finally, reductions in HCAI are likely to result in cost savings, thereby allowing resources to be used for provision of other healthcare services.

Hypothesis

We postulate a high burden of HCAIs in Ghana given the presence of potential determinants like inadequate hand hygiene practices and supplies, high patient to practitioner ratio and sub optimal infection control activity in hospitals. We believe that HCAIs in Ghanaian healthcare settings leads to high patient morbidity and mortality as well as increased economic costs to patients and the health sector. We further believe that surveillance and implementation of infection control interventions is a cost-effective strategy to reduce HCAIs.

Aim:

The study aims to assess the burden of HCAIs and antimicrobial use in Ghana, improve

surveillance and reduce morbidity and mortality by implementing multi-faceted infection

control interventions.

Objectives:

The developmental objective is to reduce morbidity, mortality and cost related to HCAIs in Ghana. The specific objectives are:

1. To determine the burden of HCAIs and related antimicrobial use in Ghana using point

prevalence survey.

2. To determine the burden of SSIs, puerperal and neonatal sepsis ascribed to HCAIs using

prospective surveillance design; and to assess associated morbidity and mortality rates,

determinants, socio-economic costs, causative organisms, antibiotic use and drug

susceptibility.

3. To evaluate the effect of infection prevention and control and surveillance interventions

on incidence of SSIs and health care associated neonatal and puerperal sepsis.

4. To build and strengthen research capacity in HCAI surveillance, quality microbiological

analysis, rational antibiotic use and interventional trials through PhD and post-doctoral

training

The project objectives are organized into 6 workpackages.