Healthcare associated infections (HAIs) pose a constant threat not only to patients, their families and healthcare systems but also to society as a whole. Apart from contributing to increased mortality they add substantially to hospital costs. Very few studies estimate the excess cost of HCAI in developing countries with the majority of these studies found in Latin America. To date, there has been no costing of HCAIs in Ghana.
Aim. The purpose of this study is to measure the patient and institutional cost of HCAIs in Ghana.
Methods. This is an 18-month (June 2017 through December 2018), prospective study of patients identified with and without HCAI. The costing study which is part of larger HCAI study will be conducted in three phases with two stages of data collection within each phase. Phase 1 will involve the costing of Surgical Site Infections (SSI) and interventions. Phase 2 will involve the costing of neonatal sepsis and interventions, while Phase 3 will involve the costing of puerperal sepsis and interventions. In each of these phases, two sets of data collection exercises will be undertaken; one at the baseline and then an endline survey after the intervention has taken place. It is expected that these will be conducted at varying times within the 18-month study period. The first phase which is the costing of SSI, involves a prospective study, to be undertaken at the surgical department of the Korle-Bu Teaching Hospital. Successive patients admitted to the department of surgery for elective and emergency surgeries over the study period would be recruited. Patients would be monitored daily post-operatively for SSIs whilst on admission. Patients identified as having SSI will be administered a structured questionnaire to capture the direct and indirect costs associated with the SSI. The second phase is a matched cohort design which will compare the costs of preterm babies with neonatal sepsis matched with preterm babies who had no neonatal sepsis during the same period. The same methodology will be applied in the third phase which will involve a prospective study to be undertaken at the Obstetrics department of Korle-Bu Teaching Hospital.
Expected outcome. The primary outcome is to determine the direct costs and indirect costs associated with SSIs, neonatal and puerperal sepsis in Ghana. By quantifying these costs, the potential cost savings of therapies targeted towards prevention of these HCAIs can be evaluated.
In Ghana, less than 40% of population has some form of health insurance coverage and out-of-pocket payments are still relatively high. In 2014, Out-of-Pocket (OOP) payments represent 27 percent of total health expenditures, which is above the WHO recommended OOP share of 15-20% of total national health expenditure . Therefore, the additional burden of costs attributable to HCAI has serious implications to the Ghanaian patient as well as for the health system. Although risks of developing HCAI have decreased in developed countries with the advancement in technology, the case of developing countries has been markedly different. HCAI pose a major threat to patient safety and quite often infection prevention and control policies are non-existent, poorly designed or inadequately funded. To ensure efficiency and optimization of healthcare spending there is the need to improve infection control. Efforts to prevent HCAI must assume even greater importance if progress is to be made in improving the quality of patient care in hospitals and reducing the cost of care in our healthcare facilities and to families. National surveillance systems, which have been systematically put in place in many developed countries to monitor HCAI especially for Surgical site infections (SSI) are missing in our hospital facilities. European surveillance of SSI detected 48% of infections post discharge only, indicating that the real burden of SSI in SSA may be significantly higher than published evidence suggests . There is a significant need to ascertain and devise possible and sustainable approaches to strengthen HCAI prevention, surveillance and control.
The general hypothesis is that patients with HCAIs have a longer length of stay and higher costs than patients without HCAI. Furthermore, it is hypothesised that infection control interventions will be economically advantageous and therefore lower costs.
The aim of this study is to measure the patient and institutional costs associated with HCAIs in Ghana.
1. To estimate the direct and indirect costs associated with Surgical Site Infections (SSI).
2. To estimate the direct and indirect costs associated with neonatal sepsis.
3. To estimate the direct and indirect costs associated with puerperal sepsis.
4. To evaluate the cost-effectiveness of control interventions associated with the selected HCAIs.
Workflow study design