Worldwide research on healthcare associated infections is dominated by data from developed countries due to paucity of data describing infections from resource limited countries. There is therefore inadequate development of evidence based strategies and relevant effective solutions for improving patient safety in these regions

Aim. This study is designed to describe the burden of healthcare associated infections in Ghana.

Methods. Between September 2016 and January 2017, a cross-sectional point prevalence survey will be conducted in selected hospitals in Ghana. These will include two teaching hospitals, four regional hospitals and four district hospitals systematically selected across Ghana. The study population comprise all patients hospitalized in the selected hospitals. The sample will exclude outpatients and those in emergency departments. The survey will determine the prevalence of healthcare associated infections in Ghana, and describe healthcare associated infections (sites, infections, microorganisms) by type of patients, specialties and healthcare facilities using operational definitions of the European Center for Disease prevention and control.

Expected outcome. At the end of the study we expect to determine the prevalence of HCAIs among the participating hospitals, the types of infections, associated organisms, distribution of infections and associated risk factors. Information generated will highlight areas for improvement in infection prevention and control and serve as a bench mark for future research. Findings from this study will provide a standardized tool for hospitals to identify targets for quality improvement.

Project Description

Healthcare associated infections (HCAIs) are a common, serious and preventable threat to patient safety. HCAIs are infections that develop as a direct result of healthcare interventions such as medical or surgical treatment, or from being in a healthcare setting. Globally, HCAIs are the most frequent adverse event due to hospitalization, and are the cause of extended admissions, increased medical costs and marked morbidity and mortality.

 Reliable data on HCAIs is scarce in developing countries, especially in Africa, and it is likely that the existing data underestimates the true burden. This is exemplified by the fact that 66% of developing countries report no data at all on HCAIs. Available data describes a pooled prevalence of HCAIs of 15.5 per 100 patients and the risk of developing HCAIs in Africa is estimated to be 2 to 20 times higher than the risk for patients receiving care at hospitals in developed countries. In Ghana, a 1-day point prevalence study conducted in the year 2000 in a teaching hospital found an overall prevalence of HCAIs of 6.7%. This remains the only study describing the burden of HCAIs in Ghana.

Key tools for reducing the burden of HCAIs are surveillance and effective implementation of infection control interventions. The World Health Organisation (WHO) estimates that the burden of HCAIs can be reduced by approximately 50% through surveillance and appropriate infection control interventions. WHO has emphasised this over the past 10 years through campaigns such as “Clean care is Safe Care” and “Safer Surgery Saves Lives” and developed related guidelines. However, infection control guidelines are being utilized by developing countries with varying degrees of success mainly because of physical, environmental, and socioeconomic factors. The implementation of infection control in developing countries is fraught with challenges such as poor compliance, inadequate supplies and lack of commitment from clinicians and senior management. In Ghana, hand hygiene practices have been shown to be poor among healthcare workers at several large Teaching Hospitals. Only few hospitals have well‐established infection prevention and control teams; this has been ascribed to lack of support from hospital administration and inadequately trained infection control staff. To ensure that interventions are adequately adapted to the specific needs and challenges of the health care workers in developing countries there is a need to develop infection control guidelines and interventions based on local evidence and in collaboration with the healthcare workers.

Aim

The aim of this study is to describe the burden of healthcare associated infections in Ghana

Objectives

1. To determine the prevalence of healthcare associated infections in selected hospitals in Ghana

2. To describe healthcare associated infections (sites, infections, microorganisms) by type of patients, specialties and healthcare facilities.

3. To disseminate results to policy makers and practitioners across all levels of healthcare in Ghana

Updates

The HAI point prevalence survey was successfully completed in December 2016. Three are manuscripts are currently underway for publications (subscribe to HAI-Ghana project for email alerts when the articles are published. You may also visit the website to download published papers)

1. Multi-center point prevalence survey of healthcare associated infections in Ghana

Excerpts from findings. Ten hospitals were surveyed, representing 32.9% (n=4208/12806) of all acute care beds in government hospitals in Ghana. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values across the various hospitals ranged from 3.5 to 14.4% with higher proportion of infections in secondary and tertiary care facilities……….(subscribe to HAI-Ghana project to read more)

Conclusions. There is a considerable burden of HAIs observed among different levels of hospitals in Ghana, with high prevalence observed in secondary and tertiary care hospitals……….(subscribe to HAI-Ghana project to read more)

2. Antibiotic prescribing among hospitalised children and adolescents in Ghana: A multi-centre point prevalence survey

Excerpts from findings. We analysed data for 849 children and adolescents, out of which 506 representing 59.6% (95% CI 56.2-62.9) were on antibiotics. A significant proportion of antibiotics 82.9% was prescribed for infants as compared to the other age groups…..(subscribe to HAI-Ghana project

Conclusions. The study points to high use of antibiotics among hospitalised paediatric and adolescent populations in Ghana…..(subscribe to HAI-Ghana project to read more)

3. Estimating trends in inpatient antibiotic use among adult populations in Ghana

Excerpts from findings. We used the database on multicentre point prevalence survey of hospital acquired infections by the HAI-Ghana project to determine trends in inpatient antibiotic use among adult populations. A total of 1258 inpatients were included in analysis, 51.0% (n=642/1258) of whom were prescribed one or more antibiotics. The top five classes of antibiotic used were third generation cephalosporins 278 (22.1%), second generation cephalosporins 125 (9.9%)………(subscribe to HAI-Ghana project to read more)

Conclusions. Aantibiotic stewardship programme should focus on optimizing appropriate use of cephalosporins.................(subscribe to HAI-Ghana project to read more)