Compliance levels with the W.H.O global guidelines for prevention of infection and associated surgical site infection following caesarean delivery in Mulago hospital

Abstract

Background: Surgical site infections (SSIs) are a substantial burden to health-care systems worldwide in terms of patient morbidity, mortality, and costs. The study’s objective was to determine the levels of compliance with the World Health Organization (WHO) global guidelines for infection prevention and evaluate the potential association between this compliance and surgical site infection in Mulago Hospital, Kawempe. Methodology: A prospective cohort study was conducted from August to December 2018. All mothers undergoing elective and emergency caesarean delivery in the labour ward theatre at Mulago Hospital (based temporarily at Kawempe Hospital) were assessed. Mothers were observed directly in theatre for compliance with the WHO global guidelines for infection prevention and the three domains of the WHO SSC. Mothers were monitored for signs of SSI daily while inpatient and every four days via phone calls as an outpatient until 30 days post-delivery. Logistic regressions were used to assess for an association between compliance and surgical site infections. Results: We analysed 768 patients (722 emergent, 22 elective CD). Overall compliance with the WHO global guidelines for infection prevention was 45.3% (95% confidence interval [CI], 44.7-45.8). Compliance with instrument sterilty was 78.4% (95% CI, 77.1-79.7), Gauze counting was 0.14% (95% CI, 0.06-0.34), hand preparation was 42.6% (95% CI, 41.6-43.6), drapes and gowns was 74.5% (95% CI, 74.3-74.8), skin preparation was 41.4% (95% CI, 37.5-44.8), surgical antibiotic prophylaxis was 69.1% (95% CI, 65.5-72.4), WHO SSC was 0%, There was a statistically significant association between levels of compliance and surgical site infection odds ratio (OR) was 0.23 (95% CI, 0.05-0.98; P value 0.049). SSI rate was 23.8% (95% CI: 18.4 – 24.9) and the majority being mother undergoing emergency caesarean (93.9%) compare to elective CD (6.1%). Conclusion: This study found low levels of compliance with the WHO global guidelines for infection prevention. High compliance with infection prevention guidelines was associated with reduced risk of surgical site infection following caesarean delivery.