5 results
Implementation of surgical site infection surveillance in 16 health facilities in Sierra Leone
- Rugiatu Z. Kamara, Monique Foster, Jamine Weiss, Christiana Conteh
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s63
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Background: Surgical site infections (SSIs) are associated with increased healthcare costs, antibiotic resistance, morbidity, and mortality. In low- and middle-income countries (LMICs), SSIs account for most healthcare-acquired infections (HAIs). In Africa, up to 20% of women who undergo a caesarean section develop a wound infection. Surveillance has been shown to be an essential component in the overall strategy to reduce SSIs. Methods: Surgical site infection surveillance is being implemented in 16 health facilities in Sierra Leone, with at least 1 from each of the 5 US Census regions: Eastern, Western, Northern, Northwestern, and Southern. These health facilities were selected based on the availability of a dedicated infection prevention and control (IPC) focal person. Women were observed for 30 days after caesarean section. A standardized surgical safety and surveillance checklist including case definitions and observable criteria (eg, purulent drainage, wound abscess, or intentional reopening) was used. Clinical staff were trained to collect data and to conduct in-person and phone interviews with patients on days 3, 7, and 30 after caesarean section. Results: From March 2021 to July 2021, a total of 2,529 women had caesarean sections in 15 health facilities; most occurred in the Northern region (785 of 2,529). Among these 2,529 women, 1,522 (60%) had an SSI surveillance checklist started, and of those 1,522, 632 (42%) had a completed checklist. Health facilities in most of the rural regions, (Eastern, Northwestern, and Southern) had no completed checklists. The overall SSI rate for the 15 health facilities was 3% (70 of 2,529). The Southern region had the highest SSI rate at 50% (35 of 70), but the Western region did not report any SSIs. Of the 70 cases, 49 (70%) were identified through active inpatient surveillance and 21 (30%) were identified through postdischarge surveillance. Conclusions: One of the priorities of Sierra Leone’s National IPC Action Plan is to establish HAI surveillance. Surgical site surveillance is an essential component of HAI surveillance and leads to timely identification so infections can be treated quickly. This study was limited by inadequate data collection and patients lost to follow-up after discharge. However, this study illustrates that surveillance leads to the diagnosis of most SSI cases after caesarean section while patients are still hospitalized. Simple yet effective SSI surveillance can be conducted in LMICs to identify and ultimately treat SSI after caesarean section. More support is needed in rural and smaller facilities for better implementation of SSI surveillance in Sierra Leone.
Funding: None
Disclosures: None
The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone
- Jamine Weiss, Amy Kolwaite, Meghan Lyman, Getachew Kassa, Miriam Rabkin, Anna Maruta, Marita Murrman, Hassan Benya, Christiana Conteh
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s498
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- October 2020
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Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.
Funding: None
Disclosure:None
Road to Increasing AMR: A Study on Antibiotics Prescribing Pattern
- Bobson Derrick Fofanah, Christiana Conteh, Jamine Weiss
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s496-s497
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- October 2020
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Background: Infectious diseases and the rapid emergence of multidrug-resistant pathogens continue to pose a threat to global health. The development of antimicrobial-resistant organisms is an alarming issue caused by inappropriate use of antibiotic agents. It is estimated that death from antimicrobial resistant pathogens could increase >10-fold to ~10 million deaths annually by 2050 if action is not taken. “It is essential to have reliable data on how medicines are used in order to identify areas to develop targeted interventions” (WHO 2011). Investigating antimicrobial use in hospitals is the first step in evaluating the underlying causes of AMR. In Sierra Leone, no other study related to antibiotic prescribing patterns in hospital setting has been undertaken. Objective: To investigate antibiotic prescription patterns using the WHO hospital antimicrobial use indicator tool at the Kingharman Hospital for 1 month. Methods: Data were collected from patient charts for 1 month, January 1–31, 2019. A data extraction tool was used to capture information on patient demographics, diagnosis, and antibiotics prescription details regarding dosage, duration, and frequency of administration. The tool adopted 6 selected indicators from the WHO antimicrobial use manual to measure the extent of antibiotic use in hospital and performance among prescribers. Results: Of the 189 charts reviewed, 175 included antibiotic prescriptions. The percentage of prescriptions involving antibiotics was 92.5%. The average number of drugs prescribed was 2, with an average duration of 5.2 days. Moreover, 50.5% of antibiotics prescribed were generic, and 96.6% were from the Ministry of Health and Sanitation Essential Medicine List (EML). The most commonly used antibiotics were ciprofloxacin (38.8%), followed by ceftriaxone (23.0%), amoxicillin (16.8%), metronidazole (8.5%), and others(12.7%). Typhoid accounted for 34.8% of broad-spectrum antibiotics, UTI accounted for 17.7%, malaria accounted for 12.5%, 25.5% were unspecified, and 9.5% were for unclear diagnoses. Typically, combinations of fluroquinolones and cephalosporins were used to treat typhoid and UTIs. Conclusions: This cross-sectional study represents a broad picture of antibiotic prescribing patterns at the King Harman Hospital. There was no strict adherence to the WHO recommended prescribing guidelines. These findings also indicate the degree of irrational and inappropriate prescribing of broad-spectrum antibiotics. This study highlights the need for a comprehensive assessment of antimicrobial use to gain a better understanding of national antibiotic use and to guide interventions to reducing AMR.
Funding: None
Disclosures: None
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Christiana Kallon
Feasible Surgical Site Infection Surveillance in Resource-Limited Settings: A Pilot in Sierra Leone
- Matthew Westercamp, Aqueelah Barrie, Christiana Conteh, Danica Gomes, Hassan Benya, Jamine Weiss, Anna Maruta, Rachel Smith
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s38
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- October 2020
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Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.
Funding: None
Disclosures: None
Development of National Infection Control and Prevention Guidelines in Georgia, 2017–2019
- Lali Madzgarashvili, Jamine Weiss, Marina Baidauri, Marika Geleishvili, Meghan Lyman, Amy Kolwaite
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s189
- Print publication:
- October 2020
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Background: In 2015, the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs (MoLHSA) of Georgia identified infection prevention and control (IPC) as a top priority. Infection control legislation was adopted and compliance was made mandatory for licensure. Participation in the universal healthcare system requires facilities to have an IPC program and infrastructure. To support facilities to improve IPC, MoLHSA and the National Center for Disease Control and Public Health (NCDC) requested assistance from the US CDC to revise the 2009 National IPC guidelines, which were translated versions of international guidelines and not adapted to the Georgian context. Methods: An IPC guideline technical working group (TWG), comprising clinical epidemiologists, IPC nurses, head nurses, and infectious diseases doctors from the NCDC, academic and healthcare organizations and the CDC was formed to lead the development of the national IPC guidelines. Additionally, an IPC steering committee was established to review and verify the guidelines’ compliance with applicable decrees and regulations. The TWG began work in April 2017 and was divided into 4 subgroups, each responsible for developing specific guideline topics. A general IPC guideline template for low- and middle-income countries was used to develop 7 of the guidelines. Additional reference materials and international guidelines were used to develop all the guidelines. Drafts were shared with the subgroups and the steering committee during 2 workshops to discuss unresolved technical issues and to validate the guidelines. Results: The revised guidelines consist of 18 topics. In addition to standard precautions (eg, hand hygiene, personal protective equipment, injection safety, etc) and transmission-based precautions, the guideline topics include laundry, environmental cleaning and disinfection, decontamination and sterilization, occupational health and safety, biosafety in clinical laboratory, blood bank and transfusion services, intensive care unit, emergency room, and mortuary. They do not include healthcare-associated infection surveillance or organism-specific guidance. To supplement the guidelines, a separate implementation manual was developed. The guidelines were approved by MoLHSA in October 2019. The TWG continues to be engaged in IPC activities, assisting with guideline rollout, training, and monitoring, and drafting the National IPC strategy and action plans. Conclusions: The Georgian Ministry of Health developed national IPC guidelines using local experts. This model can be replicated in other low- and middle-income countries that lack country-specific IPC guidelines. It can also be adapted to develop facility-level guidelines and standard operating procedures.
Funding: None
Disclosures: None