SSIs and practice in the developing world

Healthcare associated infections exercise the minds of many practitioners around the world in an effort to prevent harm happening to patients. Healthcare-associated infection (HCAI) can have a huge impact on patients and their families, on the hospital treating them and healthcare costs. The burden of HCAI is already substantial in many developed countries where The World Health Organization1 identifies that there is a 5 to 15% prevalence in hospital wards and as many as 50% of ICU patients are affected. 

In developing countries there is much less substantive data so the real magnitude of the issue is unknown. The chronic economic issues of the developing world mean that they are unable to fund their health services to a recognisable level. The issues and difficulties of a lack of trained professionals in infection control practices, few policies or guidance are all exacerbated by overcrowding in the wards and under staffing. A systematic review undertaken in 2011 looked at HCAIs across Africa, with data cited from a limited number of studies the overall prevalence was between 2.5% to 14.8% which is twice the reported European rate of 7.1%.2 Most of the papers identified surgical site infection as a particular problem, reporting incidence rates between 10% to 30.9% a rate which is markedly higher than rates in industrialised nations. 

The focus of this article will be the practices and challenges which surround surgical site infection as they are known in different parts of Africa. The author has taught in many different countries and environments in Africa and audited operating room practice, as a representative of Friends of African Nursing, a small UK based charity which educates perioperative nurses in Africa.