PT  - JOURNAL ARTICLE
AU  - Evans Otieku
AU  - Ama Pokuaa Fenny
AU  - Felix Ankomah Asante
AU  - Antoinette Bediako-Bowan
AU  - Ulrika Enemark
TI  - Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study
AID  - 10.1136/bmjopen-2021-057468
DP  - 2022 Jan 01
TA  - BMJ Open
PG  - e057468
VI  - 12
IP  - 1
4099  - http://bmjopen.bmj.com/content/12/1/e057468.short
4100  - http://bmjopen.bmj.com/content/12/1/e057468.full
SO  - BMJ Open2022 Jan 01; 12
AB  - Objective To assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.Design Before and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.Setting Korle-Bu Teaching Hospital (KBTH), Ghana.Participants All prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measures The primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.Results Before-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.Conclusion The intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.Data are available upon reasonable request. Data used for this study is not publicly available but can be assessed upon reasonable request to the corresponding author due to ethics approval guidelines.