A Quality Improvement Study Project to Improve Post Cesarean Section Surgical Site Infection Surveillance in a District Hospital in Kigali City

Post-caesarean surgical site infection (PCSI) is one of the most common cesarean section-related complications. In low- and middle-income countries (LMIC), PCSI prevalence is often under-reported and inaccurate because LMIC surveillance systems are often unable to detect PCSIs developed after discharge; this can ultimately wrongly inform the decision-making related to reducing PCSIs. This paper describes the establishment of a post-discharge PCSI surveillance system for identification of PCSI rate in a district hospital in Rwanda. A total of 540 women underwent CS in the hospital from November 2017 to February 2018, and 536 (99.3%) consented to participate in the surveillance. Among those consented, 22 had no telephone and 174 could not be reached by telephone despite multiple attempts. At the end of this study, a total of 340 women completed the entire surveillance period. The total PCSI rate was 11.5%.Out of all PCSIs, 21% were detected during hospitalization period and 79% were detected during the post-discharge period. The PCSI surveillance system developed in this project covered the 30-day period after surgery and provided a more accurate estimate of PCSI rate. The system was able to track PCSIs developed after a patient was discharged from the hospital. Long term sustainability of the project must be evaluated.