Operationalising Infection Prevention for Caesarean Section in Two Ghanaian Hospitals: A Qualitative Study of Healthcare Provider Perspectives

Why It Matters

Consistent peri‑operative bundles curb surgical site infections, but gaps in post‑discharge wound management can undermine maternal outcomes and increase health‑system costs in low‑resource settings.

Key Takeaways

• Core theatre practices align with WHO surgical safety guidelines
• Hand hygiene and barrier precautions remain central to SSI prevention
• Both hospitals use prophylactic antibiotics before incision
• Post‑discharge wound care varies: community nurses vs self‑care guidance
• Strengthening continuity of care could reduce maternal SSI rates

Pulse Analysis

Surgical site infection (SSI) after caesarean delivery remains a leading cause of maternal morbidity in low‑ and middle‑income countries, driving longer hospital stays, higher antibiotic use, and added health‑system expenses. While global guidelines prescribe a bundle of peri‑operative measures, translating these recommendations into routine practice is often uneven, especially where resources and training differ across facilities. Understanding how frontline providers interpret and enact infection‑prevention protocols is essential for closing the gap between policy and patient outcomes.

The Ghanaian study surveyed eighteen clinicians from a tertiary university hospital and a district hospital, uncovering five thematic pillars that structure infection‑prevention: pre‑operative preparation, contamination control, intra‑operative techniques, antibiotic timing, and patient education. Across both sites, staff reported strict adherence to hand hygiene, barrier precautions, skin antisepsis, and timely prophylactic antibiotics—behaviours that mirror WHO and CDC standards. However, the research highlighted a critical divergence in post‑discharge wound care: the district hospital leveraged community nurses for dressing changes, whereas the university hospital promoted guided self‑care. This variation underscores how continuity of care after patients leave the operating theatre can differ markedly, influencing SSI rates and recovery trajectories.

For policymakers and hospital administrators, the findings point to a clear implementation opportunity: standardising post‑operative wound management through integrated community health worker networks or structured home‑care protocols could reinforce the peri‑operative bundle and lower infection risk. Investing in training, supply chains for sterile dressings, and clear discharge instructions may yield measurable reductions in maternal SSI, translating into cost savings and improved health equity. Future research should quantify the impact of these post‑discharge strategies and explore scalable models that bridge hospital and community settings in similar resource‑constrained environments.