Replication and Contextual Evaluation of a Multi-modal Intervention to Reduce Surgical Site Infections in Tanzanian District Hospitals

This prospective, quasi-experimental study evaluated the transferability of a multi-modal intervention bundle to reduce surgical site infection (SSI) rates in resource-limited district hospitals. Conducted across four Tanzanian hospitals, it compared a 12-month pre-intervention baseline (2021-2022) with a 24-month post-intervention period (2023-2025). The intervention replicated a validated protocol comprising pre-operative chlorhexidine bathing, standardised antibiotic prophylaxis, reinforced intra-operative aseptic techniques, and post-operative wound care training. The primary outcome was SSI incidence within 30 days, defined by CDC criteria and ascertained via active surveillance. A total of 1,842 major surgical procedures were included. A multivariate logistic regression analysis, controlling for potential confounders including patient age, ASA score, wound classification, and procedure type, demonstrated a statistically significant reduction in SSI incidence from 12.4% to 6.1% (adjusted odds ratio 0.45, 95% CI 0.34-0.60, p<0.001). Ethical approval was granted and informed consent was obtained from all participants. These results confirm the efficacy and scalability of this low-cost bundle within district-level facilities, a critical tier of sub-Saharan Africa’s healthcare system. The study provides a rigorous model for surgical safety improvement, advocating for the policy integration of such standardised protocols to reduce morbidity and associated costs in similar resource-constrained contexts.