Building on the success of the Lucina Project, WSIS has launched an expanded implementation effort targeting district level hospitals in Kenya.

One Size Doesn’t Fit All


Infection prevention programs in high income countries have resulted in significant reduction of SSI. However, the reduction of SSI has not been reliably replicated on a large scale in LMIC. The World Health Organization has recommended use of surgical unit safety programs (SUSP) programs, which work to strengthen safety culture and teamwork, for these regions, but we hypothesize that the complexity and personnel requirements make SUSP very difficult to implement in resource limited settings, particularly at government hospitals.

“A recently published study in The Lancet reported that the most common procedure
in 25 countries in Africa was caesarean section (33%), and infections were the most
common complication resulting from overall surgeries. Among patients who died as
a result of surgery, about 8% were as a result of a caesarean surgery.”
–Source: Global Maternal Sepsis Study

Developing a scalable, sustainable surgical infection intervention bundle that is effective at this type of facility is a crucial global health objective because district level hospitals often serve a greater population than larger referral hospitals, and patient safety improvement programs developed in high-income regions or large referral hospitals in LMIC are often not feasible due to resource constraints.  Simple and low-cost quality improvement interventions are available and can be implemented at high coverage in LMICs. One such intervention is the administration of pre-operative antibiotics, which is established as extremely effective in lowering SSI rates, and was shown to be in the Lucina Project.



Project Goals


With the information gathered in our previous study, we believe that the following elements are key in improving in clinical outcomes (reduced SSI):

  • Presence of executive, surgical/obstetrical, and nursing champions

  • Adherence to the strong recommendations in the WHO guideline for the prevention of surgical site infections

  • Existence of a hospital wide infection control program with adequate staffing

  • Adequate sterilization

  • Adequate water, sanitation and hygiene


This project will map out the most effective implementation process for district level

Hospitals. We will also address the need to capture high quality and actionable data: describing personnel, infrastructure, and clinical practices in a meaningful way in order to facilitate hospital -to-hospital comparisons and potential translatable solutions.



Project Structure

This study will be divided into two phases: an initial survey to gather baseline information at the target facilities, and the implementation of the intervention bundle. This structure will allow us to gain a greater understanding of the current practices at each facility and work with staff to better tailor the implementation and intervention process to maximum effectiveness.


Principal Investigator


Clinical Investigator


Project Manager

United Kingdom

Project Manager

United States