Introduction: Little is known about hospital-acquired infections (HAI) in developing countries although surgical site infections (SSI) are thought to be a particular problem. The aim of the work in this thesis was to describe three different forms of HAI (SSI, hospital-acquired bacteraemia in children, transmission of MRSA in hospital inpatients) in hospitals in sub-Saharan Africa and to make changes, where possible, to prevent their occurrence. Methods: A literature review on the subject of SSI in sub-Saharan Africa was conducted as part of the preliminary investigation. To study the occurrence of SSI in Thika Hospital in Kenya, SSI surveillance was established at this site and we subsequently implemented a change in the use of surgical antibiotic prophylaxis at this hospital. The occurrence of MRSA amongst inpatients in Thika Hospital was measured in a cross-sectional study and the occurrence of hospital-acquired bacteraemia in children in Kilifi Hospital, Kenya was measured using surveillance data from 2002-2009. Results: The epidemiological characteristics of the SSI surveillance programme in Thika Hospital were examined including: the consistency of parameter scoring by surgeons and anaesthetists; the sensitivity and specificity of telephone-based post-discharge surveillance; the performance of risk indicators in predicting SSI after major Obstetric+Gynaecological surgery. The process, outcome and balancing effects of changing the use of surgical antibiotic prophylaxis at Thika Hospital were evaluated, showing that there was rapid and sustained uptake of pre-operative antibiotic prophylaxis use and a more gradual reduction in use of post-operative antibiotics. There was evidence of a modest reduction in the risk of superficial SSI, and an overall reduction in the use of antibiotics, with accompanying cost and time savings. The risk, rate, aetiology and morbidity and mortality impacts associated with paediatric hospital- acquired bacteraemia in Kilifi Hospital were examined. In a subsequently published correspondence questions regarding Coagulase-negative staphylococci, premature infants and competing risks were addressed. MRSA carriage rate amongst inpatients in Thika Hospital was estimated. This organism was relatively rare, and carriage was largely confined to patients with bums. All MRSA isolates obtained were in the ST239-t037 clone, suggesting within-hospital transmission. Conclusion: The work of this thesis suggests that the problem of hospital-acquired infections in sub- Saharan Africa is substantial, although there are some simple and achievable steps that can be taken to reduce their occurrence
