South Africa has no single national database to track hospital-acquired infections (HAIs), a major gap that health experts warn is leaving thousands of preventable deaths undetected.
The absence of active monitoring and systematic reporting means the true scale of infections contracted inside hospitals remains largely invisible.
A 2024 study titled The Burden of Hospital-Acquired Infections (HAI) in Sub-Saharan Africa: A Systematic Review and Meta-Analysis reveals that 12.9% of patients admitted to hospitals in the region contract deadly hospital-acquired infections. Globally, HAIs are among the leading causes of morbidity and infections that patients did not have when they were admitted.
The study found that pre-term birth, in-dwelling medical devices, antibiotic use and overcrowding are major risk factors, particularly among newborns.
Prof Angela Dramowski, head of the clinical unit in general paediatrics at Stellenbosch University’s Faculty of Medicine and Health Sciences, said postmortem data from Chris Hani Baragwanath Academic Hospital revealed that 70% of pre-term babies who died showed laboratory evidence of infection.
“The information currently collected on HAIs is not comprehensive. Most of what we know about the burden of infections in neonatal and maternity settings comes from isolated research, almost all conducted in tertiary hospitals,” Dramowski said.
She added that the BabyGerms study was the first to provide laboratory-based data on neonatal HAIs, but large-scale, national-level tracking remains nonexistent.
Infections often go undetected or unreported
Dramowski warned that while all hospital deaths are reported, the contribution of infection is often underestimated because many infections are “culture-negative” or lack appropriate laboratory specimens.
When infection and antibiotic-resistance data are shared openly, hospital leadership is more likely to take action. It helps direct resources, staff, equipment and funding to where they are most needed.
— Prof Vindana Chibabhai, head of CHARM at the NICD
“We do not have a single national database on neonatal and maternity admissions and outcomes. Such a system would be ideal to track mortality and morbidity trends and identify facilities needing urgent intervention,” she said.
Prof Vindana Chibabhai, head of the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM) at the National Institute for Communicable Diseases (NICD), echoed this concern.
“All neonatal deaths are reported to the national department of health, but it is difficult to accurately estimate the number of infection-related deaths since most are ascribed to prematurity. However, a large number of deaths in premature babies are indeed a result of infections,” she said.
The case for lab-based surveillance
Chibabhai said laboratory-based surveillance remains one of the most powerful tools for keeping patients safe.
“By analysing lab results we can identify which organisms are circulating in hospitals, whether new infections are emerging, and if bacteria are becoming resistant to antibiotics,” she said.
“This helps us detect outbreaks early and understand which areas or patient groups are most at risk.”
She added that accurate lab data allows infection prevention and control teams to make informed decisions, acting as an early warning system that pinpoints where and why infections are occurring.
“In neonatal wards, this means identifying which babies are most at risk, what organisms are causing harm, and whether infections are happening soon after birth or during hospital stays,” Chibabhai said.
Dramowski agreed, noting that lab surveillance is crucial for tracking serious bacterial infections such as bloodstream infections and meningitis, as it helps quantify disease burden, pathogens and resistance patterns.
“However, if we rely solely on laboratory surveillance, we will miss up to 60% of the total infection burden,” she cautioned.
Transparency could save lives
Both experts agreed that data transparency is crucial to reducing infection-related deaths.
“Sharing hospital data on infection rates helps identify facilities most in need of intervention,” Dramowski said.
Chibabhai added that public reporting is not about assigning blame but about improving patient safety.
“When infection and antibiotic-resistance data are shared openly, hospital leadership is more likely to take action,” she said. “It helps direct resources, staff, equipment and funding to where they are most needed.”
She noted that the government has begun taking steps towards greater transparency.
“Health minister Dr Aaron Motsoaledi recently launched a public-facing TB dashboard at the NICD, and the NICD already hosts multiple dashboards offering public access to health information,” she said.
A call for action and political will
Experts warn that HAIs and antimicrobial resistance (AMR) are already responsible for large numbers of preventable deaths and could soon overtake other infectious causes of death if left unchecked.
“We urgently need public awareness, advocacy and political will to address this growing crisis,” Dramowski said.
Without national surveillance, experts say, South Africa remains vulnerable to silent hospital epidemics that claim lives daily, unseen, uncounted and unreported.
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