Incidence and patterns of surgical site infections in a teaching hospital in central India
Abstract
Background: Surgical site infections (SSI) are one of the most common infections among the health care-associated infections. However, there is a scarcity of data on SSI from India. The present study was aimed to determine the incidences of SSI and to evaluate the associated factors at a hospital in Nagpur, central India region.
Methods: Surgical sites were considered to be infected according to the set of clinical criteria recommended by the CDC’s NNIS system. The wounds were classified using the wound contamination class system, proposed by the American Centers for Disease Control (CDC) for use in SSI surveillance-1999, into Clean, Clean contaminated, Contaminated and Dirty wounds.
Results: Among 2083 cases, 314 (15.1%) were suspected to be clinically infected, among them 250 (12%) were confirmed to have SSI. Among 2083 cases, 1214 (58.3%) operations included clean wound category and 869 cases (41.7%) were clean contaminated. From clean wounds 58 cases (4.8%) were found to be SSI and in clean contaminated wounds 192 (22.09%) cases were found to be SSI. Among the clean wounds, 103 (8.5%) were infected; about 58 cases (56.3%) were culture positive and 45 (43.7%) were culture negative. From the clean contaminated wounds, 211 (24.3%), 192 (91%) and 19 (9%) were found to be infected, culture positive and culture negative respectively. The studies of surgeries suggested that among clean surgeries Mastectomy was most common (14%), whereas Pyelolithotomy (8%) was the most common among the clean-contaminated surgeries. The prevalence of SSI was highest in Radical cystectomies (66.6%) and the least with lipoma excisions (6.4%).
Conclusion: The incidences of SSIs in postsurgical infections were low in addition to this only small numbers of cases were confirmed to be SSIs. Though the reported cases are higher than the countries with high income, a well-planned strategy is required to decrease the incidences of SSI for improving the quality of health care system in present hospital and similar centers elsewhere.
Downloads
References
2. Pittet D, Allegranzi B, Storr J, Bagheri Nejad S, Dziekan G, Leotsakos A, Donaldson L. Infection control as a major World Health Organization priority for developing countries. J Hosp Infect. 2008; 68(4): 285-292. doi: 10.1016/j.jhin.2007.12.013.
3. World Health Organization. World alliance for patient safety: forward programme 2006-2007. Geneva [Switzerland]: WHO Press; 2006.
4. Hedaoo JB, Rathod VN, Paramne AV. Bacteriology of Surgical Site Infections and Antibiotic Susceptibility Pattern in Isolates of Postoperative Wound Infections. Tehran Uni Med Sci. 2018;5:3-4.
5. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999; 27(2): 97-132. doi: 10.1016/S0196-6553(99)70088-X.
6. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control.2009;37(5):387-397.doi:10. 1016/j. ajic.2008.12.010.
7. WHO. Guideline for safe surgery.2009.p. 69–80.
8. Ernesto C, Starling F, Horizonte B. Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review. Braz J Infect Dis. 2007;11(1):134-141. doi: 10. 1590/S1413-86702007000100028
9. Suchitra J, Lakshmidevi N. Surgical site infections: assessing risk factors, outcomes and antimicrobial sensitivity patterns. Afr J Microbiol Res. 2009;3(4): 175-179.
10. Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2014;35(6): 605-627. doi: 10.1086/676022.
11. Engemann JJ, Carmeli Y, Cosgrove SE, Fowler VG, Bronstein MZ, Trivette SL, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36(5):592-598. doi:10. 1086/ 367653.
12. Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK.Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol. 2011;32(10): 970-986. doi: 10.1086/662016.
13. Agência Nacional de Vigilância Sanitária (ANVISA) Critériosdiagnósticos de infecçãorela-cionada à Assistência à Saúde [Internet] Brasília (DF): Ministério da Saúde; 2013.
14.Ercole FF, Chianca TCM, Duarte D, Starling CEF, Carneiro M. Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction. Rev. Latino- Am. Enfermagem. 2011; 19(2): 269-276. doi:10. 1590/s 0104- 1692011000 200007
15. Mathur P. Hand hygiene: back to the basics of infection control. Indian J Med Res. 2011;134(5):611-620. doi: 10.4103/0971-5916.90985.
16. KamatUS, Fereirra AMA, Kulkarni MS, Motghare DD. A prospective study of surgical site infections in a teaching hospital in Goa. Indian J Surg. 2008;70(3): 120-124. doi: 10.1007/s12262-008-0031-y.
17. Nguyen D, MacLeod WB, Phung DC, Cong QT, Nguy VH, Nguyen H, Hamer DH. Incidence and predictors of surgical site infections in Vietnam. Infect Control Hosp Epidemiol. 2001;22(8):485-492. doi:10. 1086/ 501938.
18. Arabshahi K.S., Koohpayezade J. Investigation of risk factors for surgical wound infection among teaching hospitals in Tehran. Int Wound J. 2006;3:59-62. doi:10.1111/j.1742-4801.2006. 00176.x.
19. Olson MM, Lee JT. Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg. 1990; 125: 794-803. doi: 10.1001/archsurg.1990.01410180120020.
20. Cruse PJ, Foord R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clinic North Am. 1980; 60 (1): 27-40. doi: 10. 1016/s0039-6109(16)42031-1.
21. Ojiegbe GC, Njoku-Obi AN, Ojukwa JO. Incidence and parametric determinants of post-operative wound infections in a university teaching hospital. Cent Afr J Med. 1990; 36 (3):63-67.
OAI - Open Archives Initiative
Therapoid
