Incidence of Post Operative Wound Infection Following the Use of Antibiotics in Clean Contaminated Head and Neck Surgery in a Tertiary Care Centre in Eastern Nepal

Chapagain, Kumud; Pokharel, Ridish K.; Acharya, R; Shah, Surendra; Paranjape, B.D.

doi:10.3126/bjhs.v1i1.17100

Cited by 3 publications

(4 citation statements)

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“…Inadequate sterilization of devices is one of several factors that contribute to HAIs, which are more common in low- and middle-income countries (pooled prevalence of affected patients = 10.2%; 95% CI 9.0% - 13.0%) than in high-income countries (pooled prevalence of affected patients = 7.1 per 100 patients; 95% CI 6.5–7.8), with surgical site infection (SSI) being the most frequent type of HAI [5,11]. Tertiary care hospitals in Nepal have reported high rates of SSI (2.7 to 23.0 per 100 patients) but have not investigated a link between these infections and sterilization procedures [12–15].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study

et al. 2019

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BackgroundInadequate sterilization of reusable medical devices can lead to healthcare associated infections (HAIs) through person-to-person or environmental transmission of pathogens. Autoclaving (steam sterilization) is most commonly used for sterilizing medical devices in healthcare facilities. We conducted a nation-wide cross-sectional study to evaluate the effectiveness of steam sterilization practices in primary and secondary care public hospitals in Nepal and to identify factors associated with ineffective sterilization.MethodsUsing a stratified clustered random sampling, 13 primary- and secondary-care public hospitals in Nepal were selected. 189 steam sterilization cycles from these hospitals were evaluated for their effectiveness using self-contained biological indicators, class-5 chemical indicators, autoclave indicator tape and physical parameters. Information about the hospitals and the types of autoclaves being used was also collected. Data were analysed to estimate the proportion of ineffective steam sterilization cycles. Logistic regression was used to identify factors associated with ineffective sterilization.FindingsIn primary and secondary care public hospitals in Nepal, 71.0% (95% CI 46.8% - 87.2%) of the autoclave cycles were ineffective (i.e. showed positive results) when tested with biological indicators and 69.8% (95% CI 44.4% - 87.0%) showed ‘reject’ results with class 5 chemical indicators. There was no statistically significant difference in proportions showing positive or reject results by hospital types for either biological (p = 0.51) or class 5 chemical (p = 0.87) indicators. Autoclave type and pressure achieved during sterilization were statistically significantly associated with steam sterilization failures, adjusted for holding period, evenness of pressure and barrier system used.ConclusionPrimary and secondary care hospitals in Nepal have a high proportion of steam sterilization failure, indicating a risk of person-to-person transmission of pathogens through reusable medical devices. There is an urgent need to improve steam sterilization processes in these hospitals.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study

et al. 2019

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“…20 In contrary to the recommendations, many centers in Nepal and India, antibiotics are being prescribed for various duration following thyroidectomy. [4][5][6] In an international survey among endocrine surgeons, the patterns of antibiotic use varied widely among European, American and Asian surgeons. Most of the Asian surgeons (58.3%) almost always prescribed antibiotic prophylaxis in contrary to European surgeons whereby only 8.8% do so routinely.…”

Section: Discussionmentioning

confidence: 99%

“…4 In most of the centers in Nepal, perioperative antibiotics are still administered for varying duration. 5,6 At Patan Hospital, Nepal, study regarding use of antibiotic prophylaxis has not been done in thyroid surgery, but, a study on low risk laparoscopic cholecystectomy, regarded as clean surgery, routine use of antibiotic prophylaxis did not show added advantage in preventing SSI. 7 There is a dearth of literature regarding antibiotic prophylaxis in our set up.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of perioperative antibiotics in thyroid surgery

Yadav

Dangol

Shrestha

et al. 2023

J Patan Acad Health Sci

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Introduction: Most of the guidelines do not recommend routine antibiotics prophylaxis in clean head and neck surgery like thyroidectomy. In contrary to the recommendation, antibiotics are being routinely prescribed in perioperative period for various duration in many centers of Nepal. This study was aimed to find out the need of postoperative antibiotics in surgeries for thyroid related problems. Method: Records of all patients who had undergone surgery for thyroid related problems from Jan, 2019 to Sept, 2022 were retrospectively reviewed for patterns of antibiotic use, apart from preincision antibiotic, in postoperative period which was classified as group A – no antibiotics, group B – shorter course of antibiotics (≤3 days) and group C – longer course of antibiotics (>3 days). The occurrence of surgical site infection (SSI) was recorded. Result: During the study period, 77 patients underwent surgery for thyroid related problems, out of which five were excluded (records not found in four cases and one patient was ASA III). Two out of 72 (2.77 %) patients developed superficial incisional SSI which was managed conservatively. One patient in each group A (50) and group B (8) developed SSI. Conclusion: Postoperative antibiotics can be avoided safely even in our setup in clean head and neck surgeries like thyroidectomy without increase in the risk of SSI thus reducing the cost to the patients.

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“…HAIs can prolong a patient’s stay in the hospital, cause long-term disability, increase the financial burden for health systems, increase costs for patients and their families, and result in deaths [ 2 ]. Studies in Nepal have also shown a higher proportion of SSIs (2.7 to 23.0 per 100 patients) in patients who had undergone different surgeries in different tertiary-care hospitals [ 3 – 6 ]. The studies have indicated that inadequate reprocessing and sterilization of reusable medical devices could be one of the factors contributing to the higher rates of SSIs.…”

Section: Introductionmentioning

confidence: 99%

Healthcare workers’ knowledge and attitudes towards sterilization and reuse of medical devices in primary and secondary care public hospitals in Nepal: A multi-centre cross-sectional survey

et al. 2022

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Background Healthcare facilities reprocess and sterilize reusable medical devices before each invasive clinical procedure, such as surgery, to prevent person-to-person or environmental transmission of pathogens through medical devices. We conducted a nationwide multi-centre cross-sectional survey in primary and secondary-care public hospitals in Nepal to assess the knowledge and attitudes of healthcare workers towards sterilization and reuse of medical devices. Methods We carried out a multi-centre cross-sectional survey comprising eleven primary-care (two district-level and nine district hospitals) and two secondary-care (zonal hospitals) public hospitals which covered all seven provinces of Nepal. Survey questionnaires were distributed to 234 healthcare workers including doctors, nurses, paramedics, and office assistants (involved in medical device reprocessing); 219 (93.6%) returned the completed questionnaire. Descriptive analyses of demographic information, knowledge and attitude responses of survey participants were performed. Logistic regression and ordinal regression models for complex samples were used to investigate associations between responses and independent variables. Results Except for a few areas, more than 70% of healthcare workers had proper knowledge about different aspects of sterilization and reuse of medical devices. Paramedics and office assistants were less likely to have the correct knowledge in different aspects compared to nurses. Permanent staff were more likely to give correct answers to some knowledge questions compared to temporary staff. Previous infection control training was positively associated with correct responses to some knowledge items. Most of the healthcare workers had positive attitudes towards different aspects of sterilization and reuse of medical devices, and nurses were more likely to have positive attitudes compared with other staff categories. Conclusions Most of the healthcare workers had correct knowledge and positive attitudes towards most areas of sterilization and reuse of medical devices. However, they need proper education and training in some areas such as sterilization procedures, storage of sterilized devices, prion decontamination and standard precautions.

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Incidence of Post Operative Wound Infection Following the Use of Antibiotics in Clean Contaminated Head and Neck Surgery in a Tertiary Care Centre in Eastern Nepal

Cited by 3 publications

References 0 publications

Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study

Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study

Appropriateness of perioperative antibiotics in thyroid surgery

Healthcare workers’ knowledge and attitudes towards sterilization and reuse of medical devices in primary and secondary care public hospitals in Nepal: A multi-centre cross-sectional survey

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