Surgical Site Infection Rate and Risk Factors among Obstetric Cases of Jimma University Specialized Hospital, Southwest Ethiopia

Abstract

BackgroundSurgical Site infections are the second most frequently reported infections of all nosocomial infections among hospital patients. Among surgical patients in obstetrics, Surgical Site Infections were the most common nosocomial infections and the rate is higher in sub-Saharan Africa. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to determine the surgical site infection rate among women having surgery for delivery in obstetrics of Jimma University Specialized Hospital (JUSH) from April 1, 2009 to March 31, 2010.MethodsA prospective descriptive study design was conducted with the aim of determining the surgical site infection rate on all 770 women who had surgery for delivery from April 1, 2009 to March 31, 2010 in obstetric ward of the Hospital. Data on history of the patient, patient specific demographic information on potential risk factors and the occurrence of Surgical Site infections in the first 30 days following surgery were collected using pretested data collection form. In addition, relevant data were also abstracted from the operation logbook of the cases. Then data were cleaned, edited and fed to computer and analyzed using SPSS for window version 16.0. Finally Statistical test for significance was employed using chi-squared (X 2) where appropriate at 5% level of significance.ResultsThe mean (±SD) of the subjects' age was 26(±7) years and the majority of the women were from the rural areas (72.7%). The overall surgical site infection rate was 11.4%. Of those who had surgical site infections, 64.8% had clean-contaminated wound and 35.2% had contaminated /dirty wounds. Wound class at time of surgery has a statistically significant association with Surgical Site infections (p <0.001).The Surgical Site infections rate was similar for cesarean section and abdominal hysterectomy but higher for destructive delivery under direct vision. Majority of the operations were made for emergency Obstetric conditions (96.6%) and the Surgical Site Infections rate was two times higher compared to that of elective surgery. Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections.ConclusionIt has been revealed that Surgical Site Infections rates are higher than acceptable standards indicating the need for improving Antenatal care, increasing the number of skilled birth attendants at the local clinics, increasing basic and comprehensive emergency obstetric care services, applying improved surgical techniques and improving infection prevention practices to decrease infection rate to acceptable standard.

Surgical site infections post cesarean section

“…8 Obstetric care services should be strengthened in rural areas. 59% of the patients were nulliparous which is similar to that of study in Mitt et al 9 Tran et al reported that the risk factor of surgical site infection was shown to be reduced by 39% and 60% when women had one or more children respectively.…”

“…10 Majority of the cases were unbooked which correlates with Amenu D et al study. 8 Antenatal care provides opportunities for health education, prior detection and correction of maternal problems.…”

“…Blood loss of more than 1000ml was in 22 cases similar to that in the Amenu D et al study. 8 Majority of the SSI, 63% required secondary suturing while in 37% of the cases, the wound healed with daily aseptic dressings and secondary intention. The most common pathogenic organisms causing SSI in present study (Table 5 and 6) were found to be S. aureus 35% followed by gram negative rods of which Klebsiella species 24%, E. coli.…”

Surgical Site Infection Among Gynaecological and Obstetric Abdominal Surgeries.

“…In present study prevalence of SSIs was 11.1% in gynaecological procedures while it was 9.1% in obstetric procedures. Amenu D et al [9] observed an overall surgical site infection rate of 11.4% among women having surgery for Obstetric reasons. Devjani et al [11] observed the incidence as 24.2% following lower segment caesarean section while in similar studies Ansar A et al [13] Ghuman et al [15], Vijayan et al [16] observed the prevalence as 5.8%, 5% and 4.1% respectively.…”

“…Various studies have shown that emergency cases land up in SSI more than the elective ones [17][18][19][20][21][22][23]. Amenu D et al [9] in their study observed Surgical Site Infections rate to be two times higher in emergency procedures as compared to that of elective cases. Kishwar N et al [18] also observed emergency caesarean sections as risk factor for development of SSI.…”