Surgical Site Infections in a Rural Teaching Hospital of North India

Abstract

Aims and objectives: Surgical site infections (SSIs) are one of the most important causes of health care-associated infections. Understanding SSI reduces the social and economic burden of a hospital and society. In this context, we evaluated the various aspects of SSI in our institution, Rohilkhand Medical College & Hospital (RMCH), which is a tertiary care teaching hospital in rural Uttar Pradesh in North India. Materials and methods:This prospective study was conducted in the Department of General Surgery, RMCH, Bareilly, Uttar Pradesh, India. A total number of 1,498 patients admitted for surgical procedures with effect from November 1, 2016 to December 31, 2016, formed the subjects of the present study. All operated cases during the above period, including major and minor, emergency and elective, laparoscopic and open procedures were included in the present study. Data so obtained were analyzed statistically. The Centers for Disease Control and Prevention, USA criteria were used for defining the wound. Sample swabs were collected from the first dressing and up to 2 to 4 weeks postoperatively. Samples were processed for aerobic and anaerobic flora, and the antibiotic sensitivity of the isolates was also performed. Results and discussion:The SSI rate in the present study was 8.67%. Significantly higher incidence of SSI was detected with increasing age. The SSI rate in case of emergency surgeries was more (27.7%) as compared with routine/elective surgeries (6.3%). The higher incidence (18.75%) of SSI was detected in patients having preoperative hospital stay of more than 7 days, and the maximum incidence (15.7%) was observed in patients having longer postoperative hospital stay of more than 10 days. Dirty wounds had the highest incidence of SSI (53.45%). The incidence of SSI increased with duration of surgery, order of surgery, and with the increasing duration of postoperative drains. Staphylococcus aureus was the commonest isolate (32.30%) followed by Escherichia coli (39%). Conclusion:Though the incidence of SSI in the present study was slightly low as compared with similar reports from other institutions of the country, more rational antibiotic policy and more stringent infection control measures are needed.

Surgical site infections in emergency abdominal surgeries in a tertiary care hospital of North-East India

“…In studies of Patel Sachin et al and Rajesh et al the incidence of SSI ranged from 15% to 25%. 4,5 In a study by Ansul et al 13% were male and 12% were female. 6 Highest incidence of SSI was observed in patients aged 50 years or more (44.34%) and lowest rate in the group 13-19 years and the incidence was high when associated with co-morbidities, in our study, which is similar to studies done by Narsinga Rao Bandaro et al and Keswani et al 7,8 Duration of operation was found to be an important risk factor in the development of SSI in this study with highest 63.33% cases where the operation lasted for>120 minutes.…”

A Prospective Study of Surgical Site Infections in a Medical College Hospital

“…Naveen et also found that majority (64.44%) of the cases belonged to 18-30 years group. [2] 30.7% of the cases were emergency and 69.3% were elective surgeries. 11.8% of the cases suffered from surgical site infection.…”

“…[5] Abbey et al found that SSI was seen in 3.56% of clean wounds, 9.58% of clean contaminated wounds, 22.06% of contaminated and 53.45% of dirty wounds. [2] Deep SSI was more commonly seen in contaminated and dirty wounds. However, this difference was not significant statistically (p=0.78).…”

“…[1] It is reported to be the third most common nosocomial infection responsible for 12%-16% of all nosocomial infections among hospitalized patients. [2] Increase in incidence of SSIs has been attributed to emergence of antimicrobial-resistant microorganisms, frequent use of indwelling devices and implants and increased longevity with resultant increase in elderly patients and those with chronic, debilitating, or immunocompromising diseases. [3] The rate of SSI varies from 0.5-15% worldwide while studies in India reported it to be high ranging from 20-38%.…”

Impact of using triclosan-impregnated sutures on incidence of surgical site infection: a real world Indian study

“…Another study reported SSI from rural teaching hospital to be as high as 27.7% for emergency surgeries and overall 8.67% for all surgeries. 6 With its high incidence, particularly in low resource setting like rural India, SSI places a burden on both patients and healthcare systems.…”