Factors predicting surgical site infection after clean contaminated surgery

Authors

  • Ranjith Mannarakkal Department of Surgery, MES Medical College, Perintalmanna, Kerala, India
  • Mohammed Suaib Department of Surgery, MES Medical College, Perintalmanna, Kerala, India
  • Abidali Karatparambil Department of Surgery, MES Medical College, Perintalmanna, Kerala, India
  • Abhijith N. Das Department of Surgery, MES Medical College, Perintalmanna, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175915

Keywords:

Clean contaminated, Laparotomy, Southampton, Surgical site infection

Abstract

Background: The infection of a wound is defined as the invasion of organisms through tissues following a breakdown of local and systemic host defences, leading to cellulitis, lymphangitis, abscess and bacteraemia. Southampton criteria and the centers for disease control and prevention criteria for the diagnosis of surgical site infections are used now for severity assessment. There is still controversy existing on the multifactorial causal relationship.

Methods: Longitudinal Observational study with nonrandom purposive sampling carried out in the patients in OT, Casuality, ICU and Wards, in our hospital having clean contaminated abdominal operations for one-year period starting from November 2015 determine the factors responsible for surgical site infections following clean contaminated abdominal operations with prophylactic antibiotics(n=150).

Results: Diabetes mellitus (odds ratio of 1.9) and emergency procedure (12.6%) were the most important risk factors for development of SSI. E. Coli (45%, n= 9) was the most common organism. Midline incision (n=6/22 = 27.27%) showed highest rate. Other high-risk factors are obesity, malnutrition, anemia, old age and prolonged duration of surgeries.

Conclusions: Various host factors like malnutrition, obesity, patients knowledge about hygiene, presence of co-morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation and experience of operating surgeon greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI. Moreover, in absence of highly advanced surgical amenities, preoperative resuscitative units, modern operation theatre facilities and sophisticated sterilization procedure it is necessary to use prophylactic antibiotics to encounter the various types of micro-organisms responsible for surgical site infection, particularly E. coli.

Author Biography

Ranjith Mannarakkal, Department of Surgery, MES Medical College, Perintalmanna, Kerala, India

Pro

References

Barie PS, Sabiston textbook of surgery, 19th Edn, 2012;(1):284.

Douketis JD, Berger PB, Dunn AS. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:299S-339S.

Rao AS, Harsha M. Postoperative wound infections. J Indian Med Assoc. 1975;64:90-3.

Tripathy BS, Roy N. Post-operative wound sepsis. Indian J Surg. 1984;47:285-8.

Velasco E, Thuler LCS, Martins CAdS, Dias LC, Gonçalves V. Risk index for prediction of surgical site infection after oncology operations. American J of Infection Control. 1998;26(3):217-23.

National Nosocomial Infections Surveillance (NNIS) System. NNIS report, data summary from October 1986-April 1996, issued May 1996. A report from the NNIS System.

DeFrances C, Hall M, Podgornik M. 2003 National Hospital Discharge Survey. Adv Data; 2005:1-20.

Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis. 2001;33:S67-S68.

Anvikar AR, Deshmukh AB, Karyakarte RP, Damle AS, Patwardhan NS, Malik AK, et al. A one year prospective study of 3,280 surgical wounds. Indian J Med Microbiol. 1999;17:129-32,64.

Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clinical Microbiology reviews. 1993;6(4):428-42.65

Sanjay P, Krishna BA, Abhinav A. A Prospective study of surgical site infection in elective and emergency Abdominal Surgery in CSSH, Meerut. JARBS. 2013;5(4):413-8. [cited March 21, 2014]

Guinan JL, McGuckin M, Nowell PC. Management of healthcare associated infections in the oncology patient. Oncology. 2003;17(3):415-20.

Nichols RL. Current strategies for prevention of surgical site infections. Curr. Infect. Dis. Rep. 2004;6:426-34.

Downloads

Published

2017-12-26

Issue

Section

Original Research Articles