DOI: http://dx.doi.org/10.18203/2349-2902.isj20212793

Surgical site infections in clean and clean contaminated surgeries in a tertiary care teaching hospital

Anuradha G. Tolpadi, Abhijeet K. Mane, Snehal V. Dhayagude, Meera S. Modak, Dhananjay M. Dongare, Akshata S. Tendulkar, Prerana U. Mahadik, Pallavi Lamkhade

Abstract


Background: Despite major advances in infection control interventions, health care-associated infections (HAI) remain a major public health problem and patient safety threat worldwide. Surgical site infections (SSI) are among the most commonly reported Hospital acquired infections (HAI).

Methods: This was a prospective observational study conducted in a tertiary care hospital over a period of one year from May 2019 to April 2020. Total 2382 patients who underwent clean and clean contaminated surgeries were included in the study. The data on demographics, type of surgery, duration of surgery, day of SSI event, use of prosthesis, comorbidities, post-operative stay and resuturing was collected and analyzed. From suspected patients of SSI, pus aspirate/swab was sent for culture and susceptibility.

Results: Total 2382 clean and clean contaminated surgeries were included in the study. The incidence of SSI was 2.05%. Association between SSI and gender, age group and whether the surgeries were planned or were emergency surgeries was noted. In 37 (75.51%) patients who developed SSI the post-operative stay was prolonged (>7days). 3 (6.1%) patients had to undergo resuturing due to gaping in the surgical wound. 18(36.73%) cases of SSI were diagnosed after discharge from hospital. The predominant organism causing SSI was Escherichia coli followed by Staphylococcus aureus and Coagulase negative Staphylococcus (CONS).

Conclusions: Regular surveillance of SSI with feedback of appropriate data to the stakeholders is desirable to reduce SSI rate. Post patient discharge, surveillance of SSI is challenging but it needs to be addressed by infection control team to identify cases of SSI accurately.

 


Keywords


Surveillance, Surgical antibiotic prophylaxis, Surgery, Comorbidities

Full Text:

PDF

References


World Health Organization. Report on the burden of endemic health care associated infection worldwide; clean care is safe care. Geneva [Switzerland]: WHO Document Production Services. 2011.

Pittet D, Allegranzi B, Storr J, Nejad S, Dziken G, Leotsakos A, et al. Infection control as a major WORLD Health Organization Priority for developing countries. J Hosp Infect. 2008;68:285-92.

European Centre for disease Prevention and control. Surveillance of surgical site infection in European hospitals: HAISSI protocol. Version 1.02. Stokholm. ECDC. 2012.

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;37:387-97.

Suchitra J, Lakshmidevi N. Surgical site infections: assessing risk factors, outcomes and antimicrobial sensitivity patterns. Afr J Microbiol Res. 2009;3:175-9.

Subbalaxmi M, Laxmi V, Lavanya V. Antibiotic resistance: experience in a tertiary care hospital in south India. J Assoc Physicians India. 2010;58(suppl):18-22.

Pathak A, Mahadik K, Dhaneria SP, Sharma A, Eriksson B, Lundborg CS. Surveillance of antibiotic consumption using the “focus of infection äpprocah in 2 hospitals in Ujjain, India. PLoS One. 2012;7:e38641.

Tanner J, Padley W, Davey S, Murphy K, Brown B. Patient narratives of surgical site infection: implications for practice. J Hosp Infect. 2013;83(1):41-5.

Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of Surgical Site Infections Associated with Arthroplasty and the Contribution of Staphylococcus aureus. Surg Infect (Larchmt). 2016;17(1):78-88.

Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus. Surg Infect (Larchmt). 2017;18(4):461-73.

Mangram AJ. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):247-80.

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.

Kokate SB, Rahangdale V, Katkar VJ. Study of bacteriological profile of post-operative wound infections in surgical wards in a tertiary care hospital. Int J Contemporary Med Res. 2017;4(1):77-83.

Jain A, Tolpadi A, Chaudhary B, Chaudhary A, Misra A. A Study of surgical site infections in a tertiary care hospital. Int Surg J 2019;6:3911-5.

Collee JG, Marr W. Specimen collection, culture containers and media In: Collee JG, Fraser AG, Marmion BP, Simmons A, eds. Mackie and McCartney Practical Medical Microbiology. 14th ed. NewYork: Churchill Livingstone. 1996;95-112.

Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, eds. Mackie and McCartney Practical Medical Microbiology. 14th ed. New York: Churchill Livingstone. 1996;131-50.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute. 2018.

Misha G, Chelkeba L, Melaku T. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study. Ann Clin Microbiol Antimicrob. 2021;20:33.

Courtney MT, R Daniel B, B Mark Evers, Kenneth LM. Chapter 14, Sabiston Textbook of Surgery, 18th ed, Philadelphia, USA: Saunders Elsevier. 2008;299-327.

Madhusudhan NS, Mareen T. Study of Surgical site infection in clean and clean contaminated surgeries in a tertiary care hospital. International Journal of Biomedical Research. 2014;5(490):10.7439.

Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infections in clean and clean-contaminated cases, Indian J Med Microbiol. 2005;23(4):249-52.

Gibbons C, Bruce J, Carpenter J, Wilson AP, Wilson J, Pearson A, et al. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Health Technol Assess. 2011;15:1-156.

Razavi SM, Ibrahimpoor M, Kashani SA, Jafarian A. Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital. BMC Surg. 2005;5:2.

Sahu SK, Shergill JS, Sachan PK, Gupta P. Superficial incisional surgical site infection in elective abdominal surgeries: a prospective study. Internet J Surg. 2011;26.

Leong G, Wilson J, Charlett A. Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect. 2006;63:255-62.

Pathak, Ashish & Saliba Gustafsson, Erika & Sharma, Shailendra & Mahadik, Vijay & Shah, Harshada & Stålsby Lundborg, Cecilia. Incidence and factors associated with surgical site infections in a teaching hospital in Ujjain, India. American journal of infection control. 2013;42:10.1016.

O’Keeffe AB, Lawrence T, Bojanic S. Oxford craniotomy infections database: a cost analysis of craniotomy infection. Br J Neurosurg. 2012;26:265e9.

Pinkney T, Calvert M, Bartlett D, Gheorghe A, Redman V, Dowswell G, et al. The impact of wound-edge protection devices onsurgical site infection after laparotomy (ROSSINI trial): a multicenter randomised controlled trial. Colorectal Dis. 2013;15:18.

Alfonso JL, Pereperez SB, Canoves JM, Martinez MM, Martinez IM, Martin-Moreno JM. Are we really seeing the total costs of surgical site infections? A Spanish study. Wound Repair Regen. 2007;15(4):474-81.

Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96(1):1-15.

Patel S. Study of risk factors including NNIS risk index in surgical site infections in abdominal surgeries. Gujarat Med J. 2011;66(1):42-5.

Setty NH, Nagaraja MS, Nagappa DH, Giriyaiah CS, Gowda NR, Naik RD. A study on Surgical Site Infections (SSI) and associated factors in a government tertiary care teaching hospital in Mysore, Karnataka. Int J Med Public Health. 2014;4:171-5.

Berard F, Gandon J. Factors influencing the incidence of wound infection. Ann Surg. 1964;160:32-81.

Patel SM, Patel MH, Patel SD, Soni ST, Kinariwala DM, Vegad MM. Surgical site infections: Incidence and risk factors in a tertiary care hospital, Western India. Natl J Community Med. 2012;3:193-6.