Surgical Site Infections : A One Year Prospective Study in a Tertiary Care Center (original) (raw)
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Incidence and determinants of the surgical site infection: a hospital based longitudinal study
International Surgery Journal, 2016
Surgical Site Infection (SSI) is one of the common types of nosocomial infection found in indoor patients. SSIs are associated with increased length of hospital stay, hospital cost, patient morbidity and mortality. Thus, it not only has poor patient outcome, but also has adverse impact on economic burden. 1,2 Kirkland et al found in their study, that SSIs lead to prolongation of hospitalization by a median of 6.5 days, which in its turn leads to extra economic burden of $ 3089 to the hospital economy. 3 SSIs can be attributed to several endogenous factors, i.e., age and weight of the patient, co-morbidity, immune status etc. and several exogenous factors, like, preoperative hospital stay, preoperative prophylactic measures, type of wound and surgery, sterilization of instruments etc. 4 Despite of better knowledge of pathophysiology of the disease, standard preoperative, peroperative and ABSTRACT Background: Surgical site infection (SSI) is one of the common nosocomial infections and associated with increased length of hospital stay, hospital cost, patient morbidity and mortality. Methods: A prospective longitudinal study was conducted at a tertiary care centre of Ahmadabad city. Total 480 patients operated for general surgical procedures between the periods of January 2016 to June 2016 were included for the present study. Data were collected from the data sheet which included basic demographic detail of the patient, diagnostic criteria and associated risk factors. Data entry and analysis was done in software Epi info version 7.0. Chi square was used to identify association of the risk factor with outcome. P-value <0.05 was considered to be statistically significant. Results: In present study, 9.4% of the patients had SSI. The risk factors associated with SSI were age (18.3% versus 7.1%), diabetes (25.5% versus 7.6%), type of anaesthesia (general = 13.6% versus regional=7.1%), type of surgery (emergency = 21.7% versus elective = 7.3%), duration of surgery (17.9% versus 7.2%), type of wound (dirty = 28.4% versus clean = 2.99%), pre-operative hospital stay (27.3% versus 3.3%) and presence of drain (15.2% versus 7.2%). Conclusions: Our study emphasizes that age, type of surgery and wound, preoperative hospital stay, co-morbidity and drain have definite correlation with SSI. A standard infection surveillance protocol needs to be practiced stringently in an attempt to reduce the SSI rate.
Surgical site infections in Italian Hospitals: a prospective multicenter study
BMC Infectious Diseases, 2008
Background: Surgical site infections (SSI) remain a major clinical problem in terms of morbidity, mortality, and hospital costs. Nearly 60% of SSI diagnosis occur in the postdischarge period. However, literature provides little information on risk factors associated to in-hospital and postdischarge SSI occurrence. A national prospective multicenter study was conducted with the aim of assessing the incidence of both in-hospital and postdisharge SSI, and the associated risk factors. Methods: In 2002, a one-month, prospective national multicenter surveillance study was conducted in General and Gynecological units of 48 Italian hospitals. Case ascertainment of SSI was carried out using standardized surveillance methodology. To assess potential risk factors for SSI we used a conditional logistic regression model. We also reported the odds ratios of in-hospital and postdischarge SSI. Results: SSI occurred in 241 (5.2%) of 4,665 patients, of which 148 (61.4%) during in-hospital, and 93 (38.6%) during postdischarge period. Of 93 postdischarge SSI, sixty-two (66.7%) and 31 (33.3%) were detected through telephone interview and questionnaire survey, respectively. Higher SSI incidence rates were observed in colon surgery (18.9%), gastric surgery (13.6%), and appendectomy (8.6%). If considering risk factors for SSI, at multivariate analysis we found that emergency interventions, NNIS risk score, preoperative hospital stay, and use of drains were significantly associated with SSI occurrence. Moreover, risk factors for total SSI were also associated to in-hospital SSI. Additionally, only NNIS, pre-operative hospital stay, use of drains, and antibiotic prophylaxis were associated with postdischarge SSI. Conclusion: Our study provided information on risk factors for SSI in a large population in general surgery setting in Italy. Standardized postdischarge surveillance detected 38.6% of all SSI. We also compared risk factors for in-hospital and postdischarge SSI, thus providing additional information to that of the current available literature. Finally, a large amount of postdischarge SSI were detected through telephone interview. The evaluation of the cost-effectiveness of the telephone interview as a postdischarge surveillance method could be an issue for further research.
International Journal of Clinical Obstetrics and Gynaecology, 2021
Background: Surgical Site Infections (SSI) is the third most commonly reported nosocomial infection which has an adverse impact on the hospital as well as on the patient. Global estimates of surgical site infection (SSI) ranges 0.5-15%.The overall incidence of SSI in India is from 10-33%. The incidence of SSI in the Obstetric Population varies with rates ranging from 2.8-26.6%. Objectives 1. To incidence of SSI in patients operated in department obstetrics and gynaecology. 2. To identify the risk factors for SSI. 3. To study the microbiological profile and antibiotic sensitivity of SSI in our institute. 4. To recommend the preventive measures. Methodology: We conducted a 2 year retrospective study of SSI in our hospital. Total 2673 cases operated in Obstetrics and Gynaecology were included in the study. Data collection done from-SSI register, IPD files, Laboratory registers. Results: In obstetrics-anaemia, multiparity & poor pre-op preparation were found to be most common causes and in Gynaecology-advanced age was found to have most common cause. Obesity & Diabetes mellitus were common factors in both group. Escherichia coli was the commonest pathogen, followed by Staphylococcus aureus 22%. The incidence of SSI in our set up is 2.9%. Conclusion: We found that in order to decrease the incidence of SSI we should have proper preoperative work up, correction anaemia, sugar levels, active surveillance of SSI by cooperation of infection control inspectors and surgical team.
Surgical Site Infections in an Italian Surgical Ward: A Prospective Study
Surgical Infections, 2009
Background: Surgical site infection (SSI) remains a major cause of morbidity and death. This study analyzed the results of surveillance to evaluate the incidence, risk factors, and characteristics of SSI in patients who underwent an operation in a typical Italian surgical ward. Methods: A group of 1,281 patients operated on from August 2005 to December 2007 underwent prospective and direct observation of incisions by a surgeon according to the U.S. Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) method. The minimum follow-up was 30 days. A locally-modified risk index score (LRI) based on the NNIS was calculated for each patient, using as a cut point the 75 th percentile of the duration of surgery (in minutes) for that particular procedure. Results: Seventy-six patients were affected by incision site infection, and the SSI rate was 5.9%. Thirty-four (2.6% of the series) were superficial incisional, 32 (2.5%) deep incisional, and 10 (0.8%) organ=space SSIs. An increasing value of the LRI was significantly (p < 0.05) related to an increasing risk of infection. The SSI rates were 0.6%, 3.7%, 7.3%, and 26.8% for LRI value of M ¼ À 1, 0, 1, and !2, respectively. Obesity (body mass index >30 kg=m 2 ), diabetes mellitus, and emergency surgery were associated with a higher risk of infection by multivariable analysis independent of the LRI. Conclusions: The NNIS method can be useful for SSI surveillance and monitoring in single surgical wards. Longer operations, diabetes mellitus, and obesity increase the risk of SSI, as does performance of surgery in an emergency situation.
International Surgery Journal, 2021
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.
Preventing Surgical Site Infections
AJN, American Journal of Nursing, 2010
Healthcare-associated infections (HAIs) are frequent on surgical wards [1,2] and represent a high burden on patients and hospitals [1,3] in terms of morbidity, mortality, prolonged length of hospital stay and additional costs [4]. Surgical site infections (SSIs) are an important source [1] and may even be the most frequent HAI after excluding asymptomatic bacteriuria [5]. Apart from endogenous risk factors, such as immune suppression [6-8], obesity [9] or advanced age [10], the role of external risk factors in SSI patho genesis is now clearly established [1,3]. Multimodal [11], multicenter or supranational preventive intervention programs based on guidelines [1,12], 'bundles' [13,14] or safety checklists [15] are gaining momentum on a global scale [16,17]. In parallel, randomized studies provide insight into poorly explored risk factors and practical intervention measures. The National Institute for Health and Clinical Excellence (NICE) in England, Wales and Northern Ireland issued guidance for the prevention and treatment of SSI [201] in October 2008, and the 1999 SSI guidelines of the CDC are currently under revision. We summarize the state-of-the-art regarding SSI prevention among adult inpatients, highlight important epidemiological features and discuss pitfalls of surveillance and the possible role of benchmarking SSI rates. The practical questions regarding the most effective measures to reduce SSI and the SSI rates achievable today are also addressed, as well as the theoretical possibility of achieving a zero SSI policy on a surgical ward, at least for clean orthopedic surgery [3]. Methods The aim of the research was to provide an overview of the current state-of-the-art of SSI prevention with an emphasis on literature published during the last 5 years, particularly the most recent. Landmark studies and important publications are incorporated for an overriding purpose. The first author performed a PubMed search of the literature to identify English, French and German language publications prior to 10 January 2010 using the following MeSH terms in various combinations: 'surgical site infection', 'nosocomial', 'surgery', 'ortho paedic', 'infection', 'prosthesis', 'arthroplasty', 'zero', 'prophylaxis', 'prevention', 'bundles' and 'guidelines'. The search was verified by the second and last author for pertinence to the topic. Reference lists of identified articles were searched manually to retrieve additional literature published after January 2004. Animal studies and studies with an outcome other than SSI, for example, colonization studies, in vitro studies and pediatric reports were excluded. We concentrated on articles with data on the post-discharge surveillance of SSI. A total of 205 articles were retained and form the basis of this review. Sterilization
Journal of Medical Science And clinical Research, 2017
Background: Surgical site infections (SSIs) are any infections occurring in a surgical wound within 30 days. SSIs are real risks associated with significant burden in terms of patient morbidity and mortality, and costs to health services around the world. SSIs are known to be the commonest form of hospital acquired infections. In a busy medical college hospital where the work load is tremendous and majority of the patients belong to the low socioeconomic conditions with poor hygiene and nutritional level, the incidence of SSI in emergency procedures is high causing great burden on the hospital where cost of dressing material, hospital stay, food and investigations are provided free of cost. Method: We studied 100 patients who underwent abdominal surgeries for elective or emergency procedures in the last one year who developed SSI in the immediate post-operative period. The 50 patients had undergone emergency surgery and 50 were elective. Result: In elective surgeries, 3 patient developed SSI. In Emergency Surgeries, 8 patients developed SSI. Infection with E.Coli and Staph Aureus were more common. The organisms were susceptible to Ceftriaxone, Cefaperazone-Sulbactum, Cefotaxime, Piperacillin-Tazobactum and Amikacin which were easily available in the hospital. Conclusion: Certain simple and easy to follow protocols for pre-operative care to prevent SSI which helped to reduce the rate of SSI in elective surgery patients. Simple steps can bring down the incidence and reduce the economic burden on hospitals giving low cost or free treatment.
Unveiling the burden of surgical site infections (SSI) and its determinants in tertiary care centre
IP Journal of Surgery and Allied Sciences, 2023
Background: Surgical site infections (SSIs) are prevalent hospital-acquired infections that pose a significant risk to patients, often leading to complications and even death. The incidence of SSIs can vary among different hospitals due to various factors that influence their development. Objectives: The objective of this study was to examine the occurrence and determine the factors associated with Surgical Site Infections (SSI). Materials and Methods: From August 2021 to July 2022, our tertiary care center conducted a retrospective observational study. The surgical sites were carefully assessed and categorized, and infected wounds underwent culture and sensitivity testing. The collected data was then analyzed using SPSS 13 software Results: Among the 360 patients studied, 78 (22%) developed surgical site infections (SSI). Risk factors for SSI included age, gender, BMI, diabetes, blood transfusion, and longer preoperative waiting time. Staphylococcus aureus was the predominant pathogen, and resistance to tetracycline was common. Conclusion: Surgical site infections (SSI) are prevalent, indicating a high incidence. Among the contributing factors, gender, extremes of BMI, diabetes mellitus, and blood transfusion emerge as influential risk factors associated with the occurrence of SSI. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
This study explores the prognosticators of surgical site infection among studied group. Surgical site infection (SSI) continues to be a major source of morbidity and mortality in developing countries regardless of modern advances in aseptic techniques. Therefore it was essential to conduct this study to determine the prognosticators of surgical site infection at General Hospital Funtua, Katsina State, Nigeria. A descriptive cross sectional study was used involving all subjects who underwent major surgery in surgical wards. A non- probability purposive sampling technique was employed to recruit the total sample size of one hundred and twenty seven (127). After informed written consent for the study , all subjects who met inclusion criteria were successively enrolled in to the study. Pre-operative, intra-operative and postoperative data were collected using standardized data collection form based on CDC/WHO criteria. Wound specimens were collected and processed as per standard operative procedure. Data were analysed using SPSS and STATA software. Using odds ratio analysis, inadequate operating room ventilation and surgical hand scrub for < 2 minutes were found to have an increased risk for SSI by 34, fold. Subjects within the age limit between 21-30 years have increased risk for SSI by 2 fold, and subjects with co-existing illness (fever), have an increased risk for SSI by 4 fold, OR (3.9). Sterilization technique by the use of high level disinfectant and pre morbidity has been found to be an independent prognosticator of SSI, P-valve < 0.05. The study concluded that prognosticators for surgical site infections are associated with modifiable risk factors that the surgeons, nursing staffs and hospital management can dealt with in a greater details. Prevention strategies focusing on factors associated with surgical site infection is necessary in order to reduce the rate of SSI in our setting.
Prevention and control of surgical site infections: review of the Basel Cohort Study
2012
Introduction: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. Summary of methods of the Basel SSI Cohort Study: The prospective observational cohort study included 6,283 consecutive general surgery procedures closely monitored for evidence of SSI up to 1 year after surgery. The dataset was analysed for the influence of various potential SSI risk factors, including timing of surgical antimicrobial prophylaxis (SAP), glove perforation, anaemia, transfusion and tutorial assistance, using multiple logistic regression analyses. In addition, post hoc analyses were performed to assess the economic burden of SSI, the efficiency of the clinical SSI surveillance system, and the spectrum of SSIcausing pathogens. Review of main results of the Basel SSI Cohort Study: The overall SSI rate was 4.7% (293/6,283). While SAP was administered in most patients between 44 and 0 minutes before surgical incision, the lowest risk of SSI was recorded when the antibiotics were administered between 74 and 30 minutes before surgery. Glove perforation in the absence of SAP increased the risk of SSI (OR 2.0; CI 1.4-2.8; p <0.001). No significant association was found for anaemia, transfusion and tutorial assistance with the risk of SSI. The mean additional hospital cost in the event of SSI was CHF 19,638 (95% CI, 8,492-30,784). The surgical staff documented only 49% of in-hospital SSI; the infection control team registered the remaining 51%. Staphylococcus aureus was the most common SSI-causing pathogen (29% of all SSI with documented microbiology). No case of an antimicrobial-resistant pathogen was identified in this series. Conclusions: The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30 minutes before surgery. Due to the observational nature of these data, corroboration is planned in a randomized controlled trial, which is supported by the Swiss National Science Foundation. Routine change of gloves or double gloving is recommended in the absence of SAP. Anaemia, transfusion and tutorial assistance do not increase the risk of SSI. The substantial economic burden of in-hospital SSI has been confirmed. SSI surveillance by the surgical staff detected only half of all in-hospital SSI, which prompted the introduction of an electronic SSI surveillance system at the University Hospital of Basel and the Cantonal Hospital of Aarau. Due to the absence of multiresistant SSI-causing pathogens, the continuous use of single-shot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery) has been validated.