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A Prospective Study of Postoperative Wound
Infections in a Teaching Hospital
of Rural Setup
1266-1271
Correspondence
Dr. Narasingarao Bandaru, MD., Ph.D.
Professor & Head, Department of Microbology
Rajivgandhi Institute of Medical Sciences (RIMS),
Srikakulam-532 001
Andhra Pradesh, India.
Phone: 09441126758
E-mail: narasinga_bandaru@rediffmail.com
Objective: Keeping in view the prevalence of the wound infections in our set up, this study was designed to evaluate the frequency, clinical presentation, common risk factors and the different organisms which were involved in cases of clean and clean-contaminated, contaminated and dirty surgeries.
Design and Duration:
An observational prospective study from May 2009 to April 2011.
Setting:
Surgical Units I and II of the Rajiv Gandhi Institute of Medical Sciences (RIMS), a Government Medical College cum Teaching Hospital in a rural setup in Srikakulam, Andhra Pradesh, India. Patients: Four hundred and twenty eight patients who underwent clean and clean-contaminated, contaminated and dirty surgeries.
Methodology:
The biodata of the patients, together with their clinical features, diagnosis, the type of surgery which was performed and the development of any complications, which included wound infections, was noted and the data was analyzed.
Results:
Out of the 428 patients (232 males and 196 females) in the study, 286 belonged to the clean surgery group, 97 belonged to the clean-contaminated surgery group, 27 belonged to the contaminated surgery group and 18 belonged to the dirty surgery group. The overall incidence of surgical site infections (SSI) in this study was 9.81%; 17 (5.94%) cases in the clean surgical group, 9(9.28%) cases in the clean-contaminated group, 6(22.22%) cases in the contaminated group and 10(55.56) cases in the dirty group developed infections. The patients in the age group of 51-60 years were infected more than those in the younger age groups. The incidence of the wound infections was more in the male patients (11.63%) as compared to that in the female patients (7.65%). Obesity was also a main cause of the SSIs, as was evident from the fact, that the patients with more than 60kg/m2 of weight were infected more (26.7%) as compared to those with 30-40kg/m2 of weight (6.45%). Anaemia, prolonged surgeries, operations which were done by junior surgeons and operations which were late in the list were also associated with more surgical site infections. The usual time of presentation of the SSIs was within three weeks following the surgeries and most of the patients presented with wound abscesses and cellulitis, while nine patients had wound dehiscence. The common organisms which were involved in the SSIs were Staphylococcus aureus, Escherichia.coli and Streptococcus pyogenes.
Conclusion:
Meticulous surgical techniques, the duration of the operation, proper sterilization, the judicious use of antibiotics, hygienic operation theatres and ward environments, the control of malnutrition and obesity and the treatment of infective foci and diseases like diabetes help in controlling the morbidity of the surgical wound infections.