A Prospective Study of Surgical Site Infection at Vasavi Hospital, Bangalore, Karnataka, India
Vijaya Doddaiah, A Mohan, Srivatsa Subramanya, Karthik Krishna, Venkatesh Rathod
1. Consultant Microbiologist, Department of Microbiology, Vasavi Hospital, Bangalore, Karnataka, India. 2. Consultant Urologist, Department of Urology, Vasavi Hospital, Bangalore, Karnataka, India. 3. Consultant Orthopaedics, Department of Orthopaedics, Vasavi Hospital, Bangalore, Karnataka, India. 4. Medical Superintendent, Department of Anaesthetist, Vasavi Hospital, Bangalore, Karnataka, India. 5. Consultant Orthopaedics, Department of Orthopaedics, Vasavi Hospital, Bangalore, Karnataka, India.
Correspondence Address :
Dr. Vijaya Doddaiah,
No 15, 70th cross, 14th Main, 1st stage, Kumaraswamy Layout, Bangalore-560078, Karnataka, India.
: Surgical Site Infection (SSI) is an infection which develops within 30 days after a surgical procedure or one year after the placement of an implant and the infection appears to be associated with surgery. SSI is related with complications like increased readmission rates, length of stay and cost.
Aim: To find out the incidence rate of SSI, aetiology and their antibiogram.
Materials and Methods: A prospective study of 947 patients (454 male and 493 female) who underwent surgery at Vasavi Hospital, Bangalore, Karnataka, India, from February to December 2019 formed the study group. Age, sex, type of surgery, month wise, section wise, duration of surgery, prophylaxis given, elective or emergency etc., were noted. Pathogen isolated from SSI cases was identified and their antibiogram were recorded.
Results: Of the 947 patients, 239 (25.24%) belonged to General Surgery, 301 (31.78%) Orthopaedics, 187 (19.75%) Gynaecology, 124 (13.09%) Urology, 40 (4.22%) ENT, 20 (2.11%) Oncology and 36 (3.80%) Miscellaneous. SSI rate in the present study was 0.21%. Two patients (females) aged 66 and 33 years developed deep infection at the site of incision, with purulent discharge that was operated from orthopaedic department. Pathogens isolated were Staphylococcus aureus (MSSA) and Streptococcus pyogenes. Isolates were sensitive to routinely used antibiotics.
Conclusion: SSI rate of 0.21% was been achieved by stringent quality control measures, training of hospital staff and continuous surveillance of infections.
|Keywords : Antibiogram, Nosocomial infection, Staphylococcus aureus|
SSIs are known to be one of the most common causes of nosocomial infections worldwide (1). There may be two sources of infectious agents i.e., endogenous or exogenous source. Endogenous sources are body sites like skin, nose, mouth, gastrointestinal tract or vagina that are occupied by microorganisms. Exogenous sources are health care workers, tools, medical devices or from the surroundings (2). The occurrence of SSI depends on site of surgery, duration of surgery, type of surgery (elective/emergency), age of the patient, co-morbid condition like diabetes and immune status of patient. There is paucity of data from small corporate hospitals in India on SSI. This prospective study was undertaken to determine the rate of SSI, causative pathogen and their antibiogram which would help the hospital, to improve the standards in reducing the rate of SSI.
|MATERIAL AND METHODS|
This prospective study was carried out from February to December 2019 in a 100 bedded secondary health care hospital with the occupancy of 30 to 40 beds at a time. The study was approved by the Institutional Ethical committee dated on 10/1/2019 (Ref:VHEC3;2019-2020). Informed consent was obtained from the study subjects. A total of 947 (454 males, 493 Females) patients, who underwent surgeries formed the study group.
Inclusion criteria: All patients of either sex admitted for surgical wards (Orthopaedics, General Surgery, Urology, Gynaecology, Oncology and miscellaneous) of the hospital for elective or emergency surgeries of clean procedures were included.
Exclusion criteria: Patients with infected/open wounds, who underwent surgery, were excluded from the study.
Age, sex, department of surgery, duration of surgery, antibiotics prophylaxis, and history of diabetes was recorded by the infection control nurse. In suspected cases of SSI, purulent discharge from operated site wound were collected and sent for culture and antibiogram. Bacterial isolates were identified by proteomic studies (MALDI TOF/MS-Biotyper) and antibiogram by VITEK2-Compact.
Data was entered in Microsoft Excel and analysed. The values were presented in number and percentages.
Age of the study group ranged from 4 to 93 years. Females were 493 (52.06%) and males 454 (47.94%). Age, sex and department wise distribution of the operated patients is shown in (Table/Fig 1).
Out of 947 patients, two patient developed SSI. Duration of the surgeries is shown in (Table/Fig 2). (Table/Fig 3) shows the month-wise distribution and rate of SSI. Detail of the patients who developed deep wound infection (SSI) at the site of operation is shown in (Table/Fig 4). Pathogen isolated from cases of SSI and the antibiogram are shown in (Table/Fig 5).
A 911 (96.2%) were elective and 36 (3.8%) emergency surgery. Emergency cases were all caesarean section. All patients included in the study received prophylactic antibiotics of cefuroxime within one hour prior to surgery.
Healthcare Associated Infections (HAIs) remain as an important public health concern (3). In India, SSI is one of the leading causes of morbidity and mortality (4). In the present study maximum number surgical patients were found among 31-40 (20.59%) and 21-30 (20.38%) years. Females 493 (52.06%) were more than the males 454 (47.94%). Age and gender has no significant role in the development of SSI. 96.2% patients were on elective and (3.8%) on emergency surgery. Maximum numbers of patients were from orthopaedic department (31.78%). Details of patients who developed SSI is shown in the (Table/Fig 4). In the first case, age, History of diabetes and prolonged surgery with implant, hospital stay for eight days, which might have played a role in the causation of SSI, as reported by others (2),(3). High blood sugar level is one parameter significantly associated with SSI as in the present case of SSI. The sencod case was with no History of diabetes, hospital stay of three days, but prolonged orthopaedic surgery with implant (3). Placement of implants and prolonged surgery are significant factor in the causation of SSI as in present study, has also been reported by others (2),(3),(5),(6). Length of hospitalisation prior to surgery with exposure to hospital environment and duration of postoperative stay are the factors in the causation of SSI (5). No infection was found in surgeries lasting for less than one hour in present and Lilani SP et al., study (5).
In the present study rate of SSI was 0.21% which was lower than the other report from India (2),(3),(5),(6),(7). A study by Subramanian KA et al., and Ganguly PS et al., from Aligarh reported an estimated infection rate of 24.8% and 38.8%, respectively (8),(9). In USA rate of SSI is 2.8% and in European countries 2-5% (10). Global estimates of SSI have varied from 0.5 to 15%. High rate of SSI reported from India, reflects poor consciousness about the HAIs and infection control practices (11). One of the reason for lower percentage of SSI in the present study, may be majority of the cases were elective surgery and prophylaxis with cefuroxime was given within one hour prior to surgery. This low rate was achieved by strict institutional control measures and surveillance of infections continuously.
Pathogens isolated from two cases of SSI with deep infections were Streptococcus pyogenes and Staphylococcus aureus which were sensitive to routinely used antibiotics. Staphylococcus aureus and Streptococcus pyogenes has been reported by various authors as causative agents of SSI (2),(3),(5),(6). Colonisation of anterior nares with Staphylococcus aureus and throat with Streptococcus pyogenes may act as source of infection. Most of the other studies have also reported gram negative bacilli as the causative agents of SSI (2),(3),(5),(8),(12).
This was a short period study of 11 months only on SSI.
This study presents the findings of a prospective study undertaken in a small corporate hospital. SSI is the index of health care system of any hospital. This study will provide baseline estimates for subsequent comparisons. With good infection control practices and training of hospital staff continuously, present study SSI rates were much lower than others.
Authors are grateful to Dr. Shivashankar GN, Medical Director for the support and encouragement for this study. Special thanks to Infection control nurse Mrs. Vinutha TM for her dedication and commitment. Thanks to Mr. Arjun J Rao IT department for helping in the preparation of this manuscript.
|TABLES AND FIGURES|
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