Prevalence of Surgical Site Infections in an Urban Tertiary Care Hospital in Central Maharashtra

BACKGROUND site infections (SSIs) is the third most frequently reported nosocomial infection, accounting for 12% to 16% of all infections among hospitalised patients, as reported by the National Nosocomial Infections Surveillance (NNIS) . The Centre for Disease Control and Prevention (CDC) and NNIS have developed criteria for defining SSIs, which have national standards and are widely used by surveillance and surgical personnel. These criteria define SSIs as “infections to the operative procedure that occur at or near the surgical incision (incisional or organ/space) within 30 days of an procedure or within one year if an implant is left in place”. The estimates of the incidence of SSI are dependent upon self-reporting by surgeons, which is unreliable because most wound infections occur when the patient is discharged, these infections may be treated in the community without hospital notification. Therefore, estimates of the prevalence of are almost underestimates, although the best data is available. Hence, present study was conducted so to estimate the of SSIs in tertiary care hospital in central Maharashtra. AND METHODS study was carried out over a period of 2 years (2011-2013) in the Department of Microbiology, Indira Gandhi Government College & Hospital, Nagpur, Maharashtra; around 19,127 patients were operated in different surgical departments and 517 (2.7%) patients developed SSIs. patients who were clinically diagnosed as cases of SSIs were included in study (517). A detailed history of patients was , (including age, gender, date of admission, presence of past or current infection, duration of pre & post-op hospital stay, prophylaxis received, emergency or elective type of surgery, type and duration of anaesthesia, major or minor surgery, of wound at time of first post-op dressing, class of wound, number of dressings done and antibiotics received after , etc.). The surgical wound was inspected at the time of first dressing and two specimens were collected and processed per standard microbiological techniques. 19,127 cases underwent surgery in various surgical departments. Out of these patients, the rate of SSIs was found in 517 patients (2.7%). It was found to be highest among patients of age group of 31 to 40 years (25.53%) and in males (56.86%) compared to females (43.13%). SSIs rate was highest in surgeries performed under emergency conditions (54.15%) and general anaesthesia (47.19%). SSIs rates increased with increase in duration of surgeries (>4 hours -22.05%) & with history of pre- & post-operative hospital stay (28.43%). Out of 517 cases, 370 (71.56%) patients received AMP. various operative procedures, SSI was highest in surgeries for perforation peritonitis (11.99%) & LSCS (11.02%). rate was highest in deep surgical sites (49.51%) than in organ / space (40.81%) and superficial (9.67%) surgical sites. , the rate of SSIs in class IV (dirty) was highest (41.19%) than in class III (contaminated) (29.20%), class II (clean ) (17.02%), and in class I (clean) type of wound (12.5%). of 517 samples collected, 340 samples showed growth and 177 showed no growth and 40 samples had mixed growth. most frequently isolated organism was E. coli (23.33%), followed by A. baumannii (16%) and K. pneumoniae (15.66%). . pneumoniae was found to be the commonest ESBL producer (40.62%) as well as AmpC producer (17.18%). While A. 18 (28.57%) was found to be the commonest MBL producer. The rate of MRSA was found to be (45%) and ICR was (17.5%). of all activities, SSIs remain a substantial cause of morbidity and mortality among hospitalized patients even in urban care centres. This may be partially explained by surgeons reporting the emergence of antimicrobial-resistant pathogens the increased numbers of surgical patients who are elderly and/or have a wide variety of chronic, debilitating, or immunecompromising underlying diseases, etc. these, antibiotics have potential impact on preventing mortality in developing countries. The use of antimicrobial for selected surgical procedures is one of the measures used to prevent the development of a surgical site infection. , other infection control practices include improved operating room ventilation, sterilization methods, barriers, surgical , and availability of antimicrobial prophylaxis.The points for intervention also include, reduction of duration of preoperative hospital stay, reduction in the duration of procedures, avoiding unnecessary drains in addition to initiation of standardized SSI active surveillance and feedback relevant data to surgeons that can help in reducing the rate of Surgical Site Infections. Therefore, from our study, we can conclude that SSIs depend on multiple preventable factors, stressing upon those that reduce the prevalence rate of SSIs to minimal in tertiary care hospitals.