Incidence of Surgical Site Infection, predisposing Factors and Associated Costs at Dessie Referral Hospital, Dessie, Ethiopia
No Thumbnail Available
Date
2017-03
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa University
Abstract
Background: Surgical wound infection is a prototype of (Hospital Acquired Infection) HAI
and constitutes a serious problem. Patients diagnosed with Surgical Site Infection (SSI) face a 2
to 11 times increased in mortality along with prolonged hospital stays, treatment associated risks,
culture confirmed SSI was 12.1 %. More than half of the bacteria isolated were gram negative
rods. About 79.2 % of all the isolates were Multi Drug Resistant (MDR). About 66.67 % and 100
% of E. coli and K. pneumonia were Extended Spectrum Beta Lactamase (ESBL) producers
respectively. In this study, 55.6 % of the Syaphylococcus species were methicilin resistant
(MRSA). Hypertension, ASA score-3, elective surgery and the age group 35-44 years were found
to be statistically significant associated factors for SSIs. A more than two times increase of the
cost and length of hospital stay was observed as a result of SSI in Dessie Referal Hospital.
Conclusion and recommendation: the rate of SSI, MDR, MRSA and ESBL producing bacteria
was very high among patients with SSI. A hospital based survey should be conducted on a
regular basis, evidence based information should be given to the surgical team in order to reduce
the rate of SSIs and the use of some drugs should be limited due to a high degree of resistance.
Key terms: SSI, predisposing factors, drug susceptibility, cost
pain, suffering, delayed wound healing, revision of surgery, and potential long-term sequelae.
The burdens posed by SSIs are also reflected in excess of health care costs. Advances in control
of infections have not completely eradicated the problem because of development of resistance.
There are very limited data in relation to this agenda particularly cost associated with SSI in
Ethiopia as well as Africa.
Objective: The aim of this study was to assess the incidence of surgical site infection,
predisposing factors and associated costs at Dessie Referral Hospital, Dessie, Ethiopia
Methods: A hospital based cross sectional study was conducted from July 22 – October 25,
2016 in Dessie referral hospital. About 338 surgical patients who fulfilled the inclusion criteria
were included using consecutive convenient sampling technique. Information regarding socio-
demographic status and past medical history of the respondent was collected using pre-structured
questionnaire. Two pus swabs were taken when a patient was first presented with clinical
evidence of infection. One of the swabs was processed for microscopic examination the other
one was inoculated to MacConkey agar, Blood agar and Manitol salt agar following a standard
operating procedure. Colony characteristics, Gram’s reaction and biochemical tests were used to
differentiate the organisms. Antibiotic susceptibility of the isolated bacteria was determined by
Kirby-Bauer disc diffusion technique, following CLSI guideline (CLSI document M100-S24).
The data was analyzed by SPSS version 20 and the results were presented by using tables and
different graphs. Logistic regression analysis was used to determine the association between
dependent and independent variables.
Results: out of the 338 patients included in this study 49 (14.5 %) were clinically suspected for
SSIs. Forty one out of the 49 (83.7 %) wound swabs were culture positive; hence the overall
Description
Keywords
SSI; Predisposing factors; Drug susceptibility; Cost