Surgical site infections after abdominal surgery: prevalence, causes and management at the Surgical Wards, Komfo Anokye Teaching Hospital, Ghana
Loading...
Date
2014-08-04
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND: Infections of surgical wounds are one of the most common post-operative adverse events which could impact significantly on cost of care and morbidity. Surgical site infections must be kept to the barest minimum levels. This study sought to determine the prevelance and causes of surgical site infections (SSI’s) after abdominal surgery at Komfo Anokye Teaching Hospital, how they are managed and the outcomes of management.
METHOD: This was a prospective study involving all abdominal surgery patients 18 years and above, who had no cancer or HIV/AIDS and were admitted from 29th of October to 31st December, 2012. Eighty-Six patients were enrolled but 81 of them met the inclusion criteria and were thus studied. In addition, four general surgeons and four nurses-in-charge of the surgical wards were interviewed.
FINDINGS: The overall prevalence of SSI’s was 40%. SSI prevalence rate according to wound class was 29% and 49% for clean and dirty wounds respectively. The average days for SSI’s to develop and be detected were 8 days.
The most common causes of SSI’s identified were unfavourable ward environment and reduced patient’s immunity levels. Others were non adherence to aseptic techniques at the ward and theatres, improper demarcation of surgical cases on wards, large numbers of people in the operating room and improper preparation of incision sites before surgery.
Management steps of SSI’s included opening and drainage of pus from wound, culture and sensitivity testing of wound swab/pus from wound in some cases along with dressing changes till healing took place. Pharmacologic management was in line with the Clinical Guidelines 74 2008, UK, as well as the 2010 American Surgical Society and American Society of Infectious Diseases guidelines.
Ciprofloxacin and metronidazole were the most frequently used antibiotic combination and was well tolerated by most patients. However, intravenous lines were not flushed before and after the administration of one drug after the other. There was also non- compliance with the minimum 48 hours interval between the administration of calcium containing solution and ceftriazone.
CONCLUSION: The prevalence of SSI’s after abdominal surgery was high. The causes of SSI’s in patients at the ward included patients’ low immunity status, contaminated theatre and ward environment and improper demarcation of cases at the ward. Patients who developed SSI during the study period were managed according to standard guidelines with good outcomes.
Pragmatic steps must be taken to reduce the prevalence of SSI’s and emphasis placed on effective infection prevention and control practices.
Description
A thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfillment of the requirements for the degree of Master of Science in Clinical Pharmacy, 2014