A Study on Surgical Site Infections in Emergency Non-Traumatic Abdominal Operations

Padam Kumar, B (2015) A Study on Surgical Site Infections in Emergency Non-Traumatic Abdominal Operations. Masters thesis, Madras Medical College, Chennai.

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Abstract

SUMMARY: Surgical Site Infections (SSIs), previously called post operative wound infections, result from bacterial contamination during or after a surgical procedure. The risk of infection is greater in all categories if surgery is performed as an emergency. Surgical site infection causes considerable morbidity, mortality and high cost to the health care system and is becoming increasingly important in medicolegal aspects. A few studies were conducted in our country on such an important topic. Further research is necessary to identify the important factors responsible for high infection rate following emergency nontraumatic abdominal operations in our country. In this study it had been tried to find out the common organisms responsible for surgical site infections following emergency nontraumatic abdominal operations. In addition, the sensitivity patterns of the microorganisms were ascertained. Further, factors responsible for infection were determined, that will be helpful to prevent infection in future during the similar types of surgery. General objective of the study was to determine the factors responsible for surgical site infections following emergency nontraumatic abdominal operations, which will be helpful in reducing the rate of surgical site infection. This descriptive type of study was conducted in Surgery dept, Madras Medical College and Rajiv Gandhi Government General Hospital, chennai, from 1 may, 2014 to 30 september, 2014. However, 140 cases having emergency nontraumatic abdominal operations were selected purposively. Patients with trauma were excluded from the study. Out of 140 abdominal operations 60 (42.86 %) were for acute appendicitis, while 30 (21.43%) for small intestinal obstruction, 19 (13.57%) for ileal perforation, 15 (10.71%) for duodenal ulcer perforation, 12 (8.57%) for gangrenous and / ruptured appendix and 2 (1.43%) each for volvulus of sigmoid colon and obstructed inguinal hernia. It was revealed that, overall surgical site infection rate was 17.14 per cent. It was observed that among the various host factors studied role played by age, sex, and educational status of the patients were not statistically significant, but presence of co-morbidity played a significant role in causing SSI. Among the perioperative / environmental factors category of operations, types of incisions, experience of surgeons and delay to initiate operation did not played significant role, but duration of operation and degree of wound contamination played statistically significant role. In respect of post operative wound discharge and incriminated organisms it was found that most of the SSIs (11, 45.83 %) were due to Escherischia Coli, while 9 (37.50 %) infections were due to Staph. Aureus and 2 (8.33 %) each were due to Klebsiella Pneumonae and Pseudomonus Aeruginosa. It was revealed that multiple host factors (e.g. presence of co-morbidity including jaundice, diabetes, COPD, malnutrition, obesity etc.), environmental factors (e.g. duration of exposure of the wounds to the environment and degree of wound contamination) and various micro-organisms (including E. Coli, S. Aureus, Klebsiella and pseudomonus) were responsible for surgical site infections. So, to prevent SSI emphasis should be given to all the important factors responsible for infection. CONCLUSION: This descriptive type of study was conducted in Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, chennai, from 1 may, 2014 to 30 september, 2014. It can be concluded from the findings of the study that micro-organisms that are normal inhabitants of our body are mainly responsible for surgical site infection (SSI). Various host factors like malnutrition, obesity, patients knowledge about hygiene, presence of co-morbidity etc. coupled with environmental factors such as condition of the wounds, delay to initiate operation, duration of operation, prolonged exposure of peritoneal cavity to environment, prophylactic use of antibiotics and factors associated with surgery like type of incision, type of operation and experience of operating surgeon greatly contribute to occurrences of SSI. So, quality of surgical care including immediate assessment of patients, resuscitative measures, adequate preparation of patients and aseptic environment are important for control of SSI. Moreover in absence of highly advanced surgical amenities, preoperative resuscitative units, modern operation theatre facilities and sophisticated sterilization procedure it is necessary to use prophylactic antibiotics to encounter the various types of micro-organisms responsible for surgical site infection, particularly E. Coli and Staph. Aureus.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Site Infections ; Emergency Non-Traumatic Abdominal Operations.
Subjects: MEDICAL > General Surgery
Depositing User: Punitha K
Date Deposited: 04 May 2018 18:01
Last Modified: 04 May 2018 18:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/7450

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