Post operative wound infection in surgical ward at Tirunelveli Medical College and Hospital, Tirunelveli

Amuda, D L (2006) Post operative wound infection in surgical ward at Tirunelveli Medical College and Hospital, Tirunelveli. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION: Surgical wound infection is a common post operative complication and causes significant post operative morbidity and mortality, prolongs hospital stay and adds between 10-20% to hospital costs. The understanding of wound infection has come a long way from the days when pus was “laudable”. Far reaching advances in therapeutics, techniques in surgery and maintenance of asepsis have contributed to controlling scourge of surgery which is post operative wound infection. Infection was accepted as an inevitable sequalae of surgery a century ago. The infection rate which was about 75% has now dropped to about 10% or less. Yet today infections accompanying surgical procedures contribute significantly to morbidity and mortality. Although the total elimination of wound infection is not possible, a reduction in the infection rate to a minimal level could have significant benefits in terms of both patient comfort and medical resources used. Clear understanding of pathogens and their pathogenicity, advances in the field of asepsis and aseptic technique, the advent of antibiotics and reliable suture materials have furnished the surgical armamentarium in countering infection. Hence a constant awareness of the ever present threat of infection must be a way of life for the entire surgical fraternity. In 1992, the Surgical Wound Infection Task Force replaced the term ‘Surgical Wound Infection’ with ‘Surgical Site Infection’ - SSI. AIM OF THE STUDY: 1. Determining the incidence of post operative wound infection and application of scoring system based on various risk factors in all abdominal surgeries in TVMCH. 2. Identifying the common pathogens causing surgical site infection and their sensitivity to antibiotics in TVMCH. 3. Studying commonest complications of surgical site infection and analyzing various preventive measures which reduce the incidence of surgical site infection. 4. Reviewing literature on wound healing, wound infection and prophylaxis in (post - operative) surgical site infection. 5. Studying the role of prophylactic antibiotics in reducing surgical site infection. MATERIALS AND METHODS: The following clinical materials, were selected in this prospective study, patients selected from general surgical ward at TVMCH admitted between 1/1/05 - 31/12/05. Patients with clean post operative wounds were excluded from the study. Only clean contaminated, contaminated and dirty wounds included for this study. Collection and transport of pus Cotton swabs - 2 in number collected intra operatively, subcutaneous tissue before wound closure and from the wound, post operatively when infection suspected. Special care taken to avoid contaminating the specimen with commensal organisms from the skin. As far as possible specimen from the wound was collected before antiseptic dressing was applied. Using sterile technique upto 5 ml of pus was collected from the drainage tube which was transferred to a leak-proof sterile container. When pus is not being discharged, a sterile cotton-wool swab was used to collect the sample from infected site. Special care was taken to sent the specimen with a completed request form to reach the microbiology laboratory within 6 hours. One swab was used to make a smear of the material in clean slide - For gram staining done in day 1. Other swab was used for culture. Media used for pus culture were blood agar and nutrient agar plates incubated for 24 hours aerobically. Isolates identified based on colony morphology and coagulation test. If culture turns out to be positive then antibiotic sensitivity was performed (Muller Hilton method). Patients analysed for risk of wound infection by applying following major and minor criteria. CONCLUSION: Incidence of surgical site infection (Post-operative infection) in our study is 11.8 percent. Scoring system based on various risk factors (7 major criterias and 4 minor criterias) carried out in our study and it is found that the incidence of wound infection more when score is high. This scoring system is also valuable in assessing the severity of post-operative wound infection. In this study among 49 infected cases, proteus species were most commonly isolated. Next in order are E. coli, Klebsiella, Pseudomonas and then comes Staphylococcus and Beta hemolytic streptococci. Shift from gram positive to gram negative organisms due to liberal use of antibiotics. In this study most of the organisms were sensitive to Amikacin, ciprofloxacin and gentamycin in descending order of frequency. Wound gaping, burst abdomen, enterocutaneous fistula, incisional hernia were observed as post operative complications due to wound infection. The best way to decrease wound infection is by rigorous surveillance and reporting of wound infection rate. Surgical site infection (SSI) continues to be the most common complication following surgical procedures. This infections are the biological summation of several factors the innoculam of bacteria introduced into the wound during the procedure, the unique virulence of contaminants, the microenvironment of each wound and the integrity of the patients host defense mechanisms. Prevention of surgical site infection can be achieved by several methods. The viable innoculam of bacteria in the wound can be reduced via better preoperative preparation of the surgical site, sound infection-control practice while performing operations and adherence to principles of preventive antibiotic therapy, modified surgical technique can reduce the risk of hematoma, tissue injury and foreign bodies within the surgical site that amplify the risk of infection for a given level of innoculam. Enchanced oxygen delivery, better core body temperature control and rigorous blood glucose control in the surgical patients are new areas that have the potential to even further reduce the rate of surgical site infection. Although surgical site infections cannot be completely eliminated a reduction in the infection rate to a minimal level could have significant benefits by reducing post operative morbidity and mortality and wastage of health care resources.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Post operative wound infection ; surgical ward ; Tirunelveli Medical College and Hospital ; Tirunelveli.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 08 Jun 2018 17:55
Last Modified: 09 Jun 2018 03:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/8340

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