Nosocomial surgical site infection among Photharam Hospital patients with surgery: incidence, risk factors and development of risk screening form.

OBJECTIVE: A cross-sectional analytic study of 268 patients who received surgery at Photharam Hospital was conducted to assess the incidence and risk factors of nosocomial surgical site infection (SSI). MATERIAL AND METHOD: The studied patients who voluntarily participated and signed informed consents were interviewed Pus specimens from SSI patients diagnosed by use of CDC criteria were cultured After risk factor analysis, the risk screening form was developed and calculated by the Receiving Operating Curve. RESULTS: The results revealed that incidence of nosocomial SSI was 20.52% (55/268 cases). Of 55 SSIpatients, 45.46% were positive for bacterial culture. Risk factors for nosocomial SSI from univariate analysis were (a) age of patients > 60 years, OR = 1.91 (p = 0.043), (b) gender as male, OR = 2.20 (p = 0.024), (c) admitted ward as male surgical ward, OR = 2.42 (p = 0. 028), (d) current patients' illness as diabetes mellitus (DM), OR = 7.92 (p < 0.001) and tuberculosis, OR = 11.88 (p = 0.001), (e) abnormal ASA score, OR = 3.47 (p < 0.001), 60 smoking, OR = 3.72 (p < 0.001), (g) incorrect prophylactic drug use, OR = 2.98 (p = 0.002), (h) duration of admission > 10 days, OR = 4.87 (p < 0.001), and (i) wound dressing > 1 time/day, OR = 4.16 (p < 0.001). After multiple logistic regression analysis, the significant risk factors were (a) current patient's illness as DM, OR = 14.43 (p = 0.005), (b) smoking, OR = 13.18 (p = 0.001), (c) duration of admission > 10 days, OR = 4.88 (p = 0.032) and (d) wound dressing >1 time/day, OR = 23.32 (p < 0.001). The risk screening form was developed and showed approximately 65% sensitivity and 78% specificity when a cut-off score at risk > 18 was used CONCLUSION: This risk screening form should be considered in other hospitals. When a postoperative patients has a score of 18, they should be considered a potential risk for nosocomial SSI and preventive measures should be integrated to reduce the risk for nosocomial SSI.

Antiseptics for preventing omphalitis.

BACKGROUND: Omphalitis may cause serious complications and contribute to neonatal morbidity and mortality. From January 1997 to August 1998, the incidence of omphalitis in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital had been increased from 0.9 to 17.4 per 1,000 live births. A prospective randomized trial using antiseptic applied directly to the umbilical stump was conducted aiming to reduce an epidemic outbreak of omphalitis in the newborn nursery. OBJECTIVE: To determine which antiseptic is appropriate for preventing omphalitis in the newborn infants. PATIENTS AND METHOD: Newborn infants delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital were randomized into group A (Triple dye) or group B (70% Alcohol). The infant with omphalitis was assessed by a pediatrician or a neonatology fellow. At home, the same antiseptic will be continually applied to the umbilical stump daily until a few days after cord detachment. Relative risk was calculated and statistical significance was tested by Chi-square test. RESULTS: Four hundred and twenty-seven infants were enrolled. Birth weight, gestational age and gender of the infants in both groups were not different. There were no known maternal risk factors for omphalitis. Omphalitis was observed in 9/213 (4.2%) infants in group A and 23/214 (10.7%) infants in group B. The relative incidence rate between each group was statistically significant (p<0.01). Triple dye group was 60 per cent less likely to develop omphalitis compared to 70 per cent Alcohol group (RR 0.39, 95% CI: 0.19-0.83). The mean duration for cord detachment were 13.6 and 11.5 days in group A and group B, respectively. CONCLUSION: During an epidemic outbreak of omphalitis, Triple dye was the most appropriate and effective antiseptic to prevent omphalitis but could delay cord separation.