Post operative wound infection: a surgeon's dilemma

ABSTRACT

Keeping in view the prevalence of wound infection in our set up, this study was designed to evaluate the frequency, clinical presentation, common risk factors and different organisms involved in cases of clean and cleancontaminated surgery. Observational descriptive study from March 2005 to February 2006. Surgical Unit III, Civil Hospital, Karachi. One hundred patients who underwent clean and clean-contaminated surgery. Biodata of the patients together with their clinical features, diagnosis, type of surgery performed and the development of any complications including wound infection was noted and the data analyzed. Out of the 100 patients [52 males and 48 females] in the study, 69 belonged to the clean surgery group and 31 to the clean-contaminated surgery group. The overall incidence of surgical site infection [SSI] in the study was 11%; 5[7.2%] cases in the clean surgical group and 6[19.4%] cases in the clean-contaminated group developed infection. Patients in the age group 51-60 years were infected more than those in the younger age groups. The incidence of wound infection was more in male patients [11.5%] as compared to female patients [10.4%]. Obesity was also a main cause of SSI as evident from the fact that patients with more than 60kg/m2 were infected more [20%] as compared to 30-40kg/m2 [7.1%]. Surgical site infection was found more in patients with extended pre-operative hospital stay. Anaemia, smoking, diabetes mellitus, prolonged surgery, operations by junior surgeons and operations late in the list were also associated with more surgical site infection. The usual time of presentation of SSI was within three weeks following surgery and most patients presented with wound abscess and cellulitis, while two patients had wound dehiscence. The common organisms involved in the SSI were Staphylococcus aureus, E. coli, Streptococcus pyogenes and Pseudomonas group. Meticulous surgical technique, proper sterilization, judicious use of antibiotics, improvement of operation theatre and ward environments, control of malnutrition and obesity, treatment of infective foci and diseases like diabetes, and avoidance of smoking helps control the morbidity of surgical wound infections