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INCIDENCE OF AND RISK FACTORS FOR SURGICAL-
SITE INFECTION IN A PERUVIAN HOSPITAL
Clinical Research and Pharmacovigilance Program
Christine Daquiado MD, Denzil Daquiado MD,
Petra Wallig RN, Sheila Hamak MD,Christine Gison RPh, Leane Casiding RPh
Research Program Director: Dr. Peivand Pirouzi
Christine Daquiado MD, Denzil Daquiado MD, Petra Wallig RN, Sheila Hamak MD,
Christine Gison RPh, Leane Casiding RPhResearch Program Director: Dr. Peivand Pirouzi
INTRODUCTION & OBJECTIVE
STUDY DESIGN
METHODS
An INFECTION CONTROL COMMITTEE was created. • But no active
surveillance for infections was being performed on a regular basis
INCLUSION AND EXCLUSION CRITERIA
Two (2) physicians, who
were specifically
trained for this study,
interviewed and closely
observed the patients during
their hospitalization.
METHODS
An INFECTION CONTROL COMMITTEE was created. • But no active
surveillance for infections was being performed on a regular basis
INCLUSION AND EXCLUSION CRITERIA
Two (2) physicians, who
were specifically
trained for this study,
interviewed and closely
observed the patients during
their hospitalization.
INCLUSION AND EXCLUSIONCRITERIA
INCLUSION EXCLUSIONPatients >14 years old undergoing abdominal surgery who consented.
Patient who have undergone surgical interventions at another hospital or who died or were transferred to another hospital within 24 hrs after surgery
METHODS
An INFECTION CONTROL COMMITTEE was created. • But no active
surveillance for infections was being performed on a regular basis
INCLUSION AND EXCLUSION CRITERIA
Two (2) physicians, who
were specifically
trained for this study,
interviewed and closely
observed the patients during
their hospitalization.
METHODS
Clinical charts were
systematically reviewed and, if necessary, the medical staff of the
patient were interviewed
Data regarding SSI were obtained.
CDC definition for SSI and
other nosocomial
infections were followed to detect all
postoperative nosocomial infections
METHODS
Clinical charts were
systematically reviewed and, if necessary, the medical staff of the
patient were interviewed
Data regarding SSI were obtained.
CDC definition for SSI and
other nosocomial
infections were followed to detect all
postoperative nosocomial infections
DATA COLLECTION
INPATIENT OUTPATIENTClinical evaluation during their hospitalization and until 30 days after surgical intervention
Clinical evaluation through telephone contact or chart review when patients was discharged prior to the 30 days
METHODS
Clinical charts were
systematically reviewed and, if necessary, the medical staff of the
patient were interviewed
Data regarding SSI were obtained.
CDC definition for SSI and
other nosocomial
infections were followed to detect all
postoperative nosocomial infections
CDC CRITERIA FOR SSISuperficial
incisional SSIDeep incisional
SSIOrgan/Space SSI
Infection occurs within 30 days after any NHSN operative procedure (where day 1 = the procedure date)ANDinvolves only skin and subcutaneous tissue of the incision
Infection occurs within 30 or 90 days after the NHSN operative procedure (where day 1 = the procedure date) ANDinvolves deep soft tissues of the incision (e.g., fascial and muscle layers)
Infection occurs within 30 or 90 days after the NHSN operative procedure (where day 1 = the procedure date)ANDinfection involves any part of the body deeper than the fascial/muscle layers, that is opened or manipulated during the operative procedure
METHODS
NNIS System risk index was
calculated based on three
risk factors, each worth one
point
A form was devised to collect data
Statistical analysis
RISK FACTORS
Contaminated or dirty surgical wound
American Society of Anaesthesiologist (ASA) score > 2
Duration of surgery > 75th percentile for a specific group of surgical procedures
NNIS System risk index ranges from 0-3
The National Research Council operative-site classification was also used
NRC OPERATIVE-SITECLASSIFICATION Clean: An uninfected operative wound in which no
inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered.
Clean-Contaminated: Operative wounds in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination
Contaminated: Open, fresh, accidental wounds. Dirty or Infected: Includes old traumatic wounds
with retained devitalized tissue and those that involve existing clinical infection or perforated viscera
METHODS
NNIS System risk index was
calculated based on three
risk factors, each worth one
point
A form was devised to collect data
Statistical analysis
DATA COLLECTION FORM Age Gender Presence of underlying diseases Type of surgery (elective vs emergency) Preoperative stay (in hours) Total length of hospitalization (in days) ASA preoperative assessment score Use and duration of antibiotic prophylaxis Length of surgery (in minutes) 75th percentile duration of every surgical procedure Number of surgical interventions per patient Use and duration of drainage
METHODS
NNIS System risk index was
calculated based on three
risk factors, each worth one
point
A form was devised to collect data
Statistical analysis
STATISTICAL ANALYSIS Data were analyzed by a microcomputer using SPSS
software for Windows.
Categorical Variables Chisquare Test Fisher Test
Continuous Variables T-test Mann-Whitnety Test
Pvalue of less than (0.05)were considered significant All two test were two tailed. Relative Risk and Confidence Interval of 95%
STATISTICAL ANALYSIS
Variables that attained A P value less than 0.001 on univariate analysis were included in stepwise method in multivariate analysis
All participants were requested for oral consent
RESULTS & DISCUSSION
RESULTS OF RESEARCH
N= 468 consecutive abdominal interventions were evaluated.
Majority male (average age of 37.2), 59.8 % were men.
Cases were grouped by wound classification
7.7% clean 14.7 % clean-contaminated 39.5% contaminated 38% dirty procedures
RESULTS OF RESEARCH Univariate analysis = age, gender emergency
procedures were not associated with SSI. Multivariate Analysis The incidence rate of SSI differed by wound
classification 13.5% contaminated 47.2% for dirty wounds (p<.001) Longer the procedure the increases chances of
Surgical Site Infection. A marked increase in the incidence of SSI and in RR
to develop SSI was observed at the NNI (National Nosocomial Infection) System risk index increased.
RESULT OF STATISTICAL ANALYSIS
Ho : Null Hypothesis There is no relationship between the Incidence and Riskfactors for surgical site infections in a Peruvian Hospital
Ha :Alternative Hypothesis There is a relationship between the Incidence and Risk factors for surgical site infections in a Peruvian Hospital
RESULT OF STATISTICAL ANALYSIS There is a relationship between the
Incidence and Risk factors for surgical site infections in a Peruvian Hospital
CI of 95% and pvalue of <0.001) Longer the procedure the increases
chances of Surgical Site Infection. A marked increase in the incidence of SSI
and in RR to develop SSI was observed at the NNI (National Nosocomial Infection) System risk index increased
RESULT OF RESEARCH
CONCLUSION
CONCLUSION
SSI is a major problem in the hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.
Refrences
Hernandez K, Ramos E, Seas C, Henostroza G, Gotuzzo E. Incidence of and risk factors for surgical-site infections in a Peruvian hospital. Infection Control and Hospital Epidemiology, 2005: 473-477
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