Associated Risk Factors for Postoperative Nosocomial Infections among Patients Admitted at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia
Clinical Medicine Research
Volume 2, Issue 6, November 2013, Pages: 140-147
Received: Sep. 7, 2013;
Published: Oct. 30, 2013
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Wondemagegn Mulu, Department of Medical Microbiology, Immunology and parasitology, Bahir Dar University, Bahir Dar, Ethiopia
Gebre Kibru, Department of Medical Laboratory Sciences and Pathology, Jimma University
Getenet Beyene, Department of Medical Laboratory Sciences and Pathology, Jimma University
Meku Damtie, Department of Surgery, Bahir Dar University, Bahir Dar, Ethiopia
Background: Nosocomial infections are the most challenging problem in all health care systems. In developing countries many people are dying daily due to inadequate health care services of which postoperative infections constitute a large proportion of this burden. Objective: The aim of this study was to identify risk factors associated for post operative nosocomial infections among operated patients at Felege Hiwot Referral Hospital. Methods: A cross-sectional study was conducted on patients who under gone operations from October 2010 to January 2011. A structured questionnaire was used for collection of data on socio-demographic characteristics and associated risk factors. The clinical diagnosis was made by respective surgeons and gynaecologists. Bacterial culture confirmation was done for all patients who developed clinical signs and symptoms of surgical site (SSI) and/or bloodstream infection (BSI) starting from the second day of admission until the time of discharge using standard bacteriological techniques. Bivariate analysis was made to generate to identify associated risk factors. P.value < 0.05 was considered as stastically significant. Results: A total of 294 patients were included in the study. The rate of postoperative culture confirmed nosocomial infection was 10.9%. The infection rate was higher in females (11.6%) than males (9.4%) (OR=1.27, CI=0.564- 2.863). Patients age of >51 years old were likely to develop post operative nosocomial infection (OR=6.38, CI=1.156-35.14). Patient with underlying diseases (OR=2.725, CI=1.269-5.853) and patients who undergone appendectomy ( OR=3.1, CI=1.1-8.3) were more likely developed post operative nosocomial infections. Operation duration of 91-150 minutes (OR=11.00, CI=1.989-60.83), and postoperative hospital stay of greater than 15 days (OR=82.00, CI=5.738-1.172) were also likely to be risk factor for infection. Conclusion: This study confirmed that advanced age, underlying disease, extended preoperative and postoperative hospital stay, longer duration of surgery and appendectomy were the most likely risk factors for post operative infections. Hence, more attention is required in management of such cases through prior identification of underlying disease, use of effective antibiotics as a prophylaxis and adherence of strict aseptic operating procedures.
Associated Risk Factors for Postoperative Nosocomial Infections among Patients Admitted at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia, Clinical Medicine Research.
Vol. 2, No. 6,
2013, pp. 140-147.
Babkin Y, Raveh D, Lifschitz M. Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis. 2007; 39: 890 - 895.
Torpy MJ, Burke EA, Glass MR. Postoperative infections. JAM. 2010; 303: 25-44.
Samuel SO, Kayode OO, Musa O et al. Nosocomial infections and the challenges of control in developing countries. Afr. J. Cln. Exper. Microbiol. 2010; 11: 102-110.
Jain A, Singh K. Recent advances in the management of nosocomial infections. JK Sci. 2007; 9: 3-8.
Duque SA, Ferreira FA, Cezário CR. Nosocomial infections in two hospitals in Uberlandia, Brazil. Rev Panam Infectol. 2007; 9: 14-18.
Messele G, Woldemedhin Y, Demissie M, et al. Common causes of nosocomial infections and their susceptibility patterns in two hospitals in Addis Ababa. Ethiop. J. Health Biomed Sci.2009; 2:3-8.
Mustafa A, Burkhari A, kakru KD. Incidence of nosocomial wound infection in postoperative patients at a teaching hospital in Kashmir. Jk practitioner.2004; 11: 38-40.
Cooper RA. Identifying criteria for wound infection. Understanding wound infection. London. 2005. Available at: http://ewma.org/fileadmin/user_upload/EWMA /pdf/position_ document/2005_Wound_Infection/English pos_doc_final.pdf. Accessed on: June14, 2010.
WHO. Prevention of hospital acquired infections: A practical guide. Malta: Department of Communicable Disease, Surveillance and response; 2002. Available at http://www.who.int/csr/resources/publications/whocdscsreph 200212.pdf. Accessed on: July 20, 2010.
Kollef MH, Sharpless L, Vlasnik J et al. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest.1997; 112: 666-675.
Akyurek N, Kerek M, Yuksel O, et al. Turk j med sci. 2000; 30: 275–280.
Rasnake SM, Dooley PD. Culture-negative surgical site infections. 2006; 7: 55-565.
Gedebou M, Kronvall G, Habte-Gabr E et al. The bacteriology of nosocomial infections at Tikur Anbessa Teaching Hospital, Addis Ababa. Acta Pathol Microbiol Immunol Scand (B).1987; 95:331-336.
Sangrasi KA, Leghari A, Memon A. Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan. Int WJ. 2008; 5: 74–78.
Taye M. Wound infection in Tikur Anbessa Hospital, surgical department. Ethiop Med J. 2005; 43:167-74.
Gedebou M, Habte-Gabr E, Kronvall G et al. Hospital-acquired infections among obstetric and gynecological patients at Tikur Anbessa Hospital, Addis Ababa. J Hosp Infect.1988; 11: 50-9.
Habte-Gabr E, Gedebou M, Kronvall G. Hospital-acquired infections among surgical patients in Tikur Anbessa Hospital, Addis Ababa, Ethiopia. AMJ Infect control. 1988; 16: 7- 13.
Tesfahunegn Z, Asrat D, Woldeamanuel Y, Estifanos K. Bacteriology of surgical site and catheter related urinary tract infections among patients admitted in Mekelle Hospital. Ethiop.Med. J. 2009; 47: 117-27.
Ahmed M, Alam NS, Manzar SO. Post-operative wound infection: a surgeon’s dilemma. Pakistan J Surg. 2007; 23: 41-47.
Lilani PS, Janagale N, Chowdhar A et al. Surgical site infection in clean & clean- contaminated cases. Indian J Micro Biol. 2005; 23: 249-52.
Joyce S, Lakshmidevi N. Surgical site infections: Assessing risk factors, outcomes and antimicrobial sensitivity patterns. Afr. J. Microbiol. Res. 2009; 3:175-179.
Togo A, Traore A, Kante L, et al. Fighting nosocomial infection rates in the general surgery department of the teaching hospital Gabriel Toure in Bamako, Mali. The Op Biol J. 2010; 3: 87- 91.
Isibor OJ, Oseni A, Eyaufe A. Incidence of aerobic bacteria and Candida albicans in post operative wound infections. Afr.J. microbiol. Res. 2008; 2: 288-291.
Abdel-Haleim KM, Ibrahim ZA, El-Tahl EM. Surgical site infections and associated risk factors in Egyptian orthopedic patients. J Am Sci. 2010; 6: 272-280.
Luksamijarulkul P, Parikumsil P, Oomsuwan VN. Nosocomial surgical site infection among Photharam hospital patients with surgery: Incidence, risk factors and development of risk screening form. J Med Assoc Thai. 2006; 89: 81-9.
El-Awady MY, Harak MK, Abdelrahman AA, et al. Hospital acquired infections in Madinah- Ksa: epidemiology and intervention for reduction. J Med Biomed Sci. 2010; 42- 47.
Shojaei H, Borjian S, Shooshtari JP et al. Surveillance of clean surgical procedures: an indicator of to establish a base line of a hospital infection problem in developing country, Iran. Indian J Surg. 2006; 68: 89-92.
Emori TG, Gaynes R. An overview of nosocomial infections, including the role of the Microbiology laboratory, in Atlanta, Georgia. Clin Microbiol Rev. 1993; 6: 428-442.
Pryor R & Messmer PR. The effect of traffic pattern in the OR on surgical site infections. AORN J68.1998; 68: 649-660.
Ashton J, Morton N, Beswick S. Wound care guide lines. Nurswc 001. 2010; 1-43.
Kavari SH, Rasekhi AR. Surgical site infections: Incidence and risk factors at Southern Iran Hospitals. Middle East J Int Med. 2008; 1:1-7.
Kaplan MN, Smadi AA, Al-Taani IM. Microbiology of wound infection after caesarean section in a Jordanian hospital. East Med Health J. 2003; 9: 1068-1074.
Wukich KD, Lowery JN, McMillen LR. Comparison of patients with and without diabetes mellitus. J Bone Joint Surg Am. 2010; 92: 287-295.
Chia JY, Tan KW, Tan Y. A survey of postoperative wound infections in Obstetrics and Gynecology. The kandang kerabu hospital experience. Singapore Med J.1993; 34: 221- 224.
Ganguly PS, Khan Y, Malik A. Nosocomial infections and hospital procedures. Indian community Med. 2000; xxv: 39-43.
Rajaa AY, Salam RA, Salih AY. Rate and risk factors of surgical site infections with antibiotic prophylaxis. Saudi Med J. 2002; 23: 672-674.