Socio-demographic characteristics of the study participants
A total of 281 patients have participated and the age ranged from 1 to 80 years with the mean age of 30.3 (±18.9) years. Female accounts (54.1%) and more than half of them were from rural in residency (51.6%). Concerning the educational status of the participants, the majority (38.1%) accomplished grades 1-8. (Table1).
Table 1: Socio-demographic characteristics of surgical patients at Surgical ward of Hawassa University comprehensive specialized hospital, Hawassa, SNNPR, Ethiopia, from 1 March – 1 April 2019 (n=281).
Socio-demographic characteristics
|
Frequency
|
Percent
|
Age < 15 year
|
69
|
24.6
|
15 - 65 year
|
195
|
69.4
|
>65 year
|
17
|
6.0
|
Sex Male
|
129
|
45.9
|
Female
|
152
|
54.1
|
Residency Urban
|
136
|
48.4
|
Rural
|
145
|
51.6
|
Educational status Unable to read and write
|
84
|
29.9
|
Read and write only
|
25
|
8.9
|
Grade 1-8
|
107
|
38.1
|
Grade 9-12
|
26
|
9.3
|
Certificate and above
|
39
|
13.9
|
The Surgical condition and clinical characteristics of patients
Local anesthesia was given for (59.8%) of patients and the majority (82.9%) stayed one hour or less in a surgical procedure. Antibiotic prophylaxis was given to (51.6%) patients before surgery and (61.9%) were operated in emergency surgery. Preoperative surgical site shaving was given to (29.2 %) of patients and abdominal surgery was the largest (57.3%).
The majority of patients (69.9%) had a clean wound and (86.8%) of the surgical site was closed. Sign and symptoms of malnutrition were identified on (10.0 %) of patients while nine of the respondent were identified with comorbid diseases which indicates immunosuppression like Tuberculosis, HIV/AIDS and diabetes. (Table 2).
Table 2: Surgical condition and clinical characteristics of patients at Surgical ward of Hawassa University comprehensive specialized hospital, Hawassa, SNNPR, Ethiopia, from 1 March – 1 April 2019 (n=281).
Surgical condition and clinical characteristics
|
Frequency
|
Percent
|
Type of anesthesia Local
|
168
|
59.8
|
General
|
113
|
40.2
|
Duration of surgery in hour < 1 hour
|
233
|
82.9
|
> 2 hours
|
48
|
17.1
|
Antibiotic prophylaxis before surgery Yes
|
160
|
51.6
|
No
|
121
|
48.4
|
Type of surgery Elective
|
107
|
38.1
|
Emergency
|
174
|
61.9
|
Preoperative surgical site shaving Yes
|
82
|
29.2
|
No
|
199
|
70.8
|
Site of surgery Head
|
13
|
4.6
|
Upper extremities
|
28
|
10.0
|
Lower extremities
|
68
|
24.2
|
Abdomen
|
161
|
57.3
|
Genital areas
|
11
|
3.9
|
Types of wound Clean
|
196
|
69.9
|
Clean contaminated
|
52
|
18.5
|
Contaminated
|
30
|
10.7
|
Dirty
|
3
|
1.1
|
The condition of the surgical site Opened
|
37
|
13.2
|
Closed
|
244
|
86.8
|
Sign and symptom of Malnutrition Yes
|
28
|
10.0
|
No
|
253
|
90.0
|
Comorbid diseases indicating
Immunosuppression Tuberculosis
|
6
|
2.1
|
HIV/ AIDS
|
2
|
0.7
|
Diabetic mellitus
|
1
|
0.4
|
Prevalence of Surgical Site Infection
A total of 69 out of 281 patients developed surgical site infections giving an overall prevalence (24.6%) with (95% CI [19.6 – 29.69). (Figure 1).
Figure 1: Prevalence of surgical site infection at Surgical ward of Hawassa University comprehensive specialized hospital, Hawassa, SNNPR, Ethiopia, from 1 March – 1 April 2019 (n=281).
Factors associated with surgical site infection
Different studies indicate the age of patients has effect on the development of surgical site infection. This study identified that SSIs was higher in older patients whose ages> 65 years (41.2%) and patients <15 years were (86.9%) less likely to develop surgical site infection as compared to those above 65 years old (AOR= 0.131, 95% CI 0.020, 0.087).
Those patients who received local anesthesia developed SSI almost twice (30.4%) than general anesthesia receivers (15.9%) and they were 2.3 times more likely to develop surgical site infection if all other factors were kept constant (COR= 2.301, 95% CI 1.260, 4.199) but not statistically significant in multivariate analysis.
According to this study, the prevalence of SSIs among clean and clean-contaminated wounds was (5.1%) and (69.4%) respectively. Patients with clean wounds were (99.4%) less likely to develop surgical site infection as compared to those patients with the clean-contaminated wounds (AOR=0.006, 95% CI 0.002, 0.024).
This study also identified in open kept surgical sites, the odds of developing surgical site infection was 5.2 times as compared to close kept surgical site (AOR= 5.189, 95% CI 1.511, 17.821).
The prevalence of SSI in those patients with Malnutrition was more than three folds (64.3%) and malnourished patients were 29.3 times more likely to develop SSIs than well-nourished patients (AOR= 29.351 95% CI 5.711, 150.851). Details of factors associated with surgical site infection were presented in (Table 3).
Table 3: Factors associated with SSIs at Surgical ward of Hawassa University comprehensive specialized hospital, Hawassa, SNNPR, Ethiopia, from 1 March – 1 April 2019 (n=281)
Variables
|
Surgical site infection
|
COR (95% CI)
|
AOR (95% CI)
|
NO SSI
|
SSI
|
|
|
Age group in Years
|
<15
|
57 (82.6%)
|
12 (17.4%)
|
0.301 (0.095, 0.949)*
|
0.131 (0.020, 0.087)*
|
15-65
|
145 (74.4%)
|
50 (25.6%)
|
0.493 (0.178, 1.363)
|
0.363 (0.042, 3.112)
|
>65
|
10 (58.8%)
|
7 (41.2%)
|
1
|
1
|
Sex
|
Male
|
91 (70.5%)
|
38 (29.5%)
|
1
|
1
|
Female
|
121 (79.6%)
|
31 (20.4%)
|
1.630 (0.943, 2.816)
|
1.540 (0.627, 3.782)
|
Residence
|
Rural
|
109 (81.1%)
|
27 (19.9%)
|
1
|
1
|
Urban
|
103 (71.0%)
|
42 (29.0%)
|
0.607 (0.349, 1.057)
|
1.534 (0.630, 3.737)
|
Type of anesthesia
|
Local
|
117 (69.6%)
|
51 (30.4%)
|
2.301 (1.260, 4.199)*
|
1.733 (0.616, 4.878)
|
General
|
95 (84.1%)
|
18 (15.9%)
|
1
|
1
|
Duration of surgery in hour
|
< 1 hour
|
176 (75.5%)
|
57 (24.5%)
|
1
|
1
|
> 2 hours
|
36 (75.0%)
|
12 (25.0%)
|
0.972 (0.474, 1.993)
|
1.272 (0.445, 3.639)
|
Antibiotic prophylaxis
before surgery
|
Yes
|
110 (71.4%)
|
44 (28.6%)
|
1.632 (0.932, 2.857)
|
1.631 (0.618, 4.303)
|
No
|
102 (80.3%)
|
25 (19.7%)
|
1
|
1
|
Types of Surgery
|
Elective
|
81 (75.7%)
|
26 (24.3%)
|
0.978 (0.558,1.712)
|
1.617 (0.473,5.523)
|
Emergency
|
131 (75.3%)
|
43 (24.7%)
|
1
|
1
|
Preoperative surgical site shaving
|
Yes
|
60 (73.2%)
|
22 (26.8%)
|
1
|
1
|
No
|
152 (76.4%)
|
47 (23.6%)
|
1.186 (0.659, 2.135)
|
2.626 (0.722, 9.552)
|
Type of surgical wound
|
Clean
|
186 (94.9%)
|
10 (5.1%)
|
0.24 (0.011, 0.052)*
|
0.006 (0.002, 0.024)*
|
Clean contaminated
|
26 (30.6%)
|
59 (69.4%)
|
1
|
1
|
The condition of
surgical site
|
Open
|
20 (51.4%)
|
17 (45.9%)
|
3.138 (1.535, 6.419)*
|
5.189 (1.511, 17.821)*
|
Closed
|
192 (78.7%)
|
52 (21.3%)
|
1
|
1
|
Sign and symptom of Malnutrition
|
Yes
|
10 (35.7%)
|
18 (64.3%)
|
7.129 (3.103, 16.380)*
|
29.351 (5.711, 150.851)*
|
No
|
202 (79.8%)
|
51 (20.2%)
|
1
|
1
|
Comorbid diseases indicating
Immunosuppression
|
Yes
|
4 (44.4%)
|
5 (55.6%)
|
4.062 (1.059, 15.582)*
|
0.159 (0.015, 1.705)
|
No
|
208 (76.5%)
|
64 (23.5%)
|
1
|
1
|