Transcript No Slide Title

Study on surgical site
infection
Ajita Mehta, Shireen Samson, Shweta
Ghag, Sudeep Shah, Camilla Rodrigues,
F. D. Dastur
Infection Control Committee,
P. D. Hinduja National Hospital &
Medical Research Center, Mahim,
Mumbai
INTRODUCTION
 Wound infection in clean & clean -
contaminated cases
 1 - 5 % worldwide
 Cause of morbidity, cost, hospital stay
 Index of quality care
 Surgeons may be wary of wound infections
 Irrational antibiotic policy: Prolonged
duration, Peculiar combinations, Overkill,
Leads to drug resistance (major problem)
Infection Rate – year 2003
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Oct
Nov
Dec
Overall
Rate
(%)
2.3
2.6
2.2
2.3
1.7
2.2
2.0
2.0
2.2
1.8
1.9
Infected
Vascular
(%)
4.9
4.7
6.8
4.6
3.7
6.4
2.7
4.2
4.8
4.1
5.9
Pulmonary urinary tract
infection
infection (%)
/1000days
19
32
15
26.7
24
19
23
1.5
2.5
2.0
2.0
3.4
1.3
2.0
3.1
2.0
2.3
2.1
Clean
cases (%)
1.0
2.8
2.6
0.5
1.0
2.7
0.8
1.2
2.0
2.0
1.3
Objectives
a) Current rate of Surgical Site infections
b) Assess role of rational antibiotic policy
Material & Methods

Prospective & Consecutive cases
 Clean & clean contaminated surgery cases
(no contamination of the operative field by uncontrolled
spillage of visceral contents)
 No breach in asepsis e.g. hernia, arthroplasty
CABG, Cholecystectomy
Exclusions :
 Endoscopy
 Laparoscopic surgery
 Urological & Gynaec procedures
Specialities included:
 General & Oncosurgery,
 Orthopedics,
 Cardiac surgery
* Patient recruitment
 From theatre list DAILY
* Assessment

Day 1/2 visit – proforma entry, contact no.
 Day 8th visit Rounds- staff nurse information
 Information from resident doctor
 Microbiology review
 Day 30th phone call to patients
RESULTS
Duration of study: 7 months (Nov’03 to May’ 04)
Total number of cases studied: 1000
Speciality
No.of cases
Infected
Percentage
General Surgery
303
1
0.3%
Ortho
469
4
0.8%
CVTS
228
7
3.0%
Total :
1000
12
1.2%
Surgeon
Total
Infected
cases
Antibiotic
(Days)
ORTH(469)
A
196
3 (1.5%)
Cefazolin
(3 doses)
B
56
C
132
1(0.7%)
Cefazolin
(5 doses)
D
36
-
Cefazolin
(3 doses)
E
46
-
Cefazolin
(3doses)
Cefuroxime (3 doses)
Surgeon
Total
Infected
Cases
Antibiotic
(Days)
CVTS (228)
A
49
2 (4.0%)
Amox-clav/Amikacin/Tobramycin(5)
B
69
2 (2.8%)
Cefuroxime/Amikacin (3-5)
C
72
1 (1.3%)
Cefpirome (3)
D
27
2 (7.4%)
Cefpirome (5-7)
E
10
-
F
1
-
Cefuroxime (2-3)
Cefepime (2-3)
General Surgery (303)
Surgeon Total Infected
Cases
Antibiotic
(Days)
A
109
-
B
81
-
C
13
-
D
32
E
13
-
Cefuroxime (3 dose)
F
20
-
Cefazolin (3 dose)
(3.1%)
Cefuroxime (3 dose)
5 days oral
Ceftriaxome (2 dose)
5 days oral
Cefuroxime (3 dose)
Cefazolin (3-5 dose)
Surgeon
Total Infected
Cases
Antibiotic
(Days)
G
22
-
Cefotaxime/ceftazidime
H
8
-
Cefazolin (3 dose)
I
2
-
Cefotaxime(3doses)
J
1
-
Augmentin (3 dose)
K
1
-
Cefuroxime (3 dose)
L
1
-
Amp/Amikacin (3 dose)
* Following hospital guidelines -- 5 /550
* Not following guidelines (Higher antibiotics) -- 7/450
* No significant difference in the above 2 but,
- it increases the antibiotic resistance,
- it increases cost to the patient due to higher
antibiotic,
- preserve higher antibiotics for serious cases
 How is this study better than current
available information?
• Accurate inclusion of all cases (denominator)
from OT list
• Accurate assessment of wound infection
(numerator) by survey & phone call
CONCLUSION
 Infection rate is the same irrespective of
antibiotics used
 The rate of infections is low in this study
RECOMMENDATIONS
Rational hospital antibiotic policy should be
followed by all:
Single dose of cefuroxime / cefazolin in clean
cases
• 3 doses in clean contaminated cases.
THANK YOU !