Clinico-epidemiological study of wound infection: A case series type of descriptive study
Abstract
Surgical site infections (SSIs) are a substantial problem for patients undergoing procedures in spite of advances in surgical techniques and medical care. So this case series of SSI were studied to know the clinico-epidemiological profile of these cases to better know the etiology for better prevention. This study was conducted on 100 cases of SSI admitted and operated in surgical wards of upgraded department of surgery in Sawai Man Singh Hospital Jaipur, chosen at random irrespective of age, sex undergoing emergency laparotomies. It was observed from this study that most common sign and symptom was discharge (38%) followed by pain and tenderness (33%), raised local temperature (23%) and suture under tension/cut though (11%). Most of the wound infection was detected on 3rd to 5th post operated day. Regarding collection in wound it was observed that 60% was with seropurulent collection 18% with serous and purulent collection and 5% with fecopurulent collection. Etiological agent was found E. coli in 27% followed by Enterobactor (5%), Staphylococcus (2%) and Kleibsella (1%) and Pseudomonas (1%).
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Introduction
Surgical site infections (SSIs) are defined as wound infection following an invasive surgical procedure. SSIs have been shown to contribute up to 20% of nosocomial infections with an overall incidence around 5% across all invasive surgical procedures. 1 Laparotomies carry a higher risk of wound infection and a combined rate of 15% has been reported in upper and lower gastrointestinal surgery, over three times the average risk. Despite these activities SSI remains a substantial cause of morbidity and mortality among hospitalized patients.2
Furthermore, in large bowel surgery, an overall infection rate of 17.5% has been identified in the UK. 3, 4 Rates as high as 26% in colorectal procedures5 and up to 57% in small bowel procedures6 have also been described. Moreover post operative wound infection or surgical site infection (SSI) delays return to gainful employment and prolong hospital stay7& can weaken an abdominal closure and result in wound dehiscence and incisional hernia. Alongside increasing unnecessary patient suffering and a decreased quality of life (QoL). 8,9 Advances in infection control practices include improved operating room ventilation, sterilization methods, barriers, surgical techniques and availability of antimicrobial prophylaxis. Despite these activities SSI remains a substantial cause of morbidity and mortality among hospitalized patients.
Conclusion
This study concludes that sign of inflammation were marked in post operative wound collection. In this series only 23% patients have raised local temperature, while 11% of patients have stitch line cut through. Most of the patients have discharge and local tenderness, which made the surgeon suspect, wound collection. The post operative wound collections may vary from simple serous to seropurulent/purulent/fecopurulent collection. In this series, 60% have seropurulent collection. 18% have purulent and 5% serous collection. E.coli and Enterobactor were the major organism in post operative wound infections following infective laparotomies.