SURGICAL WOUND INFECTION IN A TERTIARY CARE TEACHING RURAL HOSPITAL

BACKGROUND Surgical wound infections are one of the important and most common infections seen in surgery department. They require immediate management. They increase the economic and social burden of hospitals, clinicians and society. So, in this context, we evaluated the various aspects of surgical wound infection during surgical care in our institution, F. H. Medical College & Hospital, Agra, UP. This is a rural based college and hospital involved in teaching medical, nursing and para medical students. Rapid diagnosis and management are pivotal for the survival of patients and their effect reflects on hospital morbidity and mortality. Their accurate diagnosis and treatment are essential and are challenging to every surgeon. MATERIALS & METHODS This clinical and observational study was conducted in the department of general surgery F.H. Medical College and Hospital, Agra, U.P. A total of 1494 patients were admitted for surgical procedures from August 2018 to October 2018. All the operated cases during the said period (major, minor, elective, emergency, conventional procedures) were included in this study. Sample swabs were collected from the first dressing and up to 3 weeks post operatively for aerobic and anaerobic micro biomes culture. Microbiological sensitivity to antibiotics was performed randomly. RESULTS Infection rate was 11.44%. The Incidence of surgical wound infection was higher with increasing age. The wound infection in emergency surgery was 32% as compared to routine elective surgery. The higher incidence 13.88% to 15.62% was detected in longer hospital stay of more than 10 days in pre- and post-operative period. Dirty wounds had the highest incidence of wound infection 54%. Higher periods of keeping drains had higher incidence of wound infection 50%. Escherichia coli was isolated in 32% and Pseudomonas aeruginosa was isolated in 28%. CONCLUSION Surgical wound infection incidence is related to various factors like age, sex, duration in hospital stay, and causative factors. Increasing age had higher incidence of infection. Environmental factors, internal and external causes, had impact on infection. Duration of hospital stay, surgical procedure done, duration of surgery are all related to the incidence of infection. Multiple organisms are isolated in long duration of hospital stay which leads to more infection and short duration in all respects had less infection in surgical wound. Determination of risk also helps the surgeon towards possible outcome. Incidence of surgical wound infection is low in our study. Rational antiseptic, sterilization, antibiotic policy and more infection control measures were found to be necessary. We have taken care in hand washing, proper use of personal protective equipment and segregation instruments and articles as necessary.