Study of surgical site infection in surgical wards in Tirunelveli Medical College and Hospital, Tirunelveli

BACKGROUND: Patient whom underwent abdominal surgeries in both elective and emergencies in TVMCH was included in this prospective study. Which include clean contaminated, contaminated, dirty surgical wounds. Total no. of cases studied were 458 in which elective cases were 249 emergencies cases were 209. Case were study between 2012 – 2013. Patient was evaluated Post operatively during wound cleaning and dressing or if wound dressing is soaked with discharge, until patient get discharged from ward and also in OPD after discharged. AIM AND OBJECTIVES: 1. Determining the incidence of surgical site infection in surgical wards on Abdominal surgeries in TVMCH. 2. Identifying the common pathogen causing surgical site infection and sensitivity to antibiotics in TVMCH. 3. Studying most commonest complication of surgical site infection and analyzing various preventive measures which reduce the incidence of surgical site infection. 4. Reviewing literature on wound healing, wound infection and antibiotic prophylaxis in surgical site infection. 5. Studying the role of prophylactic antibiotic in reducing surgical site infection. MATERIALS AND METHOD: The following clinical material was collected in prospective study, Patients selected from General surgical ward at TVMCH admitted between March 2012- May 2013. Patient with clean postoperative wounds were excluded from the study. Only clean contaminated, contaminated, dirty wounds were included in this study. The operative wounds site was look for the Signs/Symptoms of inflammation and presence of micro organisms (infection) in the 1. post operative period of all patient in abdominal surgeries, 2. during wound cleaning and 3. dressing or if the dressings is soaked with discharge, 4. until the patient get discharged from the hospital and 5. Also in the OPD after discharge. When surgical site infection was clinically raised, the area around the operative wound was Cleaned with 70% ethyl alcohol. The discharge was collected from the depth of the surgical Wound using 2 sterile cotton swabs, the material was aspirated in a container which is sterile or the swab is send whenever the previous one is failed. The wounds site and the samples or pus collected were examined for characteristics that Indicate infection, which include foul smell, brick red fluorescence, black sloughed necrotic tissue or black discharge blood and purulence. RESULTS: In our study 33 cases were infected out of which 8 cases (3.21%) are elective and 25 cases (11.9%) was emergency with incidence rate of 7.2%. Most common isolated organism was klebsiella (24.2%), E.coli (18.18%), Pseudomonas (6.06%), Staphylococcus (6.06%), Acinetobacter (3.03%). Most commonly the organisms was sensitivity to ciprofloxacin, amikacin, cefoperazone sulbactum, doxycycline, ampicillin, cefotaxime in decreasing order. In our study the most common complication following surgical site infection was wound gapping, burst abdomen, incisional hernia, entro cutaneous fistula, death due to sepsis. CONCLUSION: Surgical site infection was most commonly caused by gram negative organisms more in emergencies surgery. In dirty, contaminated, clean contaminated surgical wounds in descending order. Most common isolated in our study was klebsiella followed by E.coli