Wound infection after clean operations: some predisposing factors and surveillance at Muhimbili medical center, Dar- es-Salaam, Tanzania.

Abstract

To determine the magnitude of postoperative clean wound infection, some predisposing factors, surveillance, their current pattern and antimicrobial susceptibility among general surgical patients undergoing clean operations. METHODS Patients who were scheduled for and had elective clean operations from June 1999 to January 2000 were followed for 30 days. Their demographic data were obtained, wounds examined and those who were found to have infected wounds, had pus swabs obtained for culture. Bacteriological pattern and antimicrobial susceptibility tests were conducted. A study of some predisposing factors was also done. RESULTS Of the 476 patients who had clean operations done during the study period, 464 were registered. They comprised of 285 (60.4%) males and 179 (37.2%) females. Sixty(12.9%) patients were clinically found to have wound infection of whom 47(10.1 %) had positive cultures. Forty

viii (85.7%) patients had the diagnosis of wound infection made before discharge and the remaining 7(14.3%) patients were diagnosis as outpatients. Predominantly, the isolates consisted of Staphylococcus aureas (36.1%), Klebsiella spp (31.2%), Escherichia coli (14.8%) and other organisms were less frequently isolated. CONCLUSION The magnitude of surgical wound infection obtained is unacceptably high. Prolonged preoperative hospitalization and prolonged operation duration were found to significantly predispose to wound infection. The patients' age and sex, the surgeon's rank, surgical scrub, shaving, and the ward and theatre environment were not found to be statistically significant risk factors. Patients who -suffered postoperative wound infection had a significantly prolonged postoperative hospitalization as well. The operating theatre needs modifications that can suite the requirements of a standard operating suite. Laxity in adherence to the norms of the conduct in the operating theatre was found to exit and it requires emphasis of the continuing education among the theatre personnel. Also a more extensive and long-term study that will

ix evaluate the risk factors further as well as a surveillance plan that can be suitable in our environment is recommended.