Literature review on surgical site

infection rate in different Ethiopian

hospitals
Study which was conducted at Hawassa referral hospital, Southern part of Ethiopia using prospective
observational study in all patients that undergone major surgical procedure from March 2 to May 2,
2015. HURH serves as a main referral centre for patients living in the Southern part of Ethiopia. All
patients with age ≥ 1 year admitted for elective or emergency clean and clean-contaminated surgery
were included. Patients not willing to participate on the study, receiving antimicrobial during
admission or stopped receiving within 48 hours before operation and patients with initial diagnosis
suggestive of infection were excluded.

So the study includes one –hundred twenty seven patients fulfilled the inclusion criteria, of these 22
patients were excluded based on the exclusion criteria. The analysis was done on total of 105
patients that fulfilled the inclusion and exclusion criteria. Sixty four patients (61%) were males and
more than half of the patients were from rural 60(57.1%) area. The mean age of the patients was
30.85 ± 17.72 years. The mean Body Mass Index (BMI) was 21.6 ± 4 kg/m2, three patients (2.9%)
were obese with BMI > = 30 Kg/m2. Five patients (4.8%) received blood transfusion preoperatively.
Three (2.86%) patients received systemic steroids but none of them took for more than 3 weeks.
Twenty eight (26.7%) patients were smokers. More than half of patients were under ASA score of II,
67(63.8%). The mean preoperative hospital stay and total hospital stay of the patients were 5.59 ± 
7.78 and 11.03 ± 9.71 days respectively. Out of 105 patients, 20(19.1%) patients developed SSIs.
Among patients who developed SSIs, 17(85%) patients developed SSIs before they were discharged
from hospital (Table 1).
 https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-2167-x/tables(Legesse
Laloto, Hiko Gemeda, and Abdella 2017)
In Jima Univerty specialized hospital (JUSH) study was done was to determine the surgical site
infection rate among women having surgery for delivery in obstetrics from April 1, 2009 to March
31, 2010. A prospective descriptive study design used with the aim of determining the surgical
site infection rate on all 770 women who had surgery for delivery from In the above time pariod in
obstetric ward of the Hospital. Data on history of the patient, patient specific demographic
information on potential risk factors and the occurrence of Surgical Site infections in the first 30
days following surgery were collected using pretested data collection form. In addition, relevant
data were also abstracted from the operation logbook of the cases. Then data were cleaned,
edited and fed to computer and analyzed using SPSS for window version 16.0. Finally Statistical
test for significance was employed using chi-squared (X 2) where appropriate at 5% level of
significance. RESULTS: The mean (±SD) of the subjects’ age was 26(±7) years and the majority
of the women were from the rural areas (72.7%). THE OVERALL SURGICAL SITE INFECTION RATE WAS
11.4%. O F THOSE WHO HAD SURGICAL SITE INFECTIONS, 64.8% HAD CLEAN-CONTAMINATED WOUND AND
35.2% HAD CONTAMINATED /DIRTY WOUNDS . Wound class at time of surgery has a statistically
significant association with Surgical Site infections (p < 0.001).The Surgical Site infections rate
was similar for caesarean section and abdominal hysterectomy but higher for destructive delivery
under direct vision. Majority of the operations were made for emergency Obstetric conditions
(96.6%) and the Surgical Site Infections rate was two times higher compared to that of elective
surgery. Chorioamnionitis, presence of meconium, large intraoperative blood loss and
Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001.
Absence of antenatal care follow up was also associated with increased severity of Surgical Site
Infections. But still the study revealed that Surgical Site Infections rates are higher than
acceptable standards indicating the need for improving Antenatal care, increasing the number of
skilled birth attendants at the local clinics, increasing basic and comprehensive emergency
obstetric care services, applying improved surgical techniques and improving infection prevention
practices to decrease infection rate to acceptable standard. KEYWORDS: surgical site infection,
antenatal care, chorioamnionitis, meconium.(Birhanu and Endalamaw 2020)

Geletaw and his co-workers also studied SSI at Lemlem Karl Hospital which included the data from
July 1, 2013 to June 30, 2016. He used retrospective patient’s card review for 384 women who had
caesarean section.

 AMONG 384 WOMEN WHO PERFORMED CAESAREAN SECTION, THE MAGNITUDE OF SURGICAL SITE INFECTION
FOLLOWING CAESAREAN SECTION INFECTION WAS 6.8%. The identified independent risk factors for
surgical site infections were the duration of labor AOR=3.48; 95%CI (1.25, 9.68), rupture of
membrane prior to caesarean section AOR=3.678; 95%CI (1.13, 11.96) and the abdominal
midline incision (AOR=5.733; 95%CI (2.05, 16.00). The magnitude of surgical site infection
following caesarean section is low compare to other previous studies. The independent
associated factors for surgical site infection after caesarean section in this study: Membranes
rupture prior to caesarean section, duration of labor and sub umbilical abdominal incision.
In addition to ensuring sterile environment and aseptic surgeries, use of WHO surgical safety
checklist would appear to be a very important intervention to reduce surgical site infections.
(Gelaw et al. 2017)

Another hospital based cross-sectional study was undertaken at St. Paul’s Hospital Millennium
Medical College and Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia, from October
2013 to March 2014. These hospitals are tertiary referral hospitals directly under the Federal Ministry
of Health. They is also a teaching hospital for the Medical College and it gives service to the patients
under different clinical disciplines which include surgery, orthopaedics, obstetrics, gynaecology,
paediatrics, internal medicine, and ENT.

A total of 1088 operations were done during the study period. OF THESE, 107 (9.8%) PATIENTS
DEVELOPED SURGICAL SITE INFECTION . The median age of the study population was 30 years (8–80
years), and the majority (56 (52.3%)) of the study cases were females. Fifty-eight patients
(54.2%) were from rural areas, 49 (45.8%) completed primary education, and 33 (30.8%)
were farmers. About sixty-two percent of the study population underwent emergency surgery
and the most common surgical procedure was laparotomy (34 (31.8%)), followed by
debridement (29 (27.1%)). Of the 107 patients studied, 101 (94.4%) received antimicrobial
therapy. Twenty-two patients (20.5%) received preoperative antimicrobial therapy, 100
(93.4%) received postoperative antimicrobial therapy, and 6 (5.6%) have not received any
antimicrobial therapy (Table 1). There was no significant difference between antimicrobial
classes used during the preoperative period and those used during the postoperative period.

Table 1
Sociodemographic and clinical characteristics of study subjects ().

Characteristics Frequency Percentage

Sex    

 Female 56 52.3

 Male 51 47.7

Age group    

 <10 2 1.9

 10–20 18 16.8

 21–30 36 33.6

 31–40 23 21.5

 41–50 9 8.4

 >50 19 17.8

Residence    
 Urban 49 45.8

 Rural 58 54.2

Educational status    

 Illiterate 29 27.1

 Primary 49 45.8

 Secondary 14 13.1

 College/university and above 15 14

Occupations    

 Farmer 33 30.8

 Employer 17 15.9

 Student 13 12.1

 Daily wage laborer 14 13.1

 Housewife 16 15

 Merchant 6 5.6

 Jobless 5 4.7

 Driver 3 2.8

Case type    

 Emergency 66 61.7

 Elective 41 38.3

Surgical procedure    

 Laparotomy 34 31.8

 Debridement 29 27.1

 Appendectomy 3 2.8

 Drainage 9 8.4

 Incision 5 4.7

 Cesarean section 14 13.1

 Colostomy 8 7.5

 Lithotomy 3 2.8

 Mastectomy 2 1.9

SSI class    

 Superficial 45 42.1

 Deep tissue or organ/space 62 57.9

Antimicrobial therapy received    

 Preoperative 22 20.5

 Postoperative 100 93.4

 Not at all 6 5.6

The purpose of this study was to determine the prevalence of – and factors associated with the
problem among mothers who gave birth in Hawassa University Teaching and Referral Hospital,
Southern Ethiopia.

Methods: Hospital based cross-sectional study was conducted based on the medical records of
592 women who underwent CS from June 2012 to May 2013. Data on the occurrence and
factors associated with SSIs were extracted. Factors associated with SSI were identified using
multivariate logistic regression analysis. The output of the analysis is presented using adjusted
odds ratio (OR) with the corresponding 95% confidence interval (CI).

Results: The prevalence of SSI was 11.0% (95% CI: 8.6-13.8%). Mothers with prolonged labor
(6.78, 95% CI: 2.54-18.00) and prolonged rupture of membrane (5.83, 95% CI: 2.14-15.89) had
significantly increased odds of SSI. Compared to mothers who had no digital vaginal
examination, those who had 1-4 and 5 or more examinations were at higher risk with OR of 2.91
(95% CI: 1.21-6.99) and 8.59 (95% CI: 1.74-42.23), respectively. Prolonged duration of surgery
(12.32, 95% CI: 5.46-27.77), wound contamination class III (9.61, 95% CI: 1.84-50.06) and
postoperative anemia (2.62, 95% CI: 1.21-5.69) were also significant predictors. CS conducted
by junior practitioners is likely to be followed by infection.
Conclusion: Post-CS SSI is relatively common in the hospital. Thus, it should be averted by
implementing infection prevention techniques.

Keywords: Surgical wound infection, Cesarean section, Southern Ethiopia(Wodajo, Belayneh,

and Gebremedhin 2017)