Risk Factors Associated With Post-Operative Infections Among Orthopaedic Patients With Clean Wounds In OAUTHC, Ile Ife, Nigeria
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 2
Abstract
The development of post-operative infection depends on contamination of the operative site at the end of a surgical procedure which specifically relates to the pathogenicity and inoculum of microorganisms present, balanced against the host’s immune response. This work is aimed at determining the risk factors and major pathogens involved in post-operative infection among orthopaedic patients with clean wounds managed at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. Samples were collected at pre incision (before skin preparation), incision and post incision (after the closure of the site) from Orthopaedic patients with clean wounds on admission for surgical operation at the Obafemi Awolowo University Teaching Hospital Complex, Ile – Ife. A well-structured questionnaire indicating patient demographics such as age, gender, diagnosis, duration of operation and other relevant information was used to collate data. Settle plates containing freshly prepared Blood agar, EMB agar, Tryptone soy agar (supplemented with Nystatin) and Mannitol salt agar were exposed and placed in strategic locations in the operating room and in the ward. A total of 75 consecutive orthopaedic surgery patients with clean wounds on admission were considered for this study. They were of both sexes with wound classifications as follows: Open reduction and internal fixation (ORIF) (62.7%), Excisional biopsy (6.7%), Hip hemiarthroplasty (4%), Soft tissue release, Limb lengthening, Corrective osteotomy and Bone grafting as 2.7%, Amputation, Darrach’s procedure, Total hip replacement and Patelectomy as 1.3% while other surgical procedures was 10.7%. Their age ranged from a year old (1 yr) infant to an eighty year old (80 yr) woman. The mean age of participants was 35.82 ± 0.48 (standard error of mean) for male and 43.65 ± 0.47 for female, with most of the subjects within the age range of twenty one and forty. Three (4%) out of the seventy – five subjects used in the study had post – operative surgical site infection with two (66.67 %) of them being male and one (33.33 %) female. Their occupation includes civil servants 17 (22.67%) as the highest followed by students 14 (18.67%), traders 12 (16 %), retirees 6 (8%), artisans 6 (8%), infants 3 (4%), farmers 3 (4%) and housewife 2 (2.67 %). Others include timber contractor, cocoa produce seller and self-employed making a total of 12 (16 %). The three infected subjects had their occupation as trader, civil servant and cocoa produce seller. Their source of injury were occupational hazard 2 (2.67 %), school accident 2 (2.67 %), home accident 4 (5.33 %), congenital deformities 8 (10.67 %) and road traffic accident 48 (64 %). Other source of injury includes removal of growth tumour, ganglion excision and hemiarthroplasty making a total of 11 (14.67 %). Altogether, 162 bacterial isolates were recovered; one hundred and fifty six (156) from the operative site comprising of 68 from pre incision, 36 at incision and 52 from post incision sites while the last six (6) were from the three (3) patients with post-operative infection. The predominant isolates from both operative site and wound sepsis were Staphylococcus aureus, and Corynebacterium pseudodiphtheriticum. Two hundred and ninety one (291) bacterial isolates were recovered from the settle media plates exposed at four strategic locations in the operating room. The predominant isolates were Bacillus subtilis, Corynebacterium jeikeium, Staphylococcus aureus and Corynebacterium pseudodiphtheriticum. Fifty (50) bacterial isolates were recovered from the ward environment; mainly B. subtilis,C.pseudodiphtheriticum and S. aureus. The incidence of post-operative infection in clean orthopaedic wound in this study was 4 % with Staphylococcus aureus as the commonest pathogen. Factors such as duration of surgery, surgical procedure and number of persons in the operating room were identified as risk factors for SSIs in this setting. It is recommended that installation of video conferencing device would be useful in reducing the number of persons in the operating room as this has been considered a major risk factor in post-operative infection in this study.
Authors and Affiliations
O. T Attah, A. K Ako, A. L Akinyoola, C. O Idowu, O. D Oyinloye
Keywords
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- EP ID EP467209
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