Wound infection in Tikur Anbessa hospital, surgical department

A prospective study of surgical wound infection has been conducted on 1754 surgical patients operated from January 1, 1999 to Dec 31, 1999 in Tikur Anbessa hospital. Demographic data and information on potential risk factors and the occurrence of wound infection in the first 30 days post operatively were collected using pretested data collection form. Among the patients 1162 (66.2%) were males and 592 (33.8%) were females. The age ranged from one day to 95 years with a mean of 30 (+/- 19) years. Seven hundred twenty eight (41.5%) wounds were classified as clean, 674 (38.4%) as clean-contaminated, 241 (13.7%) as contaminated and 111 (6.3%) as dirty and infected wounds. The overall wound infection rate was 14.8%. The infection rate for clean, clean-contaminated, contaminated and dirty and infected wounds were 8.0%, 14.8%, 22.0% and 44.2% respectively. The overall wound infection rates vary between 5.4% and 27.9% among consultant surgeons and it was 17.3% for residents. After adjusting for variation in patients condition and wound class, the infection rate of two surgeons was significantly higher, with odds ratio (OR) of 2.3 and 2.9. Shaving in the ward and use of drains were associated with a statistically significantly higher infection rate after adjusting for all factors considered in the study, with OR of 1.9 & 2.3 respectively. Preoperative antibiotics were found to be highly protective after multiple stepwise regressions with OR of 0.33. Post operative hospital stay and mortality were significantly higher in patients who had wound infection after adjusting for potentially confounding variables. It is concluded that the infection rate are much higher than the acceptable standard and this underscores the need for establishing hospital infection control system. Minimizing the use of drains, avoiding preoperative shaving, judicious use of preoperative antibiotics and meticulous surgical technique should be part of the immediate strategy to reduce wound infection rate.