Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India

Abstract

Background: This study set out to determine occurrence of and risk factors for surgical site infections (SSIs) before and after implementation of an alcohol-based handrub (ABHR) intervention in general surgery wards in a rural, tertiary care hospital in India.

Methods: Patients who underwent surgery between October 2010 and August 2011 (preintervention period) or September 2011 and August 2013 (intervention period) in the department of surgery were included. ABHR was introduced in September 2011. SSI was defined as per the Centers for Disease Control and Prevention guidelines. Comparison of SSI rate between the 2 periods was performed using analysis of variance. Risk factors were determined using multiple logistic regression models.

Results: Incidence of SSI was 5% (36/720) and 6.5% (103/1,581) respectively, showing nonsignificant difference (P = .5735). The risk factor common for SSI in both periods was the duration of surgery (OR = 2.6 vs OR = 1.96, pre- and intervention periods, respectively). Risk factors in the intervention period were being a woman (OR = 2.18), renal disease (OR = 3.61), diabetes (OR = 4.43), smoking (OR = 2.14), preoperative hospitalization (<3 vs >15 days; OR = 3.22), and previous hospitalization (OR = 3.5). Compared with other studies, the amount of ABHR used in our study was low.

Conclusion: The amount of ABHR used might not be sufficient to interrupt the chain of contamination of microorganisms; therefore, continuation of the intervention and surveillance is recommended.

Keywords: Cross infection; Developing countries; General surgery; Hand hygiene; Surgical wound infection.