Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

Post-operative site infections among surgical patients at Southern Ethiopia: A prospective cohort study

Objective

The current study was conducted to estimate the magnitude of SSI among surgically treated patients and identify the predictors associated with it.

Background

summary: Despite the fact that surgical site infection (SSI) is still a global health care-associated infection related to patients' discomfort, morbidity, and mortality, it is the most preventable nosocomial infection if all necessary measures are taken into account.

Methods

An institution-based prospective cohort study was conducted at a large teaching hospital in southern Ethiopia. Patients admitted to the surgical ward with a non-traumatic acute abdomen were participants in the study and were followed prospectively for 30 days. The collected data was entered into Epi-Data 4 and exported to STATA 16 for analysis. A logistic regression (bi-variable and multivariable) model was computed to detect the association between SSI and predictors. In the final model, variables with a p-value <0.05 were declared statistically significant.

Results

In this study, a total of 169 patients were enrolled. More than 3/4th (78.9%) of them were male, and the mean ± SD age of participants was 42.14 ± 12.5 years. Eighteen participants (10.5%) suffered from surgical site infection (SSI). Predictors of SSI were ever smoking [AOR = 3.9; 95% CI (1.2-16.5)], American Society of Anesthesiologists score ≥3 [AOR = 8.9; 95% CI (1.7-45.5)], appendectomy [AOR = 7.7; 95% CI (1.3-45.7)], and co-morbid diabetes [AOR = 13.8; 95% CI (2.6-72.1)].

Conclusion

The magnitude of SSI was considerable in the study setting. Predictors of SSI were smoking, ASA score, appendectomy, and co-morbid diabetes. We strongly recommend that health-care professionals provide health education and patient counseling on smoking and health-seeking behaviors. Considering co-morbid conditions before surgery has paramount importance. Moreover, further large-scale studies are suggested.

Antimicrobial approach of abdominal post-surgical infections

Abdominal surgical site infections (SSIs) are infections that occur after abdominal surgery. They can be superficial, involving the skin tissue only, or more profound, involving deeper skin tissues including organs and implanted materials. Currently, SSIs are large global health problem with an incidence that varies significantly depending on the United Nations' Human Development Index. The purpose of this review is to provide a practical update on the latest available literature on SSIs, focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.

A randomised control trial using soap in the prevention of surgical site infection in Tanzania

BACKGROUND

Surgical site infections (SSIs) are common and serious complications of surgery. Guidelines on preventing SSIs have been developed, but the role of preoperative bathing with plain soap among paediatric population is unclear. We aimed to assess the effectiveness of pre-operative bathing using plain soap in preventing SSIs among paediatric surgical patients.

MATERIALS AND METHODS

An open-label, randomised trial was conducted at Muhimbili National Hospital in Tanzania. Preoperatively, patients in the intervention group washed their body using plain soap, while those in the control group did not. The primary outcome was SSI postoperatively. Statistical tests included χ2, Wilcoxon rank sum, and univariate and multivariable logistic regression.

RESULTS

Of the 252 patients recruited,114 were randomised to the intervention arm. In the control arm, 40.6% (56/138) of participants developed SSIs compared to 11.4% (13/114) in the intervention arm (p < 0.01). After adjusting for confounding factors in multivariable analysis, the intervention reduced the odds of an SSI by 80% (OR: 0.20 [95% CI: 0.10, 0.41]; p < 0.01). Preoperative antibiotics were deemed to be an effect modifier of the association between the intervention and SSI (p = 0.05). The intervention significantly reduced the odds of an SSI by 88% among participants not given preoperative antibiotics (OR: 0.12 [95% CI: 0.05, 0.30]; p < 0.01).

CONCLUSION

This study has shown that preoperative bathing with soap significantly reduces SSIs in paediatric surgical patients. It is a simple, cost effective and sustainable intervention.

LEVEL OF EVIDENCE

Level II.

Three Pivots for Improving Health Care Provider Performance

We share recommendations on 3 important pivots away from longstanding approaches to continued professional development and in-service training programs that have demonstrated a measurable benefit across a diversity of health-related applications and projects.