Risk factors for postoperative nosocomial infections among patients seen at Felege Hiwot referral hospital, Bahirdar, Ethiopia

Abstract

Background: Nosocomial infections are the most challenging problem in all health care systems. In developing countries many people are dying daily due to inadequate health care services of which postoperative infections constitute a large proportion of this burden. Factors underlying postoperative nosocomial infections are multiple and these include the type of surgical procedure, the skills of the surgeon, the duration of surgery and the underlying disease of the host.
Objectives: The aim of this study was to identify possible risk factors for post operative nosocomial infections among operated patients at Felege Hiwot Referral Hospital.
Methods: A cross-sectional study was conducted on patients who under gone operations from October 2010 to January 2011. A predesigned structured questionnaire was used for collection of data on socio-demographic characteristics and associated risk factors. The clinical diagnosis was made by respective surgeons and gynaecologists. Bacterial culture confirmation was done for all patients who developed clinical signs and symptoms of surgical site and/or bloodstream infection starting from the second day of admission until the time of discharge using standard bacteriological techniques. The data was checked for completeness, coded and fed into SPSS version16 and P-value <0.05 was considered statistically significant for association between variables.
Results: A total of 294 patients were included in the study of which 32.7% were males and 67.3% were females making male to female ratio 1:2.1 with mean age of 32.2 years. The rate of postoperative culture confirmed nosocomial infection was 10.9%. The infection rate was higher in females (11.6%) than males (9.4%) (P=0.564, OR=1.270, 95%CI=0.564- 2.863). Patients age of >51 years old were likely to develop post operative nosocomial infection (P=0.033, OR=6.375, 95%CI=1.156-35.14) by taking 11-20 years age group as a reference category during bivariate analysis. The logistic rigration analysis showed that patient with underlying diseases (P =0.010, OR=2.725, 95%CI=1.269-5.853) and patients who undergone appendectomy (P=0.03, OR=3.1, 95%CI=1.1-8.3) were more likely developed post operative nosocomial infections. Operation duration of 91-150 minutes (P=0.006, OR=11.00, 95%CI=1.989-60.83), and postoperative hospital stay of greater than 15 days (P=0.001, OR=82.00, 95% CI=5.738- 1.172) were also likely to be risk factor for infection.
Conclusion: This study confirmed that advanced age, underlying disease, extended preoperative and postoperative hospital stay, longer duration of surgery and appendectomy as potential risk factors for post operative infections. Hence, more attention is required in management of such cases through the use of effective antibiotics as a prophylaxis and adherence of strict aseptic operating procedures.

Keywords: Post operative nosocomial infection, risk factors, clean-operation, clean-contaminated operation,