6.1 / Need for the study:
Surgical wound infections are the second most common nosocomial infections after urinary tract infections.
Infection of the postoperative wounds are very common though often clinically latent and detectable only by bacteriological study.
One of the major problems faced by the surgeons these days is to deal postoperative wound infection, as most of them are caused by multiple drug resistant bacteria.
The problems of infected surgical sites can only be tackled if all such cases are examined bacteriologically and feedback is given to the surgeons well in time; so that they can treat them with appropriate antibiotics.
The present work is undertaken to study the problem of postoperative wound infections with reference to various factors directly or indirectly related to wound infections, which hitherto has not been done in our Hospital.
6.2 / Review of Literature
A post operative wound infection is a complication in which bacteria are not only present in surgical wounds, but also multiply and usually excites a local and often systemic response by the host.1
According to Page C.P et al surgical chemoprophylaxis can be administered prior to surgical procedure to prevent postoperative wound infections.2
Giacometti et al reported common pathogens like Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis and Enterococcus faecalis in postoperative wound infections.3
Lilani et al have demonstrated that surgical site infection rate was much higher in drained wounds than non drained wounds.4
Juan et al, reported various factors which play a role in surgical site infections are age and sex of patients, duration of presurgical stay, degree of surgical contamination, duration of surgery, antibiotic prophylaxis received, duration of central venous catheter used, duration of peripheral venous catheter used, duration of urinary catheter used, duration of assisted breathing, number of diagnosis and type of surgery.5
Carl A et al reported coagulase negative Staphylococcus and group D Enterococcus were the two frequent isolates before and after antibiotic restriction policies were implemented.6
6.3 /
Objectives of the study
· To isolate and identify causative agents of post operative wound infections from Basaveshwar Teaching and General Hospital attached to M.R. Medical College, Gulbarga.· To study the antimicrobial susceptibility of the isolated species.
· To assess the factors that predispose to development of postoperative wound infections.
· To findout the prevalence of postoperative wound infections in Basaveshwar Teaching and General Hospital, Gulbarga.
· To compare our data with other studies carried out in India and abroad.
7. / Materials and Methods
7.1 / Source of Data:
Swabs collected from the wound showing clinical evidence of infection with purulent discharge are processed for bacteriological examination from the patient admitted to the Basaveshwar Teaching and General Hospital, Gulbarga
7.2. / Methods of collection of Data (Including sampling procedure, if any)
The study will be done by taking sample from wounds showing clinical evidence of infections with purulent discharge submitted to the Microbiology laboratory of Basaveshwar Teaching and General Hospital, Gulbarga between Jan 2008 to Dec 2008.
Sampling procedure : Simple random sampling
Inclusion Criteria
· Only those swabs from patients which are clinically diagnosed as post operative wound infections will be considered for this study.
Exclusion criteria
· Swabs from patients who have not undergone surgery
· Swabs from any other wounds or sites
The discharge will be collected with two sterile swabs using aseptic precautions before dressing of wounds in the morning. The first swab will be used for making a smear for direct Gram’s staining, second swab will be inoculated on blood agar, Mac Conkey agar and will be incubated at 370C for 18-24 hours. The bacterial isolates will be identified by standard methods.7
Antibiotic susceptibility testing will be performed with the Kirby – Bauer disc diffusion test, according to the guideline of the National Committee for Clinical Laboratory Standards (NCCLS).8
7.3. / Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.
No, Only those samples submitted to the Microbiology laboratory will be considered for the study.
7.4. / Has ethical clearance been obtained from your institution incase of 7.3?
Yes. Ethical clearance has been obtained from “Ethical clearance committee” of the Institution
8. / List of References
1. Dineen P. Major Infections in the post operative surgical clinics of North America. 1964; 44: 554.
2. Page C.P, Bohnen JM, Fletcher JR et al. Antimicrobial prophylaxis for surgical wound, guideline for critical care, Arch Surg.1993; 128: 79-88.
3. Giacometti A, O. Cirioni, Schimizzi AM, Delprete MS et al. Epidemiology and Microbiology of Surgical Wound Infections. Journal of Clinical Microbiology Vol. 38.No.2 Feb. 2000 Page. No. 918-922.
4. Lilani SP, Jangale N, Chowdhary A, GB Daver. Surgical site infection in clean and contaminated cases. Indian Journal of Medical Microbiology – Oct 2005; 23(4): 249-252.
5. Juan Francisco Casanova, Herruzo R, Jesus Diez. Risk factors for surgical site infection in children. Infection control and hospital epidemiology. July 2006; 27(7):709-715.
6. Carl A. Weiss III, Catherine L. Statz, MPH, RN et al. Six years of surgical wound infection surveillance at Tertiary Care Center. Arch Surg. 1999; 134.1041-1048.
7. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC JR, editors. Color Atlas and Textbook of diagnostic microbiology. 5th edition Lippincott. Raven Publishers: Philadelphia. PA; 1997.
8. National Committee for Clinical Laboratory Standards (NCCLS) performance standards for antimicrobial Disc susceptibility test. 6th edition. Approved standard. Wayne PA: NCCLS; 1997; NCCLS document M2-A6.