Surgical site infections (SSIs) are the most common healthcare-associated infection (HAI) among surgical patients and may be associated with significant risk of readmissions, intensive care unit (ICU) admissions, long-term complications and death 1, 2. An estimated 40%–60% of SSIs generally considered preventable, many hospitals in the United States have adopted specific measures, such as those endorsed by the Surgical Care Improvement Project, in hopes of reducing these and other surgical complications 1.
Globally, SSI rates have been found to be from 2.5% to 41.9% 3, 4 In Western countries, 2 – 5% of patients are undergoing clean surgery. Also, up to 20% of patients undergoing intra-abdominal surgery will develop SSIs 6, 7. In Africa, surgical site infections were the leading infections in hospitals (pooled cumulative incidence of 5.6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries 8. Another study done in Africa indicated a cumulative incidence of SSIs ranging from 2.5 to 30.9% 9.
In Ethiopia, the incidence rate of SSIs ranges from 10.9 – 75% 10, 11. Interestingly, patients who develop SSIs are up to 60% more likely to spend time in an intensive care unit, 5 times more likely to be readmitted to hospital, and 2 times more likely to die compared with patients without SSIs 7, 12–14. This accounts for 3.7 million excess hospital stay days, more than $1.6 billion excess costs annually and 3.57 extra drug use 5, 13, 15–18. Most such measures revolve around pre- and intraoperative factors—particularly the appropriate selection, timing, and dose adjustment of prophylactic antibiotics, and none generally extend beyond the immediate postoperative period (i.e., >24 hours) when much of the healing of the surgical wound may take place.
Relative dismissal of postoperative factors when discussing SSIs is not surprising given the universally entrenched principle that most SSIs occur as a result of the patient’s endogenous flora inoculating the surgical site at the time of surgery 19. Consequently, several authoritative infectious disease and infection control sources have continued to discuss the role of postoperative factors in SSIs only briefly 19-21. In addition, epidemiological studies of SSIs have often included very few, if any, postoperative variables 22-24-5–7 play a relatively minor role in SSIs. Of course, relative disregard for postoperative factors may be justified if implementation of the current “best practice” measures alone were sufficient in eliminating SSIs in the 21st century.
Unfortunately, as many surgeons and professionals in infection prevention are painfully aware, the war against SSIs is far from being won, with many patients continuing to develop such surgical complications despite implementation of best practice measures, including compliance with standard antibiotic prophylaxis administration 1, 25. In literature search engines, however, no such studies in Sudan that study the surgical site infection and associated factors. The results of such study could be face the current challenge of preventing SSIs, it may be helpful to remind ourselves that even ;50 years since the discovery of the importance of proper timing of antibiotic prophylaxis in the prevention of experimental surgical wound infections 26. The aim of this study to determine the prevalence of surgical site infection and its associated factors in Academy Charity Teaching Hospital in Khartoum, Sudan.
