SYNOPSIS

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

“INCIDENCE OF SURGICAL SITE INFECTIONS IN ELECTIVE ABDOMINAL SURGERY”

Name of the candidate : Dr. AHMED KHAN

Guide : Dr. P. SATHYAMOORTHY AITHALA

Course and Subject : M.S. (General Surgery)

DEPARTMENT OF GENERAL SURGERY,

FATHER MULLER MEDICAL COLLEGE AND HOSPITAL

KANKANADY, MANGALORE – 575002.

AUGUST - 2008

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidate and address(in block letters) / DR.AHMED KHAN
POST GRADUATE RESIDENT,
DEPT. OF GENERAL SURGERY
FR. MULLER MEDICAL COLLEGE HOSPITAL,
KANKANADY,MANGALORE-575002
2. / Name of the institution / FR..MULLER MEDICAL COLLEGE
KANKANADY, MANGALORE-575002
3. / Course of study and subject / M.S. (GENERAL SURGERY)
4. / Date of admission to the course / 11-06-2008
5. / TITLE OF THE TOPIC: INCIDENCE OF SURGICAL SITE INFECTIONS IN ELECTIVE ABDOMINAL SURGERY.
BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for out comes and cost. SSI is among the leading nosocomial cause of complication and increased medical expense. It is also outcome indicator of fundamental importance in elective surgery. Inspite of advent of antiseptics and broad spectrum antibiotics, it is a well known entity in day to day practice. This study aims to enumerate the different causal factors for surgical site infection in elective abdominal surgery and to evaluate the incidence of surgical site infection in elective abdominal surgery.
One and a half years prospective observational study of all patients undergoing elective abdominal surgery will be conducted. All operations performed electively will be eligible. During the study ethical committee approval and consent of the patient for this study will be taken into consideration. Different risk factors may be involved including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving and secondary infections. This study aims to determine the risk factors affecting abdominal surgical site infections and their incidence at FMMCH. The consequences of SSI are i) Increased hospital stay by up to 10 days. ii) Increased costs iii) Increased readmission rates & iv) Increased pain and suffering. If the surgical site is infected then the discharge from the wound will be taken for Culture/Sensitivity and incidence of various micro organisms responsible for the SSI and their antibiotic sensitivity patterns will be studied.
6.2 REVIEW OF LITERATURE:-
Surgical site infections along with pneumonia, urinary tract infections and blood stream infection are the most common nosocomial infection1. Although SSI are not associated with high mortality rate, they are significant source of morbidity among surgical patients.
Approximately 500000 episodes of SSI occur in United States every year accounting for an average of 7.3 excess hospital days and more than 1.6 billion dollars of extra hospital charges2. Surveillance programs can lead to reduction of SSI rates of 35.50%.
According to Nystron and team3 the SSI increases with obesity one reason being decrease in blood circulation in fat tissue. Malnutrition is another factor predisposing to SSI. The study conducted by Raka and coworkers4 confirmed the association between SSI and ASA score, duration of procedure and wound class. Razavi and team5 suggested that by reducing the average operation time to less than two hours, the average preoperative stay to 4 days and the overall stay to less than 11 days and approximating the timing of shaving to the operation and prophylactic antibiotic administration, the SSI may be reduced to more than acceptable level.
6.3 OBJECTIVES OF THE STUDY
1. To evaluate the incidence of SSI in elective abdominal surgeries.
2. To enumerate the different causal factors for surgical site infection in elective
Abdominal surgery.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:-
Patients admitted in surgical wards of FMMCH for elective abdominal surgery for coming one and half years about 100 cases.
7.2  METHOD OF COLLECTION OF DATA:
TYPE OF STUDY: - Prospective study
SAMPLE: - A prospective study will be conducted. All the patients above 14yrs who require abdominal surgery will be enrolled in the study. Patients with pre existing infection will be excluded from the study. Each patient will be followed up after surgery every day for 8 days. The surgical site will be inspected for Erythema (redness), Swelling, Induration, Local rise of temperature, Pain, Body temperature of 38°C and Septic discharge from the surgical site during 8 days following surgery.
If the surgical site gets infected then Culture/Sensitivity of the discharge or pus will be done and if required Blood culture.
INCLUSION CRITERIA:- All the patients who are admitted for elective abdominal surgery for various causes will be studied in depth.
EXCLUSION CRITERIA:- Patients presenting with preexisting infection.
PLAN FOR DATA ANALYSIS:- Collected data will be analysed by Chi Square test and by Logistic Regression Analysis
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals.
Yes. Investigations in the form of Culture/Sensitivity of discharge or pus and Blood Culture if required.
7.4 Has ethical clearance been obtained from your institution?
Yes
8. LIST OF REFERENCES:-
1.  Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR Guideline for prevention of surgical site infection. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999; 20:250-280.
2.  Martone W, Jarvis W, Edwards J, Culver D, Haley R Incidence And nature of endemic and epidemic nosocomial infections. In: Bennett JV, Brachman PS, Eds. Hospital Infections. Philadelphia: Lippincott-Raven; 1998; 461-76.
3.  Nystron PO, Jonstam A, Hojer H, Ling L. Incision infection after colorectal surgery in obese patients. Acta chir Scand. 1987; 153: 225-7.
4.  Raka L, Krasniqi A,Hoxha F, Musa R, Muliqi G, Krasniqi S, et al. Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital. J Infect Developing Countries 2007; 1(3):337-41.
5.  Razavi SM, Ibrahimpor M, Kashani AS and Jafarian A. Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital. BMC Surg. 2005; 5:2.
9. / Signature of the candidate
10. / Remarks of the guide
11. / Name & Designation of (in
block letters)
11.1 Guide
11.2 Signature
11.3 Co-guide(if any)
11.4 Signature
11.5 Head of the department
11.6 Signature / DR.P.SATHYAMOORTHY AITHALA
PROFESSOR AND HOD,
DEPARTMENT OF GENERAL SURGERY,
FR.MULLER MEDICAL COLLEGE,
KANKANADY,MANGALORE-575002
DR.P.SATHYAMOORTHY AITHALA
PROFESSOR AND HOD,
DEPARTMENT OF GENERAL SURGERY,
FR.MULLER MEDICAL COLLEGE,
KANKANADY,MANGALORE-575002
12. / 12.1 Remarks of the Chairman & Principal
12.2 Signature