1. Study on surgical site infection
Ajita Mehta, Shireen Samson, Shweta Ghag, Sudeep Shah, Camilla Rodrigues, F. D. Dastur
Infection Control Committee,
P. D. Hinduja National Hospital &
Medical Research Center, Mahim,
Mumbai

2. INTRODUCTION contaminated cases Wound infection in clean & clean -
 % worldwide
 Cause of morbidity, cost, hospital stay
 Index of quality care
 Surgeons may be wary of wound infections
Irrational antibiotic policy: Prolonged
duration, Peculiar combinations, Overkill,
Leads to drug resistance (major problem)

3. Infection Rate – year 2003
Month Overall Infected Pulmonary urinary tract Clean
Rate Vascular infection infection (%) cases (%)
(%) (%) /1000days
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Oct
Nov
Dec

4. Objectives Current rate of Surgical Site infections
b) Assess role of rational antibiotic policy

5. Material & Methods Prospective & Consecutive cases
Clean & clean contaminated surgery cases
(no contamination of the operative field by uncontrolled
spillage of visceral contents)
No breach in asepsis e.g. hernia, arthroplasty
CABG, Cholecystectomy

6. Specialities included:
Exclusions :
 Endoscopy
 Laparoscopic surgery
 Urological & Gynaec procedures
Specialities included:
 General & Oncosurgery,
 Orthopedics,
 Cardiac surgery

7. * Patient recruitment * Assessment  From theatre list DAILY
 Day 1/2 visit – proforma entry, contact no.
 Day 8th visit Rounds- staff nurse information
 Information from resident doctor
Microbiology review
Day 30th phone call to patients

8. RESULTS Duration of study: 7 months (Nov’03 to May’ 04)
Total number of cases studied:
Speciality No.of cases Infected Percentage
General Surgery %
Ortho %
CVTS %
Total : %

9. Surgeon Total Infected Antibiotic
cases (Days)
ORTH(469)
A (1.5%) Cefazolin (3 doses)
B Cefuroxime (3 doses)
C (0.7%) Cefazolin (5 doses)
D Cefazolin (3 doses)
E Cefazolin (3doses)

10. Surgeon Total Infected Antibiotic Cases (Days) CVTS (228)
A (4.0%) Amox-clav/Amikacin/Tobramycin(5)
B (2.8%) Cefuroxime/Amikacin (3-5)
C (1.3%) Cefpirome (3)
D (7.4%) Cefpirome (5-7)
E Cefuroxime (2-3)
F Cefepime (2-3)

11. Surgeon Total Infected Antibiotic Cases (Days)
General Surgery (303)
Surgeon Total Infected Antibiotic
Cases (Days)
A Cefuroxime (3 dose)
5 days oral
B Ceftriaxome (2 dose)
C Cefuroxime (3 dose)
D (3.1%) Cefazolin (3-5 dose)
E Cefuroxime (3 dose)
F Cefazolin (3 dose)

12. Surgeon Total Infected Antibiotic
Cases (Days)
G Cefotaxime/ceftazidime
H Cefazolin (3 dose)
I Cefotaxime(3doses)
J Augmentin (3 dose)
K Cefuroxime (3 dose)
L Amp/Amikacin (3 dose)

13. * Following hospital guidelines -- 5 /550
* Not following guidelines (Higher antibiotics) -- 7/450
* No significant difference in the above 2 but,
- it increases the antibiotic resistance,
- it increases cost to the patient due to higher
antibiotic,
- preserve higher antibiotics for serious cases

14. How is this study better than current available information?
• Accurate inclusion of all cases (denominator)
from OT list
• Accurate assessment of wound infection
(numerator) by survey & phone call

15. CONCLUSION Infection rate is the same irrespective of antibiotics used
 The rate of infections is low in this study

16. RECOMMENDATIONS
Rational hospital antibiotic policy should be followed by all:
Single dose of cefuroxime / cefazolin in clean cases
3 doses in clean contaminated cases.

17. THANK YOU !