INCIDENCE OF SURGICAL SITE INFECTIONS (SSIS) AMONG PATIENTS UNDERGOING MAJOR SURGERY IN NIGERIA: A CASE STUDY OF GENERAL HOSPITAL FUNTUA, KATSINA STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Statistically, surgical site infections (SSIs) are a prevalent type of hospital-acquired infection, constituting approximately 20 to 25% of all such infections globally (WHO, 2023). Surgical site infections (SSIs) have contributed to rising expenses, as well as increased rates of illness and death associated with surgical procedures, and remain a significant global issue. Internationally, the prevalence of surgical site infections has been documented to vary between 2.5% and 41.9% according to Mawalla et al. (2021).   Surgical site infections remain a significant source of illness and death for individuals following major surgery in Tanzania. A study conducted in Tanzania revealed surgical site infection rates of 24% at a district hospital and 19.4% in a tertiary hospital (Chalya et al., 2018). The prevalence of Healthcare-Associated Infections (HAI) is already significant in developed nations, ranging from 5% to 15% among hospitalized patients in ordinary wards and potentially exceeding 50% among patients in Intensive Care Units (ICUs) (WHO, 2023). In 2005, the World Health Organisation (WHO) initiated the First Global Patient Safety challenge called "Clean Care is Safe Care" with the aim of generating worldwide momentum and dedication to decrease the occurrence of Hospital Acquired Infection (HAI) (Watson, 2019).  

According to the National Institute of Health and Clinical Excellence (NICE) in 2018, surgical site infections account for up to 20% of all healthcare-associated illnesses. According to NICE (2018), a minimum of 5% of patients who have undergone a surgical operation experience a surgical site infection.  Inurzalioglu and Maghalu (2020) assert that the majority of surgical site infections arise from the introduction of germs from the patient's body into the incision during surgery. Postsurgical infection resulting from exogenous microorganisms is rather uncommon.  Most surgical site infections can be prevented by implementing interventions during the preoperative, intraoperative, and postoperative phases of care to minimize the risk of infection. Prior to the regular use of preventive antibiotics, the rates of infection were 1-2% or lower for wounds that were clean, 6-9% for wounds that were clean but had some contamination, 13-20% for wounds that were contaminated, and over 40% for wounds that were dirty. 

Contextually, the incidence of Surgical Site Infections (SSIs) in Nigeria has been documented to be substantially elevated when compared to international benchmarks. The factors that contribute to this situation include a scarcity of resources, insufficient infection control procedures, and a dearth of well-trained healthcare workers (Chibuzor et al., 2021). General Hospital Funtua, situated in Katsina State, is a prominent healthcare institution catering to a substantial population in Northern Nigeria. The hospital offers a variety of surgical procedures, including high-risk major surgeries that are susceptible to surgical site infections (SSIs). Gaining a comprehensive understanding of the infection control methods, resource availability, and the overall healthcare infrastructure at General Hospital Funtua is essential in order to effectively address the issue of Surgical Site Infections (SSIs). There is a lack of consistency in infection prevention methods and practices across several Nigerian hospitals, especially General Hospital Funtua.It is crucial to identify the current practices and any variations from prescribed recommendations in order to enhance infection control strategies. Therefore, the necessity for doing this investigation arises.

1.2 Statement of the problem

In recent times, Surgical Site Infections (SSIs) are a major concern in healthcare, particularly in the setting of major surgical procedures. According to Isaac et al. (2023), surgical site wound infections can arise from various sources, such as direct contact, airborne transfer, and contamination with bacteria from within the body. The vulnerability to these illnesses is influenced by many factors. The infection patterns may vary based on the particular surgical procedure, the operative approach employed, and the geographic location.   Keller (2023) argues that certain elective issues can be improved and should be given priority before surgical procedures. The factors include the act of quitting smoking, losing weight, restoring the normal functioning of the coagulation cascade, optimising glycaemic control, and stabilising other existing health conditions. Procedure-related risk factors include factors such as poor surgical procedures and skills, inadequate ventilation in the operating room (OR), insufficient use of skin preparation, and inadequate antibiotic prophylaxis, among others (Isaac et al., 2023).

According to Onipede (2019), there was a 21% incidence of Surgical Site Infections (SSI) at Obafemi Awolowo University Teaching Hospital Complex. A study conducted by Oni in 2022 found that the incidence of surgical site infections (SSI) in University College Hospital, Ibadan was 9.4%. Another research by Garba in 2022 revealed an SSI incidence of 9.1% following caesarean section in AKTH Kano. Although there have been attempts to follow infection control guidelines, there is a dearth of detailed data regarding the true occurrence of Surgical Site Infections (SSIs) in this hospital. The lack of adequate data on the frequency of SSIs at General Hospital Funtua hinders the accurate evaluation of the actual magnitude of the issue. In the absence of precise incidence rates, it becomes challenging to assess the efficiency of existing infection control strategies and to compare performance with national and worldwide benchmarks. The insufficiency of complete data and awareness of relevant elements highlights the necessity for a meticulous examination of the prevalence, causes, and consequences of SSIs. It is imperative to tackle these problems in order to enhance patient safety, improve the quality of service, and decrease healthcare expenses in the region. Therefore, the necessity for this investigation arises.

Objectives of the study

The primary objective of this study is to critically investigate incidence of surgical site infections among patients undergoing major surgery in Nigeria: a case study of general hospital Funtua, Katsina State, Nigeria. Specific objectives of this study are to:

To ascertain the incidence rate of surgical site infections among patients undergoing major surgeries at General Hospital Funtua, Katsina State, Nigeria

To identify potential risk factors associated with the development of surgical site infections in General Hospital Funtua, Katsina State, Nigeria

To evaluate current infection control practices in General Hospital Funtua, Katsina State

To recommend strategies to reduce the incidence of surgical site infections at General Hospital Funtua, Katsina State.

1.4 Research Questions

What is the incidence rate of surgical site infections among patients undergoing major surgeries at General Hospital Funtua, Katsina State?

What are the risk factors associated with the development of surgical site infections in General Hospital Funtua, Katsina State?

What are the current infection control practices in General Hospital Funtua, Katsina State?

What are the strategies to reduce the incidence of surgical site infections at General Hospital Funtua, Katsina State?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The incidence rate of surgical site infections among patients undergoing major surgeries at General Hospital Funtua, Katsina State, Nigeria is low.

Ha: The incidence rate of surgical site infections among patients undergoing major surgeries at General Hospital Funtua, Katsina State, Nigeria is high.

1.6 Significance of the study

The importance of this study rests in its ability to promote patient safety, improve infection control procedures, provide valuable information for resource allocation and policy development, and contribute to overall healthcare advancements. The findings will offer practical and implementable evidence that can be advantageous to General Hospital Funtua, the local population, and conceivably other healthcare establishments in Nigeria. Gaining a comprehensive understanding of the occurrence of Surgical Site Infections (SSIs) offers valuable information regarding the level of patient safety and the quality of surgical care.This will have a direct impact on enhancing patient outcomes and overall healthcare quality at General Hospital Funtua.

 To healthcare managers, the study will provide useful data regarding the hospital's current infection control practices. Acquiring this knowledge is essential for improving procedures, optimizing hygiene practices, and implementing more efficient infection control methods to avoid surgical site infections (SSIs). Moreover, the study's findings can provide hospital management and policymakers with valuable evidence into the specific requirements and difficulties associated with preventing surgical site infections (SSIs). This information can facilitate more efficient distribution of resources, such as financial support for infection control initiatives, education for healthcare personnel, and acquisition of essential equipment and supplies.

Furthermore, the investigation might pinpoint areas where healthcare practitioners may want supplementary training or education. The research findings can be utilised to create focused instructional programs that tackle specific concerns with SSI prevention. This will ensure that all personnel are knowledgeable and prepared to follow the most effective methods. Gaining knowledge about the occurrence and origins of SSIs helps improve patient education and involvement. Patients who have had a formal education are more inclined to adhere to postoperative care guidelines, hence decreasing the likelihood of surgical site infections (SSIs) and enhancing overall recuperation. Empirically, the study contributes to the current knowledge on Surgical Site Infections (SSIs) in Nigeria and presents empirical data that is specific to General Hospital Funtua..

1.7 Scope of the study

Broadly, this study focus is to critically investigate incidence of surgical site infections among patients undergoing major surgery in Nigeria. Specifically, this study seeks to ascertain the incidence rate of surgical site infections among patients undergoing major surgeries in Nigerian healthcare settings and identify potential risk factors associated with the development of surgical site infections in healthcare facilities across Nigeria. 

Further, this study will focus on evaluating current infection control practices in healthcare facilities across Nigeria and it also seeks to recommend strategies to reduce the incidence of surgical site infections in Nigerian healthcare settings.

 The study is carried out in General Hospital Funtua, Katsina State, Nigeria. The respondents of this study includes the healthcare professionals and surgical patients in General Hospital Funtua, Katsina state, Nigeria 

1.8 Limitations of the study

Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the dearth of comprehensive literature on the topic, given the scarcity of data pertaining to investigate incidence of surgical site infections among patients undergoing major surgery in Nigeria: a case study of General Hospital Funtua, Katsina State, Nigeria. Therefore, a substantial investment of time and effort was required to identify the suitable materials, books, or information and to collect data. 

Moreover, this study is limited by its diminutive sample size and restricted geographical range, concentrating just on General Hospital Funtua, Katsina State, Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits.

1.9 Definition of terms

Surgical site infections: This infection occurs beneath the incision area in muscle and the tissues surrounding the muscles. Organ or space SSI. This type of infection can be in any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. This includes a body organ or a space between organs

Nosocomial infections: Nosocomial infections are infections patients acquire while admitted to a health-care facility and generally develop 48 hours or later after admission. These infections can lead to serious problems like sepsis and even death.

Asepsis: Asepsis is a condition in which no living disease-causing microorganisms are present. Asepsis covers all those procedures designed to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved 'no touch' technique.