PREVALENCE OF SURGICAL SITE INFECTION IN NIGERIA: A CASE STUDY OF UNIVERSITY OF UYO TEACHING HOSPITAL

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 (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  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 Organization (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).  

In both developed and poor nations, Hospital-acquired infections (HAI) are common leading to significant illness and death (De Groote et al., 2022).  According to the European Centre for Disease Control (ECDC), around 4.1 million patients in the European Union suffer healthcare-associated infections (HCAIs) each year. This leads to up to 37,000 fatalities, longer hospital stays after surgery, and higher healthcare expenses (Atkins, 2022). In 2002, HCAI was responsible for roughly 99,000 deaths in the United States (Atkins, 2022).  In nations with low and middle-income levels, where the frequency is significantly higher, the burden is either underestimated or unknown (De Groote et al., 2022). Europe incurs an estimated annual financial deficit of around €7 billion (Atkins, 2022).  The direct costs and annual economic impact of this issue in the USA were projected to be around US$ 65 billion in 2004 (Brady et al., 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. The prevalent bacteria in question are Staphylococcus, Streptococcus, and Pseudomonas (Awad 2020). Pathogens have the ability to invade a surgical incision through different modes of transmission, including direct contact with a contaminated career or surgical tool, airborne transmission, or transfer from existing pathogens on or within the body that subsequently infiltrate the wound (Awad  2020). 

Isaac (2023) state that surgical site wound infections have different origins, including direct contact, airborne transmission, and contamination with endogenous bacteria. The susceptibility to these infections is determined by multiple factors. The infection patterns can differ depending on the specific surgical procedure, the strategy used during the operation, and the geographical region. Risk factors can be classified into two categories: patient factors and procedure variables. Common patient risk factors for wound infection encompass advanced age, malnutrition, hypovolemia, obesity, steroid use, poorly controlled diabetes, immunocompromised state, smoking, trauma, procedure site (intra-abdominal, pelvic, or extremity), extended preoperative hospitalization, inadequate preoperative skin hygiene, and existing infections at distant sites (Isaac et al., 2023).

1.2 Statement of the problem

In recent times, surgical Site Infections (SSIs) are a serious issue in surgical treatment, with a notable impact on patient outcomes and healthcare expenses (Sagawa, 2017). Although there have been significant global improvements in surgical methods and infection control practices, surgical site infections (SSIs) continue to be common, especially in impoverished nations such as Nigeria. The elevated prevalence of SSIs in these environments can be ascribed to various causes such as insufficient implementation of infection control protocols, limited availability of resources, and difficulties in healthcare provision. Surgical infections arise from the presence of microorganisms. Keller (2023) asserts that specific elective problems have the potential to be enhanced and should be prioritized prior to surgical operations. The determinants encompass smoking cessation, weight loss, normalization of the coagulation cascade, optimization of glucose control, and stabilization of other comorbidities. Procedure-related risk factors encompass elements such as substandard surgical procedures and skills, inadequate ventilation in the operating room (OR), insufficient application of skin preparation, and inadequate antibiotic prophylaxis, among others (Isaac et al., 2023).

The University of Uyo Teaching Hospital (UUTH), a prominent tertiary care facility in Akwa Ibom State, Nigeria, is particularly concerned about the problem of Surgical Site Infections (SSIs) because to its crucial role in delivering specialized medical services and training healthcare professionals (Nyong, 2023). Nevertheless, there is a scarcity of empirical data concerning the prevalence of surgical site infections (SSIs) at UUTH and the factors that contribute to their occurrence. The absence of data impedes the capacity to adopt efficient infection control measures and allocate resources effectively. The absence of extensive data on Surgical Site Infections (SSIs) at UUTH presents substantial obstacles in enhancing patient outcomes and optimizing infection control strategies. Implementing evidence-based interventions is challenging without a comprehensive grasp of the prevalence, contributing factors, and efficacy of existing practices. It is imperative to tackle these problems in order to enhance the standard of surgical treatment, decrease the occurrence of surgical site infections (SSIs), and ultimately enhance patient safety and healthcare results.

Objectives of the study

The primary objective of this study is to critically assess the prevalence of surgical site infection in Nigeria: a case study of University of Uyo Teaching Hospital. Specific objectives of this study are to:

To assess the current rate of surgical site infections among patients who undergo surgical procedures at the University of Uyo Teaching Hospital.

To analyze factors that contribute to the occurrence of surgical site infections in the University of Uyo Teaching Hospital

To evaluate adherence to infection prevention and control measures among healthcare personnel in the hospital

To propose recommendations aimed at reducing the incidence of surgical site infections in the University of Uyo Teaching Hospital

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the current rate of surgical site infections among patients who undergo surgical procedures at the University of Uyo Teaching Hospital?

What are the factors that contribute to the occurrence of surgical site infections in the University of Uyo Teaching Hospital?

What are the infection prevention and control measures practiced among healthcare personnel in the hospital?

What are the recommendations aimed at reducing the incidence of surgical site infections in the University of Uyo Teaching Hospital?

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 current rate of surgical site infections among patients who undergo surgical procedures at the University of Uyo Teaching Hospital is low.

Ha: The current rate of surgical site infections among patients who undergo surgical procedures at the University of Uyo Teaching Hospital is high.

1.6 Significance of the study

This study is important because it offers essential information on the frequency of surgical site infections, which has an impact on various elements of healthcare in Nigeria, such as enhancing quality, developing policies, allocating resources, and ensuring patient safety. The study will establish a fundamental reference point for the healthcare industry, medical professionals, surgical patients, legislators, students, and scholars. Gaining insight into the frequency of surgical site infections (SSIs) can provide a clear understanding of the magnitude of the issue inside the hospital and perhaps throughout Nigeria. 

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 utilized 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 

1.7 Scope of the study

Broadly, this study focus is to critically assess the prevalence of surgical site infection in Nigeria. Specifically, this study seeks to current rate of surgical site infections among patients who undergo surgical procedures in Nigeria and analyze factors that contribute to the occurrence of surgical site infections in Nigeria. Further, this study will focus on evaluate adherence to infection prevention and control measures among healthcare personnel in Nigeria and it also seeks to propose recommendations aimed at reducing the incidence of surgical site infections in Nigeria.

Geographically, the study is carried out in University of Uyo Teaching Hospital, Uyo, Nigeria. The respondents of the study include healthcare personnel, undergraduates and surgical patients in the University of Uyo Teaching Hospital.

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 prevalence of surgical site infection in Nigeria: a case study of University of Uyo Teaching Hospital. 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 University of Uyo Teaching Hospital, Uyo, Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. Furthermore, the researcher's restraints were predominantly attributable to financial limitations, as they are a student without a means of revenue to support themselves. The research location's high transportation costs, impacted by current inflation in Nigeria, made it difficult to afford transportation fees.

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.