Incidence and Risk Factors of Surgical Site Infections in Kathmandu University Hospital, Kavre, Nepal.

Background Surgical site infections (SSI) are the common nosocomial infection in surgical patients, and are a significant source of postoperative morbidity resulting in increased hospital stay, morbidity and cost. Objective The objective of this study was to obtain the incidence of SSI and determine various risks factors influencing the SSI rate with special reference to the National Nosocomial Infections Surveillance System risk index in Kathmandu University Hospital, Kavre, Nepal. Method Six hundred and thirty eight patients who underwent various surgeries in Dhulikhel Hospital, Kathmandu University Hospital during a three-month period were included. Using a pre designed questionnaire with follow up to 30 days and in orthopedic cases, where metal implants were used as internal fixation devices, with follow up to 90 days data were collected. Infected cases were identified using Centre for Disease Control and Prevention definition for surgical site infections. Swabs were obtained from wounds and were processed without delay using standard microbiological methods. Result Overall SSI rate was 2.6%. The most common pathogen isolated was Escherichia coli (5 isolates, 29.4 %). The SSI rate was 0.0% for clean wounds, 2.9%, 15.3% and 18.7% for clean-contaminated, contaminated and dirty wounds respectively. Increased incidence of surgical site infections were associated with higher grades of wound, emergency surgeries, American Society of Anesthesiologists score >2 and increased in National Nosocomial Infections Surveillance System risk index. Conclusion The incidence of SSI in this study meets the standard of center for disease prevention and control. Increases in surgical wound class, National Nosocomial Infections Surveillance System risk index, American Society of Anesthesiologist score >2 and emergency surgeries were associated with increased SSI rates.