A study of the rate of wound infection in contaminated and dirty emergency exploratory laparotomies.

Abstract

Introduction: Wound infections are amongst the most commonly occurring nosocomial infections, greatly increasing the mortality as well as morbidity of patients, in addition to prolonging the hospital stay thus increasing cost. Possible factors affecting the rate of wound infection may be age, sex, nutritional status, comorbidities, type of antibiotic protocol, type of procedure, technique of wound closure and perioperative blood transfusion. Certain factors need to be further evaluated, like the interval between admission and surgery, the interval between onset of acute symptoms and surgery. This study was undertaken to determine the rate of wound infection in contaminated and dirty exploratory laparotomies using the performed on an emergency basis and the possible factors for the same. Materials and Methods: It was a prospective study carried out a tertiary care hospital after obtaining institutional ethics committee clearance. 67 cases were included after written informed consent. Each wound was assessed for the presence of infection by the ASEPSIS scoring method. Data relevant to the patient (age, sex, co-morbidities); related to the surgery (indications, findings, lavage, wound closure, antibiotic protocol); and related to the post operative period (evaluation by the ASEPSIS Scoring system, culture reports of wound discharge if present) was collected. Results: The overall rate of wound infection was 8.95 %. The individual significant risk factors for surgical wound infection were the interval between onset of acute symptoms and surgery > 2 days, interval >24 hours between admission and surgery, duration of surgery > 150 mins and type of procedure (resection anastomoses or stoma). Escherechia Coli and Klebsiella pneumoniae were the prevalent microorganisms. The median length of postoperative stay in infected patients was increased by 14.5 days, which was significant. Conclusion: Early seeking of treatment by patients requiring abdominal surgeries, and timely diagnosis and management of his/her condition along with following of appropriate antibiotic and operative protocols may lead to a significant decrease in the incidence of postoperative wound infections.