English

Abstract

INTRODUCTION : Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. The most widely recognized definition of infection, which is used throughout the United States and Europe, is that devised and adopted by the Centre for Disease Control and Prevention. An SSI is defined as an infection occurring within 30 days of surgery that meets the following criteria: the diagnosis consists of the infection of an anatomic plane by one of the following manifestations: collection, inflammatory signs (pain, edema, tenderness, redness), dehiscence, or positive culture; and classification according to the anatomic plane as follows: superficial incisional SSI, infection of the skin and subcutaneous tissue; deep incisional SSI, infection of the deep soft tissue (fascia and muscles); and organ/space SSI, infection of the organ/space. In this study, SSIs were categorized by the above classifications. A system of classification for surgical wounds that is based on the degree of microbial contamination was developed by the US National Research Council group in 1964. Four wound classes with an increasing risk of SSI were described: clean, clean-contaminated, contaminated, and dirty. In this study, SSIs were researched based on each of the wound classes. AIM OF THE STUDY : To assess abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. OBJECTIVES OF THE STUDY : 1. To compare the incidence of superficial SSI in laparotomy incisions closed with coated polyglactin910 suture with triclosan versus incisions closed with coated polyglactin910 suture without triclosan. 2. To study the time frame between surgery and development of SSI. 3. To determine which bacteria is commonly associated with SSI after laparotomy closure. MATERIALS AND METHODS : Source of Data: 1. The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. 2. Type of subject: all patients undergoing emergency laparotomy procedure for any cause. 3. Choosing subjects: number to be studied: 70-divided as 35 in each group. This number was chosen keeping in mind the time restrictions of the study, the feasibility and ease of calculations. Inclusion criteria : 1. All patients above the age of 18 yrs requiring a laparotomy. 2. All superficial SSI (skin and subcutaneous layer only) developing within a 30 day period post-surgery, as per the traditional definition. Exclusion criteria : 1. Patients<18 yrs. of age. 2. Deep SSI or Organ space SSI. 3. Wound infections occurring beyond the 30 day time period post-surgery. CONCLUSION : In conclusion since there was a definite advantage inferred to the patients by using triclosan coated polyglactin 910, it is the opinion of the researcher that triclosan coated sutures has a role to play in reducing SSI in clean-contaminated, contaminated and dirty wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery. Microbialogical culture and sensitivity should be done, for all the patients who developed SSI so as to elucidate local causative agents and the most effective drugs. Microbiological testing for local patterns of resistance to triclosan should also be done. Prudent use of antimicrobial so as to reduce the development of drug resistance.