Post-Operative Wound Infections and its Risk Factors in Surgical Wards at Rajshahi Medical College Hospital

ABSTRACT


INTRODUCTION
Post-operative wound infections are a significant concern in surgical wards, often leading to prolonged hospital stays, increased healthcare costs, and patient discomfort [1].These infections not only impact patient recovery but also pose a considerable burden on healthcare systems worldwide [2].
Rajshahi Medical College Hospital, a prominent healthcare facility, witnesses a substantial number of surgical procedures annually.However, the prevalence of postoperative wound infections and the associated risk factors within this hospital's surgical wards remain understudied.Corresponding Author: Mahbuba Khanam Surgical site infections (SSIs) are a common type of healthcare-associated infection, accounting for a considerable proportion of hospital-acquired infections [3].They occur when bacteria or other pathogens colonize the surgical site, leading to local inflammation and potential systemic complications.The risk factors contributing to post-operative wound infections are multifaceted, encompassing patientspecific factors, surgical technique, and healthcare practices [4].Understanding the prevalence and risk factors of postoperative wound infections is imperative for devising effective preventive strategies.Previous studies have identified various risk factors such as pre-existing comorbidities, length of surgery, wound class, and adherence to aseptic practices [5,6].However, given the dynamic nature of healthcare practices, geographical variation, and patient demographics, it is crucial to investigate these factors within the context of Rajshahi Medical College Hospital.This study aims to address the gap in knowledge regarding post-operative wound infections and their associated risk factors in the surgical wards of Rajshahi Medical College Hospital.By elucidating the prevalence of these infections and identifying the specific risk factors, this research strives to contribute valuable insights that can guide infection control policies, surgical practices, and patient management strategies in the hospital setting.

OBJECTIVE General objective:
Post-operative wound infections and their risk factors in surgical wards at Rajshahi Medical College Hospital.

Specific objectives:
1. To find out the time of occurrence of post-operative wound infection.2. To observe wound management regarding sterilization of the instruments arrangement of the trolley, and so on.3. To observe hand washing of the doctor/ nurse with soap before and after dressing.4. To find out the relationship between post-operative wound infections and the socio-demographic characteristics of the patient.

METHODOLOGY Study Design:
This study employs a cross-sectional design to investigate the prevalence and risk factors of postoperative wound infections in the surgical wards of Rajshahi Medical College Hospital.

Study Setting:
The research was conducted at Rajshahi Medical College Hospital, located in Rajshahi, Bangladesh.The surgical wards within the hospital serve as the primary study setting.

Study Period:
January 2011 to August 2011.

Study Population:
The study population comprises patients who have undergone surgical procedures within the surgical wards of Rajshahi Medical College Hospital during the study period.

Sample Size and Sampling Technique:
A sample size of 300 participants is included in the study.The participants are selected using convenience sampling, considering feasibility and accessibility.

Data Collection:
Data is collected using structured questionnaires and observational techniques.The questionnaire is designed to collect information on demographic characteristics, hand hygiene practices, dressing techniques, sterilization practices, cleanliness of the environment, and patient-related factors.

Data Collection Process:
Trained data collectors administer the questionnaires to participants or their caregivers after obtaining informed consent.They also observe various factors related to wound care, hand hygiene, sterilization, and cleanliness within the surgical wards.Data collection takes place during a specified period to ensure consistency and uniformity.

DATA ANALYSIS
Descriptive statistics are used to summarize demographic characteristics and the prevalence of post-operative wound infections.Chi-square tests are performed to examine relationships between categorical variables (e.g., educational status and cleanliness).A p-value of 0.05 is used as the threshold for statistical significance.

Ethical Considerations:
Ethical approval is obtained from the Institutional Review Board (IRB) or Ethics Committee of Rajshahi Medical College Hospital before data collection.Informed consent is obtained from all participants or their legal guardians before their inclusion in the study.

Limitations:
Convenience sampling may introduce selection bias and limit the generalizability of the findings.The study's crosssectional design restricts the ability to establish causal relationships.Self-reporting and observation methods may introduce measurement biases.The study's findings may be context-specific and not fully representative of other healthcare settings.Corresponding Author: Mahbuba Khanam  The data shows the distribution of respondents' educational levels across different categories of dress cleanliness ("Clean" and "Not clean").Across all educational groups, a higher proportion of respondents reported patients with clean dresses.Notably, those with higher education levels, especially graduates and above, had the highest percentages of patients with clean dresses.However, the chi-squared statistical test yielded a value of 10.38 with 3 degrees of freedom and a p-value exceeding 0.05, suggesting no significant association between educational status and patient dress cleanliness based on the given data.

DISCUSSION
The findings of this study align with previous research highlighting the multifaceted nature of postoperative wound infections and the importance of infection control practices.Anderson et al. (2017) conducted a systematic review and meta-analysis, reporting that the overall incidence of surgical site infections (SSIs) varied widely across different surgical procedures, ranging from 2% to 20%.This wide range underscores the variability in risk factors and preventive measures across various surgical settings [7].Corresponding Author: Mahbuba Khanam In congruence with our findings, Tanner et al. ( 2009) conducted a study on colorectal surgery patients and emphasized the role of surgical care bundles in reducing the risk of SSIs by 38%.These bundles typically encompass a combination of interventions such as preoperative antimicrobial prophylaxis, optimal wound management, and postoperative surveillance.Our study's observations regarding dressing technique, sterilization of instruments, and cleanliness of the environment echo the importance of implementing such bundles to enhance infection control practices [8]. Bruce et al. (2015) emphasized the significance of standardized protocols and consistent surveillance for accurate assessment of post-operative wound infections.Our study's assessment of infection control practices, including hand hygiene compliance, sterilization of dressing materials, and cleanliness of the environment, resonates with their call for stringent monitoring and adherence to established protocols.Furthermore, their emphasis on quality measurement aligns with our focus on the relationship between educational status and infection control practices, as it highlights the need for a comprehensive understanding of factors affecting infection prevention [9].The lack of significant associations between educational status and cleanliness of bed sheets and patient dress is an interesting finding that might be influenced by cultural and contextual factors.In contrast, a study by Al-Tawfiq et al. (2013) found that lower education levels were associated with a higher risk of SSIs.This discrepancy could be attributed to variations in healthcare systems, cultural norms, and patient awareness between different regions and settings [10].
While our study contributes to the growing body of evidence on post-operative wound infections and infection control practices, several limitations should be acknowledged.The cross-sectional design restricts causal inference, and convenience sampling may introduce selection bias.Selfreporting and observational methods are susceptible to measurement biases.Furthermore, our findings, derived from a specific healthcare setting, might not be directly generalizable to other contexts.This study underscores the significance of infection control practices in reducing the burden of post-operative wound infections.By aligning with previous research on SSIs, surgical care bundles, and quality measurement, our findings reinforce the importance of standardized protocols, consistent surveillance, and tailored interventions.Future research could delve deeper into the contextual factors that influence infection control practices, potentially explaining the lack of significant associations between educational status and cleanliness.By addressing these challenges, healthcare systems can implement more effective preventive strategies and improve patient outcomes.

CONCLUSION
In conclusion, post-operative wound infections remain a significant concern in surgical wards, leading to increased morbidity, mortality, healthcare costs, and extended hospital stays.This study investigated the prevalence and risk factors associated with postoperative wound infections in the surgical wards of Rajshahi Medical College Hospital, Bangladesh.
The findings of this study underscore the complex interplay of patient-related, surgical, and healthcare-associated factors in contributing to the occurrence of postoperative wound infections.Patient-related factors, such as age, sex, and educational status, were examined alongside infection control practices, including hand hygiene, dressing techniques, sterilization of instruments and materials, cleanliness of the environment, and arrangement of equipment.The study identified that while infection control practices are vital, their adherence might be influenced by contextual factors.
Although the statistical analysis did not reveal significant associations between educational status and certain infection control practices, this observation might be influenced by cultural and regional variations.The study's contribution to the existing body of knowledge highlights the need for tailored interventions and systematic surveillance to address the challenges associated with post-operative wound infections.Future research endeavors could focus on an indepth exploration of the cultural and contextual factors influencing infection control practices in this setting.
Comparative studies across different healthcare contexts may provide valuable insights into the generalizability of findings.Implementation research could help bridge the gap between evidence and practice, leading to more effective preventive strategies and improved patient outcomes.This study serves as a stepping stone in the ongoing efforts to reduce the burden of post-operative wound infections.By addressing the multifaceted nature of these infections and adopting a comprehensive approach to infection control, healthcare systems can enhance patient safety and promote successful surgical outcomes.

RESULT Table 1. Distribution of the respondents by demographic variable (n=300).
Table1presents information on the demographic variables of the participants, including age, sex, education, occupation, and monthly family income.In terms of age, the respondents were categorized into different age groups.The largest proportion of participants fell into the 36-45 years age group (29.3%), followed by the 26-35 years age group (20.0%).The least represented age group was 16-25 years (9.0%).It also indicates the distribution of respondents based on their sex.Among the participants, 42.0% were male, while 58.0% were female.Regarding education, the respondents were divided into four categories.The majority (38.3%) had an education level up to class V, and 27.7% were illiterate.A smaller percentage had an education level up to class VI-XII (21.7%), and only 12.3% had a graduate education or higher.The most common occupation among the respondents was housewife (34.3%), followed by service (16.0%) and day labor (15.0%).

Table 2 . Distribution of the respondents by Hand washing and related factors (n=300).
3 Corresponding Author: Mahbuba Khanam

Table 3 . Relationship between the educational status of the respondents and cleanliness of the bedsheet.
2 = 0.41, df = 3, p > 0.05 Table3presents the relationship between the educational status of respondents and the cleanliness of their bed sheets.The respondents are categorized based on their education levels: Illiterate, Up to Class V, Up to Class VI-XII, and Graduate or higher.The table shows the distribution of respondents whose bed sheets are either clean or not clean within each education level category.Among the illiterate respondents, 61.4% had clean bed sheets and 38.6% did not have clean ones.Similarly, the percentages for the other education categories were as follows: Up to Class-V (clean: 60.9%, not clean: 39.1%), Up to class VI-XII (clean: 58.5%, not clean: 41.5%), and Graduate+ (clean: 64.9%, not clean: 35.1%).Overall, 61.0% of respondents had clean bed sheets, while 39.0% had not clean ones.The statistical analysis (chisquare test) indicates no significant relationship between education level and bed sheet cleanliness (χ² = 0.41, df = 3, p > 0.05).The table includes a total of 300 respondents.

Table 4 . Relationship between the educational status of the respondents and cleanliness of the dress of the patient. Educational status of the respondents Dress of the patient Total Clean Not clean
Based on the findings of this study, the following recommendations are suggested: 1. Enhance Infection Control Training: Implement regular training sessions for healthcare professionals on infection control practices, emphasizing proper hand hygiene, sterilization techniques, and dressing protocols.2. Standardized Protocols: Develop and implement standardized protocols for wound management, including preoperative preparation, antimicrobial prophylaxis, and postoperative surveillance.3. Contextualized Education: Tailor educational programs to address the specific educational backgrounds and cultural norms of patients, focusing on raising awareness about infection control practices.