FACTORS INFLUENCING POST OPERATIVE WOUND INFECTION AMONG PATIENTS IN SOME SELECTED HOSPITALS IN BUEA HEALTH DISTRICT

ABSTRACT

Postoperative wound infections have been responsible for increase cost, mobility, mortality, increase hospital stay in an infected patients and continues to be major problem worldwide.  Despite improvements on the management of postoperative wound, instrument sterilization methods and the best efforts of infection prevention strategies to promote healing, postoperative wound infection remain a major cause of hospital acquired infection in surgical patients in most of the developing nations.  The main objective of this study was to asses “knowledge on the factors influencing post operative wound infection in some hospitals in Buea Health District.  A descriptive cross-sectional design was used.  The main instrument for data collection was a structured questionnaire; the questionnaire was made up of straight forward questions.  The data collected was analyzed using SPSS Package and results presented in pie charts, and tables.  Majority of the patients in Buea Health District have very little knowledge about postoperative wound infection.  Majority of the patients encounter challenges like inadequate hygiene from the healthcare workers during wound dressing especially in the regional hospitals. Nurses should carry out research and seminars on postoperative wound care and hygiene so as to improve on the management of postoperative wound infection.  thus preventing complications which may result due to poor management like surgical site infection and prolong patient stay in the hospital.

CHAPTER ONE

GENERAL INTRODUCTION

1.1.Background

Postoperative wound infections or surgical site infections are infections that occur for about a week or a month after the surgical pertain or one year if implant is placed (Smith et al; in Clinical practice guideline surgical site infections).  Postoperative wound infection has always been a major complication of surgery and trauma.  They are the major cause of morbidity and mortality worldwide, affecting 5.6% surgical procedures in developing countries.  (Allegraniz Nejad et al; 2011 in Burden of endemic health care-associated infections in developing countries)

According to world health organization (WH) report, the incidence of postoperative wound infection ranges from 1.2 5o 23.6 per 1000 surgical procedures.  (Organization WH; The burden of health care associated infections worldwide; A summary in 2010).  Worldwide it has been reported that more than one third of postoperative deaths are related to postoperative wound infections.  (Arman et al., Rate and risk factors associated with surgical site infections in a tertiary care center in southwestern Nigeria 2013).  In addition, postoperative wound infection threatens the life of millions of patients each year and contributes to the spread of antibiotic resistance (organization WH preventing surgical site infections implementation approach for evidence based recommendation, 2018).

The incidence of postoperative wound is higher in developing countries then in developing countries. (Curci et al., Surgical site in elective clean and clean-contaminated surgical in Developing countries Int. infect Dis. (2019) and has been reported as the second most common cause f hospital acquired infection (HAI) in Europe and in the United states of America (USA) (Palumb et al., WH Global guidelines for the prevention Of surgical site infections; A new step to improve patients safety before, during and after surgery 2016; 2017. Approximately 2-5% of surgical patients Worldwide have developed postoperative infections (PI) (Smyth et al in fur countries health care associated infection prevalence survey 2006) are the most frequent type of hospital infections in our low and middle income countries (LMICS) and affect up to a third of patients who have undergone a surgical procedure (Danzmann et al., Health care worker causing large Nscmia outbreak). In Africa and especially in Cameron postoperative infections are the most leading cause of death in the hospitals. (Nejad et al., in Health –care-associated infection in Africa; a systematic review. Bull World Health organization 2011)

According to recent evidence, the risk factors for postoperative wound infections are so many and complex, for instance, pre-existing illness, (Mulu. et al., in Associated risk factors for postoperative nosocomial infections amongst patients admitted at Hiwt referral hospital, Bahir Dar Northwest Ethiopia) wound contaminations, American society of Anesthesiologist , (ASA) score 3-4 (A prospective study of the incidence of surgical wound infection at the NNANDZI AZIKIWE UNIVERSITY teaching hospital), non-used prophylactic antibiotics, presence of hypovolemic, longer duration of pertain, longer preoperative hospital stay, postoperative hospital stay, advance age, alcohol use, previous surgery, use of drain, use of iodine alone in skin preparation, smoking, absence of wound care, and hair removal inside operatives room. These are the factors associated with postoperative wound infection.

Globally the prevalence of postoperative complications ranges from 50%to 75%of postoperative patients (Philip & Schroeder, 2007). In United Kingdom, a recent study has reported that 30% of postoperative patient experienced pain post-surgery (Hussain et al., 2011). Insub-Saharan Africa, there are variations of postoperative complication reported from one place to another.  In Nigeria, it was reported that 95% of postoperative patients experienced various degrees of postoperative pain (Kolawole et al., 2003).

In Cameroon, a study conducted on postoperative wound management following major abdominal and thoracic operations found that 40% of patients experienced complications during postoperative management (Ocitti et al., 2000). It was reviewed that Nurses had low level of practice and high level of knowledge with a mean of 20.6% on postoperative wound care (Ameh, et al., 2009).

In every major surgery, a patient has 2-5% chances of developing an infection, at the site of incision and those who get these infections are more likely to stay in the hospital twice as long as patients without infections (Mathieu, et al., 2006). The infected patients usually suffered from pain, discomfort and often die in the process when the wound is poorly managed.

1.2. Statement of Problem

Postoperative wound infections have been responsible for increase cost, morbidity, mortality, increase hospital stay in an infected patients and continues to be a major problem worldwide. Despite improvements on the management of postoperative wound, instrument sterilization methods, and the best efforts of infection prevention strategies to promote healing, postoperative wound infections remain a major cause of hospital acquired infections in surgical patients in most hospitals in most developing nations (Anieski et al., 1998. Postoperative wound infection).  In every major surgery, a patient has chances of developing an infection, at the site of incision and those who get these infections are more likely to stay in the hospital twice as long as patients without infections. The infected patients usually suffered from pain, discomfort and often die in the process when the wound is poorly managed.  Buea Health District Hospitals have an increase rate of poor management of postoperative wound care due to negligence of the patients and therefore when patients have a very poor attitude it is going to rendered the health of the wound likewise the patients. This study shall be carried out to determine factors influencing postoperative wound infections among patients.

1.3.Rationale

It is important to do this finding and study these factors influencing postoperative wound infections in other to educate patients more about postoperative wound infection creating awareness about this situation in the world especially in the less and developing countries such that solutions can be made to combat this problem in Cameron specifically in the southwest region.

1.4.Research question

• What knowledge do the patients have about postoperative wound infection in Buea Health District Hospitals?
• What are the factors influencing postoperative wounds infections in Buea Health District Hospitals?