AN ASSESSMENT OF THE RISK FACTORS ASSOCIATED WITH SURGICAL SITE INFECTION

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Globally, surgical site infections (SSIs) provide a significant risk of sickness for patients undergoing surgery (Nichols, 2018). In the United States, there are around 500,000 infections per year out of an estimated 27 million surgical procedures. These infections make up about one quarter of the estimated 2 million infections acquired in healthcare settings each year in the United States. Surgical site infections (SSIs) are a significant type of healthcare-associated infections that occur within 30 days after a surgical treatment at the exact location where the surgery took place (CDC, 2023). These infections, although difficult, are thoroughly understood through a complex taxonomy that assists healthcare workers in their attempts to avoid and manage them. The Centres for Disease Control and Prevention (CDC, 2023) categorises surgical wounds into four distinct groups, each indicating a certain level of risk and possibility for infection (CDC, 2023). 

Apparently, prudent care is required for clean wounds, which are defined by their lack of infection and absence of inflammation, particularly while performing drainage operations. Clean-contaminated wounds go through the pulmonary, gastrointestinal, or genitourinary tracts while adhering to strict aseptic conditions. While it is recognised that there is a small chance of contamination, illnesses are still uncommon. Contaminated wounds are open wounds that show little failures in cleanliness or incisions that display intense or sterile inflammation. The realm of filthy or infected wounds refers to injuries that have not been properly treated and involve pre-existing infection or contamination with foreign material at the surgical site (CDC, 2023: O’Brien, 2023). Deep incisional surgical site infections (SSIs) penetrate into deeper layers of tissue, such as the fascia and muscle, and can occur within 30 days or up to a year if there is an implant present. Organ space surgical site infections (SSIs) are of utmost concern due to their significant morbidity and mortality concerns. This severe symptom emerges during a period of 30 days or one year (in cases involving implants) and affects the abdominal cavity, which is intricately handled throughout the surgical procedure (O’Brien, 2023).

Within the realm of healthcare-associated infections (HAIs), surgical site infections (SSIs) have a significant impact, contributing to a large part of illness, longer hospital admissions, and increased healthcare costs (Doyle, 2022). The CDC (2023) emphasises the significance of SSIs, allocating around 20% of HAIs alone to this category. SSIs have the greatest monetary impact, with an average yearly cost of USD 3.3 billion, according to the European Centre for Disease Prevention and Control Surveillance in 2023. In 2017, the European Centre for Disease Prevention and Control (ECDC) recorded a total of 10,149 surgical site infections (SSIs), providing a thorough overview of the occurrence and spread of these illnesses (ECDC, 2023). The sequence of SSIs became clear in the following manner: Superficial surgical site infections (SSIs) accounted for 47% (4739 cases), deep SSIs accounted for 30% (3088 cases), and organ/space SSIs accounted for 22% (2274 cases). Only a small proportion, specifically 0.5%, of the total reported SSIs could be attributed to a specific form of SSI, according to the ECDC (2023). Infections lead to extended hospital stays and increased expenses. Research has indicated that the duration of hospital stays significantly increased and the expenses associated with hospitalization rose accordingly when patients developed postoperative surgical wound infections (Green and Wenzel, 2017). Complex surgical procedures have a significant effect, resulting in a twentyfold increase in hospitalization duration and a fivefold increase in hospitalization costs (Taylor et al., 2019).

In poor and middle-income nations such as Nigeria, surgical site infections (SSIs) are a significant issue in worldwide healthcare, particularly where healthcare resources and infrastructure are frequently constrained. Surgical site infections (SSIs) are a significant factor in the rise of illness, longer hospital stays, and greater expenses in healthcare. Abiodun et al. (2023) state that in healthcare institutions across Nigeria, the act of bathing before surgery, locking the operating theatre door, and ensuring surgeons thoroughly clean their hands can have a significant impact on the outcome, potentially determining whether a patient lives or dies. In addition, factors such as restricted availability of sophisticated medical facilities, insufficient number of qualified healthcare professionals, and inconsistent adherence to infection control protocols can intensify the likelihood of surgical site infections (Okafor et al., 2023). Prior research has shown that the occurrence of Surgical Site Infections (SSIs) in Nigeria is more prevalent compared to numerous affluent nations, underscoring the necessity for targeted investigation in this domain. Therefore, the necessity for doing this investigation arises. Therefore, it is crucial to prioritise the prevention of SSIs as an essential part of patient care.

1.2 Statement of the problem

Surgical Site Infections (SSIs) are a grave consequence of surgical procedures that can have a substantial impact on patient well-being, extend hospital stays, and escalate healthcare expenses (Sagawa, 2017). In Nigeria, the presence of SSIs poses a significant public health problem due to a combination of variables, such as inadequate infection control procedures, insufficient resources, and a large number of patients. In the continuous effort to prevent surgical site infections (SSIs), a dual strategy is implemented, focussing on identifying risk factors that can be divided into two distinct categories: patient-related (intrinsic) variables and process/procedural-related (extrinsic) factors. The risk variables, which can be modified or non-modified, are crucial elements in the effort to prevent infections (Abiola et al., 2023). Factors that contribute to the danger for the patient include inherent aspects of the patient's health, such as pre-existing medical disorders or a weakened immune system. Modifiable patient-related risk factors may encompass behaviours such as smoking, drunkenness, or obesity. Behaviours such as smoking, alcohol addiction, or obesity have a significant impact on the process of wound healing and the functioning of the immune system. Smoking, as an instance, hampers the transportation of oxygen to tissues, a vital process for the purpose of healing, thus elevating the likelihood of infection (Okocha et al., 2023). Alcoholism can result in malnutrition and a decreased immune response, whereas obesity frequently hinders wound healing and raises the vulnerability of the tissue to infection (Ikott et al., 2023). Non-modifiable patient-related risk factors may encompass demographic variables such as age or gender (Abiola et al., 2023). Elderly individuals frequently experience diminished immune function and may have additional medical conditions that affect the surgical procedure and subsequent healing process, hence elevating the risk of surgical site infections (SSI). Sex-specific variables may impact the nature and frequency of surgeries conducted, hence affecting the risk of surgical site infections (SSI).

Although it is crucial to comprehend SSIs, there is a significant deficiency in research that explicitly investigates the risk factors linked to these infections in the Nigerian setting. This gap is a dilemma as it obstructs the progress of certain therapies and preventive actions that could greatly decrease the occurrence of Surgical Site Infections (SSIs). The lack of specific, geographically specific data on risk factors for SSI poses difficulties in formulating precise preventative strategies and enhancing patient outcomes. In the absence of a comprehensive comprehension of the specific risk factors associated with Nigerian hospitals and healthcare environments, attempts to address surgical site infections (SSIs) may prove to be unsuccessful or misguided. The objective of this study is to comprehensively evaluate the risk variables linked to surgical site infections (SSIs) in Nigeria. The study aims to identify and analyse these risk variables in order to provide practical insights that will assist healthcare professionals and policymakers in developing effective measures to decrease the occurrence of SSIs and improve patient safety nationwide.

Objectives of the study

The primary objective of this study is to critically assess the risk factors associated with surgical site infection. Specific objectives of this study are to:

To estimate the prevalence of surgical site infections among patients undergoing surgeries in healthcare facilities across Nigeria.

To determine the prevalent risk factors associated with surgical site infections (SSI) in Nigerian healthcare settings.

To evaluate current infection control practices in healthcare facilities across Nigeria.

1.4 Research Questions

What is the prevalence of surgical site infections among patients undergoing surgeries in healthcare facilities in Nigeria?

What are the prevalent risk factors associated with surgical site infections (SSI) in Nigerian healthcare settings?

What are the current infection control practices in healthcare facilities across Nigeria?

1.5 Research Hypotheses

Ho: There are no significant risk factors associated with surgical site infections (SSI) in Nigerian healthcare settings.

Ha: There are significant risk factors associated with surgical site infections (SSI) in Nigerian healthcare settings.

1.6 Significance of the study

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Through the identification of these risk factors, the study can offer valuable understanding into the fundamental causes of SSIs, enabling healthcare providers to conduct focused interventions and preventive measures. This has the potential to result in a decrease in SSI (surgical site infection) rates, shorter durations of hospitalisation, and enhanced recovery periods for patients. The study's findings will enhance the education and training of healthcare workers. The study aims to identify and emphasise the factors that increase the likelihood of surgical site infections (SSIs). This information may be used to enhance training programs and ongoing education efforts, ensuring that healthcare workers have the necessary knowledge and skills to successfully prevent and handle SSIs.

Moreover, the study will provide insight into the efficacy of existing infection control measures and identify areas that might be enhanced. By conducting a comprehensive evaluation of risk factors, healthcare organisations can enhance their infection control protocols, implement optimal strategies, and guarantee improved adherence to hygiene and sterilisation requirements. Ensuring a safer surgical environment and minimising the risk of SSIs is crucial.

Moreover, In Nigeria, healthcare resources are frequently constrained and unequally allocated. The study can direct resource allocation to areas of highest need, such as enhancing infrastructure, educating healthcare personnel, and acquiring essential equipment, by identifying the primary risk factors for SSIs. Moreover, the discoveries can provide valuable insights for the formulation of policies, resulting in the implementation of more efficient health policies at both national and local levels with the objective of diminishing SSIs.Ultimately, this study will establish a fundamental basis for future investigations on SSIs in Nigeria and comparable environments. The study will establish crucial risk variables and uncover existing knowledge gaps, so facilitating future investigations to expand on its discoveries and enhance surgical care and infection control methods.

1.7 Scope of the study

Broadly, this study focus is to critically assess the risk factors associated with surgical site infection in Nigeria. Specifically, this study seeks to determine the prevalent risk factors associated with surgical site infections (SSI) in Nigerian healthcare settings and estimate the prevalence of surgical site infections among patients undergoing surgeries in healthcare facilities across Nigeria.Further, this study will focus on evaluating current infection control practices in healthcare facilities across Nigeria and it also seeks to offer strategies to mitigate the identified risk factors associated with surgical site infections in Nigerian healthcare settings. The study is carried out in Nigeria. The respondents of this study will include patients who have undergone surgery in selected hospitals and healthcare workers involved in surgical care.

1.8 Limitations of the study

Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the dearth of comprehensive literature on the topic, given the scarcity of data pertaining to assessment of the risk factors associated with surgical site infection. Therefore, a substantial investment of time and effort was required to identify the suitable materials, books, or information and to collect data. Moreover, this study is limited by its diminutive sample size and restricted geographical range, concentrating just on Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. 

Furthermore, the researcher's restraints were predominantly attributable to financial limitations, as they are a student without a means of revenue to support themselves. The research location's high transportation costs, impacted by current inflation in Nigeria, made it difficult to afford transportation fees.In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits.

1.9 Definition of terms

Surgical site infections: This infection occurs beneath the incision area in muscle and the tissues surrounding the muscles. Organ or space SSI. This type of infection can be in any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. This includes a body organ or a space between organs

Nosocomial infections: Nosocomial infections are infections patients acquire while admitted to a health-care facility and generally develop 48 hours or later after admission. These infections can lead to serious problems like sepsis and even death.

Asepsis: Asepsis is a condition in which no living disease-causing microorganisms are present. Asepsis covers all those procedures designed to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved 'no touch' technique.

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