Risk Factors for Healthcare Associated Infections after Elective General Surgery in Nepal

Abstract

Abstract Degree Project in Medicine: Risk factors for healthcare associated infections after elective general surgery at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. By Isak Moen Programme in Medicine, Sahlgrenska Academy, Gothenburg, Sweden, 2018 Background/Introduction: Healthcare Associated Infections, HAI, and the risk factors associated with it are poorly studied in low-income countries. It is known is that there is a higher incidence of HAI there compared to wealthier regions, and that the impact of HAI is greater both on patients and on the healthcare system itself. Apart from this details are scarce. Most studies have focused on patients undergoing emergency operations or patients admitted to intensive care units, leaving the incidence and risk factors for HAI for patients undergoing elective surgery an unexplored issue. Objectives: To determine the incidence of HAI, i.e. surgical site infections, blood stream infection, pneumonia and urinary tract infection in patients undergoing elective surgery at Tribhuvan University Teaching Hospital, Kathmandu, Nepal and to examine associated risk factors. Methods: A prospective cohort study of patients admitted to surgical wards following elective abdominal, urological, breast and thyroid operations between March 2nd 2018 and March 30th 2018. Patients were examined daily while admitted and followed up using a phone call questionnaire 30 days after their date of surgery. Results: Out of the 99 participants who were reached by phone call, none were diagnosed with infection. 4 had been diagnosed with HAI while admitted to hospital, resulting in a cumulative incidence of 4%. The incidence rate was 1.37 infections per 1000 patient-days, including follow-up. The cohort had a mean age of 47 years old. The sexes were evenly represented (47.5% female). 66% of the participants had no significant comorbidities. A third of the patients (33) had undergone laparoscopic cholecystectomy. 85% of performed surgeries were classified as clean or clean/contaminated. In the patients with HAI there was a higher incidence of pre-operative anaemia, and the surgeries they had undergone were to a higher extent major and 2 lengthy (time of surgery > 2 hours). The mean length of stay of patients with HAI was 31.5 days, compared with 5.86 days in the non-infected group. Conclusions: This comparatively low estimation of the incidence of HAI indicates that planned surgery in young and relatively healthy patients confers a low risk of infection.