Background
Methods
Study area
Study design and period
Population
Source population
Study population
Inclusion criteria
-
All 384 women who had surgery related to delivery and who developed surgical site infections in obstetrics ward at Assela teaching hospital
Exclusive criteria
-
Patients who died before the third post operative days were excluded, because SSIs cannot be diagnosed before three days of operative procedure.
-
Women referred from other health care facilities for the diagnosis of SSIs
-
Infection associate with minor procedures like episiotomy and stitch site infection
Sample size and sampling procedures
Data collection instrument and procedure
Data processing and analysis
Result
Socio-demographic characteristics of study population
Variable | Frequency | Percent | |
---|---|---|---|
Age | ≤ 19 | 23 | 13.9 |
20–34 | 309 | 63.9 | |
≥35 | 52 | 22.2 | |
Address | Urban | 166 | 47.2 |
Rural | 218 | 52.8 | |
Ethnicity | Oromo | 259 | 67.4 |
Amhara | 62 | 16.1 | |
Tigrie | 32 | 8.3 | |
Guragie | 20 | 5.2 | |
Other | 11 | 2.9 | |
Religion | Orthodox Christian | 136 | 35.4 |
Protestant | 61 | 15.9 | |
Muslim | 184 | 47.9 | |
Other | 3 | 0.8 | |
Occupation | House wife | 225 | 58.6 |
Civil servant | 100 | 26 | |
Farmer | 3 | 8 | |
Merchant | 56 | 14.6 | |
Educational Status | Illiterate | 77 | 20.1 |
Read &Write Only | 54 | 13.8 | |
Grade 1–8 | 68 | 17.7 | |
Grade 9–12 | 98 | 25.5 | |
Above grade 12 | 88 | 22.9 | |
Marital Status | Married | 383 | 99.7 |
Divorced | 1 | 0.3 | |
Average monthly income of Family | Less than 1000 | 175 | 45.6 |
1001–3999 | 107 | 27.9 | |
Greater than 4000 | 102 | 26.6 |
Types of surgical procedure
Indication | Frequency | Percent |
---|---|---|
NRFHBP | 121 | 31.5 |
CPD | 42 | 10.9 |
Protracted /arrest of cervical dilatation | 31 | 8.1 |
Previous two cesarean section scar | 21 | 5.5 |
Failed vacuum/forceps | 20 | 5.2 |
Macrosomia | 20 | 5.2 |
Failed induction/augmentation | 18 | 4.7 |
Other a
| 111 | 28.9 |
Total | 384 | 100 |
Magnitude of SSI
Variables | Category | Frequency(N = 36) | Percent |
---|---|---|---|
The time surgical site infection detected | Before discharge | 14 | 38.9 |
After discharge | 22 | 61.1 | |
Types of surgical site infections detected | Superficial | 11 | 30.5 |
Deep | 23 | 63.8 | |
Organ /space | 2 | 5.7 | |
Postoperative day SSIs detected | ≤ 7 | 19 | 52.7 |
8–14 | 16 | 44.4 | |
15–30 | 1 | 2.9 | |
Number of additional hospital stay due to SSIs | ≤ 7 | 7 | 19.4 |
8–14 | 19 | 52.8 | |
15–30 | 8 | 22.2 | |
≥31 | 2 | 5.6 |
Socio-demographic determinants of surgical site infection
Variable | Category | SSI |
Crude OR(95%CI)
| |
---|---|---|---|---|
Yes Number (%) | No Number (%) | |||
Age | ≤ 19 | 5(13.9%) | 18(52%) | 3.453(1.18–10.00) |
20–34 | 23(63.9%) | 286(82.2%) | 1 | |
≥35 | 8(22.2%) | 44(12.6%) | 2.26(0.95–5.37) | |
Residence | Urban | 17(47.2%) | 149(42.8%) | 1 |
Rural | 19(52.8%) | 199(57.2%) | 0.837(0.437–1.66) | |
Ethnicity | Oromo | 24(66.7%) | 235(67.5%) | 1 |
Amhara | 8(22.2%) | 54(15.5%) | 1.45(0.618–3.404) | |
Tigrie | 2(5.6%) | 30(8.6%) | 0.653(0.147–2.901) | |
Guragie | 1(2.8%) | 19(5.5%) | 0.515(0.066–4.020) | |
Other | 1(2.8%) | 10(2.9%) | 0.979(0.120–7.981) | |
Religion | Orthodox | 17(47.2%) | 119(34.2%) | 1.500(0.729–3.088) |
Protestant | 3(8.3%) | 58(16.7%) | 0.543(0.153–1.931 | |
Muslim | 16(44.4%) | 168(48.3%) | 1 | |
Other | 0 | 3(0.9%) | 0.000 | |
Occupation | House Wife | 26(72.2%) | 199(57.2%) | 2.047(0.815–5.14) |
Civil Servant | 6(16.7%) | 94(27%) | 1 | |
Farmer | 0 | 3(0.9%) | 0.000(0.000) | |
Merchant | 4(11.1%) | 52(14.9%) | 1.205(0.325–4.465) | |
Education Status | Illiterate | 10(27.8%) | 67(19.3%) | 1.727(0.64–4.783) |
Read and Write only | 2(5.6%) | 51(14.7%) | 0.454(0.091–2.270) | |
Grade 1–8 | 7(19.4%) | 61(17.5%) | 1.328(0.442–3.985) | |
Grade 9–12 | 10(27.8%) | 88(25.3%) | 1.315(0.478–3.617) | |
Above Grade 12 | 7(19.4%) | 81(23.3%) | 1 | |
Month Income | ≤ 1000 | 17(47.2%) | 158(45.4%) | 0.890(0.400–1.983) |
1001–3999 | 8(22.2%) | 99(28.4%) | 0.669(0.257–1.736) | |
≥4000 | 11(30.6%) | 91(26.1%) | 1 |
Association of surgical site infection and obstetric variable
Variable | Category | SSI |
Crude OR(95%CI)
| |
---|---|---|---|---|
Yes number (%) | No number (%) | |||
Parity | I | 11(30.6%) | 101(29%) | 1.343(0.595–3.034) |
II-IV | 15(41.7%) | 185(53.2%) | 1 | |
≥ V | 10(27.8%) | 62(17.8%) | 1.989(0.85–4.655) | |
ANC Follow Up | Yes | 26(72.2%) | 284(81.6%) | 1 |
No | 10(27.8%) | 64(18.4%) | 1.707(0.784–3.716) | |
Gestation Age | Preterm | 4(11.1%) | 10(2.9%) | 4.225(1.254–14.238) |
Term | 32(88.9%) | 338(97.1%) | 1 | |
Duration of Labor | ≤ 24 h | 24(66.7%) | 284(81.6%) | 1 |
≥25 h | 12(33.3%) | 64(18.4%) | 2.219(1.054–4.670) | |
Duration Rupture of Membrane | ≤12 h | 23(63.9%) | 318(91.4%) | 1 |
≥12 h | 13(36.1%) | 30(8.6%) | 5.991(2.757–13.022) | |
Chorioamnionitis | Yes | 6(16.7%) | 7(2%) | 9.743(3.077–30.848) |
No | 30(83.3%) | 341(98%) | 1 | |
Meconium | Grade III | 12(33.3%) | 83(23.9%) | 1.596(0.765–3.33) |
No | 24(66.7%) | 265(76.1%) | 1 | |
Total | 36 | 348 |
Surgical characteristics and surgical site infection
Variable | Category | SSI | Crude OR(95%CI) | |
---|---|---|---|---|
Yes Number (%) | No Number (%) | |||
Type of Anesthesia | Spinal | 30(83.3%) | 306(87.9%) | 1 |
General | 6(16.7%) | 42(12.1%) | 1.457(0.573,3.708) | |
Prior Cesarean section scar | Yes | 4(11.1%) | 38(10.9%) | 1.020(0.342,3.041) |
No | 32(88.9%) | 310(89.1%) | 1 | |
Circumstance of Surgery | Emergency | 31(86.1%) | 313(89.9%) | 0.693(0.253,1.898) |
Elective | 5(13.9%) | 35(10.1%) | 1 | |
Type of Operation | Cesarean section | 32(88.9%) | 338(97.1%) | 1 |
Abdominal hysterectomy | 3(8.3%) | 6(1.7%) | 7.922(1.698,36.960) | |
Uterine Repair | 1(2.8%) | 4(1.1%) | 2.641(0.286,24.340) | |
Type of Skin Incision | Vertical Incisions | 6(16.7%) | 14(4%) | 4.771(1.709,13.322) |
Transverse Incision | 30(83.3%) | 334(96%) | 1 | |
Time of antibiotic admission | With 30 min before surgery | 22(61.1%) | 252(72.4%) | 1 |
After operation | 14(38.9%) | 96(27.6%) | 0.662(0.138,2.624) | |
Type of antibiotic | Ampicillin | 26(72.2%) | 331(95.1%) | 1 |
Ceftriaxone &Metrindazole | 10(27.8%) | 17(4.9%) | 7.489(3.115,18.004) | |
Intraoperative blood loss | Less than 1000 | 35(97.2%) | 344(98.9%) | 1 |
Greater than 1000 | 1(2.8%) | 4(1.1%) | 2.457(0.267,22.595) | |
Perioperative Blood Transfusion | Yes | 7(19.4%) | 12(3.4%) | 6.759(2.471,18.489) |
No | 29(80.6%) | 336(96.6%) | 1 | |
Acute /Chronic medical problem | UTI | 0 | 12(3.4%) | 0.000 |
Pneumonia | 1(2.8%) | 8(2.3%) | 1.282(0.155,10.642 | |
HIV/AIDS | 1(2.8%) | 3(0.9%) | 3.420(0.344,34.021 | |
Diabetes mellitus | 4(11.1%) | 11(3.2%) | 3.731(1.112,12.519) | |
Other | 3(8.3%) | 37(10.6%) | 0.832(0.240,2.878) | |
No known illness | 27(75%) | 277(79.6%) | 1 |
Multivariate logistic regression analysis of risk factors of surgical site infection
Variable | Category | SSI | COR(95%CI) | AOR (95% CI) | |
---|---|---|---|---|---|
Yes Number (%) | No Number (%) | ||||
Age | ≤ 19 | 5(13.9%) | 18(52%) | 3.453(1.18,10.00) | 3.81(1.05,13.83) |
20–34 | 23(63.9%) | 286(82.2%) | 1.0 | 1.0 | |
≥35 | 8(22.2%) | 44(12.6%) | 2.26(0.95–5.37) | 2.13(0.79,5.73) | |
Duration Rupture of Membrane | ≤12 h | 23(63.9%) | 318(91.4%) | 1.0 | 1.0 |
≥12 h | 13(36.1%) | 30(8.6%) | 5.99(2.75–13.022) | 3.77(1.53,9.31) | |
Chorioamnionitis | Yes | 6(16.7%) | 7(2%) | 9.74(3.08–30.84) | 9.05(2.35,34.83) |
No | 30(83.3%) | 341(98%) | 1.0 | 1.0 | |
Perioperative Blood Transfusion | Yes | 7(19.4%) | 12(3.4%) | 6.76(2.47,8.49) | 7.78(2.37,25.54) |
No | 29(80.6%) | 336(96.6%) | 1 | 1.0 | |
Acute /Chronic medical problem | UTI | 0 | 12(3.4%) | 0.000 | 0.000 |
Pneumonia | 1(2.8%) | 8(2.3%) | 1.28(0.15,10.64) | 0.50(0.02,9.18) | |
HIV/AIDS | 1(2.8%) | 3(0.9%) | 3.42(0.34,34.02) | 3.14(0.25,39.0) | |
Diabetes mellitus | 4(11.1%) | 11(3.2%) | 3.73(1.11,12.52) | 5.41(1.45,20.11) | |
Other | 3(8.3%) | 37(10.6%) | 0.83(0.24,2.88) | 0.46(0.11,1.94) | |
No | 27(75%) | 277(79.6%) | 1.0 | 1.0 |