Incidence of Surgical Site Infection and Use of Antibiotics Among Patients who Underwent Caesarean section and Herniorrhaphy at a Regional Referral Hospital, Sierra Leone

Surgical site
infections (SSIs) are common postoperative complications. Surgical Antibiotic
Prophylaxis (SAP) can prevent the occurrence of SSIs if administered appropriately. We carried out a retrospective cohort study to determine
the incidence of SSIs and assess whether SAP were administered according to WHO
guidelines for Caesarean section (CS) and herniorrhaphy patients in Bo regional
government hospital from November 2019 to October 2020. The analysis included
681 patients (599 CSs and 82 herniorrhaphies). Overall, the SSI rate was 6.7%
among all patients, and 7.5% and 1.2% among CS patients and herniorrhaphy
patients respectively. SAP was administered preoperatively in 85% of CS and 70%
of herniorrhaphy patients. Postoperative antibiotics were given to 85% of CS
and 100% of herniorrhaphy patients. Ampicillin, metronidazole and amoxicillin
were the most commonly used antibiotics. The relatively low rate of SSIs
observed in this study is probably due to improved Infection Prevention and
Control (IPC) measures following the Ebola outbreak and the current COVID-19
pandemic. Good compliance rate with WHO guidelines for preoperative SAP was
observed. However, there was high use of postoperative antibiotics, which is
not in line with WHO guidelines. Recommendations were made to ensure
appropriate administration of SAP and reduce unnecessary use of antibiotics.

The study variables included presence of SSI, type of
surgical procedure (CS or herniorrhaphy), socio-demographic and clinical
variables, type of antibiotics given, timing and method of antibiotics (pre,
during or post-operatively; intravenously or orally).

For this study, an SSI was defined as any surgical wound
infection as a result of CS or herniorrhaphy occurring during a patient’s
admission up until 30 days after surgery. The rate was calculated as the number
of SSI cases as a percentage of the total number of surgical procedures during
the surveillance period. Diagnosis of SSI was based on clinical assessment by
the physician as culture and sensitivity were unavailable. The following
clinical features were considered as SSIs: presence of purulent (pus) discharge
coming from the wound, unexpected redness or pain, fever, or other signs of
sepsis.

Data from patient registers, the wound dressing book and
individual patient medical records were collected and double entered into
EpiData software by the principal investigator supported by three data clerks.
Data were collected over four months, double entered and validated using
EpiData (version 3.1, EpiData association, Odense, Denmark).
Data analysis was performed using EpiDataStat analysis
(v2.2.2.187) software. Descriptive data was summarised using median and
interquartile ranges and also frequencies and proportions.

National ethics approval was received from the Sierra Leone
Ethics and Scientific Review Board, Freetown, Sierra Leone. International
ethics approval (EAG number: 14/21) was given by the Union Ethics Advisory
Group of the International Union against Tuberculosis and Lung Disease, Paris,
France.