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.