Postoperative wound infection to the orthopaedic patients, Khartoum Teaching Hospital, Orthopaedic department

Abstract

This study was carried in the period from 17/3/2003 to 16/7/2003 (four months duration) in Khartoum teaching hospital(K.T.H.), in the orthopaedics and traumatology department. The study objectives were to know the actual rate of postoperative wound infection(POWI), to know the pattern of its presentation and to know the effect of some risk factors in the causation of POWI. An initial questionnaire was filled to all patients who had clean elective orthopaedic procedure during the above mentioned period. The questionnaire was filled just prior to the performance of the procedure. A second questionnaire was filled for each patient each time he came for follow-up. During this period 319 patients to whom 329 clean elective procedures were performed, were included in the study. Two patients were known to die during the follow up period.From the rest, we were able to follow 153 patients (46.1%).. Follow up ranged from 9 days to 105 day, with a mean of 42.7 days and standard deviation of 22.38. For the patients who were followed up females were 37 (24.2%) and males were 116 (75.8%). Age ranged from 0.5 year to 85 years, with the mean age of 35.3 years, and standard deviation of 21.7. Half of the patient (49.7%) were below 30 years. Femur was the site of operation of almost half of the patients (49.0%) and fractures accounted for (79.7%). Postoperative wound infection was found in 9 out of 153 patients (5.9%). The superficial infection was found in 4 patients (2.6%) superficial and deep in 5 patients (3.3%). All the patients with superficial infection and one with deep and superficial infection had complete resolution. But 4 out of 5 patients with deep and superficial infection ended in chronic osteomylitis. POWI was found to be related to the type of operation (P=0.004). Plating was a significant factor in causing POWI. Four (4) out of five (5) who had deep POWI, had the operation of plate and screw. The 5th patients had DHS, which is actually a variant of plate and screw. POWI was also found to be related to the duration of operation( P=0.008). All operations that developed deep POWI took more than one hour. Out of the nine patients with postoperative wound infection, cultures were done to six patients. All patients with deep and superficial infection had cultures. Staphylococcus aureus was isolated from four (4) patients, streptococcus group B from one, and, coliform bacteria from the other. The study recommended urgent intervention to reduce this significant high rate of deep POWI, special attention to plating which was in particular associated with POWI and one antibiotic policy to all units.We also recommended a system of continuous statistics concerning POWI.