RISK FACTORS AND ETIOLOGIES OF CLEAN AND CLEAN CONTAMINATED SURGICAL SITE INFECTIONS AT A TERTIARY CARE CENTER IN MALAYSIA

Surgical site infections (SSI) are among the most commonly encountered healthcare associated infections (HCAI). Identification of the risk factors and its causative agents may inform prevention and management strategies. The objective of this study was to determine risk factors and etiological agents of SSI and their sensitivities. We conducted a prospective cohort study at Hospital Universiti Sains Malaysia from June 2013 to July 2014. Seventy-two patients who underwent clean and clean-contaminated surgeries were included in the study. Each studied patient was followed for 30 days post-operation. Tissue samples or wound swab specimens were obtained and sent for culture and sensitivity testing. Among the patients who developed an infection during the 30 day follow-up period, patients with the highest rates of SSI were those who had undergone coronary artery bypass graft (CABG) surgery (50%, n=8) followed by thyroid surgery (15%, n=2), laparoscopic cholecystectomy (12%, n=2) and herniorrhaphy (4%, n=1). Risk factors significantly associated with a SSI on multiple logistic analysis were: having a history of diabetic mellitus (DM) (OR=6.97; 95% CI: 1.49-32.71) and having undergone CABG surgery (OR=5.54; 95% CI: 1.22-25.03). Antibiotic sensitive gram negative bacilli were the most common organisms identified. Patients with DM and those undergoing CABG surgery were those at greatest risk for developing a SSI in the study population. Diabetic patients need to be monitored more carefully post-operatively for SSI and infection control procedures for patients undergoing CABG surgery need to be reviewed and upgraded.