Incidence and Risk Factors of Surgical Site Infections: Insights from Kakamega County General Hospital in Kenya

Abstract

Surgical site infections (SSIs) are common complications associated with increased morbidity, hospital stay and mortality amongst patients’ post-surgery. This poses a huge economic burden and reduced quality of life in low and middle-income countries (LMICs). Data on incidence and risk factors for SSI following surgeries in Kenya is limited. Guided by the infection chain theory, this cross-sectional study investigated the incidence and risk factors associated with surgical site infections amongst the post-surgery patients in Kakamega County General Hospital (KCGH). Pus swabs were collected from infected surgical sites suspected of SSI from 128 patients attending Kakamega County General Hospital in the year 2023. Demographic data was also collected from patients who underwent a surgical procedure at KCTRH. Risk factors were identified from patient demography while wound swabs were subjected to microbiological techniques according to the Centres for Disease control guidelines for SSI surveillance. Associations between identified risk factors and the occurrence of SSIs were examined using Chi-square (categorical) and t-test (Continuous). A total of 128 patients underwent a surgical procedure during the study period. The incidence of SSI was 66% (n=84). Seven bacterial species were isolated namely, Pseudomonas aeruginosa (22%), gram negative rods (15%), Staphylococcus aureus (9%), Klebsiella species (9%), Escherichia coli (7%), Klebsiella oxytoca (2%) and gram-positive cocci (0.8%). Incidence of SSI was 66% (n=84). Diabetes was 32%, obesity 41% and smoking 17%, among the pre-operative factors but showed no association with SSIs (p > 0.05). There was a correlation between longer surgeries and fewer SSIs (mean duration 114 minutes) and pre-operative stays did not significantly contribute to SSI risk. SSIs remain a challenge in LMICs. From this study, it was concluded that there is a continued systemic and procedural element in the onset of SSIs and highlights the role of post-operative practices in the prevention of SSIs. There is need for targeted interventions in the care of surgical wounds to mitigate the burden of SSIs in the region.