ASSESSMENT OF MICROBIAL CAUSE OF SURGICAL SITE INFECTION AMONG POSTOPERATIVE PATIENTS IN FEDERAL TEACHING HOSPITAL IDO EKITI.

Abstract

This quantitative survey research aimed to examine the perceptions of healthcare professionals at Federal Teaching Hospital Ido Ekiti concerning surgical site infections (SSIs). A structured questionnaire was developed and administered to a sample of 120 respondents selected via convenient sampling. The study employed a rigorous quantitative survey research design to obtain detailed insights into the microbial causes, antibiotic susceptibility patterns, and associated risk factors of SSIs. Data collected were processed and analyzed using SPSS version 27, with the formulated hypotheses tested through t-tests. The findings revealed a significant association between specific microbial species and the occurrence of SSIs, underscoring the critical role of microbial factors in postoperative infections. Respondents also perceived a significant difference in the antibiotic susceptibility patterns of the microbial agents responsible for SSIs, which highlights the necessity for tailored antibiotic stewardship programs. Furthermore, the study demonstrated a statistically significant contribution of certain risk factors to the acquisition of microbial causes of SSIs among postoperative patients, emphasizing the importance of implementing targeted preventive measures. In conclusion, this study provides valuable insights into healthcare professionals’ perceptions of SSIs, with particular emphasis on the roles of microbial factors, antibiotic susceptibility patterns, and risk variables. The results establish a foundation for evidence-based practices aimed at improving patient outcomes and enhancing the quality of postoperative care. Recommendations include strengthening microbial surveillance protocols, conducting regular antibiotic susceptibility studies, and implementing customized antibiotic stewardship programs. Although the study offers important contributions, limitations such as the use of convenient sampling and the cross-sectional design should be acknowledged. Future research should incorporate diverse perspectives, including those of patients, to further deepen the understanding of surgical site infections.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Surgical site infections (SSIs) constitute a major and ongoing challenge in healthcare delivery, posing a substantial threat to patients who undergo surgical procedures. This issue extends beyond individual institutions, and Federal Teaching Hospital Ido Ekiti has similarly encountered difficulties related to postoperative infections. Such challenges have created an urgent need for comprehensive research to investigate the microbial causes of SSIs, given their considerable effect on patient recovery and overall outcomes.

In a prospective cohort study carried out in a teaching hospital in Ghana, Bediako-Bowan et al. (2020) stressed the value of surveillance in mapping the landscape of surgical site infections. Their results highlighted the necessity for detailed examination of microbial contributors to SSIs, reflecting the global dimension of the issue. Likewise, Pantvaidya et al. (2022) performed a propensity-matched analysis among patients undergoing major oncological surgery during the COVID-19 pandemic, illuminating the complex interplay between surgical interventions and infectious complications. This research drew attention to the shifting dynamics of SSIs, especially during major procedures in difficult circumstances.

Microorganisms including bacteria, viruses, and fungi are ubiquitous in the environment and can readily contaminate surgical wounds, thereby endangering patient recovery and well-being. Cappelli et al. (2022) offered notable observations from the COVID-19 pandemic, documenting surgical site infections in patients undergoing breast oncological surgery during lockdown periods. Their work illustrated the unforeseen difficulties introduced by the pandemic and reinforced the need for a more refined understanding of microbial causes in SSI development.

The incidence and etiology of surgical site infections among emergency postoperative patients were examined by Lubega et al. (2021) at Mbarara Regional Referral Hospital in South Western Uganda. Their findings revealed regional variations and the unique challenges confronting emergency postoperative cases, adding meaningful contributions to the wider body of knowledge on SSIs. El-Saed et al. (2020), in their Saudi Arabian study, drew attention to the substantial role and impact of resistant gram-negative pathogens in causing surgical site infections, emphasizing the escalating problem of antimicrobial resistance in postoperative settings.

Additional investigations have addressed the prevalence of particular microbial species implicated in SSIs across diverse environments. El-Kholy et al. (2020) reported a high prevalence of VIM, KPC, and NDM expression among pathogens isolated from surgical site infections in patients undergoing emergency surgery, thereby clarifying the range of microbial agents involved. Collin et al. (2019) carried out a systematic review and meta-analysis on Group B Streptococcus in surgical site and non-invasive bacterial infections globally, affirming the worldwide significance of specific microbial species in SSI contexts.

In a more localized context, Singh et al. (2021) investigated microorganisms isolated from postoperative wound infections among patients admitted to a hospital in Moradabad, India. This research reinforced the importance of comprehending local microbial profiles to develop effective, context-specific prevention and treatment approaches.

Ethiopia, similar to many other regions, contends with distinct challenges regarding surgical site infections. Shakir et al. (2021) studied Harari Region Public Hospitals in Eastern Ethiopia, offering insights into the magnitude, bacterial etiologies, associated factors, and antimicrobial susceptibility patterns among postoperative patients. Legesse Laloto et al. (2023) further advanced knowledge of SSIs in Ethiopia through a prospective cohort study on incidence and predictors.

The occurrence of postoperative wound infections at Ayder Teaching and Referral Hospital in Mekelle, Ethiopia, was explored by Mengesha et al. (2022), with a focus on aerobic bacteria and their antimicrobial susceptibility patterns. This work shed light on local microbial dynamics and resistance trends. Mulu et al. (2022) assessed postoperative nosocomial infections and antimicrobial resistance patterns of bacterial isolates at Felege Hiwot Referral Hospital in Bahirdar, Ethiopia, providing essential data for designing targeted treatment strategies.

Through a systematic review and meta-analysis, Birhanu and Endalamaw (2020) synthesized existing evidence on surgical site infections and their pathogens in Ethiopia. Their review underscored the requirement for interventions tailored to the predominant microbial causes within the Ethiopian setting.

The dynamic character of surgical site infections has become particularly apparent during the COVID-19 pandemic, as shown in studies by Collin et al. (2019), Pantvaidya et al. (2022), and Cappelli et al. (2022). These works collectively emphasize the ongoing need for research to adjust prevention and treatment strategies in response to evolving conditions.

1.2 Statement of Problem The continued prevalence of surgical site infections (SSIs) represents a pressing issue in healthcare, impacting patients who undergo surgery and presenting ongoing difficulties for institutions such as Federal Teaching Hospital Ido Ekiti. Despite improvements in surgical methods and infection prevention protocols, the sustained presence of SSIs demands a targeted investigation into the specific microbial causes and contributing factors.

This problem is clearly illustrated by Bediako-Bowan et al. (2020), whose prospective cohort study in a Ghanaian teaching hospital revealed persistent difficulties in surveillance and comprehension of the SSI landscape. Pantvaidya et al. (2022) further highlighted the changing nature of SSIs, particularly in major oncological surgeries conducted amid the COVID-19 pandemic, stressing the demand for flexible strategies.

Cappelli et al. (2022) revealed unexpected lessons from the pandemic, demonstrating how lockdown conditions created additional complexities in surgical site infections and intensifying the need to address underlying causes. Lubega et al. (2021) focused on emergency postoperative patients in Uganda, calling attention to the particular vulnerabilities of this group and the requirement for a detailed understanding of associated risk factors and microbial agents.

The substantial impact of resistant gram-negative pathogens, as documented by El-Saed et al. (2020), underscores the alarming growth of antimicrobial resistance and its added complications for postoperative care. The identification of specific resistance mechanisms such as VIM, KPC, and NDM by El-Kholy et al. (2020) further illustrates the broad array of microbial agents involved, necessitating customized intervention approaches.

Within the Ethiopian context, research by Shakir et al. (2021), Legesse Laloto et al. (2023), Mengesha et al. (2022), and Mulu et al. (2022) reveals the distinctive challenges encountered by postoperative patients, encompassing infection magnitude, bacterial causes, associated factors, and resistance patterns. This variety of evidence points to the multifaceted nature of the problem, requiring comprehensive strategies to tackle SSIs effectively at Federal Teaching Hospital Ido Ekiti and comparable facilities.

1.3 Objectives of the Study

1. To identify the prevalent microbial species causing surgical site infections among postoperative patients at Federal Teaching Hospital Ido Ekiti.
2. To assess the antibiotic susceptibility patterns of the identified microbial agents responsible for surgical site infections.
3. To evaluate the risk factors associated with the acquisition of microbial causes of surgical site infections among postoperative patients.

1.4 Research Questions

1. What are the predominant microbial species responsible for surgical site infections among postoperative patients at Federal Teaching Hospital Ido Ekiti?
2. What is the antibiotic susceptibility pattern of the identified microbial agents causing surgical site infections?
3. What are the risk factors associated with the acquisition of microbial causes of surgical site infections among postoperative patients?

1.5 Research Hypotheses Null Hypotheses (H₀):

1. There is no significant association between specific microbial species and the occurrence of surgical site infections among postoperative patients.
2. The antibiotic susceptibility patterns of microbial agents causing surgical site infections do not differ significantly.
3. Certain risk factors do not contribute significantly to the acquisition of microbial causes of surgical site infections among postoperative patients.

Alternative Hypotheses (H₁):

1. There is a significant association between specific microbial species and the occurrence of surgical site infections among postoperative patients.
2. The antibiotic susceptibility patterns of microbial agents causing surgical site infections differ significantly.
3. Certain risk factors contribute significantly to the acquisition of microbial causes of surgical site infections among postoperative patients.

1.6 Significance of the Study This research holds considerable importance in the healthcare sector, especially in relation to surgical procedures and postoperative management. A thorough understanding of the microbial origins of surgical site infections (SSIs) is essential for designing precise preventive strategies and effective treatment protocols. By clarifying the specific microbial causes, the study is expected to add meaningfully to current knowledge and serve as a valuable guide for healthcare professionals in strengthening infection control measures and improving patient outcomes.

The insights derived from this research have the capacity to transform approaches to infection prevention and control. Equipped with detailed knowledge of the microbial factors underlying SSIs, healthcare professionals will be better positioned to address the fundamental causes of postoperative infections. This will support the refinement of existing infection control practices to more effectively counter the specific microbial challenges encountered in surgical settings.

Moreover, the determination of prevalent microbial species and in-depth evaluation of their antibiotic susceptibility patterns constitute key elements of the study. These findings have immediate relevance for clinical decision-making, allowing practitioners to select appropriate antimicrobial agents with greater confidence. The capacity to choose antibiotics aligned with local susceptibility profiles not only improves treatment efficacy but also supports broader efforts to limit the development of antibiotic-resistant organisms. Through such targeted treatment approaches, healthcare providers can make important contributions to worldwide initiatives aimed at combating antimicrobial resistance.

1.7 Scope of the Study This research was carried out at Federal Teaching Hospital Ido Ekiti and focused on postoperative patients within a defined period. The study covered the identification of microbial causes of surgical site infections, evaluation of antibiotic susceptibility patterns, and investigation of associated risk factors.

1.8 Operational Definition of Terms Surgical Site Infections (SSIs): Infections that develop following a surgical procedure, affecting the incision site or the organ/space involved in the operation.

Microbial Agents: Pathogenic microorganisms, including bacteria, viruses, and fungi.

Antibiotic Susceptibility Patterns: The level of susceptibility or resistance exhibited by microorganisms to the effects of various antibiotics.

Prevalent Microbial Species: The most frequently identified and isolated microorganisms in cases of surgical site infections.

Risk Factors: Conditions or variables that elevate the probability of developing surgical site infections.

Postoperative Patients: Individuals who have undergone surgical procedures and are in the recovery period.

Infection Control Strategies: Protocols and measures adopted to prevent the development and transmission of infections in healthcare environments.

Antimicrobial Agents: Substances capable of destroying or inhibiting the growth of microorganisms, encompassing antibiotics, antivirals, and antifungals.