Assessment of Bundle of Measures Perioperatively to Decrease the Incidence of Surgical Site Wound Infection in Patients Undergoing Abdominal Hysterectomies

Abstract

Background: Surgical site infections (SSIs) are the second most common reason for unplanned hospital readmissions after hysterectomy and result in increased morbidity and health care costs. The estimated rate of SSI after hysterectomy varies between 1% and 4%. The objective of the study is to investigate if a bundle of perioperative measures (as stated earlier) reduces down the incidence of post-operative surgical site wound infection after abdominal hysterectomy. Materials and Methods: The present prospective study was carried out on total 200 women who were undergo hysterectomy in the operation theater of Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital due to gynecological conditions requiring hysterectomy. Four perioperative bundles of measures are considered – 1. chlorhexidine gluconate and Cetrimide solution (Savlon) wash of the operative field 1 h before the operation, 2. administration of single dose antibiotic (Inj. Ceftriaxone 1 g intravenous) 1 h or less before the incision, 3. vaginal wash with povidone-iodine, and 4. sterile dressing is to be maintained and removed postoperatively after 48 h. Result: We found that in case, 94 (94.0%) patients had Ceftriaxone and 6 (6.0%) patients had clindamycin and gentamicin. In control, 96 (96.0%) patients had ceftriaxone and 4 (4.0%) patients had clindamycin and gentamicin. Association of choice of antibiotic versus group was not statistically significant (P = 0.5164). In case, 6 (6.0%) patients had wound gaping. In control, 11 (11.0%) patients had wound gaping. Association of wound gaping versus group was statistically significant (P = 0.048). Conclusion: The present study found that hospital stay was more in control compared to case which was statistically significant. Fever was more in control compared to case which was statistically significant. In this study, local wound discharge was more in control compared to case which was statistically significant. It was found that wound gaping was more in control compared to case which was statistically significant.