Incidence and predictors of surgical-site infections in Vietnam

OBJECTIVE: To determine the incidence of, and risk factors for, surgical-si te infections (SSIs). DESIGN: Prospective observational study of all patients undergoing surgery during a 3-month period. SETTING: Two urban hospitals in Hanoi, Vietnam. PATIENTS: All 697 patients admitted for emergent and elective surgery. METHODS: Data were collected on all patients undergoing surgery during a 3- month period at each hospital. We stratified the data by type of surgery, w ound class, and Study on the Efficacy of Nosocomial Infection Control (SENI C) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identi fied using a logistic-regression model. RESULTS: During the period of observation, 10.9% of 697 patients had SSI. T he SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% f or contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and hig h-risk patients, 24.2%. In a logistic-regression model, abdominal surgery ( odds ratio [OR], 4.46; P < .01) and wound class IV (OR, 5.67; P < .01) were significant predictors of SSI. All patients were treated with prolonged co urses of perioperative antibiotics. Overall infection control practices wer e poor as a result of deficient facilities, limited surgical instruments, a nd a lack of proper supplies for wound care and personal hygiene. CONCLUSIONS: There was a higher incidence of SSI in low-risk patients in Vi etnam compared with developed countries. Excessive reliance on antimicrobia l therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program wit h guidelines for antimicrobial use should improve the use of prophylactic a ntibiotics and attention to proper surgical and wound-care techniques. Thes e interventions also should reduce the incidence of SSI and its associated morbidity and costs (Infect Control Hosp Epidemiol 2001;22:485-492).