A detailed study by the Indian Council of Medical Research (ICMR) has uncovered that the rate of Surgical Site Infections (SSIs) at three leading hospitals in India is higher compared to several high-income countries. SSIs are a common and concerning complication associated with healthcare, significantly contributing to patient morbidity, longer hospital stays, and increased medical costs.

Study Overview and Key Findings:

The ICMR study involved a cohort of 3,020 patients from three major hospitals: Jai Prakash Narayan Apex Trauma Centre (JPNATC), Kasturba Hospital (KMC) in Manipal, and Tata Memorial Hospital (TMH) in Mumbai. Among the various types of surgeries, debridement procedures — often performed in conjunction with amputations or internal fixation surgeries (both open and closed) — were found to have the highest rate of SSIs, reaching 54.2%. This finding underscores the necessity for enhanced infection control measures in surgical practices, especially in high-risk procedures.

SSI Rates and Comparative Data:

The results of this study indicated that the SSI rates at the three Indian hospitals were higher than those typically reported in high-income countries, where SSI rates generally range from 1.2% to 5.2%. In comparison, the study revealed that 5.2% of patients in India developed SSIs. While this figure is lower than the rate of 8.95% found in Gujarat, it is still higher than the 5% SSI rate reported in Dehradun, India. Additionally, the rates observed in this study were also higher than those seen in countries like Iran (17.4%), Egypt (17%), and Pakistan (7.3%).

This research is noteworthy as it represents India's first large-scale, multicentric systematic effort to track SSIs, monitoring patients for up to six months after surgery. Out of 3,090 patients in the study, 161 developed SSIs, contributing to a 5.2% incidence rate. The authors emphasize that this study provides important insights into the prevalence and risk factors associated with SSIs in India.

Risk Factors and Post-Surgical Monitoring:

The study identified several critical risk factors associated with an increased likelihood of developing SSIs. One of the primary factors was the classification of wounds as clean but polluted, as well as surgeries that lasted longer than 120 minutes. These factors were strongly linked to a higher risk of infection following surgery.

Moreover, the study emphasized the significant role of post-discharge surveillance in identifying SSIs that might otherwise remain undetected. Around 66% of SSIs were identified through post-discharge surveillance. This finding is particularly significant, as there is a notable lack of data on post-discharge SSIs, especially in low- and middle-income countries like India. The absence of a comprehensive SSI surveillance system that covers the post-discharge period has been a major concern, and this study aimed to fill that gap by providing crucial data on SSIs occurring after patients leave the hospital.

The study also highlighted that combination surgeries — where multiple surgical procedures are performed on a patient simultaneously — were associated with an increased risk of SSIs. In fact, post-discharge surveillance identified 50% of SSI cases in patients who had undergone combination surgeries.

Impact on Healthcare Systems:

The findings of the study carry significant implications for healthcare systems, particularly in countries with limited resources for post-discharge monitoring. SSIs contribute to extended hospital stays and increased healthcare costs, which burden both patients and healthcare providers. The lack of post-discharge surveillance systems in India is a major gap in the healthcare infrastructure, which the study aims to address. The researchers propose that a multicentric analysis like this one is crucial to estimating the prevalence of SSIs and identifying the risk factors associated with their occurrence, both during the hospital stay and after discharge.

The study found that patients who developed SSIs experienced significantly longer hospitalizations. These prolonged stays not only increase the financial burden on healthcare systems but also delay patient recovery, potentially leading to more serious complications.

(Input from various sources)

(Rehash/Sai Sindhuja K/MSM)