Project – Incidence of Surgical Site Infections (SSIs) Among Patients Undergoing Major Surgery in Nigeria

CHAPTER ONE

1.1 Background to the Study

Surgical site infections (SSIs) are among the most common healthcare-associated infections globally, particularly in developing countries. According to the World Health Organization (WHO, 2016), SSIs account for up to 60% of all healthcare-associated infections in low- and middle-income countries (LMICs). These infections occur within 30 days of a surgical procedure or within a year if an implant is placed and are classified based on their depth and location—superficial incisional, deep incisional, and organ/space infections (Mangram et al., 1999).

In Nigeria, SSIs remain a significant cause of postoperative morbidity, leading to increased length of hospital stay, additional surgical interventions, higher treatment costs, and increased mortality rates (Ameh et al., 2009). The risk factors are multifactorial, including patient-related factors (e.g., diabetes, age, immune status), surgical factors (e.g., type and duration of surgery, wound classification), and institutional factors (e.g., sterilization practices, antibiotic use, and staff hygiene) (Oguntibeju et al., 2009).

Despite global advancements in surgical techniques, antisepsis, and infection control, Nigeria continues to struggle with a high incidence of SSIs, especially following major surgeries such as abdominal, orthopedic, and obstetric procedures (Nwankwo et al., 2014). Factors such as inadequate infection control protocols, lack of infrastructure, delayed wound healing due to malnutrition, and inconsistent use of prophylactic antibiotics contribute significantly to this burden.

Understanding the incidence of SSIs among patients undergoing major surgeries in Nigeria is essential for formulating targeted interventions and improving surgical outcomes. This study aims to provide empirical data on the incidence and contributing factors of SSIs in Nigerian tertiary hospitals.

1.2 Statement of the Problem

Despite the availability of standard infection prevention guidelines, surgical site infections continue to pose a major challenge in Nigeria’s healthcare system. The lack of consistent surveillance, poor adherence to aseptic techniques, and limited capacity for post-operative monitoring significantly contribute to high infection rates. Studies have reported that SSI incidence in Nigerian hospitals ranges from 10% to 33%, which is considerably higher than the 2% to 5% reported in high-income countries (Ogundeji et al., 2017).

This elevated incidence has far-reaching consequences. Patients suffer from prolonged hospital stays, re-admissions, and in some cases, death. For hospitals, SSIs translate into increased resource utilization and strained healthcare delivery. Yet, there is insufficient local data on the incidence of SSIs following major surgeries in Nigeria, making it difficult to implement effective control measures. This study seeks to address this gap by assessing the current incidence of SSIs and identifying associated risk factors in selected Nigerian hospitals.

1.3 Objectives of the Study

The broad objective of this study is to assess the incidence of surgical site infections among patients undergoing major surgery in Nigeria. The specific objectives are to:

1. Determine the incidence rate of SSIs among patients undergoing major surgery in selected Nigerian hospitals.

2. Identify the common types and classifications of SSIs observed.

3. Examine patient-related and surgery-related risk factors associated with the occurrence of SSIs.

4. Suggest strategies to reduce the incidence of SSIs based on the findings.

1.4 Research Questions

1. What is the incidence rate of surgical site infections among patients undergoing major surgeries in Nigeria?

2. What are the most commonly observed types of surgical site infections?

3. What patient-related and surgery-related factors contribute to the development of SSIs?

4. What practical strategies can be employed to minimize the incidence of SSIs in Nigerian hospitals?

1.5 Research Hypotheses

• H₀₁: There is no significant relationship between patient-related factors (such as age, comorbidities, and immune status) and the incidence of SSIs among patients undergoing major surgery.

• H₁₁: There is a significant relationship between patient-related factors and the incidence of SSIs among patients undergoing major surgery.

• H₀₂: Surgical factors (such as duration, wound classification, and type of surgery) have no significant effect on the incidence of SSIs.

• H₁₂: Surgical factors have a significant effect on the incidence of SSIs.

1.6 Significance of the Study

This study holds considerable significance for healthcare providers, policymakers, and patients. It contributes to a better understanding of the current trends in SSIs among patients undergoing major surgeries in Nigeria. By identifying the factors influencing SSI rates, the study can guide clinicians in risk assessment and management before and after surgery. The findings will also be valuable for hospital infection control committees, helping them to formulate or strengthen SSI prevention policies. Moreover, the study will support public health authorities in developing nationwide surgical infection surveillance systems.

1.7 Scope of the Study

This study is confined to tertiary healthcare institutions in Nigeria and focuses specifically on patients undergoing major surgeries, including abdominal, orthopedic, and gynecological procedures. It investigates both patient-related and procedure-related risk factors over a six-month observation period. The study excludes minor surgeries and outpatient procedures.

1.8 Operational Definition of Terms

• Surgical Site Infection (SSI): An infection that occurs after surgery in the part of the body where the surgery took place, typically within 30 days.

• Major Surgery: A surgical procedure involving a significant risk to the patient, typically requiring general anesthesia and extended recovery time.

• Incidence Rate: The frequency or rate at which new cases of SSIs occur in a specified population during a defined time period.

• Risk Factors: Conditions or variables associated with a higher likelihood of developing SSIs.

• Wound Classification: A system used to categorize surgical wounds based on the level of contamination (e.g., clean, clean-contaminated, contaminated, dirty/infected).