Project – AN ASSESSMENT OF THE RISK FACTORS ASSOCIATED WITH SURGICAL SITE INFECTION

CHAPTER ONE

1.1 Background to the Study

Surgical site infections (SSIs) are among the most common healthcare-associated infections, contributing significantly to patient morbidity, prolonged hospital stays, increased healthcare costs, and in some cases, mortality (Allegranzi et al., 2016). These infections occur at or near the surgical incision within 30 days of the procedure or within one year if an implant is placed (Centers for Disease Control and Prevention [CDC], 2020). The global burden of SSIs is substantial, especially in low- and middle-income countries (LMICs), where infection control measures may be inadequate or inconsistently applied (WHO, 2018).

The risk of SSI is multifactorial, involving patient-related factors (such as age, obesity, diabetes, smoking, and immunosuppression), procedure-related factors (including wound class, duration of surgery, and emergency vs elective surgery), and healthcare system-related factors (such as the use of prophylactic antibiotics, operating room conditions, and surgical techniques) (Mangram et al., 1999). In sub-Saharan Africa, studies have indicated that SSI rates can be as high as 20%, which is significantly higher than in high-income countries where the rate is generally below 5% (Aiken et al., 2013).

The burden of SSIs in Nigeria remains a major public health concern. Poor adherence to infection prevention protocols, limited access to sterilization equipment, and lack of surveillance systems all contribute to increased risk. Many hospitals in Nigeria lack standard surgical site surveillance programs, making it difficult to track infection rates and institute timely interventions (Nwankwo et al., 2014). Understanding the specific risk factors contributing to SSIs in Nigerian healthcare settings is therefore essential to inform targeted strategies for prevention and control.

1.2 Statement of the Problem

Despite advances in surgical techniques and antiseptic practices, surgical site infections continue to be a persistent challenge in healthcare delivery. In many Nigerian hospitals, the incidence of SSIs remains unacceptably high, leading to extended hospital stays, increased antibiotic use, higher medical costs, and even death (Oguntibeju et al., 2009). The problem is exacerbated by inadequate infrastructure, inconsistent use of antibiotics, poor hygiene practices, and limited knowledge of infection control among healthcare workers.

Moreover, there is a scarcity of up-to-date, institution-specific data on the risk factors for SSIs in Nigeria. This lack of data undermines efforts to develop and implement effective infection prevention policies. As such, an assessment of the risk factors associated with SSIs is urgently needed to reduce the burden of postoperative infections and improve surgical outcomes in Nigerian healthcare institutions.

1.3 Objectives of the Study

The main objective of this study is to assess the risk factors associated with surgical site infections. Specifically, the study aims to:

1. Identify patient-related risk factors contributing to SSIs.

2. Evaluate surgical and procedural factors that increase the likelihood of SSIs.

3. Examine hospital and healthcare provider practices that may contribute to the incidence of SSIs.

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

1.4 Research Questions

The study seeks to answer the following research questions:

1. What patient-related factors are associated with the occurrence of surgical site infections?

2. How do surgical and procedural characteristics influence the development of SSIs?

3. What hospital practices contribute to the prevalence of SSIs?

4. What preventive measures can be adopted to reduce the incidence of SSIs?

1.5 Research Hypotheses

To guide the study, the following hypotheses are formulated:

• H₀₁: There is no significant relationship between patient-related factors (such as age, diabetes, obesity) and the occurrence of surgical site infections.

• H₁₁: There is a significant relationship between patient-related factors and the occurrence of surgical site infections.

• H₀₂: Surgical and procedural factors (such as duration of surgery and wound class) have no significant effect on the risk of SSIs.

• H₁₂: Surgical and procedural factors have a significant effect on the risk of SSIs.

• H₀₃: Hospital practices and healthcare provider behavior do not significantly contribute to the prevalence of SSIs.

• H₁₃: Hospital practices and healthcare provider behavior significantly contribute to the prevalence of SSIs.

1.6 Significance of the Study

This study is significant for several reasons. Firstly, it contributes to the body of knowledge on infection prevention and control by providing empirical data on the risk factors for SSIs within Nigerian healthcare settings. Secondly, it assists hospital administrators, surgeons, and infection control officers in identifying high-risk patients and modifying surgical practices to minimize infection risk. Thirdly, the study may influence policy by highlighting the need for structured SSI surveillance systems and standardized protocols in Nigerian hospitals. Ultimately, the findings may lead to improved patient outcomes, reduced healthcare costs, and a decline in hospital-acquired infections.

1.7 Scope of the Study

The study focuses on surgical patients admitted to selected tertiary hospitals in Nigeria. It assesses both preoperative and intraoperative factors, as well as postoperative hospital practices. The study does not extend to outpatient surgeries or procedures performed outside recognized surgical units. It covers a time frame of six months for data collection and analysis.

1.8 Operational Definition of Terms

• Surgical Site Infection (SSI): An infection occurring at or near the surgical incision within 30 days of the procedure or within one year if an implant is involved.

• Risk Factors: Attributes, characteristics, or exposures that increase the likelihood of developing SSIs.

• Prophylactic Antibiotics: Antibiotics administered before, during, or after surgery to prevent infections.

• Healthcare-Associated Infection: An infection that a patient acquires while receiving treatment in a healthcare facility.

• Sterilization: The process of eliminating all forms of microbial life from surgical instruments and surfaces.

Project – AN ASSESSMENT OF THE RISK FACTORS ASSOCIATED WITH SURGICAL SITE INFECTION