A comprehensive study conducted by the Indian Council of Medical Research (ICMR) has shed light on the high rate of Surgical Site Infections (SSIs) in India, revealing that the incidence is notably higher in three major hospitals compared to many high-income countries. Surgical Site Infection (SSIs) are among the most common healthcare-associated infections (HAIs), and they contribute significantly to both morbidity and healthcare costs, often extending the length of hospital stays.
The ICMR study, which was carried out across 3,020 patients, focused on three prominent hospitals: Jai Prakash Narayan Apex Trauma Centre (JPNATC), Kasturba Hospital (KMC) in Manipal, and Tata Memorial Hospital (TMH) in Mumbai. The research primarily aimed to examine the incidence of SSIs during hospital stays as well as after patients were discharged.
A significant gap in data was noted, particularly regarding post-discharge SSIs, which are often underreported in low- and middle-income countries, including India. Notably, there is no established surveillance system in India to track SSIs after patients leave the hospital, which prompted the authors to propose a multicentric analysis to estimate the proportion of Surgical Site Infection (SSIs) and identify the risk factors linked to their occurrence both during hospitalization and after discharge.
The study results revealed that the SSI rates at the three hospitals in India were considerably higher than those found in many high-income countries, where the typical SSI rate ranges from 1.2 to 5.2 percent. The rate observed in the study was lower than the one reported in Gujarat, India, where the SSI rate was 8.95 percent, and it was also higher than rates seen in Dehradun (5 percent) in India, and in other countries like Iran (17.4 percent), Egypt (17 percent), and Pakistan (7.3 percent).
Out of the 3,090 patients monitored in the study, 161 patients developed SSIs, resulting in an overall incidence of 5.2 percent. One key finding from the study was that the risk of developing SSIs was particularly high following debridement surgeries, which were performed in cases involving amputation, open reduction internal fixation (ORIF), or closed reduction internal fixation (CRIF) surgeries.
These procedures had the highest reported Surgical Site Infection (SSI) rate of 54.2 percent, reflecting the complexity and severity of the surgeries involved.
Additionally, the study highlighted several factors that were strongly associated with an increased risk of developing SSIs. These included the classification of the wound as either clean or contaminated (polluted), and surgeries that lasted longer than 120 minutes.
Both of these factors were found to substantially elevate the likelihood of infection. Patients who developed Surgical Site Infection (SSIs) typically experienced longer hospital stays, contributing to increased healthcare costs and delayed recovery.
An essential finding of the study was the importance of post-discharge surveillance in identifying SSIs that may not have been detected during the hospital stay. The study showed that post-discharge surveillance helped in diagnosing 66 percent of all SSI cases, which is a crucial step in improving patient outcomes and minimizing the long-term effects of infections. Furthermore, combination surgeries—those that involve multiple procedures—were found to increase the risk of SSIs. For these patients, post-discharge monitoring played a critical role in identifying 50 percent of SSI cases.
The authors of the study emphasized that this research was India’s first multicentric systematic surveillance effort focused on monitoring SSIs for up to six months after surgery. This prolonged surveillance period allowed for a more comprehensive understanding of SSIs, covering both in-hospital and post-discharge occurrences. The findings underscore the need for enhanced monitoring and surveillance systems in India, particularly regarding post-discharge infections, to improve patient care and reduce the burden of SSIs on healthcare systems.
The ICMR study reveals that SSIs remain a significant public health issue in India, with higher rates observed in major hospitals compared to those in high-income countries. The study advocates for better surveillance and management of SSIs, particularly after patients are discharged, to ensure timely detection and treatment.
Source of Information: https://www.livemint.com/news/india/surgical-infection-rate-higher-at-three-hospitals-in-india-than-many-high-income-countries-icmr-study-11736730602584.html
