Mansoor Khan, Jawad Khalil, Rooh -ul- Muqim, Mohammad Zarin, Touseef Ul Hassan, Nisar Ahmed, Muhammad Salman, Ghulam Muhammad


ackground: Surgical site infections (SSI) are among the most common complications in surgical
patients and have serious consequences for outcomes and costs. This study aimed to determine the rates
and risk factors affecting surgical site infections and their incidence at Surgical ‘C’ Unit, Khyber
Teaching Hospital, Peshawar, Pakistan. The study was conducted to compare with rates obtained by
large international multi-centre studies. Methods: A review of all general surgical interventions
involving an incision, excluding anal procedures, performed between December 2008 and March 2009
(n=269) was undertaken. Various clinical parameters were recorded. Infection rates were calculated.
Data were analysed using the Fisher’s exact test. Results: The overall SSI rate was 9.294%, 4.88% in
clean cases (C), 8.39% in clean contaminated cases (CC), and 20.45% in contaminated or dirty cases
(D). There were significantly higher surgical site infection rates among patients with combined
American Society of Anaesthesiologists scores II and III than those with ASA score I in clean
contaminated (p=0.0007), and dirty cases (p=0.0212). There were also significantly higher surgical site
infection rates among patients with combined Co-morbidity Scale score 1–6 than those with no comorbid factors in clean contaminated (p=0.0002). Surgical site infection rate was highest in
gastrointestinal system surgeries. Conclusion: The Surgical site infections can be minimised by
adopting international protocols for surveillance.
Keywords: Charlson Co-morbidity Index, Surgical Site Infection, Clean, clean-contaminated and dirty
surgeries; Risk factors

Full Text:



Haley RW. Measuring the intrinsic risk of wound infections in

surgical patients. In: Problems in general surgery. Hagerstown

(MD): Lippincott Williams & Wilkins;1993. p.396–417.

Weiss CA, Statz CL, Dahms RA, Remucal MJ, Dunn DL,

Beilman GJ. Six years of surgical wound infection surveillance at

a tertiary care centre: review of the microbiologic and

epidemiological aspects of 20007 wounds. Arch Surg


National Nosocomial Infections Surveillance (NNIS) System

report, data summary from January 1990–May 1999, issued June

Am J Infect Control 1999;27:520–32.

Lizioli A, Privitera G, Alliata E, Boselli L, Panceri ML, Perna MC

et al. Prevalence of nosocomial infections in Italy: result from the

Lombardy survey in 2000. J Hosp Infect 2003;54:141–8.

Gastmeier P, Geffers C, Sohr D, Dettenkofer M, Daschner F,

Rüden H. Five years working with the German nosocomial

infection surveillance system (Krankenhaus Infektions

Surveilance System). Am J Infect Control 2003;31:316–21.

Gastmeier P, Sohr D, Rath A, Forster DH, Wischnewski N,

Lacour M, et al. Repeated prevalence investigations on

nosocomial infections for continuous surveillance. J Hosp Infect


Prevalence of nosocomial infections in France: results of the

nationwide survey in 1996. The French Prevalence Survey Study

Group. J Hosp Infect 2000;46:186–93.

Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM.

Surgical site infections: reanalysis of risk factors. J Surg Res


Martone WJ, Nichols RL. Recognition, prevention, surveillance,

and management of SSI. Clin Infect Dis 2001;33:s67–8.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG.

CDC definitions of nosocomial surgical site infections, 1992: a

modification of CDC definitions of surgical wound infections.

Am J Infect Control 1992; 20:271–4.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new

method of classifying prognostic comorbidity in longitudinal

studies: development and validation. J Chronic Dis


12 Medeiros AC, Aires-Neto T, Azevedo GD, Vilar MJ, Pinheiro

LA, Brandão-Neto J. Surgical Site Infection in a University

Hospital in Northeast Brazil. Braz J Infect Dis 2005;9(3):310–4.

Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed.

Philadelphia (PA): WB Saunders;2000. p.1585.

Malangoni MA. Surgical site infections: the cutting edge. In:

Current opinion in infectious diseases. Philadelphia (PA):

Lippincott–Raven;1998. p.465–9.

Chattopadhyay R, Zaroukian S, Potvin E. Surgical site infection

rates at the Pontiac Health Care Centre, a rural community

hospital. Can J Rural Med 2006;11:41–8.

Sramova H, Roth Z, Subertova V, Krecmerova M. Prevalence of

nosocomial infections in general surgery, orthopedic surgery and

urological departments in the Czech Republic. J Hyg Epidemiol

Microbiol Immunol 1991;35:271–80.


  • There are currently no refbacks.

Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]