THE ROLE OF SUBCUTANEOUS TISSUE IRRIGATION WITH NORMAL SALINE IN DECREASING SURGICAL SITE INFECTION FOLLOWING APPENDICECTOMIES AT THE KORLE-BU TEACHING HOSPITAL

Abstract

BACKGROUND According to the World Health Organization Surgical Site Infection(SSI) is the most common type of hospital acquired infection in the developing world and it is common after appendicectomy with an incidence of SSI as high as 37.4% in low income countries. Wound irrigation may reduce the level of bacterial contamination in the surgical wound and may reduce SSI but there is lack of evidence for its usage, and the agent to use that is safe, effective and affordable.In Ghana no studies have been conducted on the use of normal saline as irrigation fluid in reducing surgical site infection following appendicectomy.

AIM To evaluate the role of subcutaneous tissue irrigation at incision site using normal saline, in reducing post appendicectomy surgical site infection at the Korle-Bu Teaching Hospital (KBTH).

METHODOLOGY This was a randomized prospective study involving patients diagnosed with appendicitis, who underwent appendicectomy at the Korle-Bu Teaching Hospital (KBTH). Recruited patients were randomized into 2 groups. One group had the subcutaneous tissue irrigated with normal saline after closure of the fascia during appendicectomy while the second group, the control group, did not. Patients were followed up with wound inspection on post-operative days 3, 7, 14 and 30 for signs of surgical site infection. All data collected were captured on Microsoft excel work sheet and imported into Statistical Package for the Social Sciences (SPSS version 23) for analysis. A Chi-square test/ Fisher’ exact test was used to compare the incidence of SSI between those with irrigation of the subcutaneous tissue and those with non-irrigation of the subcutaneous tissue following appendicectomy. Relative Risk (RR) and their confidence intervals between the two groups were also determined. P-values less than 0.05 was considered statistically significant. RESULTS In total one hundred and fourteen (114) patients were recruited for the study, 57 in each arm. The patients were followed up on post-operative days 3,7,14 and 30 for signs of surgical site infection. The overall surgical site infection rate was 8.8%. The surgical site infection rate in the irrigation arm was 3.5 % and non-irrigation arm was 14%. There was a significant statistical reduction in the rate of SSI when irrigation was done. Various factors associated with SSI include wound class, duration of hospital stay, male gender and age were identified as risk factors The commonest organisms isolated were Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus and Pseudomonas aeruginosa.

CONCLUSION: Irrigation of the subcutaneous tissue using saline solution during appendicectomy is effective in reducing SSI at the KBTH.