The incidence of surgical site infection (SSI) in the surgical department with the national referral hospital in Thimphu was 30.7 percent, one of the highest in the region.

This is according to an observational descriptive study carried out at the hospital from July to December last year, to establish the incidence and factors associated with SSI at the department.

The study found that the infection was significantly associated with older age and wound class such as clean-contaminated wound and dirty wound. Factors like gender, obesity, co-morbidities, tobacco, emergency cases, operated by junior surgeon are not statistically associated with the infection.

“Exogenous factors were not studied but implicated to be responsible for infection like staff hygiene. Hand hygiene, operation theatre and instrument sterility among others,” Dr Sonam Jamtsho said.

An SSI is an infection that occurs after surgery in the part of the body where the surgery took place.

Dr Sonam Jamtsho, a surgical resident with the Khesar Gyalpo University of Medical Sciences of Bhutan, said that it is one of the most concerning yet preventable hospital-associated infections (HAI), even in advance health centres. “SSI is the second highest HAI worldwide and a huge burden on health economics.”

He said that all patients admitted to the surgical department for incisional surgery who are willing to come for follow up until 30 days are approached for the study.

Of 298 participants, 40 were lost to follow up. He said 62 percent of SSI was detected after discharge from hospital highlighting the significance of follow up.

“Wound examinations were done in the wards before they are sent home and when they come for stitch removal,” he said. “Infected wounds with discharges were sent for culture.”

In terms of procedures, he said that deroofing and drainage of hydrated cyst, appendectomy, percutaneous nephrolithotomy (procedure to remove stones from the kidney), and open ureteriolithotomy (a surgery to remove stones from the ureter) have a high rate of SSI.

The study was also conducted to determine microbiological growth in SSI and their antibiotic susceptibility pattern.

Dr Sonam Jamtsho said that identifying the microbiological organism and their antibiotic sensitivity would benefit in choosing prophylactic antibiotics and improving general sterility of the environment. “There is no published data on SSI incidence in Bhutan to date.”

Of the 26 swabs, it was found that the most common organism isolated is Escherichia coli (E.coli). Gentamycin was found to be the most sensitive antibiotic and amoxicillin as the most resistant antibiotic.

The study recommends further studies on risk factors associated with SSI and optimises treatment.

Dr Sonam Jamtsho said there is a need to have a better surveillance system, to strengthen hospital guidelines and protocols and adhere to it. “We also need to look into correctable exogenous factors.”

“It is high time we have a robust hospital infection control policies in all the health centres so that we can not only reduce the incidence of SSI but also reduce the burden of HAI in the country,” he said.

Dechen Tshomo