Incidence and Risk Factors of Surgical Site Infections: Insights from Kakamega County General Hospital in Kenya

https://doi.org/10.51867/ajernet.6.1.43

Authors

Keywords:

Surgical Site Infections (SSIs), Incidence, Risk Factors, Lower and Middle-Income Countries, Sub-Saharan Africa

Abstract

Surgical site infections (SSIs) are common complications associated with increased morbidity, hospital stay and mortality amongst patients’ post-surgery. This poses a huge economic burden and reduced quality of life in low and middle-income countries (LMICs). Data on incidence and risk factors for SSI following surgeries in Kenya is limited. Guided by the infection chain theory, this cross-sectional study investigated the incidence and risk factors associated with surgical site infections amongst the post-surgery patients in Kakamega County General Hospital (KCGH). Pus swabs were collected from infected surgical sites suspected of SSI from 128 patients attending Kakamega County General Hospital in the year 2023. Demographic data was also collected from patients who underwent a surgical procedure at KCTRH. Risk factors were identified from patient demography while wound swabs were subjected to microbiological techniques according to the Centres for Disease control guidelines for SSI surveillance. Associations between identified risk factors and the occurrence of SSIs were examined using Chi-square (categorical) and t-test (Continuous). A total of 128 patients underwent a surgical procedure during the study period. The incidence of SSI was 66% (n=84). Seven bacterial species were isolated namely, Pseudomonas aeruginosa (22%), gram negative rods (15%), Staphylococcus aureus (9%), Klebsiella species (9%), Escherichia coli (7%), Klebsiella oxytoca (2%) and gram-positive cocci (0.8%). Incidence of SSI was 66% (n=84). Diabetes was 32%, obesity 41% and smoking 17%, among the pre-operative factors but showed no association with SSIs (p > 0.05). There was a correlation between longer surgeries and fewer SSIs (mean duration 114 minutes) and pre-operative stays did not significantly contribute to SSI risk. SSIs remain a challenge in LMICs. From this study, it was concluded that there is a continued systemic and procedural element in the onset of SSIs and highlights the role of post-operative practices in the prevention of SSIs. There is need for targeted interventions in the care of surgical wounds to mitigate the burden of SSIs in the region.

Dimensions

Alfonso-Sanchez, J. L., Martinez, I. M., Martín-Moreno, J. M., González, R. S., & Botía, F. (2017). Analyzing the risk factors influencing surgical site infections: the site of environmental factors. Canadian Journal of Surgery, 60(3), 155-161. https://doi.org/10.1503/cjs.017916 DOI: https://doi.org/10.1503/cjs.017916

Allegranzi, B., Aiken, A. M., Kubilay, N. Z., Nthumba, P., Barasa, J., Okumu, G., Mugarura, R., Elobu, A., Jombwe, J., Maimbo, M., Musowoya, J., Gayet-Ageron, A., & Berenholtz, S. M. (2018). A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study. The Lancet Infectious Diseases, 18(5), 507-515. https://doi.org/10.1016/s1473-3099(18)30107-5 DOI: https://doi.org/10.1016/S1473-3099(18)30107-5

Allegranzi, B., Bischoff, P., De Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., Van Rijen, M., Boermeester, M. A., Egger, M., Kluytmans, J., Pittet, D., & Solomkin, J. S. (2016). New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases, 16(12), e276-e287. https://doi.org/10.1016/s1473-3099(16)30398-x DOI: https://doi.org/10.1016/S1473-3099(16)30398-X

Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2010). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377(9761), 228-241. https://doi.org/10.1016/s0140-6736(10)61458-4 DOI: https://doi.org/10.1016/S0140-6736(10)61458-4

Alverdy, J. C., Hyman, N., & Gilbert, J. (2020). Re-examining causes of surgical site infections following elective surgery in the era of asepsis. The Lancet Infectious Diseases, 20(3), e38-e43. https://doi.org/10.1016/s1473-3099(19)30756-x DOI: https://doi.org/10.1016/S1473-3099(19)30756-X

Ansari, S., Hassan, M., Barry, H. D., Bhatti, T. A., Hussain, S. Z. M., Jabeen, S., & Fareed, S. (2019). Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus. https://doi.org/10.7759/cureus.4801 DOI: https://doi.org/10.7759/cureus.4801

Badia, J. M., Pérez, I. R., Manuel, A., Membrilla, E., Ruiz-Tovar, J., Muñoz-Casares, C., Arias-Díaz, J., Jimeno, J., Guirao, X., & Balibrea, J. M. (2020). Medidas de prevención de la infección de localización quirúrgica en cirugía general. Documento de posicionamiento de la Sección de Infección Quirúrgica de la Asociación Española de Cirujanos. Cirugía Española, 98(4), 187-203. https://doi.org/10.1016/j.ciresp.2019.11.010 DOI: https://doi.org/10.1016/j.ciresp.2019.11.010

Bucataru, A., Balasoiu, M., Ghenea, A. E., Zlatian, O. M., Vulcanescu, D. D., Horhat, F. G., Bagiu, I. C., Sorop, V. B., Sorop, M. I., Oprisoni, A., Boeriu, E., & Mogoanta, S. S. (2023). Factors contributing to surgical site infections: A Comprehensive Systematic review of etiology and risk factors. Clinics and Practice, 14(1), 52-68. https://doi.org/10.3390/clinpract14010006 DOI: https://doi.org/10.3390/clinpract14010006

CDC. (2025). Surgical Site Infection Event (SSI). In January 2025 Procedure-associated Module SSI Events (pp. 9-1). https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Cooper, R. A. (2013). Surgical site infections: epidemiology and microbiological aspects in trauma and orthopaedic surgery. International Wound Journal, 10(s1), 3-8. https://doi.org/10.1111/iwj.12179 DOI: https://doi.org/10.1111/iwj.12179

Damonti, L., Atkinson, A., Fontannaz, L., Burnham, J., Jent, P., Troillet, N., Widmer, A., & Marschall, J. (2023). Influence of environmental temperature and heatwaves on surgical site infection after hip and knee arthroplasty: a nationwide study. Journal of Hospital Infection, 13(5), 125-131. https://doi.org/10.1016/j.jhin.2023.03.014 DOI: https://doi.org/10.1016/j.jhin.2023.03.014

Duran, A., Gülay, H., & Terzi, M. C. (2024). Risk factors in surgical site infections. Surgical Science, 15(02), 64-80. https://doi.org/10.4236/ss.2024.152008 DOI: https://doi.org/10.4236/ss.2024.152008

Ezugwu, N. V., Gayle, A., & Anyamene, C. (2024). Epidemiology of Antimicrobial Resistance and the WASH Project: Averting a Potential public health crisis in Nigeria using the United Kingdom as a case study. International Journal of TROPICAL DISEASE & Health, 45(6), 87-104. https://doi.org/10.9734/ijtdh/2024/v45i61542 DOI: https://doi.org/10.9734/ijtdh/2024/v45i61542

Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse's education on patient mortality in medical and surgical wards: an observational multicentre study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4688-7 DOI: https://doi.org/10.1186/s12913-019-4688-7

Hou, Y., Collinsworth, A., Hasa, F., & Griffin, L. (2022). Incidence and impact of surgical site infections on length of stay and cost of care for patients undergoing open procedures. Surgery Open Science, 11, 1-18. https://doi.org/10.1016/j.sopen.2022.10.004 DOI: https://doi.org/10.1016/j.sopen.2022.10.004

Iskandar, K., Molinier, L., Hallit, S., Sartelli, M., Hardcastle, T. C., Haque, M., Lugova, H., Dhingra, S., Sharma, P., Islam, S., Mohammed, I., Mohamed, I. N., Hanna, P. A., Hajj, S. E., Jamaluddin, N. a. H., Salameh, P., & Roques, C. (2021). Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture. Antimicrobial Resistance and Infection Control, 10(1), 13-17. https://doi.org/10.1186/s13756-021-00931-w DOI: https://doi.org/10.1186/s13756-021-00931-w

Kabir, C. M. N. (2022, October 21). Surgical site infection: impacts and challenges of antibiotic rationalism. Abstract. https://www.pulsus.com/abstract/surgical-site-infection-impacts-and-challenges-of-antibiotic-rationalism-11242.html

Kenya National Bureau of Statistics & The National Treasury and Planning. (n.d.). Kenya National Bureau of Statistics. https://www.knbs.or.ke/wp-content/uploads/2023/09/2019-Kenya-population-and-Housing-Census-Analytical-Report-on-Population-Dynamics.pdf

Magalhães, J. M., Zambelli, R., Oliveira-Júnior, O., Avelar, N. C. P., Polese, J. C., & Leopoldino, A. A. (2024). Incidence and associated factors of surgical site infection in patients undergoing foot and ankle surgery: a 7-year cohort study. The Foot, 59, 102092. https://doi.org/10.1016/j.foot.2024.102092 DOI: https://doi.org/10.1016/j.foot.2024.102092

Mogoi, N. N., Sifuna, A. W., Okoth, P. K., Reva, O., Malaba, R., Negesa, R., Nyongesa, K. P., Osoro, K. E., & Welch, M. (2024). Staphylococcus aureus associated with surgical site infections in Western Kenya reveals genomic hotspots for pathogen evolution. Access Microbiology, 6(6). https://doi.org/10.1099/acmi.0.000734.v4 DOI: https://doi.org/10.1099/acmi.0.000734.v4

Nejad, S. B., Allegranzi, B., Syed, S., Ellis, B., & Pittet, D. (2011). Health-care-associated infection in Africa: a systematic review. Bulletin of the World Health Organization, 89(10), 757-765. DOI: https://doi.org/10.2471/BLT.11.088179

https://doi.org/10.2471/BLT.11.088179

Pal, S., Sayana, A., Joshi, A., & Juyal, D. (2019). Staphylococcus aureus: A predominant cause of surgical site infections in a rural healthcare setup of Uttarakhand. Journal of Family Medicine and Primary Care, 8(11), 3600. https://doi.org/10.4103/jfmpc.jfmpc_521_19 DOI: https://doi.org/10.4103/jfmpc.jfmpc_521_19

Saeedinia, S., Nouri, M., Azarhomayoun, A., Hanif, H., Mortazavi, A., Bahramian, P., Yarandi, K. K., & Amirjamshidi, A. (2015). The incidence and risk factors for surgical site infection after clean spinal operations: A prospective cohort study and review of the literature. Surgical Neurology International, 6(1), 154. https://doi.org/10.4103/2152-7806.166194 DOI: https://doi.org/10.4103/2152-7806.166194

Seidelman, J. L., Mantyh, C. R., & Anderson, D. J. (2023). Surgical site infection prevention. JAMA, 329(3), 244. https://doi.org/10.1001/jama.2022.24075 DOI: https://doi.org/10.1001/jama.2022.24075

Temu, T. M., Macharia, P., Mtui, J., Mwangi, M., Ngungi, P. W., Wanjalla, C., Bloomfield, G. S., Farquhar, C., Nyanjau, L., Gathecha, G. K., & Kibachio, J. (2021). Obesity and risk for hypertension and diabetes among Kenyan adults. Medicine, 100(40), e27484. https://doi.org/10.1097/md.0000000000027484 DOI: https://doi.org/10.1097/MD.0000000000027484

Tessy, A., Awandu, S. S., Ochung, A., Mudibo, E. O., & Ayodo, G. (2024). Factors associated with hospitalisation among diabetes patients in Western Kenya. African Journal of Health Sciences, 37(1), 65-75. https://doi.org/10.4314/ajhs.v37i1.7 DOI: https://doi.org/10.4314/ajhs.v37i1.7

Van Seventer, J. M., & Hochberg, N. S. (2016). Principles of infectious diseases: transmission, diagnosis, prevention, and control. In Elsevier eBooks (pp. 22-39). https://doi.org/10.1016/b978-0-12-803678-5.00516-6 DOI: https://doi.org/10.1016/B978-0-12-803678-5.00516-6

World Health Organization: WHO. (2023, November 21). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Published

2025-02-25

How to Cite

Kindiki, S., Mogoi, N. N., & Kiprono, S. (2025). Incidence and Risk Factors of Surgical Site Infections: Insights from Kakamega County General Hospital in Kenya. African Journal of Empirical Research, 6(1), 510–517. https://doi.org/10.51867/ajernet.6.1.43