Abstract:
Surgical site infections (SSIs) have the highest frequency of postsurgical
complications with a global range of 2.5-41.9% and have a significant impact upon the
health or illness process of the patient and satisfaction levels. In addition to potential
economic consequences, SSIs can have a negative impact on patient outcomes and
may potentially be life-threatening. There are no practice guidelines to inform the
perioperative teams on when to change the surgicals and instruments when presumed
to be contaminated. This study determined surgical instruments exposure time and
microbial colonization in relation to SSIs in the Main Theatres of Kenyatta National
Hospital, Kenya and came up with strategies and recommendations that will lead to
development of practice guidelines for the perioperative teams. A mixed method
quantitative and sequential qualitative was used. In the quantitative arm; analytical
cross-sectional design and purposive sampling method was adopted. Check lists and
standard laboratory request forms for data collection were used. A sample of 92
patients was used. The qualitative arm Seven experts in the subject area were
purposively sampled for the Key Informants Interviews. Data was analyzed using
Statistical Package for Social Sciences (SPSS) software. Descriptive and Inferential
statistics such as Chi-square and t-test were used to describe the data and show the
relationship between variables respectively. Bivariate analysis was used to determine
the strength of association between dependent and independent variables. P values less
than or equal to 0.05 was considered statistically significant. Qualitative data was
transcribed verbatim by using the Colaizzi thematic analysis transcription techniques.
Field notes were compared with the audio recordings for validity. Data was analyzed
and described verbatim. Results showed that more than half of the instruments were
colonized by micro-organisms intraoperatively (51.6%; n=48). About twelve percent
(11.8%; n=11) patients had microbial colonization on the surgical site pre-surgery. A
few instruments were found to be contaminated at time 0. A third of the population got
post-surgery microbial colonization on the surgical site (31.2%; n=29).
Staphylococcus aureus was the most common microorganism in surgical sites and the
surgical instruments. There was 50% of microbial colonization of instruments after 4
hours intraoperatively. The longer the surgery the more the exposure of instruments
and the higher was the microbial colonization rate. There is need to enhance the
processing and sterilization of surgical instruments. By the fourth hour of surgery
surgical instruments should be changed and social wash should be done to all surgical
sites before the actual surgical prepping. It is recommended that these strategies should
be adopted by Kenyatta National Hospital management and Ministry of Health to
guide the perioperative teams intraoperatively.
