Microbial Colonization of Surgical Instruments and Surgical Sites Intra-Operatively in Main Theatres of Kenyatta National Hospital, Kenya

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.