الفهرس 
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Abstract
SSI are defined as infections occurring within 30 days after a surgical operation (or within 90 days if an implant is left in place after the procedure) and affecting either the incision or deep tissue at the operation site. There are some known risk factors associated with the surgical wound infection and disruption.
The aim of this study is to detect the incidence of surgical site infection and to detect the common microorganism causing postoperative wound infection and evaluate the effect of implementation of infection control measures to decrease the incidence of surgical site infection.
This prospective study was carried out on 111 patients admitted to the Gynecology and Obstetrics ward at a Governmental health care facility from May 2019 to June 2019. Data regarding SSI surveillance was collected twice from the patients undergoing surgical operations. The first time was around the time of the operation itself and the second was within 30-day period after the operation.
This study reported that:
(1) The age of patients included in this study ranged from 20 years to 50 years with a median age of 35 years.
(2) The majority of the cases 42 (37.8%) out 111 cases performed multi Cesarean section operation followed by 36 (32.4%) primary Cesarean section operation. All cases were elective surgeries.
(3) The current study reported that the majority of the cases were grouped in ASA class I 71 (63.9%) followed by class II 38 (34.2%) followed by class III 2 (1.8%) out of the 111 cases and class IV and V were not detected in this study.
(4) This study showed that almost all of the cases were grouped as Clean-contaminated wounds in 105 (94.5%) followed by clean wounds in 6 (5.4%) and no contaminated or infected wound classes were detected .This study showed that majority of the cases had risk index RI 0 in 80 (72.1%) followed by RI 1 in 29 (26.1%) while RI 2 were detected in 2 (1.8%) and RI 3 was not detected.
(5) Out of the 111 cases included in this study, 32 (28.8%) of 111 cases developed SSI. Half 3(50%) out of 6 total hysterectomy operations developed SSI, followed by multi Cesarean section in 15 (35.7%) out of 42 cases and 2(33.3%)out of 6 lymphoid tumors developed SSI. No cases undergone ectopic pregnancy or Oophorectomy or Laparoscopic exploration or Laparoscopic ovarian cystectomy operation developed SSI and the highest SSI rate (37%) occurred in the age group from 41-50 years old.
(6) In this study 99 (89.2%) were given antibiotic one hour before the procedure and 12 cases (10.8%) received antibiotic more than one hour prior to surgery.
(7) The current study showed that out of the 32 cases (28.8%) diagnosed as SSI 15 cases (46.9%) diagnosed by the physician according to clinical signs and symptoms without microbiological testing and 17 cases (53.1%) were diagnosed as SSI with microbiological testing and 4 of them their results showed no growth .
Chapter (6): Summary, Conclusion and Recommendations
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(8) Staph.aureus were isolated from 9(69.2%) samples ( 4 isolates were from multi Cesarean section operation). Pseudomonas aeruginosa was isolated 2 times (15.4%) (one Primary Cesarean section operation and from one multi Cesarean section operation). One MRSA (7.7%) isolate was from total hysterectomy operation and E.coli (7.7%) was from multi Cesarean section operation
(9) Environmental swabs were collected from the three operating rooms of the hospital from four different places (surgical bed, instrument table, anesthesia device, portable light source) weekly for a period of one month using pre-moistened sterile cotton . Only week 2 showed growth of Coagulase negative staphylococci both on the instruments table and from the bed in addition to Air quality testing from OR 1
(10) This study showed that the surgical operations were done by 4 groups group I, group II, group III, group IV performed 30 (27%), 23(20.7%), 25(22.5%), 33(29.7%) surgical operations 4 (13%), 6 (26%), 9 (36%), 13 (39.4%) of them developed SSI respectively. 13 (39.4%) resulted from operations performed by group IV and these results showed no Statistical significance.
(11) The checklist was designed to revise certain Infection control measures used with each operation to evaluate the effect of implementation of infection control measures to decrease the incidence of SSI.
o As regard hand scrubbing, the majority of surgeons 88(79.2%) did hand scrubbing correctly and spent the required contact time while the remaining 23(20.7%) surgeons did not spend the required contact time during hand scrubbing. The majority of assistant nurses 90(81%) did hand scrubbing correctly and spent the correct contact time while the remaining assistant nurses 21(18.9%) did not spend complete contact time during hand scrubbing.
o Overall, 75(67.5%) of Surgeons staff wore PPE correctly except 36(32.4%) of Surgeons wore the surgical mask under the nose and female surgeons did not wear the overhead and no eye protection worn.
o All cases were covered with a sterile drape except at the operation site.
o In general, as regard operation room ventilation, bad ventilation and no positive pressure in the operating theatre was observed. In addition, the doors of the operating room were always left open during the operation.
o The surfaces and environmental cleaning prior to surgery was performed in all 111 procedures but not performed adequately.
o Surgical instruments used in all procedures were sterilized by the autoclave.
o The foot traffic did not keep to a minimum at all the procedures.
o The majority of cases 99 (89.1%) took a shower at the morning of the operation day while 12(10.8%) took a shower at the night before the operation day.
o As regards hair removal, the majority of cases 64 (57.6%) used shaving in hair removal, while 47(42.3%) used depilatory cream in hair removal.
o Appropriate patient skin antisepsis was performed in 75(67.6%) of procedures but in 36(32.4%) of procedures antiseptic solutions did not take complete contact time during skin antisepsis.
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6.2. Conclusion
SSI continues to be a significant postoperative complication and in the present study the rate of SSI was high. Several factors such as the duration of operations, class of wounds, age, basic SSI risk index and present of some comorbid conditions were found to be independent pAedictoAs of occuAAence of SSI. The findings highlight the need foA improved surveillance of SSIs and review of infection control policies of the hospital.