ISSN 3078-3836 (Print) | ISSN 3078-3844 (Online) Volume-1, Issue-1

Original Research Article DOI: 10.70818/apjnr.2020.v01i01.05

Proportion of Post-Operative Wound Infection and Associated Factors

of Patients Attending General Surgery Wards in Rajshahi Medical
College Hospital
Md. Khairul Islam*
1Nursing Instructor, Rajshahi Nursing College, Rajshahi, Bangladesh

Abstract: Background: Post-operative wound infections are a significant healthcare

concern. They can lead to complications, prolonged hospital stays, and increased
healthcare costs. Understanding their prevalence and associated factors is essential for
effective prevention and management, ultimately improving patient care and outcomes.
Objective: Aimed to assess the proportion of post-operative wound infections and
associated factors among patients attending the general surgery wards at Rajshahi
Medical College Hospital in Bangladesh. Methods: This descriptive study, n=296
Citation: postoperative patients were randomly selected between January and July 2018 at
Md. Khairul Islam (2020). Proportion
of Post-Operative Wound Infection Rajshahi Medical College Hospital, Bangladesh. Data, including demographics, surgical
and Associated Factors of Patients details, complications, and medical histories, were collected using a researcher-
Attending General Surgery Wards in
Rajshahi Medical College Hospital. developed questionnaire. Descriptive statistics in SPSS were employed to determine the
Asia Pac J Nurs Res, 1(1), 21-28. proportion of post-operative wound infections and associated factors. Results: The study
revealed varying proportions of post-operative wound infections in different surgical
cases, with acute abdomen (16.9%), appendicitis (31.1%), cholecystitis (25%), and
perforation (22.3%). Emergency surgeries accounted for 44.3% of cases, while elective
Received: 18/06/2020
Accepted: 16/07/2020 surgeries comprised 55.4%. Common complications included pain or swelling at the
Published: 31/12/2020 operation site (74.3%), gaping at the operation site (6.1%), and discharge from the
surgical site (19.6%). Past medical history showed that diabetes mellitus (33.4%),
prolonged steroid use (3.4%), and hypertension (33.4%) were prevalent among the
patients. Conclusion: The study underscores the urgency of enhancing infection control
Copyright © 2020 The Author(s):
This is an open-access article measures to address the notable incidence of post-operative wound infections in Rajshahi
distributed under the terms of the Medical College Hospital. Notably, patients reported high satisfaction with healthcare
Creative Commons Attribution 4.0
International License (CC BY-NC providers, emphasizing a positive aspect of care. Addressing these infections requires a
4.0) which permits unrestricted use, focus on patient education and fostering positive attitudes toward associated risk factors.
distribution, and reproduction in any
medium for non-commercial use
provided the original author and Keywords: Post-operative wound infection, Surgical complications, Healthcare quality.
source are credited.

Significance: The study highlights crucial insights for improving infection control,
reducing complications, and enhancing patient outcomes in surgical care.

INTRODUCTION complications are an inevitable part of medical

Surgical wound infections, a common practice. Attending to complications with diligence
postoperative complication, have far-reaching and intellectual honesty is paramount for surgeons.
consequences including increased morbidity and Comprehensive postoperative care is as crucial as
mortality, prolonged hospitalization, and escalated preoperative preparation, affecting surgical
healthcare costs [1]. While complete eradication of outcomes regardless of the procedure's standard
wound infections may be unattainable, reducing [2].
infection rates to minimal levels can significantly
benefit patients and healthcare resources. Surgical Surgical Site Infections (SSIs) encompass
infections in incision and operative tissues. SSIs
https://www.apjnr.org/index.php/apjnr 21
Md. Khairul Islam, Asia Pac J Nurs Res; Volume-1, Issue-1 (Nov-Dec, 2020): 21-28

remain a significant concern, causing elevated clean, clean-contaminated, contaminated and

costs, patient distress, and even mortality, even in dirty.
modern healthcare settings [3]. SSIs, a common • To find out socio-demographic characteristics
type of nosocomial infection, correlate with of the respondents.
extended hospital stays, increased healthcare • To study the hospital incidence of post-
expenditures, and patient suffering, imposing both operative wound infection.
clinical and economic burdens [4,5,6]. Diabetes, • To assess proper use of the available surgical
affecting millions globally, hinders acute wound dressing materials
healing and exacerbates chronic non-healing • during wound care in surgical wards.
diabetic foot ulcers. Smoking, another risk factor, is
recognized for its detrimental effects on wound RESEARCH METHODOLOGY
healing, leading to complications such as infections The descriptive design study was used to
and delayed recovery [7]. Nutrition plays a pivotal explore the proportion of post- operative wound
role in wound healing, with malnutrition or infection and associated factors of the patients
nutrient deficiencies adversely affecting the attending general surgery wards in Rajshahi
process. Obesity, characterized by a body weight Medical College Hospital. The population of this
exceeding the ideal by 20% or more, is linked to a study N=296 was postoperative patients who came
heightened risk of wound complications and to receive treatment and follow up in indoor
diseases, exacerbating healthcare challenges [8]. department during the study period of January
2018 to July 2018. According to hospital
In Bangladesh, studies have highlighted identification numbers, there were approximately
the prevalence of Surgical Site Infections (SSIs), 3500 general surgical patients came to receive
with pathogens like Staphylococcus aureus and treatment in those department per month.
Escherichia coli being common culprits.
Additionally, diabetes prevalence among urban Inclusion Criteria
populations in Dhaka city is noteworthy, • Post-operative patients at Rajshahi Medical
significantly contributing to pyogenic infections in College Hospital.
diabetic patients [9,10]. Understanding the • Patients of all age groups.
multifaceted factors impacting surgical wound • Both male and female patients.
infections is imperative for mitigating their
consequences and optimizing patient care. This Exclusion Criteria
study seeks to shed light on the prevalence and • Non-postoperative patients.
contributors to post-operative wound infections in • Patients from non-surgical specialties.
the context of Rajshahi Medical College Hospital, • Language barriers or cognitive impairments.
Bangladesh. • Patient refusal to participate.

OBJECTIVES Data Collection

General Objective Data collection occurred through
• To assess the Proportion of post-operative structured interviews with postoperative patients
wound infection and associated factors of the at Rajshahi Medical College Hospital. The
patients attending in general surgery wards in interviews were conducted on weekdays, from 8:00
Rajshahi Medical College Hospital, am to 4:00 pm, excluding Fridays. Participants
Bangladesh. provided informed consent and were presented
with a clear explanation of the study's purpose and
Specific Objectives methodology. A researcher-developed
• To determine the frequency of post-operative questionnaire was utilized, ensuring that
wound infection. participants comprehended and responded to
• To identify the associated risk factors of post- questions accurately. Each interview lasted
operative wound infection. approximately 25-30 minutes. The gathered data
• To Study distribution of post-operative wound were subsequently coded, entered into a computer
infection among different surgeries such as

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Md. Khairul Islam, Asia Pac J Nurs Res; Volume-1, Issue-1 (Nov-Dec, 2020): 21-28

spreadsheet, and prepared for analysis using Faculty of Biological Science, University of
statistical software. Rajshahi. The Director of Rajshahi Medical College
Hospital also granted IRB permission. All
Data Analysis participating patients were provided with
Data were analyzed using the Statistical comprehensive information regarding the study's
Package for the Social Sciences (SPSS). Descriptive objectives, data collection process, and potential
statistics, including mean, standard deviation, and risks. Strict confidentiality and subject autonomy
percentages, were computed to summarize and were maintained, with participants signing
explore the dataset. This analysis aimed to provide informed consent forms voluntarily. They retained
a clear overview of the data, facilitating the the right to withdraw at any point without needing
understanding of key variables such as the to provide a reason. Data collected were kept
proportion of post-operative wound infections and confidential and subsequently destroyed. The
associated factors among patients attending researcher was prepared to manage any unforeseen
general surgery wards at Rajshahi Medical College risks, although none occurred during data
Hospital in Bangladesh. collection.

Ethical Consideration
The research proposal gained approval RESULT
from the Institutional Review Board (IRB) at the

Table 1: Demographic Characteristics of the Sample (n = 296)

Characteristic Frequency Percentage (%)
Age (years)
- Mean 44.39
- Standard Deviation 17.38
Sex
- Male 169 57.1
- Female 127 42.9
Marital Status
- Married 205 69.3
- Single 54 18.2
- Widow 37 12.5
Education Level
- Illiterate 71 24.0
- Primary School 45 15.2
- Secondary School 50 16.9
- Higher Secondary 74 25.0
- Diploma/equivalent 18 6.1
- University 38 12.8
Religion
- Muslim 256 86.5
- Hindu 38 12.8
- Christian 2 0.7
Current Occupation
- Jobless 36 12.2
- Retirement 30 10.1
- Service 76 25.7
- Labour 26 8.8
- Farmer 35 11.8
- Housewife 57 19.3

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- Business 14 4.7
- Others 22 7.4
Income (BDT)
- Mean 18168.91
- SD 10407.22
Health Status
- Healthy 251 84.8
- Ill health 45 15.2
BMI
- Optimum 280 94.6
- Overweight 10 3.4
- Obese 6 2.0

Figure 1: Distribution of patient according to age

health status, and BMI. Most respondents
The table provides a comprehensive are middle-aged, married, and educated up to the
overview of demographic characteristics among secondary or higher secondary level. The majority
postoperative patients. It reveals a diverse are Muslim, employed in various occupations, and
distribution across age, sex, marital status, exhibit favorable health statuses with
education level, religion, occupation, income, predominantly optimal BMI ranges.

Table 2: Characteristics of Pre-operative Factors and Patient Complaints Summary

Characteristics Frequency Percentage (%)
Pre-operative diagnosis
- Acute abdomen 50 16.9
- Appendicitis 92 31.1
- Cholecystitis 74 25.0
- Perforation 66 22.3
Pre-operative hospital stays
- <3 days 152 51.4
- 4-7 days 112 37.8
- >7 days 32 10.8
Pre-operative hair removal
- Previous night before surgery 223 75.3
- Morning of surgery 73 24.7
Good bath before going to operation theatre

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- Yes 212 71.6

- No 84 28.4
Wearing hospital dress before going to operation
theatre
- Yes 124 41.9
- No 172 58.1
Nature of Surgery
- Emergency surgery 131 44.3
- Elective surgery 164 55.4
Presenting complaints
- Pain or swelling at operation site 220 74.3
- Gaping at the operation site 18 6.1
- Discharge from surgical site 58 19.6
Past medical history
- DM 99 33.4
- Prolonged steroid use 10 3.4
- Hypertension 99 33.4
How many times of hospital admission?
- Once 83 28.0
- Twice 83 28.0
- Thrice 12 4.1
History of previous use of antibiotics
- Yes 180 60.8
- No 115 38.9
Regular dressing your wound
- Yes 281 94.9
- No 15 5.1
Satisfied about doctors/nurse behavior
- Yes 284 95.9
- No 12 4.1

The study revealed that appendicitis (31.1%) was the most common pre-operative diagnosis, with most
patients having hospital stays of less than three days (51.4%). Pre-operative hair removal the night before
surgery was common (75.3%), and most surgeries were elective (55.4%). Patients frequently reported pain at
the operation site (74.3%), with significant comorbidities like diabetes (33.4%). High patient satisfaction with
healthcare provider behavior was observed (95.9%), highlighting positive aspects of care despite the prevalence
of complications.

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Figure 2: Pre-operative Factors and Patient Complaints Summary

The table presents crucial pre-operative [11]. This gender disparity may reflect differences
factors and patient complaints among the in healthcare-seeking behavior, occupational
respondents. It delineates the distribution of exposure, or biological factors influencing surgical
diagnoses, pre-operative hospital stays, hair indications [12].
removal practices, bathing habits before surgery,
attire worn to the operation theatre, surgery nature, Furthermore, the distribution of
presenting complaints, medical histories, hospital participants across different age groups highlights
admissions, antibiotic usage, wound dressing the diverse age range of individuals requiring
adherence, and satisfaction with healthcare surgical interventions. The mean age of 44.39 years
providers' behavior. These insights inform the pre- suggests that surgical procedures are performed
operative care and management strategies for across various stages of the lifespan, from young
postoperative patients. adults to older individuals. These findings align
with existing literature indicating that surgical
DISCUSSION procedures are not limited to a specific age group
The findings presented in the Results but are required across the lifespan for various
section provide valuable insights into the medical conditions [13]. Education level and
demographic characteristics, pre-operative factors, occupation are important socio-economic factors
and medical history of postoperative patients that can influence health outcomes. The
attending a tertiary care hospital in Bangladesh. predominance of participants with higher
This Discussion section aims to interpret these secondary education (25%) underscores the
results, discuss their implications, their alignment importance of education in accessing healthcare
with existing literature, and their practical services and understanding postoperative care
significance in clinical practice. Firstly, the instructions [14]. Additionally, the distribution of
demographic characteristics of the sample participants across different occupational
population revealed interesting insights. The categories reflects the diverse socio-economic
predominance of males in the sample (57.1%) backgrounds of individuals requiring surgical
compared to females (42.9%) is consistent with interventions. These findings highlight the need for
previous studies that have reported a higher targeted healthcare interventions and health
prevalence of surgical procedures among males education programs tailored to different

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educational and occupational backgrounds to potential risk of antibiotic resistance and the need
improve postoperative outcomes. for judicious antibiotic prescribing practices [20,21].
Pre-operative factors play a crucial role in In the research findings provide valuable insights
determining surgical outcomes and postoperative into the demographic characteristics, pre-operative
complications. The majority of participants factors, and medical history of postoperative
underwent pre-operative hair removal either the patients in a tertiary care hospital in Bangladesh.
previous night before surgery (75.3%) or on the These findings have implications for clinical
morning of surgery (24.7%). While pre-operative practice, highlighting the importance of tailored
hair removal is a common practice in surgical interventions to improve surgical outcomes and
settings, it is essential to ensure adherence to reduce postoperative complications. Furthermore,
evidence-based guidelines to minimize the risk of the alignment of these findings with existing
surgical site infections (SSI) (Tanner et al., 2015). literature underscores their validity and relevance
Similarly, the importance of pre-operative hygiene in the broader context of surgical care.
practices, such as bathing before surgery, cannot be
overstated in reducing the risk of postoperative CONCLUSION
infections [15]. The study outcomes contribute to nursing
education, practice, administration, and research in
The nature of surgery, whether elective or Bangladesh. Findings enhance nursing education
emergency, can significantly impact postoperative by providing awareness of post-operative wound
outcomes. The higher proportion of elective infection factors. In practice, nurses can improve
surgeries (55.4%) compared to emergency surgeries care and conduct health education. Nursing
(44.3%) reflects the diversity of surgical cases administrators can utilize findings for planning
encountered in a tertiary care hospital setting [16]. interventions, and researchers can use them for
Elective surgeries are often associated with better future studies.
perioperative preparation and lower complication
rates compared to emergency surgeries [17]. Recommendation
However, further investigation into the specific • Implement rigorous infection control protocols
types of surgeries and their associated to reduce post-operative wound infections.
complications is warranted to develop targeted • Develop educational programs to increase
interventions for improving surgical outcomes in patient awareness of wound infection risk
both elective and emergency settings. The factors and proper wound care techniques.
prevalence of presenting complaints such as pain or • Allocate resources for further research into
swelling at the operation site (74.3%) and discharge identifying and addressing specific risk factors
from the surgical site (19.6%) underscores the for post-operative wound infections.
importance of postoperative monitoring and
wound care. Adequate pain management and Funding: No funding sources
timely detection of complications such as wound
infections are crucial for promoting patient Conflict of interest: None declared
recovery and reducing morbidity and mortality
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Corresponding Author: Md. Khairul Islam

Nursing Instructor, Rajshahi Nursing College, Rajshahi, Bangladesh

© Asia Pacific Journal of Nursing Research 28