Incidence and predictors of surgical-site infections in Vietnam.
OBJECTIVE
To determine the incidence of, and risk factors for, surgical-site infections (SSIs).


METHODS
Prospective observational study of all patients undergoing surgery during a 3-month period.


METHODS
Two urban hospitals in Hanoi, Vietnam.


METHODS
All 697 patients admitted for emergent and elective surgery.


METHODS
Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model.


RESULTS
During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46; P<.01) and wound class IV (OR, 5.67; P<.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene.


CONCLUSIONS
There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.
Nguyen
D
D
Department of Medicine, New England Medical Center-Tufts University School of Medicine, Medford, Massachusetts, USA.
MacLeod
W B
WB
Phung
D C
DC
Cong
Q T
QT
Nguy
V H
VH
Van Nguyen
H
H
Hamer
D H
DH
D000293:Adolescent; D000328:Adult; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000145:classification*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014744:Vietnam / Q000453:epidemiology