title: Surgical site infections, occurrence, and risk factors, before and after an alcohol-based handrub intervention in a general surgical department in a rural hospital in Ujjain, India.
abstract: BACKGROUND
  This study set out to determine occurrence of and risk factors for surgical site infections (SSIs) before and after implementation of an alcohol-based handrub (ABHR) intervention in general surgery wards in a rural, tertiary care hospital in India.
  
  
  METHODS
  Patients who underwent surgery between October 2010 and August 2011 (preintervention period) or September 2011 and August 2013 (intervention period) in the department of surgery were included. ABHR was introduced in September 2011. SSI was defined as per the Centers for Disease Control and Prevention guidelines. Comparison of SSI rate between the 2 periods was performed using analysis of variance. Risk factors were determined using multiple logistic regression models.
  
  
  RESULTS
  Incidence of SSI was 5% (36/720) and 6.5% (103/1,581) respectively, showing nonsignificant difference (P = .5735). The risk factor common for SSI in both periods was the duration of surgery (OR = 2.6 vs OR = 1.96, pre- and intervention periods, respectively). Risk factors in the intervention period were being a woman (OR = 2.18), renal disease (OR = 3.61), diabetes (OR = 4.43), smoking (OR = 2.14), preoperative hospitalization (<3 vs >15 days; OR = 3.22), and previous hospitalization (OR = 3.5). Compared with other studies, the amount of ABHR used in our study was low.
  
  
  CONCLUSIONS
  The amount of ABHR used might not be sufficient to interrupt the chain of contamination of microorganisms; therefore, continuation of the intervention and surveillance is recommended.
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Electronic address: cecilia.lindsjo@gmail.com.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lindsjö
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Megha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mahadik
authors.affiliation: Department of Surgery, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India.
authors.forename: Shalendra
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Stålsby Lundborg
authors.affiliation: Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical Collage, Ujjain, Madhya Pradesh, India; Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden.
authors.forename: Ashish
authors.initials: A
authors.lastname: Pathak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000438:Alcohols / Q000008:administration & dosage*; D005260:Female; D006235:Hand Disinfection / Q000379:methods*; D006780:Hospitals, Rural; D006801:Humans; D007194:India; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000438:Alcohols
keywords: Cross infection; Developing countries; General surgery; Hand hygiene; Surgical wound infection