CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

Surgical site infections (SSIs) are defined by the Centers for Disease Control and Prevention (CDC) as infections that occur within 30 days after surgery (or within 90 days for implant-related procedures) and involve the incision site or deeper tissues, including organs or spaces manipulated during the operation. These infections are classified into superficial incisional (involving skin and subcutaneous tissue), deep incisional (involving deeper soft tissues), or organ/space types, and are primarily caused by endogenous or exogenous bacteria, leading to significant postoperative complications [1].

Globally, SSIs affect approximately 2.5% to 11% of surgical patients, with a pooled incidence of 2.5% (95% CI: 1.6–3.7) across diverse procedures, contributing to 20% of all healthcare-associated infections (HAIs) [1, 2]. The World Health Organization (WHO) estimates that SSIs lead to extended hospital stays (up to 10 additional days), increased costs (300–400% higher per case), and higher readmission rates, with low-and middle- income countries (LMICs) bearing a disproportionate burden due to limited resources. In high-income countries, rates are lower (1.2–5.2%), but SSIs still impose an annual economic burden exceeding US$900 million in the United States alone [3, 4].

In Africa, SSI prevalence is markedly higher, ranging from 2.5% to 30.9%, with a pooled rate of 7.2% and up to 16% (6.8–26%) in sub-Saharan settings, where they account for 41.6% of HAIs [5,6]. Factors exacerbating this include inadequate infection prevention infrastructure, high antimicrobial resistance, and comorbidities like human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and malnutrition. Caesarean sections and abdominal procedures report rates of 5.6% and up to 20%, respectively, underscoring the regional vulnerability [5,6].

In Cameroon, SSI rates mirror regional trends, with hospital-based studies reporting 9.16% to 20.6% overall prevalence, and up to 13.56% in surgical wards [7].  At Limbe Regional Hospital (LRH), a 200-bed referral facility in Southwest Cameroon, postoperative infection prevalence is 20.6%, predominantly in obstetrics/gynecology (61.7%) and surgical wards (38.3%), though specific abdominal surgery data are scarce. National surveillance gaps limit precise estimates, but SSIs contribute to prolonged stays (12 extra days) and higher mortality in resource-constrained settings like LRH [8].

Existing studies highlight several gaps: most focus on general HAIs rather than abdominal surgery-specific SSIs; few address associated risk factors (e.g., emergency procedures, contaminated wounds) or management outcomes (e.g., antibiotic resistance, debridement success) in LMICs like Cameroon [9]. Surveillance is inconsistent, with limited post-discharge follow-up, underreporting, and scant economic burden analyses. In Cameroon, hospital-level data exist but lack integration with national systems, ignoring local variables like malnutrition or prolonged operative times prevalent in abdominal case [10].

The present challenge lies in the high SSI burden at LRH among abdominal surgery patients, where modifiable risks (e.g, diabetes, smoking, operative duration >2 hours) and poor management outcomes (e.g,43.9% multidrug-resistant isolates, extended stays) persist amid resource limitations. This study focuses on prevalence, associated risk factors (patient-related: age, comorbidities; procedure-related: wound class, duration; institutional: prophylaxis adherence), and management outcomes (e.g., resolution rates, readmissions), to inform targeted interventions.

1.2 Research Questions/Hypothesis

1.2.1 Research Questions

1. What is the prevalence of SSIs among patients undergoing abdominal surgery at LRH?
2. What patient- and procedure-related factors are associated with the development of SSIs in this population?
3. What are the management outcomes for SSIs following abdominal surgery at LRH?

1.2.2 Null Hypotheses

1. There is no significant association between patient-related factors and the occurrence of SSIs among abdominal surgery patients at LRH.
2. There is no significant association between procedure-related factors and the occurrence of SSIs among abdominal surgery patients at LRH.
3. Management interventions for SSIs do not significantly influence resolution rates or readmission frequency in abdominal surgery patients at LRH.

1.3 Research Objectives

1.3.1 General Objective

To determine the prevalence, associated risk factors, and management outcomes of surgical site infections among patients who have undergwent abdominal surgery at Limbe Regional Hospital, Mile 1, from January 2026 to June 2026.

1.3.2 Specific Objectives

1. To estimate the prevalence of SSIs within 30 days post-abdominal surgery at LRH.
2. To identify patient-related risk factors associated with SSIs at LRH.
3. To assess management outcomes within the period of on going research.