ICMR Study: Surgical Infections in India Higher Than Global Standards

A recent study conducted by the Indian Council of Medical Research (ICMR) reveals concerning insights into the rate of Surgical Site Infections (SSIs) in India. The study, which analyzed data from three major hospitals across the country, found that SSI rates in India are significantly higher compared to many high-income countries. These findings underscore the urgent need for improved healthcare protocols, infection control measures, and post-discharge monitoring systems.

What are Surgical Site Infections (SSIs)?

Surgical Site Infections are among the most prevalent healthcare-associated infections globally. SSIs occur at or near the site of a surgical incision and can develop during a patient’s hospital stay or after discharge. These infections often lead to severe complications, including prolonged recovery periods, additional surgical interventions, and increased healthcare costs.

ICMR Study Overview

The ICMR study was conducted on a cohort of 3,020 patients across three leading hospitals in India:

1. Jai Prakash Narayan Apex Trauma Centre (JPNATC)
2. Kasturba Medical College (KMC), Manipal
3. Tata Memorial Hospital (TMH), Mumbai

The study monitored these patients for six months post-surgery, making it India’s first multicentric systematic surveillance effort for SSIs.

Key Findings of the Study

1. Higher SSI Rates in India

• The SSI rate among the hospitals studied was 5.2%, which is notably higher compared to rates in high-income countries, typically ranging from 1.2% to 5.2%.
• However, the rate was found to be lower than previously reported in Gujarat (8.95%) but higher than Dehradun (5%) and comparable to some low- and middle-income countries like Iran (17.4%) and Egypt (17%).

2. Post-Discharge Surveillance

• 66% of SSI cases were detected through post-discharge surveillance, highlighting the importance of long-term monitoring.
• Many infections go unnoticed without adequate follow-up, contributing to underreported SSI rates in India.

3. Prolonged Hospital Stays

• Patients who developed SSIs experienced longer hospital stays, leading to additional financial burdens and increased strain on healthcare facilities.

4. High-Risk Factors for SSIs

• Debridement surgeries, particularly those involving amputations or internal fixation procedures, showed the highest SSI rate at 54.2%.
• Other risk factors include:
  • Longer surgical duration (over 120 minutes).
  • Clean or polluted wound classes.
  • Combination surgeries.

5. Impact of Surveillance

• The study demonstrated that proper monitoring systems can diagnose 50% more cases post-discharge.
• This finding emphasizes the need for structured post-discharge SSI surveillance programs across Indian healthcare facilities.

Comparative Analysis with High-Income Countries

SSI rates in high-income countries, supported by robust infection control systems and surveillance mechanisms, range from 1.2% to 5.2%. In contrast, the Indian healthcare system faces several challenges:

1. Lack of Standardized Surveillance:
   Unlike high-income countries, India lacks a nationwide system to monitor SSIs, particularly post-discharge.
2. Inadequate Infection Control Protocols:
   Limited resources and inconsistent adherence to hygiene standards in many hospitals contribute to higher infection rates.
3. Limited Awareness Among Healthcare Workers and Patients:
   Many healthcare professionals and patients are unaware of the importance of post-surgery care and follow-up monitoring.

Global Perspective on SSIs

The findings from the ICMR study also align with global data from low- and middle-income countries (LMICs). For instance:

• Iran: 17.4%
• Egypt: 17%
• Pakistan: 7.3%

These countries face similar challenges, including inadequate healthcare infrastructure and lack of post-discharge follow-up.

Challenges in India’s Healthcare System

1. Resource Constraints:
   Many Indian hospitals, especially in rural and semi-urban areas, lack the resources to implement stringent infection control measures.
2. Underreporting of Cases:
   A significant number of SSIs go unreported due to the absence of follow-up systems and patient education.
3. High Patient Load:
   Overcrowded hospitals and limited staff make it difficult to maintain optimal hygiene standards during surgeries.
4. Antimicrobial Resistance (AMR):
   The misuse of antibiotics has led to AMR, further complicating the treatment of SSIs.

Recommendations for Reducing SSI Rates

To address the challenges identified in the study, the following measures are crucial:

1. Strengthening Infection Control Protocols

• Establish strict hygiene and sterilization standards in operating rooms and post-operative wards.
• Train healthcare staff on best practices for infection prevention.

2. Implementing Nationwide Surveillance Systems

• Develop a standardized system to monitor SSIs across all healthcare facilities.
• Ensure post-discharge surveillance is an integral part of SSI monitoring.

3. Educating Patients and Healthcare Workers

• Conduct awareness campaigns about the importance of post-surgery care.
• Educate patients on recognizing SSI symptoms and seeking timely medical attention.

4. Promoting Research and Innovation

• Encourage studies to identify region-specific risk factors for SSIs.
• Invest in technologies like surgical robots and advanced wound care solutions to reduce infection rates.

5. Combating Antimicrobial Resistance

• Implement strict guidelines for antibiotic use.
• Promote the development and use of alternative treatments for infections.

The ICMR study serves as a wake-up call for India’s healthcare system to prioritize infection control and surveillance measures. By adopting evidence-based strategies and learning from high-income countries, India can reduce SSI rates and improve patient outcomes.

This comprehensive approach will not only alleviate the burden on healthcare facilities but also enhance the overall quality of surgical care, making it safer and more effective for patients.