Surgeries and surgical site infection in India: A analysis of Health Management Information System 2019-2020

Introduction

Surgical site infection is defined as an infection occurs within 30 days after the operation if no implant is left in place or within one year if implant is in place and the infection appears to be related to the operation and infection involves deep soft tissue (e.g. fascia, muscle) of the incision and/or the infection appears to be related to the operation and infection involves any part of the anatomy other than the incision that was opened or manipulated during an operation (e.g. organs and spaces) [1]. The World Health Organization (WHO) defined that Surgical Site Infection (SSI) is the most surveyed and frequent type of Healthcare-Associated Infections (HAI) in low-and middle-income countries which affects one third of patients who have undergone a surgical procedure. SSI incidence is the second most frequent type of HAI [2]. It is one of the most common postoperative complications and causes significant postoperative morbidity, mortality, prolongs hospital stay, and increases hospital costs also (Anderson DJ, 2014). The global estimates of SSI have varied from 0.5% to 15%, studies in India have consistently shown higher rates ranging from 23% to 38% [3]. The incidence of SSI may be influenced by factors such as pre-operative care, the theatre environment, post-operative care and the type of surgery. Many other factors influence surgical wound healing and determine the potential for, and the incidence of, infection [4,5]. As it is a rare event and also it is complicated to maintain the data at national level as well as tracking of such incidents is also difficult. In this context we have tried to enlighten on the SSI rate through available data in the Health Management Information System (HMIS) portal which was launched by the Government of India. The HMIS portal provides the data on surgeries conducted at public health institutions throughout India, which includes major and minor surgeries with post-operative surgical site infections. As per HMIS major surgeries/operations are defined as surgeries requiring spinal or general anesthesia (alternative definition –surgeries that take more than 30 minutes to complete). Similarly, minor surgeries are defined as minor surgical care and should be available even where there is no surgeon. Draining abscesses, stitching injuries, hemorrhoids management etc. would be counted here (alternative definition –surgeries that take less than 30 minutes to complete).  The limitation of the study is whatever the data is available in the HMIS web-portal that has been considered for the analysis. The data shows that in India, total 1,88,82,734 surgeries were carried out during 2019-20 in the public health facilities. Of them 48,51,788 and 1,40,30,946 were major and minor surgeries respectively. Among operated surgeries 23,286 people had experience with surgical site infections during the reference period at national level.

The data reveals that, at national level 123 persons had experienced surgical site infection per 100 000 surgeries, Further, as high as SSI were reported in Meghalaya (923 Persons), Assam (669 persons), and Dadra & Nagar Haveli (611 persons), Daman & Diu (597) followed by Arunachal Pradesh (380 persons), Karnataka (364 persons) and Uttar Pradesh (419 persons). The least number of infections were reported in Kerala, Nagaland, Odisha and Rajasthan. The quality of surgeries can be assessed based on the SSI rate. The reporting of least number of SSI cases itself indicates that quality of surgeries is better and it is vice versa. For policy makers it helps to rectify the factors which are associated with performance as well as focus on the inputs for enhancing the quality through providing infrastructure facilities and skilled human resources. 

Declarations

Funding statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability statement: The data used for the study is obtained from the web portal of Health Management Information System (https://nrhm-mis.nic.in/SitePages/Home.aspx).

1. European Centre for Disease Prevention and Control (2012) Surveillance of surgical site infections in European hospitals – HAISSI protocol. Version 1.02. Stockholm: ECDC; 2012. Link: https://bit.ly/2J2Dvuz
2. WHO guideline (2016) Global Guidelines for the Prevention of Surgical Site Infection. Link: https://bit.ly/2TiZPC7
3. Ganguly PS, Khan Y, Malik A (2000) Nosocomial Infections and hospital procedures. Indian J Commun Med Accessed.
4. Arora A, Bharadwaj P, Chaturvedi H, et al. (2018) A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection. 2016. Journal of Patient Safety and Infection Control 6: 1–12.
5. Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, et al. (2014) Strategies to prevent surgical site infections in acute care hospitals: update. Infect Control Hosp Epidemiol 35: 605-627. Link: https://bit.ly/35v95c0