Surgical Site Infection Rates in Five Middle Eastern Countries: International Nosocomial Infection Control Consortium Findings

Abstract

Objectives: This study of surgical site infection (SSI) rates covers 29 International Nosocomial Infection Control Consortium (INICC) member hospitals in 22 cities across the Middle East, including Bahrain, Egypt, Kuwait, Lebanon, and Saudi Arabia. Methods: Prospective cohort multinational surveillance data were collected through the INICC Surveillance Online System. Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) definitions were applied for SSI. Surgical procedures (SPs) were categorized into 12 types according to the International Classification of Diseases, ninth revision (ICD-9) criteria, 9th edition. Results: From 2014 to 2023, we collected data on 304 SSIs associated with 21 322 SPs. Among the 12 observed types of SPs, comparable incidences were noted between the INICC hospitals of the Middle East and CDC/NHSN datasets across six types of SPs: breast, 1.1% vs. 0.9% (p = 0.870); cholecystectomy, 0.1% vs. 0.2% (p = 0.360); craniotomy, 3.0% vs. 2.1% (p = 0.510); herniorrhaphy, 0.8% vs. 0.7% (p = 0.770); abdominal hysterectomy, 1.2% vs. 1.1% (p = 0.880); and laminectomy, 1.6% vs. 0.7% (p = 0.100), respectively. INICC hospitals of the Middle East exhibited a significantly lower cesarean section rate compared to CDC/NHSN rates: 1.04% compared to 1.5% (relative ratio (RR) = 0.71, 95% CI: 0.58–0.87; p = 0.001). However, the following four types of SPs showed SSI rates significantly higher than those of CDC/NHSN: Appendix surgery, 1.8% vs. 1.1% (RR = 1.55, 95% CI: 1.02–2.36; p = 0.041); coronary artery bypass, 4.5% vs.1.4% (RR = 3.32, 95% CI: 1.82–6.08; p < 0.001); open reduction of fracture, 2.5% vs. 1.1% (RR = 2.24, 95% CI: 1.50–3.36; p < 0.001); and exploratory abdominal surgery, 3.8% vs. 1.7% (RR=2.30, 95% CI: 1.56–3.39, p < 0.001). Conclusions: Most SSI rates in this set of hospitals in the Middle East are similar to those of CDC/NHSN. It is recommended to focus on implementing effective interventions to reduce SSI rates for procedures with higher rates.