ETHIOPIAN DEFENCE UNVERSITY COLLEGE OF HEALTH SCIENCE, POST-

GRADUATION PROGRAM DEPARTMENT OF INTEGRATED EMERGENCY

SURGERY AND OBSTETRIC AND GYNECOLOGY

Incidence of surgical site infection and associated risk factors among surgical
case patients in AFCSH, Addis Ababa, Ethiopia
BY- ( ALENA ASALE).

ADIVISSER- ( MEBRATE D )

A proposal submitted to the Ethiopian defense university college of health sciences post-
graduate program in partial fulfillment for requirements of masters of integrated
emergency surgery and obstetrics and gynecology.

FEBRUARY 2024

ADDIS ABABA, ETHIOPIA.

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DECLARATION
I. Title of the research:

This proposal is my original work and has not been presented for a degree in any other
university.

Name of the student ALENA ASALE

Signature_______________________________Date 06/28/2024

Name of primary advisor ------------

Signature___________________________________________Date__________________

Name of co-advisor_________________________________________________________

Signature________________________________________________Date_____________

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Acknowledgments................................................................................... Error: Reference source not found
List of abbreviations and Acrimony........................................................ Error: Reference source not found
Abstract................................................................................................... Error: Reference source not found
CHAPTER I: INTRODUCTION......................................................................................................................... 6
1.1. Background information.............................................................. Error: Reference source not found
1.2. Statement of the problem............................................................ Error: Reference source not found
1.3. Significance of the study.............................................................. Error: Reference source not found
CHAPTER II: LITERATURE REVIEW.............................................................................................................. 10
CHAPTER III: OBJECTIVE......................................................................... Error: Reference source not found
3.1. General objectives........................................................................ Error: Reference source not found
3.2. Specific objectives........................................................................ Error: Reference source not found
CHAPTER IV: CONCEPTUAL FRAME WORK.............................................. Error: Reference source not found
CHAPTER V: METHOD AND MATERIAL.................................................... Error: Reference source not found
5.1. Study area and period.................................................................. Error: Reference source not found
5. 2. Study design................................................................................ Error: Reference source not found
5.3. Population.................................................................................... Error: Reference source not found
5.3.1. Source of population............................................................. Error: Reference source not found
5.3.2. Study population................................................................... Error: Reference source not found
5.4. Inclusion and exclusion criteria.................................................... Error: Reference source not found
5.4.1. Inclusion criteria.................................................................... Error: Reference source not found
5.4.2. Exclusion criteria................................................................... Error: Reference source not found
5.5. Sample size................................................................................... Error: Reference source not found
5.6. Sampling techniques.................................................................... Error: Reference source not found
5.7. Data collection tools and technique............................................. Error: Reference source not found
5.8. Study variables............................................................................. Error: Reference source not found
5.8.1. Dependent Variables............................................................. Error: Reference source not found
5.8.2. Independent Variables.......................................................... Error: Reference source not found
5.9. Operational definition.................................................................. Error: Reference source not found
5.10. Data processing and analysis...................................................... Error: Reference source not found
5. 12. Ethical consideration................................................................. Error: Reference source not found

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 5.13. Dissemination plan..................................................................... Error: Reference source not found
6. APPENDICES........................................................................................ Error: Reference source not found
6.1. Work Plan..................................................................................... Error: Reference source not found
6.2. Budget breakdown....................................................................... Error: Reference source not found
7. References.......................................................................................... Error: Reference source not found
8. ANNEXII. STRUCTURED ENGLISH VERSION QUESTIONNAIRE..............Error: Reference source not found
8.1. Information sheet........................................................................ Error: Reference source not found
8.2-Informed Consent......................................................................... Error: Reference source not found
8.3 Annex 1:........................................................................................ Error: Reference source not found

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ACKNOWLEDGEMENT

I would like to give my sincere gratitude to the all DUHSC and AFCSH
staffs members who helped me to achieve this task and my special tanks
go to my advisor -------to help throughout research form the process of
proposal writing and comment. Finally, I would like to thank all the others
who helped me in one way or another in doing this research proposal.

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 I. ABBREVIATION
AAA Abdominal aortic aneurysm

ANC Antenatal care

AFCS Armed Forces Comprehensive Specialized Hospital

CDC: Centers for Disease Control and Prevention

DHMD: Defense Health Main Directorate

DUCHS: Defense University College of Health Sciences

ER Emergency room

FMOH Federal ministry of health

GIT Gastro intestinal tract

NHSN National Healthcare Safety Network

HAI: Healthcare Associated Infection

IESO: Integrated Emergency Surgery and Obstetric

ICU Intensive care unit

OR: Operating room

SPSS statistical Package of Social Sciences

SSI Surgical Site Infection

WHO World health organization

1. CHAPTER I: INTRODUCTION

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1.1 Back ground-

Surgical site infections (SSIs) are infection that occurs within the first 30 days after
a surgical procedure if no implant is placed or within 1 year after a surgical
procedure if an implant is placed.(1,3)

Globally, SSI rates have been found to be from 2.5% to 41.9% In Western
countries, 2 to 5% of patients undergoing clean surgery and up to 20% of patients
undergoing infra-abdominal surgery will develop SSIs (2)

Prevalence of SSI in elective clean and clean-contaminated surgeries was

estimated to be 6%. The overall prevalence of SSI in Africa/Middle East, Latin
America, Asia, and China was 10% (3)

In Ethiopia, different studies had conducted to find the prevalence of SSI and
pathogens. The prevalence of SSI found in the range between 6.4 to 75.5% (4)

Surgical site infection is a common complication in patients who undergo surgery.

The prevalence is higher in low-income countries. In Ethiopia, prevalence and
pathogens of surgical site infection (SSI) reported are variable (3, 4)

Surgical; wound are classified as clean, clean contaminated, contaminated and

dirty /infected wound. (5)

SSIs are preventable complications following surgery and imposes significant

burden in terms of patient morbidity, mortality and increased cost of treatment (6)

The aim of this study will be to determine the incidence, and associated risk factors
of surgical site infection in AFCSH ADIS Ababa

1.2 Statement of the problem.

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Surgical site infection {SSI} is one of the global health problems and common
complication in patient who undergoes surgery, the incidence of SSIs is higher in
developing countries relative to developed nations (8) It contributes to occur
antibiotics resistance then further leads to life threatening morbidity it also increase
hospital stay and cost of health service more over according to the CDC report, SSI
cause 3% of death by the end of 2015 (8, 9)

A first global report claimed that SSI is one of the most major problem, this has
shown that it occurred in every types of surgery according to 2016 WHO report
after the surgery infected patient were 11%it burden report both in developed and
developing countries (10)

Regardless of advances in infection control, surgical site infections (SSIs) remain

a substantial cause of morbidity and mortality among hospitalized patients..(10)

The prevalence of SSIs among post operative patients in Ethiopia remains high
with pooled prevalence of 12.3% in 24 extracted studies then situation based
intervention and specific prevention strategies be developed to reduce the
prevalence of SSI among postoperative patients (11)

The risk of infection varies by type of surgical incision site. For example, invasive
procedures that penetrate bacteria-laden body sites, especially the bowel, are more
prone to infection. The traditional wound classification system designed by the
CDC stratifies the increased likelihood and extent of bacterial contamination
during the surgical procedure into four separate classes of procedures, clean
wound, and clean contaminated, contaminated and dirty wounds (12)

Surgical site infection acquisition depends on several factors namely exposed to

bacteria and the host’s ability to control the inevitable bacterial contamination of

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the incision they are typically caused by bacteria inoculated in to the surgical site
at the time of surgery. (13)

Approximately 70%to90%are caused by the patient s endogenous flora the most

common organisms are staphylococcus aures coagulate –negative staphylococcus
and E.coli in some patient exogenous sources of Contamination during surgery
such as bacterial transmitted from surgical personnel or heater –cooler unit can
also lead to infection. (13)

Factors associated with SSI included old age, immunosuppression, obesity,

effectiveness of antimicrobial prophylaxis diabetes surgical site tissue condition
such as the presence of foreign body and degree of contamination. (! 4)

1.3 Significance of the study The outcome of this study will be helpful in
understanding and describing the incidence and main associated factors that
affect the desired outcome of surgical intervention.
It will also help the organization and health service providers to develop and
implement new strategies towards implementing effective wound care
services and infection prevention control, which will help to reduce the
degree of surgical site infections.
1.4 Research questions

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2. CHAPTER II: LITERATURE REVIEW
The CDC healthcare-associated infection (HAI) prevalence survey found that there
were an estimated 110,800 surgical site infections (SSIs) associated with inpatient
surgeries in 2015. Based on the 2021 HAI data results published in the NHSN’s
HAI Progress Report, about a 3% increase in the SSI standardized infection ratio
(SIR) related to all NHSN operative procedure categories combined compared to
the previous year was reported in 2021.(4,14)

Surgical site infection (SSI) is one of the global health problems It contributes to
occur antibiotic resistance that further leads to life-threatening morbidity It also
increases hospital stay and costs of healthcare services.(14)

Effective infection prevention activities have implemented in national and

international settings. These are because of to prevent and control devastating
health problems. Notable, improving surgical techniques, operating rooms, and
providing antimicrobial prophylaxis (11, 15)

Surgical site infection (SSI) is the most common healthcare-associated infection

(World Health Organization, 2018), with an estimated risk of 3–5% after all
surgery in the United Kingdom (UK) (National Institute for Health and Care
Excellence, 2019).

SSIs lead to increased morbidity and mortality beyond the original indication for
surgery and are potentially preventable. Existing SSI statistics cited in guidelines
are often based on large observational studies in general surgical populations
(Gibbons et al., 2011; Leaper et al., 2008).(5)

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Surgical site infections is often the result of contamination during the surgical
procedure or contamination of the surgical wound after the procedure .SSIs very
common HAIs and then require additional surgical procedures to treat the infection
{National infection prevention and control guideline}

Postoperative wound infection has been a problem which causes high mortality in
the developing world; postoperative wound has been reported to cause devastating
consequences.

The prevalence of SSIs among post operative patients in Ethiopia remains high
with pooled prevalence of 12.3% in 24 extracted studies then situation based
intervention and specific prevention strategies be developed to reduce the
prevalence of SSI among postoperative patients SSIs are a major cause of
morbidity and mortality worldwide, affecting

5.6% of surgical procedures in developing countries

According to a World Health Organization (WHO) report, the incidence of SSIs

ranges from 1.2 to 23.6 per 100 surgical procedures [3]. Worldwide, it has been
reported that more than one-third of postoperative deaths are related to SSIs [4]. In
addition, SSIs threaten the lives of millions of patients each year and contribute to
the spread of antibiotic resistance
The risk of developing SSI varies greatly according to the nature of the operative
procedure and the specific clinical characteristics of the patient undergoing that
procedure. (18)

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 3. Conceptual farm work
The most important factors for SSI to occur are not genetic rather service delivery and
environmental factors. Socio-demographic factors also have undeniable contribution to the fate
of SSI unless the Infection Prevention polices in provision of health care not only their
availability but also in the way that health facilities and services are accessible at large.

Socio-demographic factors such as age, obesity, educational status are of the other socio-
demographic factors, have an important role on the occurrence of SSI regardless of other factors.
Another factor that has an important role for the occurrence of surgical site infection is
inappropriate post operation care services. Of these, extended hospitalization after the procedure
is takes place.Blood loss , Duration of the surgery. Qualification of the surgeon , Hair removal/clipping, Anti-
septic skin preparation
Co-morbidity is another independent factor that may be contributes the occurrence of SSI to the
patient such as diabetes, HIV/Aids, heart diseases …--

Patient related fators: - Procedure related

factors:
 Age – Residence
- Blood loss
 Preoperative condition Surgical site
 Pre-existing co-morbidty - Duration of the surgery
infection
- Qualification of the
surgeon

- Hair removal/clipping

- Anti-septic skin
preparation

- Timing of antibiotic
prophylaxis

- Type of surgery

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4. Objective
I.1 general objective
 To assess the proportion of surgical site infection and its associated factors
among surgical procedures done in the AFCSH
I.2 specific objectives
 to determine the proportion of SSI and its associated factors
 To identify the associated risk factors for SSI
5. Method and material;

5.1 Study area:-the study will be conducted among operated patients in Armed
Force Compressive Specialized Hospital the hospital is located in Ledeta sub-city
in the southwest part of Addis Ababa,

The Hospital provides different clinical services for army members and their
families, It provides general outpatient and inpatient services, including medical,
surgical, pediatric, gynecology obstetric and also orthopedics surgery ‘and also
antenatal care services, , family planning services, postnatal care services, &
immunization, care and treatment for HIV/AIDS

5.2. Study period:-The study will be conducted from January15 to April 15

2024, in AFCSH, Addis Ababa, Ethiopia.

5.3. Study design A 30-day Institutional-based prospective cohort follow-up of

surgical patient in the first month of the data collection period will be conducted.

5.4 source populations:-The source population will be drawn from surgical

patient in Armed hospitals in Addis Ababa ,Ethiopia

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 5.4.1 Study population: The sample population will be drawn from surgical
patient in the first 30 days of the data collection period in Armed hospitals in Addis
Ababa, Ethiopia.
5.4.2 Inclusion and exclusion
Inclusion:-Patients admitted in obstetrics and gynecology and general surgical
wards for surgery and underwent clean or clean contaminated surgeries, and/or
those who were willing to give informed consent to participate in this study will be
included.
Exclusion: - Patients with; infection occurring 30 days after the operation if no
implant is in place, Infection on episiotomy, contaminated wounds, Procedures in
which healthy skin was not incised such as opening abscess and orthopedic
surgeries will be excluded from this study
5.5 variables
5.5.1 Dependent variable
Surgical Site Infection
5.5.2 Independent variable
Age, sex, residence, diabetic status, hypertension status, steroid intake, wound
contamination level, nature of the procedure, preoperative prophylaxis, duration of
surgery, preoperative hospital stay, postoperative hospital stay, drugs prescribed
after surgery, laboratory tests requested, number of injections, number of wound
cares, presence of drains and ASA score.

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5.6 Sample size determination
The sample size was determined by using a single population proportion formula.
The following assumptions were applied: p, prevalence of 50%(since there is no
local data), d is the expected margin of error (5%), Z, the standard score
corresponding to a 95% confidence interval and α, the risk of rejecting the null
hypothesis (0.05). Accordingly the required sample size became 384.

Were
 n= is the minimum sample required
 P= the prevalence rate of surgical site infection (50 % = 0.5)
 D = the margin of error (the required precision) assume to be = 5%= 0.05
 Z= the upper percentile of the normal distribution 1.96
 N= (1.96) 2 (0.05) (0.05) /0.05 2 = (384 +38) = 422 the final sample size is 405
 The desired sample size calculated using the following correction factor formula as
follows: n=
 n/( 1+ [n/N]) ,where N= study population, sample size = 405

5.7Sampling techniqueby using systematic sampling technique surgical patient

will be selected to identify the study Subjects
5.8 Data collection technique;-structured questionnaire will be used to extract
data from the participants and their charts by the surgeon/resident and interns in
charge of the patient who were briefed on the CDC criteria how to diagnose SSIs.
Each participant follow for 30 days for development of SSI.The information
included was; socio demographic data, existing chronic disease (such as diabetes
mellitus), past medical history, current drug use such as steroid, length of
preoperative hospital stay, duration of the operation, antimicrobial prophylaxis,
postoperative hospital stay, postoperative antibiotic given, and laboratory tests
ordered

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5.9 Data quality measures

To control the quality of the data, before the actual data collection procedure starts, pretesting
will be carried out in the study area and thorough discussion will be done with the data collectors
and supervisors about the overall procedures that will be carried out.
The principal investigator will check all of the questionnaires filled by the data collectors daily
whether it is filled correctly or not. Every day at the field, data will be checked for completeness
and consistency by supervisors.
Data analysis
Data will be entered, cleaned and analyzed using Epi-info software version 7.2.2.6 and SPSS
Version 23 and presented using tables and figures
Operational definitions:

CDC classification of Surgical Site Infections

Superficial SSI: - infection which involves only skin and subcutaneous tissue of the incision and
at least one of: -
1. Purulent drainage with or without laboratory confirmation,
2. Organism isolated from superficial incision,
3. Presence of sign and symptoms of infection at the site,
4. Diagnosis of SSI by physician/surgeon where Stitch abscess, Infection of an episiotomy are
not included.
Deep Incisional SSI: - infection involving deep soft tissues (e.g., facial and muscle layers) of the
incision and at least one of:
1. Purulent drainage from the deep incision,
2. A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the
patient has at least one of the following signs or Symptoms: Fever (>38ºC), localized pain, or
tenderness, unless site is culture-negative, an abscess or other evidence of infection involving the
deep incision,
3. Diagnosis of a deep incisional SSI by a surgeon or attending physician

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5.10 Ethical Consideration
This proposal will be submitted to Defense University, collage of health science
department of integrated emergency surgery and obstetrics..Conducted to AFCSH

Then Ethical clearance will be obtained from the DUCHS ethical review board to
carry out the study.
A formal letter will be written to army force comprehensive specialized hospital
(AFCSH) Permission will be obtained from concerned bodies; written consent will
be secured from AFCSH. And also Permission will be obtained from the client.
5.11 Dissemination of the Study-- The results of this study will be submitted to AFCSH,
EDUCHS, and DHMD. In addition, the findings will be presented at appropriate seminars,
To help in future interventions, the result will be communicated to AFCSH and
DHSC.

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6. Reference
1. Smith MA, Dahlen NR, Bruemmer A, Davis S, Heishman C: Clinical practice
guideline surgical site infection prevention. Orthopaedic Nursing 2013,
32(5):242-248.
2. Tamrat Legesse Laloto1 , Desta Hiko Gemeda2 and Sadikalmahdi Hussen
Abdella3* Incidence and predictors of surgical site infection in Ethiopia:
prospective cohor
3. Curcio D, Cane A, Fernández F, Correa J. Surgical site infection in elective
clean and clean-contaminated surgeries in developing countries. Int J Infect
Dis. 2019;80:34–45.
4. National Healthcare Safety Network, Centers for Disease Control and
Prevention. Surgical site infection (SSI)
event. http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published
January 2017. Accessed January 25, 2017.
5. . Ding S, Lin F, Marshall A, Gillespie B. Nurses’ practice in preventing
postoperative wound infections: an observational study. J Wound Care.
(2017) 26(1):28–37. doi: 10.12968/jowc.2017.26.1.28
6. Suzanne M. Pear. Patient Risk Factors and Best Practices for Surgical Site Infection Prevention. 2007.

7. Department of Microbiology and Parasitology, Faculty of Medicine, Bayero

University Kano, Nigeria
8. Department of Microbiology, Faculty of Life Sciences, University of Benin,
Benin city, Nigeria
9. Surgical Site Infection Event (SSI)national health care safety net work
(NHSN)
10. Surgical site infection and pathogens in Ethiopia: a systematic review and
meta-analysis.by(AKLILU ENDALAMAW AND YENEABAT BIRHANU
11. by Suzanne M. Pear, RN, Ph.D, CIC Patient Risk Factors and Best Practices for Surgical Site Infection
Prevention

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12. Culver DH, Horan TC, Gaynes RP et al. Surgical wound infection rates by
wound class, operative procedure, and patient risk index. National
Nosocomial Infections Surveillance System. Am J Med 1991; 91(3B):152S-
157S.

13. C.D. Owens, K. Stoessel* Kimberly-Clark Healthcare, Atlanta, GA, USSurgical

site infections: epidemiology, microbiology and prevention

14. Centers for Disease Control and Prevention Guideline for the Prevention of
Surgical Site Infection, 2017

15. Frehiwot A, Teshager E, Surgical Res. Practice; Gondar, 736175published online 2015
Dec15 doi 10.1155/2015/736175 PMCID;PMC 2693022
16. Rajar AS et.al. KAP assessment about SSI among health care workers, Muhimbili
University of health and Allied sciences, Tanzania, November 2013.
17. Robert S. Namba, MD, Maria C.S. Inacio, MS, and Elizabeth W. Paxton, MA
18. Prevention of Surgical Site InfectionAuthor links open overlay panelJohn
P. Kirby MS,MD, John E. Mazuski MD, PhD

5. ANNEXES:
7.1. Component stages of the project
Phase 1

Proposal development and release budget

 Correspond with advisor

 Write proposal draft
 Prepare work plan and budget
 Submit proposal to department head
 Presentation

Phase 2

Field work and data collection

 Receive ethical clearance from DUHSC

 Receive permission from AFCSH

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  Select and train data collectors from study area
 Pilot test data collector
 Data collection

Phase 3

Data analysis, writing report and defense of the final thesis

 Make data entry analysis

 Write thesis
 Present final thesis to department
 Gain thesis approval
 Hold presentation
 Dissemination of the results

Work plan

Responsibility
December

Faburary
January

March

Phases
April

Phase One

Preparation of proposal
Submission of draft proposal to Dpt.
Review by advisors
Incorporate comments and suggestion
Mock presentation
Proposal presentation
Incorporate comments & suggestion
Submission of proposal document to Dpt.
IRB

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 Phase Two
Data collection
Data analysis and report writing
Phase Three
Thesis submission to Dpt.
Review of primary advisor
Incorporate comment and suggestion
Final thesis submission
External examiner review
Thesis defense

6.3. Budget
6.3.1 Personal allowance

Each of Total
cost
Budget Category Daily cost cost

Birr Ct.

Principal investigator(P.I) 200.00 1x200x30days 6000 00

Data collector 150.00 2x150x15days 4500 00

Data editor 200.00 2x200x10days 4000 00

Secretary 200.00 1x200x6days 1200 00

Subtotal 15700 00

6.3.2. Stationery Supplies

Printing 2.00 2x100 page 200 00

Photo copy 5.00 5x350 1750 00

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 Printer paper 200 6packx200 960 00

Pen(lax) 20 20x10 200 00

Pencil 5 10x5 50 00

Stapler 500 1x500 500 00

Steeples 60 3packx60 180 00

note book 50 50x5 250 00

Draft paper print 5draft 5x100pagesx1 500 00

Parkers 40.00 3x40 120 00

Sub Total 4710 00

6.3.3. Miscellaneous

Tell-phone 100.00 6x100 600 00

E-mail charge 25.00 4x25 100 00

SubTotal 700 00

Total 21110 00

Contingency 10%---------------------------------------------------------------------Birr
2111
Ground total ------------------------------------------------------------------------- Birr
23221

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I. Socio-demographic characteristics of participants

1. Age

1.≤ 25
2. 26–45
3. > 45

2. Sex
1. Male
2. Female

3. Level of Education
1. None
2. Primary
3. Secondary
4. Tertiary

4. Cigarette Smoking
1. Yes
2. No
5. Alcohol consumption
1. Yes
2. No
6. BMI kg/m2
1. < 25
2. 25 to < 30
3. ≥30

II. Clinical and procedure characteristics of participants who had surgeryDiagnosis

1. Acute abdomen
2. Peritonitis
3. Urology
3. Injury
4. Other
3. Surgical procedures done at surgical ward
1. Head and neck surgery
2. Breast surgery
3. Gastrointestinal surgery
4. Urological surgery
5. Hepato-biliary surgery
6. Vascular procedure

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 7. Lipoma excision
8. Hernia repair
9. Limb
10. Others

4. Type of Surgery
1. Elective
2. Emergency

5. Outcome
1. Discharge
2. Death
6. pre oprativive blood transfusion

1. Yes
2. No
7. Pre oprative hospital stay
1. <=7days
2. >7days
8. Hospital stay post-operatively (days)
1. ≤ 14
2. > 14
9. Wound class
1. Clean
2. Clean contaminated
3. Contaminated
4. dirty
III. surgical risk factors associate with SSI
1. ASA score
1. ASA I
2. ASA II-IV

2. Grade of surgeon
1. Surgeon
2. Resident

3. Use of prophylactic antibiotic

1. Yes
2. No
4. If yes Q5 Time of prophylaxis before skin incision
1. ≤ 15 min
2. 15–30 min
3. 30 min-1 h
5. Duration of surgery (hours)
1. < 2

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 2. ≥ 2
6. Number of staff in the room
1. ≤ 6
2. > 6

7. Co morbidity
1. Yes
2. No
8. If yes for Q7
1. HIV
2. CA
3. Diabetes mellitus
4. Heart disease
5. Chronic hypertension
6. Liver disease
7. Obesity
8. Anaemia
9. Other

9 Previous surgery
1. Yes
2. No

10 Skin closure
1. Interrupted
2. Sub-circular
11 Antibiotic use post-surgery
1. Yes
2. No
12. If yes Q15 Types of Prophylactic antibiotic
1. Tetracycline
2. Erythromycin
3. Ampicillin
4. Gentamycin
5. Amikacin
6. Cotrimoxazole
7. Cephalexin
8. Norfl oxacin
9. Ciprofl oxacin
10. Cefotaxime

13. Site of hospital admission

1. Intensive care units
2. Surgical wards
3. Other
14. Microbiological characteristics of SSI

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 1.S aureus
2.Coagulase-negative Staphylococcus
3.Enterococcus sp.
4.E coli
5.P aeruginosa
6.Enterobacter sp
7.K pneumoniae
8.mixed culture containing organisms
a. S. aureus &P. aeruginosa
9. other
Amharic

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