LEVEL OF KNOWLEDGE TOWARD SURGICAL SITE INFECTIONS AMONG CLINICAL YEARS MEDICAL STUDENTS IN THE WESTERN REGION OF SAUDI ARABIA

Yasser Hussain Alnofaiey¹, Hulayyil Huwayda H Almuqati^2*, Awad Ahmed Alasmari², Mohammed Hussain W Alosaimi², Mohamed Ali M Alshehri², Abdulaziz Saud F Aljuaid², Rayan Eidhah H Alzaidi²

ABSTRACT

A surgical site infection is an infection that develops within 30 days following a surgery in the body where the surgical incision was performed. Aim: This study aimed to assess the knowledge of medical students about SSI in western Saudi Arabia. This study aims to assess awareness of surgical site infection among medical students in clinical years in the western region of Saudi Arabia and to show the difference in knowledge between governmental universities. We performed an observational study with a cross-sectional study design. A validated structured online questionnaire was used as a study tool. The questionnaire was distributed among the medical students through online means. Our study included 441 participants, of whom 46.7% were males. Only 7.3% of participants had a good knowledge score (≥70%), whereas 58.5% had a poor knowledge score (<50%). There was a significant association between knowledge level with gender (p=0.000), university (p=0.017), current study year (p=0.000), and whether the participant had studied surgery before (p=0.006). Good knowledge was more evident among females (75%) than males (25%). Students of Umm Al Qura University had the highest prevalence of good knowledge (53.1%) among other groups. Similarly, senior students (78.1%), and students who had studied surgery before (100%) had better SSI knowledge. Awareness and level of knowledge regarding SSI among medical students are generally low. We recommend improving their knowledge of SSI by providing them with more courses and sessions.

Keywords: Knowledge, Surgical site infections, Medical students, Western region, Saudi Arabia

Introduction

A surgical site infection (SSI) is an infection that develops within 30 days following a surgery in the body where the surgical incision was performed. Surgical site infections can either be superficial infections that just affect the skin or deep infections which can be more severe, affecting tissues beneath the skin, organs, or implanted materials [1-3]. Those who acquire surgical site infection are up to 60% more likely to stay in the intensive care unit, five times more likely to be readmitted to the hospital, and twice as likely to die as patients who do not get SSI [4, 5].

Surgical site infections may be the most preventable healthcare-associated infection, especially when a care bundle strategy is applied because there are so many risk factors to target [6, 7]. Contaminated operations, emergency surgeries, lengthy procedures, improper sterilization, insufficient tool handling, and insufficient antiseptic surgical site preparation are examples of surgery-related issues [3, 8].

Many infection control methods, such as surgical hand preparation, increased nutritional support, pre-operative bathing, surgical site skin preparation, hair removal, mechanical bowel preparation, and the use of oral antibiotics, can help to prevent SSI. Proper hand hygiene and the use of basic precautions during invasive procedures are simple and inexpensive, but they necessitate students' education and monitoring systems. As is well known, SSI prevention is a critical component of implementing the patient safety and quality care concepts [9]. Thus, this study was conducted to assess awareness of the surgical site infection (SSI) among medical students in clinical years in the western region of Saudi Arabia and to demonstrate the potential differences in knowledge among sociodemographic factors.

Materials and Methods

Study Design

This is an observational study with a cross-sectional sample.

Study Area and Settings

This is an observational cross-sectional study, the study was conducted in the Western region of Saudi Arabia, which is also known as the province of Mecca often referred to as Mecca, the foremost important governance is Mecca, Jeddah, and Taif.

Study Subjects

Our study population included 441 participants clinical years medical students in governmental universities which are King Abdulaziz University, Jeddah University, King Saud Bin Abdulaziz University for Health Sciences-Jeddah, Umm Al-Qura University, and Taif university either male or female in the western region of Saudi Arabia.

Inclusion Criteria

Clinical years medical students studying in governmental universities in the western region either male or female.

Exclusion Criteria

Pre-clinical years students, private school medical students, and students outside the western region.

Data Collection Methods, Instruments Used, Measurements

Study Tool

A structured online questionnaire was used as a study tool. The validated questionnaire-based survey regarding the awareness and knowledge about surgical site infection among respondent physicians and interns in King Abdulaziz university hospital. The questionnaire consists of two parts, the first talks about demographic features such as gender, age, study year, and university. The second part consists of 20 questions related to surgical site infections. The questionnaire was distributed among the medical students through online means.

Data Analysis and Entry Method

Data was entered on the computer using “Microsoft office excel software”. To be statistically assessed, the data was uploaded to the Statistical Package of Social Science Software (SPSS) software, version 26 (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.).

Results and Discussion

Table 1 showed the socio-demographic data of the participants. We included a total of randomly taken 441 participants who filled out our questionnaire according to the inclusion criteria. Over half of our participants (53.3%) were females and 46.7% of them were males. Of all, 70.3% were aged between 18 and 23 years, whereas 29.7% were aged 24 to 30 years. Most of our participants were students at King Abdulaziz University (37.4%), and Umm Al Qura University (37%). Over half of the participants were in the last year of their program (54.9%), and have studied the surgery module already (86.8%).

Table 2 showed the knowledge items among respondents and Table 3 shows the knowledge score and knowledge score levels among respondents. Only 7.3% had good knowledge, 34.2% had fair knowledge, and 58.5% had poor knowledge. The average knowledge score among participants was 44.6 ± 15.7.

Table 4 shows that there was a significant association between knowledge level with gender (p=0.000), university (p=0.017), current study year (p=0.000), and whether the participant had studied surgery before (p=0.006). Good knowledge was more evident among females (75%) than males (25%). Students of Umm Al Qura University had the highest prevalence of good knowledge (53.1%) among other groups. Similarly, senior students (78.1%), and students who had studied surgery before (100%) had better SSI knowledge.

Table 1. Sociodemographic characteristics of participants (n=441)

Table 2. Knowledge of participants of SSI (n=441)

Table 3. SSI Knowledge levels among respondents (n=441)

Table 4. SSI Knowledge in association with sociodemographic characters

Bacterial infection and the ever-growing bacterial resistance have imposed intense hazard to human fitness. And bacterial infection ought to substantially menace the wound healing system [10]. In this study, we included 441 medical students from five different universities in the West of Saudi Arabia to assess their knowledge of SSI.

Among all participants, 52.4% of participants were aware of the CDC definition of SSI. In contrast to a study by Labeau et. al., (2010) [11], which found that only 7% of nurses knew the correct classification of SSI [12], 46% of medical students in our study knew that the superficial SSI refers to an infection of the epidermis and dermis, and 43.1 percent knew that the superficial SSI accounts for more than half of all SSIs.

The most prevalent organisms causing SSI were recognized by 36.7 percent of the participants (S aureus and E. coli). Nearly half of those surveyed (49.2%) were aware of the ideal time to provide prophylactic antibiotics, which is one hour before surgery. In studies conducted in Saudi Arabia and Nigeria, higher percentages (78.2 percent and 57.58 percent, respectively) were reported [9, 11].

Only 17.5 percent were aware of the SSI incidence rate, which ranged from 1% to 3%. Fidaxomicin was identified by 45.6 percent of survey participants as an antibiotic that was not typically indicated for SSI. Furthermore, 38.1 percent of medical students were aware that a clean-contaminated wound was described as an incision made under sterile conditions with a hollow viscus incision and no active infection. Less than half of the students (44.7%) were aware that hairy skin was less likely to be related to SSI.

As reported in the study of Albishi et al., the CDC defines SSI as a proliferation of the pathogenic microbes that can be superficial (colonization in an incisional site inside the skin or subcutaneous fat), deep (colonization in the musculofascial layers), or in an organ or cavity [9]. According to [13], the majority of respondents named the hospital as the primary source of nosocomial illness. They also agreed that all students and patients, regardless of their diagnosis, should be considered potentially infectious and should know how to avoid and control hospital-acquired diseases.

According to our findings, gender (P=0.000), university (P=0.017), current study year (p=0.000), and if the subject had studied surgery before (p=0.006) all demonstrated a significant relationship with knowledge level. Females (75%) had a higher level of knowledge than males (25%). Among the other groups, Umm Al Qura University students had the highest proportion of good knowledge (53.1%). Senior students (78.1%) and students who had previously studied surgery (100%) also demonstrated greater SSI knowledge.

Conclusion

Awareness and level of knowledge regarding SSI among medical students are generally low. We recommend improving their knowledge of SSI by providing them with more courses and sessions and providing training programs for the future doctors which can improve the knowledge and awareness of SSI which in turn would decrease the length of hospital stay, economic costs, morbidity, and mortality rate because of SSI.

Acknowledgments: None

Conflict of interest: None

Financial support: None

Ethics statement: The permission was taken through the questionnaire and confidently was insured by not asking for names or any source of identification. The data was secured by not asking for names or any source of identification and data was secured in an online survey and then transformed into a secured Excel file.

1.        Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017;18(6):722-35. doi:10.1089/sur.2017.089

2.        Alsalamah M, Alwallan NS, Alshahrani SM, Al-Khateeb BF, Aldahash R, Angawi K, et al. Predictors of prolonged adult hospitalization in the tertiary care hospital emergency department of Saudi Arabia‎. J Adv Pharm Educ Res. 2021;11(3):95-100. doi:10.51847/2KJHALZg1d

3.        Ansari S, Hassan M, Barry HD, Bhatti TA, Hussain SZM, Jabeen S, et al. Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus. 2019;11(6):e4801. doi:10.7759/cureus.4801

4.        Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res. 2020;48(4):0300060520907776. doi:10.1177/0300060520907776

5.        Abujamel TS. Understanding the Mechanisms of Bacterial Antimicrobial Resistance within Biofilms. Int J Pharm Phytopharmacol Res. 2022;12(1):17-24. doi:10.51847/o5Bt4kEqyT

6.        Leaper D, Ousey K. Evidence update on prevention of surgical site infection. Current opinion in infectious diseases. 2015;28(2):158-63. doi:10.1097/QCO.0000000000000144

7.        Samsuar S, Simanjuntak W, Qudus HI, Yandri Y, Herasari D, Hadi S. In Vitro antimicrobial activity study of some organotin (IV) chlorobenzoates against Staphylococcus aureus and Escherichia coli. J Adv Pharm Educ Res. 2021;11(2):17-22. doi:10.51847/kaijZKAFCO

8.        Zyuzkov GN, Miroshnichenko LA, Polyakova TY, Stavrova LA, Simanina EV. Wound healing properties of the protein kinase A inhibitor and the mechanisms of their development. Bangladesh J Pharmacol. 2021;16(2):34-41. doi:10.3329/bjp.v16i2.50575

9.        Albishi W, Albeshri MA, Mortada HH, Alzahrani K, Alharbi R, Aljuhani F, et al. Awareness and Level of Knowledge About Surgical Site Infections and Risks of Wound Infection Among Medical Physicians in King Abdulaziz University Hospital: Cross-Sectional Study. Interact J Med Res. 2019;8(1):e12769. doi:10.2196/12769

10.     Liang Y, Liang Y, Zhang H, Guo B. Antibacterial biomaterials for skin wound dressing. Asian J Pharm Sci. 2022;17(3):353-84.

11.     Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, et al. Executive Board of the Flemish Society for Critical Care Nurses Nurses' knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews Evid Based Nurs. 2010;7(1):16-24. doi:10.1111/j.1741-6787.2009.00177.x

12.     Sadaf S, Inayat S, Afzal M, Hussain M. Nurse’s knowledge and practice regarding prevention of surgical site infection at allied hospital Faisalabad. Int J Sci Eng Res. 2018;9(5):351-69.

13.     Alhassan AR, Kuugbee ED, Der EM. Surgical Healthcare Workers Knowledge and Attitude on Infection Prevention and Control: A Case of Tamale Teaching Hospital, Ghana. Can J Infect Dis Med Microbiol. 2021;2021. doi:10.1155/2021/6619768