Impact of Sterilization Compliance on Frequency of Port Site Infection Following Laparoscopic Cholecystectomy
Main Article Content
Abstract
Background: Laparoscopic cholecystectomy is the preferred surgical treatment for symptomatic gallstone disease; however, port site infection remains an important postoperative complication, especially in settings where sterilization practices and instrument reprocessing systems may vary. Objective: To assess sterilization compliance in the operating theatre, determine the frequency of port site infection, and evaluate the association between sterilization compliance and port site infection after elective laparoscopic cholecystectomy. Methods: This prospective observational analytical study was conducted at District Headquarter Hospital Batkhela over four months. Eighty-six adult patients undergoing elective standard four-port laparoscopic cholecystectomy were enrolled through consecutive sampling. Sterilization compliance was assessed perioperatively using a structured compliance score and categorized as low compliance (≤21) or high compliance (≥22). Patients were followed for seven postoperative days for clinical evidence of port site infection. Data were analyzed using descriptive statistics, chi-square testing, and exploratory binary logistic regression. Results: The mean age was 42.81 ± 15.37 years, and 50 patients (58.1%) were female. Overall, port site infection occurred in 10 patients (11.6%). Infection was observed in 9 of 41 low-compliance procedures (22.0%) compared with 1 of 45 high-compliance procedures (2.2%; p = 0.004). In exploratory regression, higher sterilization compliance score was associated with lower odds of infection (OR 0.63, 95% CI 0.42–0.95; p = 0.028). Conclusion: Lower sterilization compliance was associated with increased frequency of early port site infection after elective laparoscopic cholecystectomy. Strengthening sterilization protocols, staff training, and infection-control audits may improve postoperative safety.
Article Details
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Lei QC, Wang XY, Zheng HZ, Xia XF, Bi JC, Gao XJ, et al. Laparoscopic versus open colorectal resection within fast track programs: an update meta-analysis based on randomized controlled trials. J Clin Med Res. 2015;7(8):594-601. doi:10.14740/jocmr2177w.
2. Deng Y, Zhang Y, Guo TK. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: a meta-analysis based on seven randomized controlled trials. Surg Oncol. 2015;24(2):71-77. doi:10.1016/j.suronc.2015.02.003.
3. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery. 2015;157(1):45-55. doi:10.1016/j.surg.2014.06.081.
4. Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2014;10:CD004638. doi:10.1002/14651858.CD004638.pub3.
5. Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A. 2014;24(11):811-818. doi:10.1089/lap.2014.0194.
6. Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol. 2002;97(2):334-340. doi:10.1111/j.1572-0241.2002.05466.x.
7. Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002;42(3):246-254. doi:10.1111/j.0004-8666.2002.00246.x.
8. Hamzaoglu I, Baca B, Böler DE, Polat E, Ozer Y. Is umbilical flora responsible for wound infection after laparoscopic surgery? Surg Laparosc Endosc Percutan Tech. 2004;14(5):263-267. doi:10.1097/00129689-200410000-00007.
9. Francis NK, Mason J, Salib E, Allanby L, Messenger D, Allison AS, Smart NJ, Ockrim JB. Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis. 2015;17(8):O148-O154. doi:10.1111/codi.13002.
10. Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005;23(4):249-252.
11. Brill A, Ghosh K, Gunnarsson C, Rizzo J, Fullum T, Maxey C, Brossette S. The effects of laparoscopic cholecystectomy, hysterectomy, and appendectomy on nosocomial infection risks. Surg Endosc. 2008;22(4):1112-1118. doi:10.1007/s00464-008-9815-1.
12. Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg. 2003;237(3):358-362. doi:10.1097/01.SLA.0000055221.50062.7A.
13. Redmond HP, Watson RW, Houghton T, Condron C, Watson RG, Bouchier-Hayes D. Immune function in patients undergoing open vs laparoscopic cholecystectomy. Arch Surg. 1994;129(12):1240-1246. doi:10.1001/archsurg.1994.01420360030003.
14. Karthik S, Augustine AJ, Shibumon MM, Pai MV. Analysis of laparoscopic port site complications: a descriptive study. J Minim Access Surg. 2013;9(2):59-64. doi:10.4103/0972-9941.110964.
15. Mir MA, Malik UY, Wani H, Bali BS. Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir. Int Wound J. 2013;10(1):110-113. doi:10.1111/j.1742-481X.2012.00963.x.
16. Yanni F, Mekhail P, Morris-Stiff G. A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications. Ann R Coll Surg Engl. 2013;95(5):345-348. doi:10.1308/003588413X13629960045959.
17. Taj MN, Iqbal Y, Akbar Z. Frequency and prevention of laparoscopic port site infection. J Ayub Med Coll Abbottabad. 2012;24(2):197-199.
18. Yi F, Jin WS, Xiang DB, Sun GY, Huaguo D. Complications of laparoscopic cholecystectomy and its prevention: a review and experience of 400 cases. Hepatogastroenterology. 2012;59(113):47-50. doi:10.5754/hge11232.
19. Triantafyllidis I, Nikoloudis N, Sapidis N, Chrissidou M, Kalaitsidou I, Chrissidis T. Complications of laparoscopic cholecystectomy: our experience in a district general hospital. Surg Laparosc Endosc Percutan Tech. 2009;19(6):449-458. doi:10.1097/SLE.0b013e3181bd8f6d.
20. Chuang SC, Lee KT, Chang WT, Wang SN, Kuo KK, Chen JS, Sheen PC. Risk factors for wound infection after cholecystectomy. J Formos Med Assoc. 2004;103(8):607-612.
21. Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A. Factors influencing wound infection following laparoscopic cholecystectomy. Trop Gastroenterol. 2003;24(2):90-92.
22. den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder surgery. J Hosp Infect. 1998;39(1):27-37. doi:10.1016/S0195-6701(98)90240-7.