ورقة علمية / Research Paper

Background and Rationale Surgical Site Infection (SSI) is one of the most frequent complications following surgical procedures and remains a major public health problem, particularly in low- and middle-income countries (LMICs). SSIs increase hospital stay, healthcare costs, antibiotic use, and postoperative morbidity and mortality (Allegranzi et al., 2016). According to the World Health Organization (WHO, 2018), the incidence of SSIs in LMICs can reach up to 20%, compared with 2–5% in high-income countries. A systematic review by Allegranzi et al. (2011) found that the pooled incidence of SSI in developing countries was 11.8%, with the highest rates reported in sub-Saharan Africa. In Ethiopia, prevalence rates of SSIs ranged from 9.4% to 19.1% depending on surgical type and hospital setting (Alemnew et al., 2019; Abebe et al., 2020). In Nigeria, Adisa et al. (2017) reported an SSI prevalence of 12.2% among general surgical patients, while Sudanese studies such as Musa et al. (2019) observed an infection rate of 16% in general surgical wards of Khartoum Teaching Hospital. SSIs are influenced by multiple factors including patient-related factors (age, diabetes mellitus, obesity, anemia, smoking), surgery-related factors (type of operation, duration, wound class, emergency vs elective), and perioperative practices (antibiotic prophylaxis, asepsis adherence, operating room environment) (Owens & Stoessel, 2008). Despite global and regional progress in infection control, SSIs remain underreported and under-investigated in Sudan. Determining their prevalence and predictors is vital for improving surgical outcomes and establishing evidence-based infection control strategies. Research Problem Surgical site infections continue to represent a preventable yet frequent postoperative complication among surgical patients in Sudanese hospitals. There is limited local evidence on the current prevalence and key predictors of SSIs in Sudan, making it difficult to design effective prevention and control programs. Research Questions 1. What is the prevalence of surgical site infection among surgical patients? 2. What are the significant predictors associated with the development of surgical site infections. Objectives General Objective To determine the prevalence and predictors of surgical site infection among surgical patients. Specific Objectives 1. To estimate the prevalence of surgical site infection among patients undergoing surgical procedures. 2. To identify patient-related factors associated with surgical site infection. 3. To determine surgery- and procedure-related factors influencing SSI development. 4. To assess perioperative factors associated with SSI occurrence. Methodology Study Design A hospital-based cross-sectional analytical study will be conducted. Study Area The study will be carried out in the General Surgery Department oftertiary-level teaching hospital in Northern Sudan. Study Population All adult patients (≥18 years old) who underwent major or minor surgical procedures in the selected hospitals. Inclusion Criteria Patients who underwent any type of surgical procedure (elective or emergency). Exclusion Criteria Patients with pre-existing infections at the surgical site. Sample Size Determination The sample size will be calculated using the single population proportion formula: n = \frac{{Z^2 P (1-P)}}{{d^2}} Where: Z = 1.96 (95% confidence level) P = 0.16 (based on local SSI prevalence of 16%; Musa et al., 2019) d = 0.05 (margin of error) n = \frac{{(1.96)^2 (0.16)(0.84)}}{{(0.05)^2}} = 206 Data Collection Tools A structured questionnaire and observational checklist will be used. Data will be collected from patient files, operation registers, and direct observation. Section A – Patient Information Age, sex, BMI Comorbidities (diabetes, hypertension, anemia, smoking, malnutrition) Preoperative hospital stay and nutritional status Section B – Surgery-Related Factors Type of surgery (orthopedic, general, gynecologic, etc.) Wound class (clean, clean-contaminated, contaminated, dirty) Duration of surgery (minutes) Urgency (elective/emergency) Use of drains, implants, or catheters Section C – Perioperative Factors Timing and type of antibiotic prophylaxis Intraoperative aseptic techniques Operating theater environment (number of staff, sterilization) Section D – Postoperative Assessment Daily wound inspection Presence of pus, redness, swelling, or wound dehiscence Diagnosis of SSI according to CDC criteria (Horan et al., 2008) Length of hospital stay and postoperative complications Data Collection Procedure Trained data collectors (nurses or surgical interns) will extract relevant information from medical records and observe wound conditions during postoperative rounds. Patients will be followed up until discharge and, if necessary, reviewed at outpatient clinics up to 30 days after surgery. Data Analysis Data will be entered and analyzed using jamovi. Descriptive statistics: Frequency tables, percentages, means, and standard deviations will describe patient and surgery characteristics. Bivariate analysis: Chi-square test and t-test will assess associations between potential risk factors and SSI. Multivariate logistic regression: To identify independent predictors of SSIs (variables with p < 0.2 in bivariate analysis will enter the model). Significance level: p < 0.05.

Written informed consent will be obtained from all participants after explaining the purpose, procedures, risks, and benefits of the study in simple, understandable language.

• Contributes to reducing healthcare costs by preventing avoidable infections and prolonged hospital stays. • Provides baseline data for monitoring trends in SSIs and evaluating future interventions. • Supports evidence-based policy-making and resource allocation in surgical care and infection control.