Surgical Site Infections (SSIs) are serious events that surgeons regularly encounter during their practice and one of the most common postoperative complications, affecting nearly half of the patients undergoing surgical procedures [1,2].

Several studies have identified that SSIs are the very frequently reported nosocomial infections, which are associated with substantial mortality and morbidity and the leading cause of extended hospitalization as well as a source of a financial burden on health care. Due to various factors including lack of resources and staff shortage, the problem of SSIs is more prominent in developing countries [2,3,4].

Surgical antibiotic prophylaxis is defined as the use of antibiotics to prevent infections at the surgical site. Surgical Antibiotic Prophylaxis (SAP) has been recognized as one of the major factors and essential tools in combating and decreasing SSIs. Numerous guidelines have been developed, describing the types, dosage and duration of administration of SAP. However, several studies have demonstrated poor adherence among doctors towards these guidelines [5,6,7].

There is paucity of studies regarding doctors’ knowledge and practices towards SAP guidelines in India, so we did this study with the aim was to assess knowledge, attitude and adherence to the practice of SAP guidelines among doctors working at GMC Jammu.

Objectives of the Study

To evaluate the knowledge, attitude and adherence to the practice of SAP guidelines among doctors working at GMC Jammu.

• Research Approach: Descriptive

• Study Design: Cross Section Hospital based study design

• Setting of the Study: GMC Jammu

• Study Duration: Between June- October 2021

• Study Population: Doctors working in surgical specialties and super-specialties 

Sample Size

A total of 100 doctors including Professors, Associate professors, Assistant Professers, resistrars, Senior and Junior Residents and medical officers working in surgical specialties and super-specialties like Surgery, Neurosurgery, Gynecology, Orthopedics, Eye and ENT, Urology, Cardiology etc. were participated:

• Sampling Technique: Random sampling technique

• Sampling Criteria: Everyday 2-3 doctors working in surgical specialties and super-specialties were selected randomly till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality of the selected participants was also maintained

Inclusive Criteria 

Doctors working in surgical specialties and super-specialties of GMC Jammu and were present during the day of data collection and were willing to participate in the study.

Exclusion Criteria

Doctors who were not willing to participate in the study. 

Development of Tool

Self-administered, pre-tested, semi-structured questionnaire having knowledge, Attitude and Practices related questions.

Description of Tool:

• Section A: Socio-demographic characteristics of the Doctors (age, gender, level of training, specialty, designation and duration of services etc.)

• Sections B-Contained: Knowledge, Attitude and Practices related questions

Knowledge

These sections contained 10 structured knowledge questions regarding SAP having four options. The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 10 and minimum score was zero. Scoring was done on the basis of marks as:

>80%(9-10)=very good,60-79%(6-8) =Good,41-59% (4-8)=Fair,<40%(< 4)=poor

Attitude: These sections evaluated doctor’s attitude towards national SAP guidelines There were 10 questions of Attitude having the 5 points rating scale as Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree and it consists of total 50 marks. There were positive and negative statements. Positive statements were scored 5,4,3,2,1 and negative statements were scored 1,2,3,4,5 respectively Scoring was done on the basis of marks as:

>80%(40-50)=very good,60-79%(30-39)=Good,41-59%(20-29) =Fair,<40%(<20) =poor

Practices

This sections contained adherence of doctors towards different SAP practices. There were 10 structured practices questionnaire having options of Yes or No. The participants have to choose right one. One mark was given for each correct Practice and zero for incorrect practices. The maximum score was 10 and minimum score was zero. Scoring was done on the basis of marks as:

>80%(9-10)=very good,60-79%(6-8) =Good,41-59% (4-8)=Fair,<40%(< 4)=poor

• Validity of tool - by the experts in this field

• Permission- obtained from the concerned authorities of GMC Jammu

Data collection by myself and each participants was given 10-15 minutes time to complete that questionnaire and collected at the end of the prescribed time.

Data analysis with appropriate statistical test in terms of frequencies and percentage.

The present study was non-experimental descriptive study carried out to evaluate the knowledge, attitude and practice of surgical staff towards preoperative antibiotic prophylaxis at GMC Jammu.

A total of 100 doctors including Professors, Associate professors, Assistant Professers, resistrars, Senior and Junior Residents and medical officers working in surgical specialties and super-specialties like Surgery, Neurosurgery, Gynecology, Orthopedics, Eye and ENT, Urology, Cardiology etc. were participated. Among the 61 were Males while 39 were females, 57 were less 40 years of age while 43 were above 40 years of age, 63 were having less than 5 years of service while 37 had more than 5 years of services at GMC Jammu and 88 were working in surgical specialties while 12 were working in surgical super-specialties.

In the knowledge section, we asked about knowledge regarding indication, first line of SAP, second line for SAP, drug of choice, dosage, duration of SAP from the participants. Among the total, 22 participants had very good knowledge regarding SAP, 55 had good knowledge, 14 had fair knowledge and 9 had poor knowledge regarding SAP (Table 1).

Table 1: Knowledge of Doctor’s Regarding SAP

Maximum =10 Minimum=0

Table 2: Doctor’s attitude towards national SAP guidelines

Maximum =50 Minimum=5

Table 3: Adherence of doctors towards different SAP practices

Maximum =10 Minimum=0

In the Attitude section, we asked about attitude towards prophylactic surgical antibiotics and its effects on rate of infection, patient outcome, antibiotic resistance, side-effects etc. from the participants. Among the total, 16 participants had very good attitude towards SAP, 58 had good attitude, 12 had fair attitude and 14 had poor attitude towards SAP (Table 2).

In the practice section, we asked about practices and deviations of SAP guidelines in different surgical condition from the participants. Among the total, 14 participants had very good practices of SAP, 57 follow good practices,11 had fair practices and 18 follow poor practices of SAP (Table 3).

Surgical antibiotic prophylaxis is an effective management strategy for reducing postoperative infections, provided that appropriate antibiotics are given at the correct time for appropriate durations and for appropriate surgical procedures [8].

Our study results showed a adequate knowledge, positive attitude and good adherence towards antibiotic prophylaxis guidelines among the doctors working in various surgical specialties and super-specialties in GMC Jammu. Almost analogous results were found in different studies conducted in different setting and countries with some variation which might be due to many factors including differences in local guidelines, personal experiences, studies settings and medication availability [5-10].

The present study findings indicate that Hospital surgical antibiotic prophylaxis protocols should be regularly reviewed, as both the cost of individual antibiotics and the endemicity of multi-resistant bacteria in certain units or hospitals are subject to frequent  change. Effective educational programs compiling national and hospital guidelines may improve SAP prescription and decrease SSIs. More studies are needed to identify the gaps in knowledge and practices of doctors in different settings.

The results of this study showed that doctors’ knowledge regarding surgical antibiotics prophylaxis in various clinical scenarios and their attitude and practices of national and local hospital guidelines was satisfactory. But still there is a scope of improvement in order to reduce the incidence of preventable surgical site infections. 

Furthermore, Implementation of these SAP guidelines into practice is very crucial and an institution-based training program about SAP is extremely endorsed.

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2. Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization, 2018. https://www.ncbi.nlm.nih.gov/books/NBK536426/

3. Haque, M. et al. "Health Care-Associated Infections – An Overview." Infection and Drug Resistance, vol. 11, 2018, pp. 2321–2333.

4. Crader, M.F. and Varacallo M. "Preoperative Antibiotic Prophylaxis." StatPearls [Internet], StatPearls Publishing, January 2022. https://www.ncbi.nlm.nih.gov/books /NBK442032/

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