SURVEILLANCE STUDY SURGICAL SITE INFECTIONS AS A PUBLIC HEALTH INDICATOR PREVENTION AND MONITORING

Background: Surgical site infections (SSIs) remain a major contributor to postoperative morbidity and healthcare burden, especially in low- and middle-income countries. As preventable complications, SSIs also serve as critical indicators of surgical safety and infection control standards. Objective: To monitor and evaluate the incidence, prevention practices, and temporal trends of surgical site infections through a prospective active surveillance approach in tertiary care hospitals in Pakistan. Methods: A prospective cohort study was conducted over 12 months across three urban tertiary care hospitals in Pakistan. A total of 600 adult patients undergoing elective clean and clean-contaminated surgeries were enrolled. Data on patient demographics, surgical details, and infection prevention practices were collected using standardized tools. SSIs were identified and classified using CDC criteria, and post-discharge surveillance was performed at days 7, 14, and 30. Statistical analysis included logistic regression to identify risk factors and repeated-measures ANOVA for trend analysis. Results: The overall SSI incidence was 9.7%, with superficial infections accounting for 65.5% of cases. High adherence was noted for timely antibiotic prophylaxis (92.5%) and sterile draping (94.2%). Diabetes mellitus (OR 2.14, p=0.008), obesity (OR 1.89, p=0.039), and surgeries exceeding two hours (OR 2.71, p=0.002) were significantly associated with increased SSI risk. A consistent pattern of infections was noted across quarters, with minor fluctuations. Conclusion: Active surveillance proved effective in quantifying the burden of SSIs and highlighting areas for improvement in infection prevention. The findings advocate for strengthened surveillance infrastructure and tailored interventions to reduce SSI rates and improve surgical safety in Pakistan.