Vol. 22 No. 8 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 485 INCIDENCE AND PREDICTORS OF SURGICAL-SITE INFECTIONS IN VIETNAM Dao Nguyen, MD; William Bruce MacLeod, ScD; Dac Cam Phung, MD, PhD; Quyet Thang Cong, MD, MS; Viet Hung Nguyen, MD; Van Hoa Nguyen, MD; Davidson Howes Hamer, MD OBJECTIVE: To determine the incidence of, and risk fac- tors for, surgical-site infections (SSIs). DESIGN: Prospective observational study of all patients undergoing surgery during a 3-month period. SETTING: Two urban hospitals in Hanoi, Vietnam. PATIENTS: All 697 patients admitted for emergent and elective surgery. METHODS: Data were collected on all patients undergo- ing surgery during a 3-month period at each hospital. We stratified the data by type of surger y, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model. RESULTS: During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the inci- dence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic- regression model, abdominal surgery (odds ratio [OR], 4.46; P<.01) and wound class IV (OR, 5.67; P<.01) were significant pre- dictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene. CONCLUSIONS: There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treat- ment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgi- cal and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs (Infect Control Hosp Epidemiol 2001;22:485-492). In industrialized countries such as the United States, surgical site-infections (SSI) are the most common nosoco- mial infections in surgical patients, accounting for an aver- age of 37%, according to reports from the National Nosocomial Infection Surveillance (NNIS) System. 1 Developing countries often have reported higher inci- dences of SSI due to characteristics of the hospital envi- ronment, limitations of perioperative care, and economic constraints. The higher rates of SSI are associated not only with a higher morbidity and mortality but also with increased medical costs, a financial burden these countries often cannot afford. 2-5 At the current time in Vietnam, there are few report- ed data on the incidence of SSI. Few infection control programs have been established, and the approaches to perioperative care, antibiotic prophylaxis, and infection control techniques are inconsistent. Since the National Conference on Nosocomial Infections in 1998, organized by the Ministry of Health of Vietnam, there has been an increasing effort in developing, improving, and monitoring countrywide infection control standards. The Vietnamese National Conference on Nosocomial Infections reported results from a cross-sectional study involving 12 centers across the country with a total of 901 patients. 6 They found that SSI accounted for 51% of all noso- comial infections and the national average rate of SSI was 12%, with individual hospital rates varying from 0% to 39%. Unfortunately, these results were collected over a short period of time (three 1-day surveys at least 1 week apart) and included no further information regarding the patients or the surgeries performed. We carried out a prospective study in two hospitals in Hanoi in order to define better the incidence of SSI and the characteristics of the affected patient populations. From the Department of Medicine (Drs. D. Nguyen and Hamer), New England Medical Center–Tufts University School of Medicine, Medford, Massachusetts; the Department of International Health (Drs. MacLeod and Hamer), Applied Research on Child Health Project, Center for International Health, Boston University School of Public Health, Boston, Massachusetts; the National Institute of Hygiene and Epidemiology (Dr. Phung); the Department of Clinical Microbiology (Dr. Van Hoa Nguyen), the Department of Anaesthesia (Dr. Cong), Friendship Huu Nghi Hospital; and the Division of Infection Control (Dr. Viet Hung Nguyen), Bach Mai Hospital, Hanoi, Vietnam. Address reprint requests to Davidson H. Hamer, MD, Boston University School of Public Health, 715 Albany St, T4w, Boston, MA 02118. The authors thank Bernadette Sullivan for her assistance with the preliminary groundwork for this study and Michael Barza for his comments on the design of the study and his review of the manuscript. This work was supported by a cooperative agreement between Harvard University and the Office of Health and Nutrition of the United States Agency for International Development. Dr. D. Nguyen currently is affiliated with the Division of Respirology, McGill University Health Center, McGill University, Montreal, Quebec, Canada. 00-OA-275. Nguyen D, MacLeod WB, Phung DC, Cong QT, Nguyen VH, Nguyen VH, Hamer DH. Incidence and predictors of surgical-site infec- tions in Vietnam. Infect Control Hosp Epidemiol 2001;22:485-492. ABSTRACT