Did suturing services at Alexandra Health Centre need upgrading?

Due to financial restrictions patients at the Alexandra Health Centre (AHC) were sutured under conditions of cleanliness but not complete asepsis. A study was undertaken in 1987 to determine the need and priority for upgrading suturing services at AHC by determining the rate of wound sepsis after suturing in 348 consecutive patients during 1 month. One hundred and thirty-nine (40%) returned for removal of sutures, of whom 31 (22.3%) were assessed as having septic wounds, 15 (10.8%) with mild sepsis (inflammation only) and 16 (11.5%) severe (pus present). Depending on whether one considers mild or only severe sepsis and how one takes account of the effect of non-responders, the overall sepsis rate is between 4.6% and 22.3%. The only factor found to be a predictor of sepsis was clinically evident wound contamination. A follow-up study, undertaken to investigate the reasons for so many patients not returning to the AHC for removal of sutures, found that most patients removed their sutures at home. The literature is reviewed and the problems in defining sepsis and handling poor response rates are discussed. In all, we recommended that the introduction of complete asepsis should not occur at the expense of other priorities at the AHC.