This article examines the high surgical wound infection rates in African hospitals, which can reach 25% or higher. The author argues that common explanations—poverty, poor nutrition, flies, and patient behavior—are insufficient or unsupported. Instead, the primary cause is poor surgical technique and inappropriate materials, particularly the use of thick silk and catgut sutures that create dead tissue. Other contributing factors include inadequate wound lavage, excessive reliance on drains and dressings, premature wound closure, and misplaced faith in antibiotics and disinfectants. The author contends that wound infection results primarily from surgeon-induced tissue damage, not bacterial contamination alone. He emphasizes that living tissue can tolerate massive bacterial loads, but dead cells provide an ideal culture medium for bacteria. The underlying problem reflects two modern misconceptions—that infection is caused mainly by bacteria and that only fully trained surgeons understand surgical principles—combined with ancient beliefs about wound closure and healing substances. The author recommends prioritizing meticulous surgical technique, adequate lavage with copious water, leaving contaminated wounds open, and careful tissue handling. He concludes that water is the most important substance for preventing wound infection, and that improved teaching of proper operative techniques is essential.

Key findings

• Surgical wound infection in African hospitals is primarily caused by poor surgical technique and devitalized tissue rather than bacterial contamination alone
• Current wound management practices—including premature primary closure, use of thick sutures, inadequate lavage, and reliance on dressings and antibiotics—actively promote infection
• The high infection rates result from misconceptions about wound infection causation and adherence to harmful ancient practices rather than from poverty or patient factors
• Proper surgical technique emphasizing tissue care, copious water lavage, and open wound management for contaminated cases can significantly reduce infection rates
• Training deficiencies among non-surgeon operators and the migration of experienced surgeons to private practice have degraded surgical standards in African teaching hospitals