Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center

Evaluation of independent risk factors associated with surgical site infections from caesarean section

BACKGROUND

The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section).

METHODS

Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK).

RESULTS

At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes.

CONCLUSIONS

High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.

A Case Report of Secondary Postpartum Hemorrhage in a Pregnant Woman With a Mechanical Mitral Valve: Challenges of Anticoagulation

A pregnant woman with rheumatic heart disease always runs the risk of developing both thromboembolic and hemorrhagic symptoms, necessitating careful monitoring of her anticoagulation treatments both throughout pregnancy and after delivery. Postpartum haemorrhage, a hemorrhagic manifestation, can be challenging to control and presents a significant challenge when it comes to beginning anticoagulation after delivery. Thus, pregnancy in these patients is an extremely risky endeavour. Given that these women take anticoagulants, managing these women with artificial heart valves throughout pregnancy can be difficult. The diminished clotting ability in these women may be the cause of postpartum haemorrhage, and a multidisciplinary approach is necessary for a successful treatment. To manage this potentially fatal illness, a well-equipped institution with proper support systems is essential. We present a 23-year-old primigravida who was 39 weeks and three days pregnant and had a repaired aortic valve as well as a prosthetic mitral valve. She was taking warfarin to prevent clotting when she was pregnant.

Obstetric Safety and Quality at Istishari Arab Hospital: Where Are We Now and How Can We Improve

Background: Indicators for tracking progress in maternal and newborn health have been recommended by a number of global monitoring initiatives. Quality of care is increasingly recognized as an important aspect of maternal and newborn health, particularly in the labor and delivery and immediate postnatal period. Objectives: The purpose of this study is to estimate the frequency of obstetric complications. Furthermore, in 2018, Istishari Arab Hospital assessed the safety and quality of obstetrical procedures. Identifying risk factors that contributed to adverse events in the obstetric department. Methods: A retrospective study is dependent on the use of electronic medical records from inpatient hospitals. Research was conducted in the field of inquiry in an electronic database, as well as related studies. Maternal morbidity and adverse outcomes were identified using diagnosis and procedure codes from the International Classification of Diseases, 10th Revision (ICD-10-CM) within the health information system. Aside from the paper files. SPSS was used for descriptive, univariate, and multivariate analysis. Results This study included 418 women, with 62.2 percent of them having their babies delivered by CS. The average age of the women in this study was 27.84.8 years, with 58.1 percent of them coming from Ramallah. Following a multivariate analysis using logistic regression, our study discovered a positive correlation with P-value 0.05 between educational level and prior CS on one side and surgical site infection on the other. Furthermore, our study found a link between the rate of CS on one side and maternal age, diabetes, hypertension, and gynecological factors on the other (prematurity, multiple gestation). Conclusion: Regardless of the number, patients with a lower education level or a history of CS have a higher risk of surgical site infection and other complications. By focusing on these factors and increasing awareness and education, we may be able to reduce obstetric complications in the future.

:

Background

We aimed to determine the prevalence and risk factors of surgical site infection (SSI) after cesarean delivery (CD) in a rural area in China.

Methods

We identified 155 patients with incisional and organ/space SSIs by International Classification of Disease codes and matched them with 465 patients (controls) in a time-matched retrospective quality assurance analysis. Multiple logistic regression analyses were performed to examine the risk factors for SSI: the work-years of providers, the number of antenatal care (ANC) visits, CD after labor, positive discharge culture, postoperative C-reactive protein (CRP) levels and fever.

Results

and discussion: During the study, 155 women with SSI were identified among the 8640 patients who delivered by CD. The incidence of SSIs was 179 per 10 000patients (95%CI: 151–207 per 10 000 patients). The total duration of hospitalization in patients with SSI was 14.49 ± 8.68 days compared with 7.96 ± 2.35 days in patients with no SSI (P < 0.01). Multiple logistic regression analysis showed that the work-years of providers (odds ratio [OR] = 3.729, 95% confidence interval [CI]: 1.463–9.501, p = 0.006), irregular ANC visits (OR = 3.245, 95% CI: 1.264–8.329, p = 0.028), CD after labor (OR = 2.545, 95% CI: 0.935–6.926, p = 0.020), postoperative CRP level (OR = 2.545, 95% CI: 0.935–6.926, p = 0.016) and a positive discharge culture (OR = 2.954, 95% CI: 0.305–28.643, p = 0.019) were positively associated with SSI. However, the rates of maternal request (OR = 0.186, 95% CI: 0.065–0.535, p = 0.002) and postoperative fever (OR = 0.208, 95% CI: 0.087–0.494, p = 0.001) were negatively related to SSI.

Conclusions

Special attentions should be paid to CD patients who had irregular ANC visits, attempted labor, a positive discharge culture, higher CRP levels and fever after surgery, who had a greater risk of SSI.

•

The incidence of SSIs was 179 per 10 000 patients (95%CI: 151–207).

•

Risk factors of SSIs included: irregular ANC visits, a positive discharge culture.

•

Higher CRP levels and fever after surgery had a greater risk of SSI.

Complications of Cesarean Birth: Clinical Recommendations for Prevention and Management

The increase in severe maternal morbidity and mortality in the United States correlates with a significant rise in U.S. cesarean birth rates from 5.5% in 1970 to a rate of 31.9% of all births in 2018, far beyond the World Health Organization goal of 10% to 15%. Three key contributors to maternal morbidity and mortality related to cesarean birth include complications of hemorrhage, surgical site infection, and venous thromboembolism. All women should be screened for risk factors associated with these major complications during the antepartum, intrapartum, and postpartum period to assure the availability of immediate resources based on the assessment. Implementing evidence-based maternity care safety bundles, toolkits, and protocols to manage these complications can reduce adverse outcomes.

A Risk-Stratified Peri-Operative Protocol for Reducing Surgical Site Infection after Cesarean Delivery

Background: Surgical site infections (SSI) are multifaceted. Pre-operative, intra-operative, and post-operative factors influence the risk of developing an infection. Our objective was to evaluate the effectiveness of an infection risk-stratification checklist, utilizing known SSI risk factors, and a tailored surgical protocol for SSI prevention in women undergoing cesarean delivery. Patients and Methods: A prospective project to reduce SSI was conducted for women undergoing cesarean delivery on the resident staff service at a midwestern, urban tertiary care hospital. Patients were categorized according to an SSI risk-stratification checklist as high risk or low risk. The low-risk group received the local standard of care (single prophylactic dose of pre-operative intravenous antibiotics and a standard pressure dressing). In the high-risk group, prophylactic antibiotic agents were given pre-operatively and continued for the first 24 hours post-operatively. Additionally, patients at high risk received an absorbent dressing (Mepilex Ag^®; Mölnlycke Health Care AB, Gothenburg, Sweden) that was applied in the operating room and worn for one week. Results: The overall rate of SSIs decreased from 6.1% (pre-study rate) to 1.4% after initiation of the protocol, a 77% reduction (p < 0.001). The low- and high-risk groups did not differ in infection rate (0% and 1.4%, respectively; p < 0.59). Both deep incisional and organ/space SSIs decreased after initiation of the protocol (91% and 62% decrease, respectively). Conclusion: Stratifying patients into high- and low-risk groups with tailored peri-operative management strategies reduced overall SSIs. The protocol incorporates known risk factors for SSI in a surgical procedure with high rates of SSI. This approach offers a structured method that can be adopted by other hospital systems for SSI prevention in patients undergoing cesarean delivery.

Surgical site infection and associated factors among women underwent cesarean delivery in Debretabor General Hospital, Northwest Ethiopia: hospital based cross sectional study

Background

Cesarean section rates have been increasing dramatically during the past three decades and surgical site infections are becoming a leading cause of morbidity and mortality among women undergoing cesarean deliveries. However there is lack of sound evidence on both the magnitude of the problem and the associated factors in developing countries including Ethiopia. The purpose of this study was to assess proportion of surgical site infection and associated factors among women undergoing cesarean delivery in Debretabor General Hospital.

Methods

An institution based cross sectional study was conducted from May to December / 2017. All women delivered by cesarean section in Debretabor General Hospital during data collection period were our study population. Data were collected using Pre-tested, semi-structured questionnaire/ data extraction tool and post discharge phone follow up and analyzed using SPSS version 20. Logistic regression model was used to determine the association of independent variables with the outcome variable and odds ratios with 95% confidence interval were used to estimate the strength of the association.

Results

Proportion of surgical site infection among cesarean deliveries was about 8% (95%Cl: 5.4, 11.6). Pregnancy induced hypertension (AOR = 4.75, 95%CI: 1.62, 13.92), chorioaminitis (AOR = 4.37, 95%CI: 1.53, 12.50), midline skin incision (AOR = 5.19, 95% CI: 1.87, 14.37 and post-operative hemoglobin less than 11 g/deciliter (AOR = 5.28, 95%CI: 1.97, 14.18) were significantly associated with surgical site infection.

Conclusions

Pregnancy induced hypertension, chorioaminitis, midline skin incision and post-operative hemoglobin of less than 11 g/deciliter were independent factors associated with surgical site infection. Cesarean deliveries with concomitant pregnancy induced hypertension, chorioaminitis and post-operative anemia needs special care and follow up until surgical site infection is ruled out. It is also advisable to reduce generous midline skin incision and better replaced with pfannensteil incision.

Infections complicating cesarean delivery

PURPOSE OF REVIEW

Cesarean sections are common surgical procedures performed in a healthy population and are unique because of a relatively high rate of postoperative infection. There have been many important advances in understanding the pathogenesis of infection and evaluation of interventions to prevent post cesarean section infections in the last few years. Our purpose in this review is to analyze these new data, discuss unanswered questions, and propose changes in standard of care.

RECENT FINDINGS

Wound closure techniques including subcuticular sutures and subcutaneous suturing have been shown to be effective at reducing surgical site infections. Wound dressings including negative pressure dressings likely do not decrease infection rates. The type, timing, and duration of preoperative prophylactic antibiotics, including adjunctive azithromycin for laboring women and multidose antibiotics in obese women, have also yielded mixed results. Our understanding of normal uterine microbiome and the impact of intrapartum antibiotics on the newborn is emerging.

SUMMARY

The pathogenesis of surgical site infections after Cesarean section is complex and multifactorial. Many interventions to reduce infections have been studied with varying degrees of effectiveness. Despite advances in the area, important questions remain unanswered.

Knowledge and Attitudes of Health Care Providers Toward Transgender Patients Within a Rural Tertiary Care Center

Purpose: Members of the transgender community face significant health disparities within our society, especially within the state of West Virginia, which is primarily rural. We sought to examine and compare existing attitudes and knowledge of resident and faculty physician medical professionals at our institution about treating transgender individuals within a rural tertiary care center.

Methods: The Medical Practitioner Attitudes Towards Transgender Patients (MP-ATTS) survey and the Medical Practitioner Beliefs and Knowledge about Treating Transgender Patients (MP-BKTTP) survey were sent to all faculty and resident physicians at West Virginia University Hospitals. Demographics included information about gender, rurality of hometown, race, and description of medical practitioner status (i.e., years out of residency, residency status).

Findings: In general, there were positive attitudes and reception of the survey among residents and faculty physicians. 76.45% of providers assumed that their patients were not transgender. More than 40% of respondents believed that they would need further education about transgender patients to provide appropriate health care. Male health care providers had significantly higher negative perceptions of the transgender community (N=85, M=4.46, standard deviation [SD]=0.55, p<0.0001) and perceived fewer barriers due to personnel (N=80, M=3.24, SD=0.96, p<0.0001).

Conclusion: A clear need exists for increased training in transgender health care among physicians taking care of this patient population. A gender divide exists among health care providers within West Virginia over attitudes regarding the transgender community. Further studies are needed to fully understand the health care needs and barriers of the transgender population.

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

OBJECTIVE

To investigate optimal timing of dressing and staples removal after cesarean delivery (CD).

METHODS

This prospective clustered clinical trial enrolled women undergoing CD between January 1, 2013, and October 31, 2014, at Hadassah-Hebrew University Hospital, Jerusalem. Women were assigned to one of five clusters differing in timing of dressing and staples removal. We assessed scar healing at 6 weeks.

RESULTS

920 women completed telephone questionnaires. Wound healing did not differ significantly among the clusters: the healing complication rate was 21% in the control group (n=46) and ranged from 18% to 26% (n=27-50) in clusters two to five (P=0.49). More healing complications were observed in women with a body mass index (BMI) of more than 35 kg/m² versus 35 kg/m² or less (P=0.016), urgent versus elective CD (P=0.013), preterm premature rupture of the membranes (PPROM) versus intact membranes (P=0.016), and chorioamnionitis at delivery versus no chorioamnionitis (P=0.001). 586 (64%) women underwent physician assessment at staples removal and at 6 weeks post CD.

CONCLUSIONS

Timing of dressing and staples removal has no effect on CD scar healing in low- and high-risk parturients. A BMI of more than 35 kg/m² , urgent CD, PPROM, and chorioamnionitis were associated with mal-healing, regardless of cluster. Clinicaltrials.gov: NCT01724255.