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Pepper M, Campbell OMR, Woodd SL. Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300377. [PMID: 38599685 PMCID: PMC11057794 DOI: 10.9745/ghsp-d-23-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The postpartum period is critical for the health and well-being of women and newborns, but there is limited research on the most effective methods of post-childbirth follow-up. This scoping review synthesizes evidence from high-, middle-, and low-income countries on approaches to following up individuals after discharge from childbirth facilities. METHODS Using a systematic search in Ovid MEDLINE, we identified quantitative studies describing post-discharge follow-up methods deployed up to 12 months postpartum. We searched for English-language, peer-reviewed articles published between January 1, 2007 and November 2, 2022, with search terms covering 2 broad areas: "postpartum/postnatal period" and "surveillance." We single-screened titles and abstracts and double-extracted all included articles, recording study design and location, population, health outcome, method, timing and frequency of data collection, and percentage of study participants reached. RESULTS We identified 1,654 records, of which 31 studies were included. Eight studies used in-person visits to follow up participants, 10 used telephone calls, 7 used self-administered questionnaires, and 6 used multiple methods. Across studies, the minimum length of follow-up was 1 week after delivery, and up to 4 contacts were made within the first year after delivery. Follow-up (response) rates ranged from 23% to100%. Postpartum infection was the most common outcome investigated. Other outcomes included maternal (ill-)health, neonatal (ill-)health and growth, maternal mental health and well-being, care-giving/-seeking behaviors, and knowledge and intentions. CONCLUSION Our scoping review identified multiple follow-up methods after discharge, ranging from home visits to self-administered electronic questionnaires, which could be implemented with high response rates. The studies demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying postpartum illness or complications that would otherwise be missed. Therefore, the identified methods have the potential to become an important component of fostering a continuum of care and measuring and addressing postpartum morbidity.
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Affiliation(s)
- Maxine Pepper
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah L Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Miyazaki K, Jwa SC, Katayama E, Tamaru S, Ishihara O, Kamei Y. Postoperative C-reactive protein as a predictive marker for surgical site infection after cesarean section: Retrospective analysis of 748 patients at a Japanese academic institution. PLoS One 2022; 17:e0273683. [PMID: 36083881 PMCID: PMC9462722 DOI: 10.1371/journal.pone.0273683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Surgical site infection (SSI) is a common but potentially serious maternal complication of cesarean section (CS). C-reactive protein (CRP) can be used in early detection of SSI. However, its predictive value for post-cesarean SSI has never been investigated. This study aims to evaluate the predictive value of CRP for the development of SSI. This was a hospital-based retrospective cohort study of 748 pregnant women who underwent CS at our university hospital between January 2017 and December 2019. CRP was measured on postoperative days 1, 3, and 6. The predictive values of CRP for SSI were evaluated using receiver operating characteristics analysis. Forty-seven (6.3%) patients developed SSI, of whom 38 (80.9%) underwent emergency CS. Serum CRP levels were significantly higher in the SSI group than in the non-SSI group from postoperative day 1 (64 vs. 81 mg/L, p = 0.001); the difference became more evident on postoperative days 3 and 6. The area under the receiver operating characteristic curve (AUC) for CRP on days 1, 3, and 6 was 0.58 (95% confidence interval [CI], 0.49 to 0.68), 0.70 (0.62 to 0.78) and 0.73 (0.65 to 0.81), respectively. The optimal cutoff value for day 3 and 6 CRP was 66.4 mg/L (sensitivity = 76.1% and specificity = 54.4%) and 22.2 mg/L (sensitivity = 76.5% and specificity = 63.2%), respectively. CRP on postoperative days 3 and 6 can be used as a predictive marker for the development of SSI after CS. Further studies to validate the predictive value in different populations is essential.
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Affiliation(s)
- Kazuko Miyazaki
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Seung Chik Jwa
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
- * E-mail:
| | - Eri Katayama
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Shunsuke Tamaru
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Osamu Ishihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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Goodman JR, Durazo-Arvizu R, Nashif S, McAlarnen LA, Wagner SA, Lal AK. Preventing caesarean section wound complications: use of a silver-impregnated antimicrobial occlusive dressing. J Wound Care 2022; 31:S5-S14. [PMID: 35797250 DOI: 10.12968/jowc.2022.31.sup7.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1°LTCS) delivery. METHOD Women aged 18-45 years admitted to the labour and delivery or the antepartum unit undergoing a 1°LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1°LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. RESULTS A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1°LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1°LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18-1.67). CONCLUSION Among women undergoing 1°LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant.
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Affiliation(s)
- Jean Ricci Goodman
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, Missouri, US
| | - Ramon Durazo-Arvizu
- Department of Biostatistics, Loyola University Chicago Health Sciences Division, Maywood, Illinois, US
| | - Sereen Nashif
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Lindsey A McAlarnen
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Sarah A Wagner
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
| | - Ann K Lal
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Illinois, US
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Peter EG, Ali Seif S. The influence of home environment and wound care practice on surgical site infection among post cesarean section women in Dodoma- Tanzania. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bizuayew H, Abebe H, Mullu G, Bewuket L, Tsega D, Alemye T. Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals, Amhara region, North West Ethiopia, 2020. PLoS One 2021; 16:e0261951. [PMID: 34972176 PMCID: PMC8719744 DOI: 10.1371/journal.pone.0261951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Maternal surgical site infection after cesarean delivery is a clinical problem which contributes to significant morbidity and mortality. In Ethiopia admissions following cesarean section due to surgical site infection have been routine activities of health care institutions but there is limited scientific evidence on both the magnitude of the problem and factors associated with it making prevention mechanisms less effective. Therefore, this study aimed to assess magnitude and risk factors of post-cesarean section surgical site infection at primary hospitals of East Gojjam Zone, Northwest Ethiopia. METHODS Institution-based cross sectional study with retrospective chart review was conducted from September 10-30 /2020 at 3 randomly selected primary hospitals of east Gojjam zone. The data were entered in Epi data version 3.1 and exported to Statistical Package for Social Science Software version 26. Post-cesarean section surgical site infection was measured based on disease classification and definition of the term by Center for Disease Control and Prevention. After checking for presence of multicollinarity, presence and degree of association of factors with outcome variable were computed through logistic regression analysis. Factors with P value ≤ 0.2 in bi-variable logistic regression analysis were included in the multivariable logistic regression analysis and those variables with P-value of <0.05 in multivariable analysis were considered statistically significant. RESULT From 622 medical records of women who underwent cesarean section, 77 (12.4%) of them developed surgical site infection. Rural residence [(AOR = 2.30, 95%CI: (1.29, 4.09)], duration of labor greater than 24hrs [(AOR = 3.48, 95%CI: (1.49, 8.09)], rupture of membrane>12hrs[(AOR = 4.61,95%CI:(2.34,9.09)], hypertension[(AOR = 3.14,95%CI:(1.29,7.59)] and preoperative Hematocrit ≤30%[(AOR = 3.22,95%CI:(1.25,8.31)] were factors significantly associated with post-cesarean section surgical site infections. CONCLUSION Magnitude of post-cesarean section surgical site infection was a significant problem in primary hospitals. Minimizing prolonged labor; minimize early rupture of membrane, properly managing patients with comorbidities like hypertension, strengthen prophylaxis and treatment for anemia during antenatal care and raising awareness for rural residents can reduce the problem. Zonal police makers should give emphasis to reduce its burden.
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Affiliation(s)
- Hulubante Bizuayew
- Department of Midwifery, Mizan Aman Health Science College, Mizan, Ethiopia
| | - Haimanot Abebe
- Department of Nursing, Wolkite University, Wolkite, Ethiopia
| | - Getachew Mullu
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Likinaw Bewuket
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Tsega
- Department of Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Tsegaw Alemye
- Department of Midwifery, Mizan Aman Health Science College, Mizan, Ethiopia
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Risk factors for surgical site infection after cesarean delivery in a rural area in China: A case-controlled study. Ann Med Surg (Lond) 2021; 72:103110. [PMID: 34876985 PMCID: PMC8633558 DOI: 10.1016/j.amsu.2021.103110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Clinical effectiveness of adding azithromycin to antimicrobial prophylaxis for cesarean delivery. Am J Obstet Gynecol 2021; 225:335.e1-335.e7. [PMID: 34052192 DOI: 10.1016/j.ajog.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A recent large clinical trial demonstrated an approximately 50% decrease in the rate of postoperative infection in women who were laboring and/or had rupture of membranes for >4 hours and who received azithromycin in addition to standard preoperative antibiotic prophylaxis at the time of cesarean delivery. Given these results, our institution made a policy change in May 2017 to add azithromycin to standard preoperative prophylaxis for all cesarean deliveries. OBJECTIVE This study aimed to evaluate the clinical effectiveness of adding azithromycin to preoperative antibiotic prophylaxis for cesarean delivery. STUDY DESIGN We conducted a before-and-after cohort study of women delivered via cesarean delivery at our institution. The preimplementation group included women who delivered from March 1, 2016, to February 28, 2017, (before an institutional practice change of adding azithromycin to standard preoperative prophylaxis), and the postimplementation group included women who delivered from September 1, 2017, to August 31, 2018 (allowing a 6-month period for uptake of the practice change). The primary outcome was a composite of postoperative infections (endometritis, wound infection, other maternal infections). Unadjusted and adjusted risk ratios and 95% confidence intervals were estimated using a modified Poisson regression model. RESULTS In the preimplementation (n=1171) and postimplementation (n=1168) groups, the incidence rates of the composite outcomes were 4.7% and 5.3%, respectively (P=.49). Both unadjusted (relative risk, 1.13; 95% confidence interval, 0.78-1.62) and adjusted (adjusted relative risk, 1.06; 95% confidence interval, 0.74-1.52) comparisons were not significantly different. In addition, results were statistically nonsignificant, but in the direction of lower rates of infection, in the after cohort for women in labor and/or with rupture of membranes for ≥4 hours (relative risk, 0.88 [95% confidence interval, 0.56-1.39]; adjusted relative risk, 0.82 [95% confidence interval, 0.52-1.30]) and for women with clinical chorioamnionitis (relative risk, 0.37 [95% confidence interval, 0.08-1.67]; data too sparse for adjusted analysis). In the subgroup of women who were not in labor, the after cohort had a statistically nonsignificant increased risk of the composite outcome in both unadjusted (relative risk, 1.53; 95% confidence interval, 0.86-2.72) and adjusted (adjusted relative risk, 1.48; 95% confidence interval, 0.83-2.65]) comparisons. CONCLUSION In clinical practice, the addition of azithromycin to standard preoperative antibiotic prophylaxis for cesarean delivery may have an effect size smaller than seen in the large clinical trial prompting this practice change. Extrapolation of this regimen to women not in labor may be ineffective.
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Baxter E. A midwifery-led prevalence programme for caesarean section surgical site infections. J Hosp Infect 2020; 109:78-81. [PMID: 33346042 DOI: 10.1016/j.jhin.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
Caesarean section (CS) is a common procedure accounting for 29% of all deliveries. Surgical site infections (SSI) are a risk with any surgical procedure. A CS SSI prevalence programme led by a midwife, who is also an infection prevention and control matron, was implemented to determine the rate of CS SSI within the trust. The initial CS SSI rate was 26% over a 3-month period (June-August 2012). Targeted interventions were put in place to reduce the CS SSI rate, and by 2019, it had decreased to 8%. Hospitals should consider implementing CS SSI surveillance and prevention programmes. Real benefits can be realized with minimal resources.
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Affiliation(s)
- E Baxter
- Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Tuuli MG, Liu J, Tita ATN, Longo S, Trudell A, Carter EB, Shanks A, Woolfolk C, Caughey AB, Warren DK, Odibo AO, Colditz G, Macones GA, Harper L. Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery: A Randomized Clinical Trial. JAMA 2020; 324:1180-1189. [PMID: 32960242 PMCID: PMC7509615 DOI: 10.1001/jama.2020.13361] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Obesity increases the risk of both cesarean delivery and surgical-site infection. Despite widespread use, it is unclear whether prophylactic negative pressure wound therapy reduces surgical-site infection after cesarean delivery in obese women. OBJECTIVE To evaluate whether prophylactic negative pressure wound therapy, initiated immediately after cesarean delivery, lowers the risk of surgical-site infections compared with standard wound dressing in obese women. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized trial conducted from February 8, 2017, through November 13, 2019, at 4 academic and 2 community hospitals across the United States. Obese women undergoing planned or unplanned cesarean delivery were eligible. The study was terminated after 1624 of 2850 participants were recruited when a planned interim analysis showed increased adverse events in the negative pressure group and futility for the primary outcome. Final follow-up was December 18, 2019. INTERVENTIONS Participants were randomly assigned to either undergo prophylactic negative pressure wound therapy, with application of the negative pressure device immediately after repair of the surgical incision (n = 816), or receive standard wound dressing (n = 808). MAIN OUTCOMES AND MEASURES The primary outcome was superficial or deep surgical-site infection according to the Centers for Disease Control and Prevention definitions. Secondary outcomes included other wound complications, composite of surgical-site infections and other wound complications, and adverse skin reactions. RESULTS Of the 1624 women randomized (mean age, 30.4 years, mean body mass index, 39.5), 1608 (99%) completed the study: 806 in the negative pressure group (median duration of negative pressure, 4 days) and 802 in the standard dressing group. Superficial or deep surgical-site infection was diagnosed in 29 participants (3.6%) in the negative pressure group and 27 (3.4%) in the standard dressing group (difference, 0.36%; 95% CI, -1.46% to 2.19%, P = .70). Of 30 prespecified secondary end points, 25 showed no significant differences, including other wound complications (2.6% vs 3.1%; difference, -0.53%; 95% CI, -1.93% to 0.88%; P = .46) and composite of surgical-site infections and other wound complications (6.5% vs 6.7%; difference, -0.27%; 95% CI, -2.71% to 2.25%; P = .83). Adverse skin reactions were significantly more frequent in the negative pressure group (7.0% vs 0.6%; difference, 6.95%; 95% CI, 1.86% to 12.03%; P < .001). CONCLUSIONS AND RELEVANCE Among obese women undergoing cesarean delivery, prophylactic negative pressure wound therapy, compared with standard wound dressing, did not significantly reduce the risk of surgical-site infection. These findings do not support routine use of prophylactic negative pressure wound therapy in obese women after cesarean delivery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03009110.
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Affiliation(s)
- Methodius G Tuuli
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Jingxia Liu
- Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
- Center for Women's Reproductive Health, University of Alabama at Birmingham
| | - Sherri Longo
- Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, Louisiana
| | - Amanda Trudell
- Division of Maternal Fetal Medicine, BJC Medical Group St Louis, Missouri
| | - Ebony B Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Anthony Shanks
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
| | - Candice Woolfolk
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - David K Warren
- Department of Medicine, Washington University School of Medicine in St Louis, Missouri
| | - Anthony O Odibo
- Department of Obstetrics and Gynecology, University of South Florida School of Medicine, Tampa
| | - Graham Colditz
- Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - George A Macones
- Department of Obstetrics and Gynecology, Dell School of Medicine, University of Texas at Austin
| | - Lorie Harper
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
- Center for Women's Reproductive Health, University of Alabama at Birmingham
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Bolte M, Knapman B, Leibenson L, Ball J, Giles M. Reducing surgical site infections post-caesarean section in an Australian hospital, using a bundled care approach. Infect Dis Health 2020; 25:158-167. [PMID: 32160964 DOI: 10.1016/j.idh.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The past 20 years have seen increasing Caesarean section (CS) rates in Australia. Increasing antenatal morbidity means that post-CS surgical site infection (SSI) is an issue impacting Australian women, mostly low-socioeconomic and regional communities. Recent trends supporting development of evidence-based bundled approaches to SSI reduction, have not proved efficacy nor supported bundle implementation. AIMS This pilot study aimed to develop, implement and assess an evidence-based Caesarean Infection Prevention ("CIP") bundled intervention to reduce post-CS SSI rates in a high risk population. METHODS The study was a pre-post-intervention study, including women undergoing CS at one referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified women who developed a post-CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Data was collected for the subsequent 12 months on women undergoing CS. RESULTS A total of 710 procedures were monitored with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent over time. Post-CS SSI rates significantly reduced post-intervention (5.5% vs. 1.6%, p = 0.007), the greatest benefit in class II and III obese patients (12.2% vs. 2.5%, p = 0.019). Higher hypertension rates (24% vs. 9%, p = 0.01) and lower maternal mean age (27 vs. 30, p = 0.01) were seen in patients with SSI. CONCLUSION The "CIP" bundle effectively reduced post-CS SSIs in a high risk population. Our findings substantiate the need for development and evaluation of multifaceted, evidenced-based interventions to reduce post-CS SSIs. TRIAL REGISTRATION Retrospectively registered. TRIAL REGISTRATION ACTRN12619001001189, July 2019.
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Affiliation(s)
- Michelle Bolte
- Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340.
| | - Blake Knapman
- Wollongong Hospital, 348 Crown Street, Wollongong, NSW, Australia, 2500.
| | - Lilach Leibenson
- Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340.
| | - Jean Ball
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300.
| | - Michelle Giles
- Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300.
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Bediako-Bowan A, Owusu E, Debrah S, Kjerulf A, Newman MJ, Kurtzhals JAL, Mølbak K. Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study. J Hosp Infect 2020; 104:321-327. [PMID: 31931045 DOI: 10.1016/j.jhin.2020.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surveillance systems for surgical site infections (SSIs), as a measure of patient safety, help health institutions devise strategies to reduce or prevent them. No surveillance systems exist to monitor SSIs in Ghana. AIM To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs. METHODS An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1st, 2017 to December 31st, 2018 to identify SSI. It involved a daily inpatient surveillance of patients who had had a surgical procedure, followed by post-discharge surveillance by means of a healthcare personnel-based survey and a patient-based telephone survey. We supplied quarterly feedback of results to surgeons. FINDINGS Among the 3267 patients included, 331 were identified with an SSI, a 10% incidence risk. Patients who acquired an SSI experienced increased morbidity including nine extra days in hospital and an adjusted relative mortality risk of 2.3 (95% confidence interval: 1.3 - 4.1; P=0.006) compared to patients without SSI. Forty-nine per cent (161/331) of SSIs were diagnosed post discharge using the healthcare personnel-based survey. The patient-based telephone survey contributed 12 additional cases. SSI incidence risk decreased from 12.8% to 7.5% during the study period. CONCLUSION Post-discharge surveillance is feasible using existing healthcare personnel, and the results highlight the high risk and burden of SSIs in Ghana. A surveillance system with feedback for monitoring SSIs may contribute to reducing SSIs; however, firm conclusions regarding the impact need longer observation time.
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Affiliation(s)
- A Bediako-Bowan
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana; Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana; Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark; Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
| | - E Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Science, University of Ghana, Accra, Ghana
| | - S Debrah
- Department of Surgery, University of Cape Coast, Cape Coast, Ghana
| | - A Kjerulf
- National Centre for Infection Control, Department of Infectious Disease Epidemiology and Prevention, Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - M J Newman
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - J A L Kurtzhals
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital (Righospitalet), Copenhagen, Denmark
| | - K Mølbak
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark; Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
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Surgical site infection following cesarean section in a general hospital in Kuwait: trends and risk factors. Epidemiol Infect 2019; 147:e287. [PMID: 31597580 PMCID: PMC6805794 DOI: 10.1017/s0950268819001675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.
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Zejnullahu VA, Isjanovska R, Sejfija Z, Zejnullahu VA. Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors. BMC Infect Dis 2019; 19:752. [PMID: 31455246 PMCID: PMC6712729 DOI: 10.1186/s12879-019-4383-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are a common complication after a cesarean section (C-section) and mainly responsible for increased maternal mortality and morbidity, dissatisfaction of patients, longer hospital stays as well as higher treatment costs. The aim of this study is to determine the incidence rate and risk factors of surgical site infections in women undergoing caesarean section at the University Clinical Center of Kosovo (UCCK), in the Clinic for Obstetrics and Gynecology. METHODS We conducted a prospective observational cohort study involving 325 women who underwent labor and scheduled C-sections from January, 2018 to September, 2018 at the University Clinical Center of Kosovo, Clinic for Obstetrics and Gynecology. Each woman was followed for 30-postoperative days. Data analysis included descriptive statistics, univariate and multivariate logistic regression analysis. Culture-based microbiological methods were used to identify causal agents in postoperative wounds. RESULTS Overall the SSI rate was 9.85% and the median time to SSI was the 7th postoperative day. The mean age of the patients was 31.3 ± 5.5 years (range from 17 to 46 years). The average length of stay was 4.2 ± 3.4 days. Several factors reduced the risk of SSI. These included: age less than 35 years (RR 0.25; 95% CI; 0.199-0.906 and P = 0.027) preoperative use of antibiotics (RR 0.232; 95% CI; 0.107-0.502 and P = 0.000) and duration of the operation less than 1 h (RR 0.135; 95% CI; 0.054-0.338 and P = 0.000). Previous cesarean section and one or more co-morbidity were associated with 7.4 fold and 8 fold increased risk of SSI, respectively. We found a statistically significant association between SSI and co-morbidity, preoperative antibiotic use, duration of operation, age and history of previous cesarean section (P = 0.000; 0.000; 0.0001; 0.023; 0.000; respectively using chi-square test). Multivariable logistic regression analysis confirmed that one or more co-morbidity, previous C-section, preoperative antibiotics and duration of the surgery < 1 h are predictors of SSI. CONCLUSION The high incidence rate of SSIs after C-sections in this study highlight the need for prioritizing SSI control and surveillance. Patient demographics, procedures utilized and surgical factors must be incorporated in programs to reduce the infection rate. Additionally, an effort must be given to decrease number of the C-sections performed for the first time through assuring optimal care for the mother and child. The National Committee for Prevention and Control of Nosocomial infection in Kosovo should provide updated guidelines for control and prevention of the nosocomial infections.
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Affiliation(s)
- Vjosa A. Zejnullahu
- Department of Obstetrics and Gynecology, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Rozalinda Isjanovska
- Institute of Epidemiology, Biostatistics and Medical Informatics, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Zana Sejfija
- Department of Oral Surgery, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Valon A. Zejnullahu
- Departments of Abdominal Surgery, University Clinical Center of Kosovo, Pristina, Kosovo
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Short-Term Postoperative Outcomes between 4% Icodextrin Solution and Hyaluronic Acid- Carboxymethyl Cellulose Membrane during Emergency Cesarean Section. J Clin Med 2019; 8:jcm8081249. [PMID: 31426585 PMCID: PMC6723814 DOI: 10.3390/jcm8081249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022] Open
Abstract
Emergency cesarean sections are associated with more postoperative complications than with elective cesarean sections. Seprafilm and Adept are commonly used adhesion reduction devices and have been applied in abdominal or pelvic surgery for a long time. This study focuses on comparing the short-term postoperative outcomes of emergency cesarean sections between two groups. We performed a retrospective study that included all patients who received emergency caesarean sections from the same surgeon at MacKay Memorial Hospital between August 2014 and November 2017, We analyzed the overall cases and conducted a subgroup analysis of cases with contaminated or dirty/infected wounds in regard to the rates of surgical-site infection (SSI), bandemia, delayed flatus passage, and length of hospital stay. The two groups were similar with respect to the rates of SSI, bandemia, and length of hospital stay. However, Seprafilm was associated with higher risk of delayed flatus passage over 48 h (OR: 2.67, 95% CI = 2.16–7.64, p = 0.001). It also needs less time for recovery of the digestive system and less medical management postoperatively. In cases of contaminated or dirty/infected wounds, Adept user also had significantly lower rates (10.3% vs. 32%, p= 0.048, OR: 4.12, CI = 1.09–15.61) of postcesarean metritis.
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Grundy TJ, Davies BM, Patel HC. When should we measure surgical site infection in patients undergoing a craniotomy? A consideration of the current practice. Br J Neurosurg 2019; 34:621-625. [DOI: 10.1080/02688697.2019.1645298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tom J. Grundy
- Department of Neurosurgery, Salford Royal Foundation Trust, Salford, UK
| | | | - Hiren C. Patel
- Department of Neurosurgery, Salford Royal Foundation Trust, Salford, UK
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Merzougui L, Marwen N, Hannachi H, Asma M, Ben Elhaj O, Waddah M, Fatnassi R. [Incidence and risk factors of surgical site infection following caesarean section in a Tunisian maternity unit]. SANTE PUBLIQUE 2019; 30:339-347. [PMID: 30541263 DOI: 10.3917/spub.183.0339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Surgical site infection (SSI) is a major health concern and is one of the most common complications following caesarean section, with an incidence of 3%-15%. With the worldwide increase in caesarean section rates, the incidence of SSI is expected to increase in parallel. This study was designed to estimate the incidence and determine the risk factors of SSI after caesarean section in an Obstetrics and Gynaecology department in the Kairouan region in Tunisia. METHODS A prospective cohort study of all patients who delivered by caesarean section between December 2015 and February 2016 was conducted in the Kairouan Obstetrics and Gynaecology department. The clinical status of these women was monitored during the 30-day postoperative period (in the outpatients department, emergency room or they were contacted by phone). A multivariate logistic regression model was used to identify risk factors. RESULTS Of the 714 patients admitted for caesarean delivery, 636 (89%) were monitored for 30 days. Thirty-two of these women were diagnosed with SSI, corresponding to an incidence of 5% (95% CI = 3.3%; 6.6%). 87.5% (n = 28) of SSI were superficial and 12.5% (n = 4) were complex (deep and organ/space). Multivariate logistic regression analysis identified the woman's age as a risk factor of SSI (RR = 1.07 for every year increment, 95% CI = 1.007; 1.17), whereas drainage was identified as a protective factor (RR = 0.16, 95% CI = 0.05; 0.48). CONCLUSION This study identified the incidence and risk factors of postoperative infection following caesarean section. Prevention of these infections should be a public health priority.
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Aslan Çetin B, Aydogan Mathyk B, Barut S, Koroglu N, Zindar Y, Konal M, Atis Aydin A. The impact of subcutaneous irrigation on wound complications after cesarean sections: A prospective randomised study. Eur J Obstet Gynecol Reprod Biol 2018; 227:67-70. [PMID: 29894926 DOI: 10.1016/j.ejogrb.2018.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the effectiveness of subcutaneous saline irrigation in preventing wound complications after cesarean sections. STUDY DESIGN Patients undergoing primary cesarean sections were randomly assigned to either the subcutaneous saline irrigation group or the control group. The participants were asked to come to the hospital for routine inspection of the skin incision on day 7 and day 30 postoperatively. The wounds were inspected for hematoma, seroma, separation and signs of superficial infection. The prime outcome was the comparison of the superficial surgical site infection (SSI) rates among the groups. Additionally, factors associated with wound complications were also analyzed using logistic regression. RESULTS A total of 204 women undergoing primary cesarean sections were randomized, and 185 were included in the final analysis. There was no significant difference in terms of SSI rates among the groups (14.3% in the saline group vs 12.8% in the control group, p = 0.76). However, the existences of hematoma and seroma were significantly lower in the saline irrigation group compared to the control group. CONCLUSION Irrigation of subcutaneous tissue decreases the occurrences of both postoperative hematoma and seroma in women undergoing primary cesarean sections.
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Affiliation(s)
- Berna Aslan Çetin
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Begum Aydogan Mathyk
- University of North Carolina, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Chapel Hill, NC, USA.
| | - Sibel Barut
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Nadiye Koroglu
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Yelda Zindar
- Okmeydani Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Merve Konal
- Sarkoy State Hospital, Department of Obstetrics and Gynecology, Tekirdag, Turkey
| | - Alev Atis Aydin
- Kanuni Sultan Suleyman Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study. Am J Infect Control 2018; 46:20-25. [PMID: 28967511 DOI: 10.1016/j.ajic.2017.07.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. METHODS The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. RESULTS SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. CONCLUSIONS Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control.
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Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors. Sci Rep 2017; 7:12210. [PMID: 28939862 PMCID: PMC5610177 DOI: 10.1038/s41598-017-12431-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022] Open
Abstract
Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6-9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.
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Nguhuni B, De Nardo P, Gentilotti E, Chaula Z, Damian C, Mencarini P, Nicastri E, Fulment A, Piscini A, Vairo F, Aiken AM, Ippolito G. Reliability and validity of using telephone calls for post-discharge surveillance of surgical site infection following caesarean section at a tertiary hospital in Tanzania. Antimicrob Resist Infect Control 2017; 6:43. [PMID: 28503302 PMCID: PMC5422869 DOI: 10.1186/s13756-017-0205-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/04/2017] [Indexed: 01/29/2023] Open
Abstract
Background Surgical site infection (SSI) is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved. Methodology We conducted an observational cohort study in Dodoma, Tanzania to examine the sensitivity and specificity of telephone calls to detect SSI after discharge from hospital in comparison to a gold standard of clinician review. Women undergoing caesarean section were enrolled and followed up for 30 days. Women providing a telephone number were interviewed using a structured questionnaire at approximately days 5, 12 and 28 post-surgery. Women were then invited for out-patient review by a clinician blinded to the findings of telephone interview. Results A total of 374 women were enrolled and an overall SSI rate of 12% (n = 45) was observed. Three hundred and sixteen (84%) women provided a telephone number, of which 202 had at least one telephone interview followed by a clinical review within 48 h, generating a total of 484 paired observations. From the clinical reviews, 25 SSI were diagnosed, of which telephone interview had correctly identified 18 infections; telephone calls did not incorrectly identify SSI in any patients. The overall sensitivity and specificity of telephone interviews as compared to clinician evaluation was 72 and 100%, respectively. Conclusion The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.
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Affiliation(s)
- Boniface Nguhuni
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania.,'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Pasquale De Nardo
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania.,'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Elisa Gentilotti
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania.,Department of Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Zainab Chaula
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania
| | - Caroline Damian
- Department of Obstetrics and Gynaecology, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - Paola Mencarini
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania.,'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Emanuele Nicastri
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Arnold Fulment
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Alessandro Piscini
- Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, P.O Box 904, Dodoma, Tanzania.,'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Francesco Vairo
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Alexander M Aiken
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Giuseppe Ippolito
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
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Shrem G, Egozi T, Naeh A, Hallak M, Walfisch A. Pre-cesarean Staphylococcus aureus nasal screening and decolonization: a prospective randomized controlled trial. J Matern Fetal Neonatal Med 2016; 29:3906-11. [PMID: 26857727 DOI: 10.3109/14767058.2016.1152243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Staphylococcus aureus (S. aureus) is a common pathogen in surgical site infections (SSIs). Mupirocin ointment is an effective treatment for nasal carriers. We aimed to investigate whether screening for nasal colonization of S. aureus and treating carriers prior to a cesarean section (CS) decreases the likelihood of SSI. METHODS This is a randomized controlled trial. All participants underwent nasal culture prior to the CS. Nasal carriers of S. aureus were treated with Mupirocin ointment according to a standardized protocol. In the control group, nasal cultures were obtained immediately prior to surgery and carriers were not treated. RESULTS We recruited 568 patients. Demographic characteristics were comparable between the groups. S. aureus nasal colonization rates were 20.1% and 14.9% in the intervention and control groups, respectively (p = 0.12). S. aureus eradication rate with Mupirocin treatment was 88%. SSI rates were similar in the intervention and control groups (13.1% versus 12.1%, respectively, p = 0.78) and in treated carriers, untreated carriers, and non-carriers (7.4% versus 13.0% versus 13.1%, respectively, p = 0.69). Previous CS was the only factor found to independently predict SSI (OR 2.5, CI 1.09-5.65 p = 0.029). CONCLUSION Pre-cesarean screening for nasal S. aureus carriage and decolonization does not appear to be an effective intervention in reducing SSI rates.
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Affiliation(s)
- Guy Shrem
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and
| | - Tomer Egozi
- b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Amir Naeh
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and
| | - Mordechai Hallak
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and.,b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
| | - Asnat Walfisch
- a Department of Obstetrics & Gynecology , Hillel Yaffe Medical Center , Hadera , Israel and.,b The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology , Haifa , Israel
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Lima JLDDA, de Aguiar RALP, Leite HV, Silva HHRM, de Oliveira WM, Sacramento JPTDC, Wakabayashi EA, de Souza HC, Clemente WT, Romanelli RMDC. Surveillance of surgical site infection after cesarean section and time of notification. Am J Infect Control 2016; 44:273-7. [PMID: 26686415 DOI: 10.1016/j.ajic.2015.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. OBJECTIVE To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. METHODS We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. RESULTS Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. CONCLUSIONS The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients.
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Affiliation(s)
- Júnia Leonne Dourado de Almeida Lima
- Specialization in Prevention and Control of Hospital Infection, Hospital das Clínicas of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Faculdade Dinâmica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil
| | | | - Henrique Vitor Leite
- Department of Gynecology and Obstetrics, Medical School of Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Helen Cristina de Souza
- Medical School of Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | - Wanessa Trindade Clemente
- Propedeutics Department, Medical School of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Pediatrics Department, Medical School of Universidade Federal de Minas Gerais, Universidade José do Rosário Vellano, Belo Horizonte, Minas Gerais, Brazil
| | - Roberta Maia de Castro Romanelli
- Pediatrics Department, Medical School of Universidade Federal de Minas Gerais, Universidade José do Rosário Vellano, Belo Horizonte, Minas Gerais, Brazil; Hospital Infection Control Committee, Hospital das Clínicas of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Ng W, Brown A, Alexander D, Ho MF, Kerr B, Amato M, Katz K. A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system. Am J Infect Control 2015; 43:805-9. [PMID: 25957817 DOI: 10.1016/j.ajic.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system. METHODS Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis. RESULTS Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001). CONCLUSIONS A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.
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Affiliation(s)
- Wil Ng
- North York General Hospital, Toronto, Ontario, Canada.
| | - Adrian Brown
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Man Fan Ho
- North York General Hospital, Toronto, Ontario, Canada
| | - Bonnie Kerr
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
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Padoveze MC, Figueiredo RMD. The role of primary care in the prevention and control of healthcare associated infections. Rev Esc Enferm USP 2014; 48:1137-44. [DOI: 10.1590/s0080-623420140000700023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 09/12/2014] [Indexed: 11/22/2022] Open
Abstract
Little research has been conducted to date on the role of primary health care (PHC) in the prevention of healthcare associated infections (HCAIs). The present article is a theoretical study of the principle of primum non nocere and aims to promote reflection on the role of PHC in HCAI prevention with emphasis on practical recommendations. The indirect and direct roles of PHC in HCAI prevention are debated in light of this guiding principle. With respect to the indirect role of PHC, we discuss the issues of hospital-centrism and ambulatory care-sensitive conditions. The article outlines a number of challenges faced by health services related to PHC’s direct role in HCAI prevention, highlights seven key components of HCAI prevention programmes within the PHC sphere and provides practical recommendations for HCAI control and prevention.
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Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control 2014; 3:25. [PMID: 25126415 PMCID: PMC4131772 DOI: 10.1186/2047-2994-3-25] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 08/05/2014] [Indexed: 12/03/2022] Open
Abstract
Background Surgical site infection (SSI) is the second most common infectious complication after urinary tract infection following a delivery by caesarean section (CS). At Bugando Medical Centre there has no study documenting the epidemiology of SSI after CS despite the large number of CSs performed and the relatively common occurrence of SSIs. Methods This was a prospective cohort study involving pregnant women who underwent a CS between October 2011 and February 2012 at Bugando Medical Centre. A total of 345 pregnant women were enrolled. Preoperative, intraoperative and postoperative data were collected using a standardized questionnaire. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was carried out using a disc diffusion technique. Data was analyzed using STATA version 11. Results The overall cumulative incidence of SSI was 10.9% with an incidence rate of 37.5 per 10,000 people/day (95% CI, 26.8-52.4). The median time from CS to the development of SSI was 7 days (interquartile range [IQR] = 6–9 days). Six independent risk factors for post caesarean SSI as identified in this study by multivariate analysis are: hypertensive disorders of pregnancy (HR: 2.5; 95% CI, 1.1-5.6; P = 0.021), severe anaemia (HR: 3.8; 95% CI, 1.2-12.4, P = 0.028), surgical wound class III (HR: 2.4; 95% CI, 1.1-5.0; P = 0.021), multiple vaginal examinations (HR: 2.5; 95% CI, 1.2-5.1; P = 0.011), prolonged duration of operation (HR: 2.6; 95% CI, 1.2-5.5; P = 0.015) and an operation performed by an intern or junior doctor (HR: 4.0; 95% CI, 1.7-9.2; P = 0.001). Staphylococcus aureus was the most common organism (27.3%), followed by Klebsiella pneumoniae (22.7%). Patients with a SSI had a longer average hospital stay than those without a SSI (12.7 ± 6.9 vs. 4 ± 1.7; P < 0.0001) and the case fatality rate among patients with a SSI was 2.9%. Conclusion SSIs are common among women undergoing CSs at Bugando Medical Centre. SSIs were commonly associated with multiple factors. Strategies to control these factors are urgently needed to control SSIs post CS at Bugando Medical Centre and other centres in developing countries.
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Affiliation(s)
- Filbert J Mpogoro
- Department of Obstetrics and Gynecology Weill School of Medicine, CUHAS-Bugando, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology/Immunology Weill School of Medicine, CUHAS-Bugando, BOX 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Obstetrics and Gynecology Weill School of Medicine, CUHAS-Bugando, Mwanza, Tanzania
| | - Benson R Kidenya
- Department of Biochemistry and Molecular Biology, Weill School of Medicine, CUHAS-Bugando, Mwanza, Tanzania
| | - Balthazar Gumodoka
- Department of Obstetrics and Gynecology Weill School of Medicine, CUHAS-Bugando, Mwanza, Tanzania
| | - Can Imirzalioglu
- Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
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The relationship between obesity and surgical site infections in women undergoing caesarean sections: An integrative review. Midwifery 2013; 29:1331-8. [DOI: 10.1016/j.midw.2012.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/14/2012] [Accepted: 12/20/2012] [Indexed: 01/28/2023]
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Corcoran S, Jackson V, Coulter-Smith S, Loughrey J, McKenna P, Cafferkey M. Surgical site infection after cesarean section: implementing 3 changes to improve the quality of patient care. Am J Infect Control 2013; 41:1258-63. [PMID: 23938001 DOI: 10.1016/j.ajic.2013.04.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is an important complication of cesarean section (CS) delivery and a key quality indicator of patient care. METHODS A baseline assessment was undertaken to determine SSI rates, and subsequently a quality improvement program was introduced, followed by repeat surveillance. Data were collected during in-hospital stays and for up to 30 days after CS during both periods. Interventions in the quality improvement program included the use of nonabsorbable sutures for skin closure, use of clippers instead of razors, and use of 2% ChloraPrep for skin disinfection before incision. RESULTS A total of 710 patients were surveyed before the interventions, and 824 patients were surveyed after the interventions. Of these, 114 (16%) had an SSI before the interventions, and 40 (4.9%) had an SSI after the interventions (P < .001; odds ratio, 0.27), with 90% and 83%, respectively, detected after hospital discharge. In multivariate analysis, obesity (P = .002) and the use of absorbable suture materials for skin closure (P = .008) were significantly associated with a higher SSI rate before the interventions; however, only obesity was associated with a higher SSI rate after the quality program. CONCLUSION Surveillance of SSI rates after CS followed by 3 interventions contributed to a significant reduction in SSI rate and improved patient care.
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Branch-Elliman W, Lee GM, Golen TH, Gold HS, Baldini LM, Wright SB. Health and economic burden of post-partum Staphylococcus aureus breast abscess. PLoS One 2013; 8:e73155. [PMID: 24039877 PMCID: PMC3764182 DOI: 10.1371/journal.pone.0073155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/17/2013] [Indexed: 12/05/2022] Open
Abstract
Objectives To determine the health and economic burdens of post-partum Staphylococcus aureus breast abscess. Study design We conducted a matched cohort study (N = 216) in a population of pregnant women (N = 32,770) who delivered at our center during the study period from 10/1/03–9/30/10. Data were extracted from hospital databases, or via chart review if unavailable electronically. We compared cases of S. aureus breast abscess to controls matched by delivery date to compare health services utilization and mean attributable medical costs in 2012 United States dollars using Medicare and hospital-based estimates. We also evaluated whether resource utilization and health care costs differed between cases with methicillin-resistant and -susceptible S. aureus isolates. Results Fifty-four cases of culture-confirmed post-partum S. aureus breast abscess were identified. Breastfeeding cessation (41%), milk fistula (11.1%) and hospital readmission (50%) occurred frequently among case patients. Breast abscess case patients had high rates of health services utilization compared to controls, including high rates of imaging and drainage procedures. The mean attributable cost of post-partum S. aureus breast abscess ranged from $2,340–$4,012, depending on the methods and data sources used. Mean attributable costs were not significantly higher among methicillin-resistant vs. –susceptible S. aureus cases. Conclusions Post-partum S. aureus breast abscess is associated with worse health and economic outcomes for women and their infants, including high rates of breastfeeding cessation. Future study is needed to determine the optimal treatment and prevention of these infections.
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Affiliation(s)
- Westyn Branch-Elliman
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Grace M. Lee
- Department of Population Medicine, Center for Child Health Care Studies, Harvard Pilgrim Institute and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Pediatric Infectious Disease and Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Toni H. Golen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Howard S. Gold
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Linda M. Baldini
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Sharon B. Wright
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infection Control/Hospital Epidemiology. Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Perioperative Oxygen Supplementation and Surgical Site Infection After Cesarean Delivery. Obstet Gynecol 2013; 122:79-84. [DOI: 10.1097/aog.0b013e318297ec6c] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Post-discharge surveillance of wound infections by telephone calls method in a Sudanese Teaching Hospital. J Infect Public Health 2013; 6:339-46. [PMID: 23999331 DOI: 10.1016/j.jiph.2013.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Surveillance of wound infections has been shown to be a powerful preventive tool, and feedback to the clinical staff reduces wound infection rates. The main objectives of this study were to identify the applicability of telephone calls as a method of post-discharge wound infection surveillance, and to identify patients and procedures characteristics associated with loss for follow-up after hospital discharge. MATERIALS AND METHODS This was a prospective cohort study conducted in Khartoum Teaching Hospital, Sudan. Patients, aged >18 years admitted for elective clean and clean-contaminated surgery during March 1st to 31st October 2010 were recruited. 1-month surveillance of wound infections was conducted with telephone interviews. RESULTS Overall 3656 patients were operated on. Of them 1769 (48.4%) were eligible {mean age 37.8+14 years; females, n=1472 (83.3%)}. The performed surgical interventions were 1814. Of these 1277 (70.4%) were clean-contaminated and 537 (29.6%) were clean. Patients who successfully completed the follow-up were 1387 (78.4%), while 368 (20.8%) were lost, and 14 (0.8%) died. The percentage of male patients (85.3%) who successfully completed the follow-up was significantly higher than females (77.8%); (P=0.002). Wound infection was detected in 15 (0.8%) cases during hospital stay and 110 (6.2%) others after hospital discharge. CONCLUSIONS The majority of wound infections in the current study appeared in post-discharge period; this emphasis the need for establishment of surveillance program in the hospital. Surveillance of wound infections using telephone calls is applicable in this setting and can be used as an alternative method to clinic-based diagnosis of wound infections.
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Bianco A, Roccia S, Nobile CGA, Pileggi C, Pavia M. Postdischarge surveillance following delivery: the incidence of infections and associated factors. Am J Infect Control 2013; 41:549-53. [PMID: 23219668 DOI: 10.1016/j.ajic.2012.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/21/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess the effectiveness of a postdischarge surveillance system to reveal cases of postpartum infections that could be missed by the current in-hospital routine surveillance and to identify predictors of postpartum infections. METHODS The prospective surveillance included obstetrics patients. The information recorded included sociodemographic characteristics, infection-predisposing conditions, documentation of extrinsic risk factors, variables related to pregnancy and delivery, and variables related to each patient's newborn. A telephone interview on Day 30 after hospital discharge was performed to retrieve information related to signs and symptoms of infection. RESULTS One thousand seven hundred five patients agreed to participate for a response rate of 93%. One hundred forty-nine (8.9%) patients contacted by telephone reported at least 1 episode of infection within 30 days of discharge. There were 24 infections occurring during hospitalization, representing only 16.1% of all infections. There was an increased risk of postpartum infections in women with complications during labor, in those who had a caesarean delivery, and in those who reported alcohol consumption during pregnancy. CONCLUSION Our study demonstrated the need for implementing postdischarge surveillance programs for obstetrics patients that also identify infections following vaginal delivery. Postdischarge surveillance by telephone contact proved to be a feasible and effective method.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, Medical School, University of Catanzaro Magna Græcia, Catanzaro, Italy
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Ma CY, Ji T, OW A, Zhang CP, Sun J, Zhou XH, Wang LZ, Sun KD, Han W. Surgical Site Infection in Elderly Oral Cancer Patients: Is the Evaluation of Comorbid Conditions Helpful in the Identification of High-Risk Ones? J Oral Maxillofac Surg 2012; 70:2445-52. [DOI: 10.1016/j.joms.2011.10.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022]
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Kittur ND, McMullen KM, Russo AJ, Ruhl L, Kay HH, Warren DK. Long-Term Effect of Infection Prevention Practices and Case Mix on Cesarean Surgical Site Infections. Obstet Gynecol 2012; 120:246-51. [DOI: 10.1097/aog.0b013e31825f032a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Henman K, Gordon CL, Gardiner T, Thorn J, Spain B, Davies J, Baird R. Surgical site infections following caesarean section at Royal Darwin Hospital, Northern Territory. ACTA ACUST UNITED AC 2012. [DOI: 10.1071/hi11027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gong SP, Guo HX, Zhou HZ, Chen L, Yu YH. Morbidity and risk factors for surgical site infection following cesarean section in Guangdong Province, China. J Obstet Gynaecol Res 2012; 38:509-15. [PMID: 22353388 DOI: 10.1111/j.1447-0756.2011.01746.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To estimate the incidence of and identify the risk factors for a surgical site infection after a cesarean section. METHOD A survey of women who underwent a cesarean section was conducted in eight hospitals in Guangdong Province, China. The rate of surgical site infection was estimated and a nested case control study was then carried out to identify the risk factors. RESULTS Among 13 798 women surveyed, 96 (0.7%) developed a surgical site infection after a cesarean section. Multivariate logistic regression analysis identified six factors independently associated with an increased risk of surgical site infection, which included obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations performed during hospitalization. CONCLUSION Surgical site infection occurs in approximately 0.7% of cesarean section cases in the general obstetric population in China. Obesity, premature rupture of membranes, lower preoperative hemoglobin, prolonged surgery, lack of prophylactic antibiotics and excessive anal examinations during hospitalization are considered to be independent risk factors.
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Affiliation(s)
- Shi-Peng Gong
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Daneman N, Ma X, Eng-Chong M, Callery S, Guttmann A. Validation of administrative population-based data sets for the detection of cesarean delivery surgical site infection. Infect Control Hosp Epidemiol 2011; 32:1213-5. [PMID: 22080661 DOI: 10.1086/662623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We validated population-based hospital, emergency room, and physician claim databases for the detection of surgical site infections against the reference standard of clinical surveillance. Although these data sets are highly specific and could be used to define research cohorts, their low sensitivity and positive predictive value make them inadequate for use as quality indicators.
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Affiliation(s)
- Nick Daneman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Tsai PS, Hsu CS, Fan YC, Huang CJ. General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study. Br J Anaesth 2011; 107:757-61. [PMID: 21857016 DOI: 10.1093/bja/aer262] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study compared the odds ratio (OR) of surgical site infection (SSI) within 30 days after operation with general anaesthesia (GA) or neuraxial anaesthesia (NA) in Taiwanese women undergoing Caesarean delivery (CD). METHODS An epidemiologic design was used. The study population was based on the records of all deliveries in hospitals or obstetric clinics between January 2002 and December 2006 in Taiwan. Anonymized claim data from the Taiwan National Health Insurance Research Database (NHIRD) were analysed. Women who received CD were identified from the NHIRD by Diagnosis-Related Group codes. The mode of anaesthesia was defined by order codes. Multivariate logistic regression was used to estimate the OR and associated 95% confidence interval (CI) of post-CD SSIs for GA when compared with NA. The outcome was whether a woman had been diagnosed as having an SSI during the hospitalization or was re-hospitalized within 30 days after CD for the treatment of SSIs using five or 81 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. RESULTS Among the 303 834 Taiwanese women who underwent CD during the 5 yr observation period, the 30 day post-CD SSI rate was 0.3% or 0.9% based on five or 81 ICD-9-CM codes. The multivariate-adjusted OR of having post-CD SSIs in the GA group was 3.73 (95% CI, 3.07-4.53) compared with the NA group (P<0.001) using five ICD-9-CM codes for the definition of SSI. CONCLUSIONS GA for CD was associated with a higher risk of SSI when compared with neuraxial anaesthesia.
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Affiliation(s)
- P-S Tsai
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
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