1
|
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.
Collapse
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
| |
Collapse
|
2
|
Erritty M, Hale J, Thomas J, Thompson A, Wright R, Low A, Carr M, George R, Williams L, Dumitrescu A, Rees J, Irukulla S, Robin J, Fry CH, Fluck D, Han TS. Evaluation of independent risk factors associated with surgical site infections from caesarean section. Arch Gynecol Obstet 2023; 308:1775-1783. [PMID: 36567354 PMCID: PMC10579128 DOI: 10.1007/s00404-022-06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Matthew Erritty
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Joann Hale
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - James Thomas
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Thompson
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Ria Wright
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Anna Low
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Megan Carr
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Richard George
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Lisa Williams
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Alexandra Dumitrescu
- Obstetrics and Gynaecology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jacqui Rees
- Department of Quality, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Shashi Irukulla
- Surgical Site Infection Surveillance Team, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Jonathan Robin
- Department Acute Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, KT16 0PZ, Surrey, UK.
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, TW20 0EX, Surrey, UK.
| |
Collapse
|
3
|
Nkurunziza T, Riviello R, Kateera F, Nihiwacu E, Nkurunziza J, Gruendl M, Klug SJ, Hedt-Gauthier B. Enablers and barriers to post-discharge follow-up among women who have undergone a caesarean section: experiences from a prospective cohort in rural Rwanda. BMC Health Serv Res 2022; 22:733. [PMID: 35655212 PMCID: PMC9160515 DOI: 10.1186/s12913-022-08137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are thus sub-optimal for answering post-discharge outcomes questions. This study aims to determine enablers and barriers to returning to the hospital after discharge among women who have undergone a c-section at a rural district hospital in Rwanda. Methods Women aged ≥ 18 years who underwent c-section at Kirehe District Hospital in rural Rwanda in the period March to October 2017 were prospectively followed. A structured questionnaire was administered to participants and clinical data were extracted from medical files between March and October 2017. At discharge, consenting women were given an appointment to return for follow-up on postoperative day 10 (POD 10) (± 3 days) and provided a voucher to cover transport and compensation for participation to be redeemed on their return. Study participants received a reminder call on the eve of their scheduled appointment. We used a backward stepwise logistic regression, at an α = 0.05 significance level, to identify enablers and barriers associated with post-discharge follow-up return. Results Of 586 study participants, the majority (62.6%) were between 21–30 years old and 86.4% had a phone contact number. Of those eligible, 90.4% returned for follow-up. The predictors of return were counselling by a female data collector (OR = 9.85, 95%CI:1.43–37.59) and receiving a reminder call (OR = 16.47, 95%CI:7.07–38.38). Having no insurance reduced the odds of returning to follow-up (OR = 0.03, 95%CI:0.03–0.23), and those who spent more than 10.6 Euro for transport to and from the hospital were less likely to return to follow-up (OR = 0.14, 95%CI:0.04- 0.50). Conclusion mHealh interventions using calls or notifications can increase the post-discharge follow-up uptake. The reminder calls to patients and discharge counselling by a gender-matching provider had a positive effect on return to care. Further interventions are needed targeting the uninsured and patients facing transportation hardship. Additionally, association between counselling of women patients by a female data collector and greater return to follow-up needs further exploration to optimize counselling procedures. Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08137-5.
Collapse
|
4
|
Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdú-Soriano J. Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. J Wound Care 2021; 29:S1-S48. [PMID: 33170077 DOI: 10.12968/jowc.2020.29.sup11a.s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Charmaine Childs
- Professor of Clinical Science, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, UK
| | - Kylie Sandy-Hodgetts
- Senior Research Fellow/Senior Lecturer, Faculty of Medicine, School of Biomedical Sciences, University of Western Australia; Director, Skin Integrity Research Unit, University of Western Australia, Perth, Australia
| | - Carole Broad
- Clinical Specialist Physiotherapist in Pelvic Health, Department of Physiotherapy, Cardiff and Vale UHB, Cardiff, Wales, UK
| | - Rose Cooper
- Former Professor of Microbiology at Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Margarita Manresa
- Maternal and Fetal Medicine, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Verdú-Soriano
- Professor of Community Nursing and Wound Care, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| |
Collapse
|
5
|
Sandy-Hodgetts K, Parsons R, Norman R, Fear MW, Wood FM, White SW. Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial-the CYGNUS protocol. BMJ Open 2020; 10:e035727. [PMID: 33077559 PMCID: PMC7574944 DOI: 10.1136/bmjopen-2019-035727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Caesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother's health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified 'at-risk' population prior to surgery for prophylactic intervention are yet to be forthcoming. METHODS AND ANALYSIS A parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I-IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I-IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines. ETHICS AND DISSEMINATION Ethics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
Collapse
Affiliation(s)
- Kylie Sandy-Hodgetts
- Skin Integrity Research Institute, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Richard Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Richard Norman
- School of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- Fiona Stanley and Princess Margaret Hospitals, Burns Service of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Department of Obstetrics and Gynaecology, The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| |
Collapse
|
6
|
Lusher J, Djatmika C. Living with a non-healing caesarean section wound: A mini-review. Int Wound J 2020; 17:1094-1096. [PMID: 32293102 PMCID: PMC7948895 DOI: 10.1111/iwj.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joanne Lusher
- School of Health and Life SciencesUniversity of the West of ScotlandLondonUnited Kingdom
| | - Clementine Djatmika
- Department of PsychologyUniversity of the West of EnglandBristolUnited Kingdom
| |
Collapse
|
7
|
Wloch C, Van Hoek AJ, Green N, Conneely J, Harrington P, Sheridan E, Wilson J, Lamagni T. Cost-benefit analysis of surveillance for surgical site infection following caesarean section. BMJ Open 2020; 10:e036919. [PMID: 32690746 PMCID: PMC7375637 DOI: 10.1136/bmjopen-2020-036919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. DESIGN Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. SETTING England. PARTICIPANTS Women undergoing caesarean section in National Health Service hospitals. MAIN OUTCOME MEASURE Costs attributable to treatment and management of surgical site infection following caesarean section. RESULTS The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018-2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. CONCLUSION Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
Collapse
Affiliation(s)
- Catherine Wloch
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Albert Jan Van Hoek
- Immunisation, Hepatitis, and Blood Safety, Public Health England, London, UK
| | - Nathan Green
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanna Conneely
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Pauline Harrington
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Elizabeth Sheridan
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| | - Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | - Theresa Lamagni
- Healthcare Associated Infection and Antimicrobial Resistance, Public Health England, London, UK
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Alidina S, Kuchukhidze S, Menon G, Citron I, Lama TN, Meara J, Barash D, Hellar A, Kapologwe NA, Maina E, Reynolds C, Staffa SJ, Troxel A, Varghese A, Zurakowski D, Ulisubisya M, Maongezi S. Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania's Lake Zone: protocol for a quasi-experimental study. BMJ Open 2019; 9:e031800. [PMID: 31594896 PMCID: PMC6797473 DOI: 10.1136/bmjopen-2019-031800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Effective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term. METHODS AND ANALYSIS Our design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania's Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance. ETHICS AND DISSEMINATION The study has received ethical approval from Harvard Medical School and Tanzania's National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania's Lake Zone region and other similar contexts.
Collapse
Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - John Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States
| | - David Barash
- GE Foundation, Boston, Massachusetts, United States
| | | | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutritional Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Alena Troxel
- The Innovations Unit, JHPIEGO, Baltimore, Maryland, United States
| | | | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Mpoki Ulisubisya
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| |
Collapse
|
11
|
Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L, Nelson G, Wilson RD. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol 2019; 221:247.e1-247.e9. [PMID: 30995461 DOI: 10.1016/j.ajog.2019.04.012] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. OBJECTIVE The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. STUDY DESIGN The literature search (1966-2017) used Embase and PubMed to search medical subject headings that included "Cesarean Section," "Cesarean Delivery," "Cesarean Section Delivery," and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. RESULTS The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. CONCLUSION As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.
Collapse
Affiliation(s)
- George A Macones
- Department of Obstetrics & Gynecology, Washington University in St Louis, St. Louis, MO.
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Stephen L Wood
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian J Wrench
- Sheffield Teaching Hospitals Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom
| | | | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Pettersson
- Division of Obstetrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital, Egerton Road, Guildford, United Kingdom
| | - Medhat M Shalabi
- Departments of Anesthesiology and Intensive Care, Alzahra Hospital, Dubai, United Arab Emirates
| | - Amy Metcalfe
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - R Douglas Wilson
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| |
Collapse
|
12
|
The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology. Clin Microbiol Rev 2019; 32:32/4/e00125-18. [PMID: 31413046 DOI: 10.1128/cmr.00125-18] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.
Collapse
|
13
|
Castillo E, McIsaac C, MacDougall B, Wilson D, Kohr R. Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:645-651.e1. [PMID: 28729097 DOI: 10.1016/j.jogc.2016.12.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 11/16/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). PRIMARY OBJECTIVE Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. SECONDARY OBJECTIVE Estimate the rate of SSIs and associated predisposing factors. METHODS Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. RESULTS A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. CONCLUSIONS Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.
Collapse
Affiliation(s)
- Eliana Castillo
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB.
| | - Corrine McIsaac
- Department of Nursing, University of Dalhousie, Halifax, NS; Health Outcomes Worldwide, Founder & CEO, New Waterford, NS; Health Outcomes Worldwide, New Waterford, NS
| | | | - Douglas Wilson
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB
| | | |
Collapse
|
14
|
Abdelraheim AR, Gomaa K, Ibrahim EM, Mohammed MM, Khalifa EM, Youssef AM, Abdelhakeem AK, Hassan H, Alghany AA, El Gelany S. Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt. BMC Pregnancy Childbirth 2019; 19:234. [PMID: 31286872 PMCID: PMC6615272 DOI: 10.1186/s12884-019-2394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. METHODS The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. RESULTS During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15-16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69-10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS > 1 h (AOR 3.42; 95% CI =2.45-5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14-4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04-3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78-3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26-2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11-2.39; p = 0.021). CONCLUSIONS The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.
Collapse
Affiliation(s)
- Ahmed R Abdelraheim
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Khaled Gomaa
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Emad M Ibrahim
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mo'men M Mohammed
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eissa M Khalifa
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ayman M Youssef
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed K Abdelhakeem
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Abd Alghany
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| | - Saad El Gelany
- Department of Obstetrics &Gynecology, Minia Maternity & Children University Hospital, Faculty of Medicine, Minia University, Minia, Egypt
| |
Collapse
|
15
|
Dimovska-Gavrilovska A, Chaparoski A, Gavrilovski A, Milenkovikj Z. The Importance of Perioperative Prophylaxis with Cefuroxime or Ceftriaxone in the Surgical Site Infections Prevention after Cranial and Spinal Neurosurgical Procedures. ACTA ACUST UNITED AC 2019; 38:85-97. [PMID: 28991759 DOI: 10.1515/prilozi-2017-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Surgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%. Different antibiotics and administration regimes have been used in the perioperative prophylaxis so far, and there are numerous comparative studies regarding their efficiency, however, it is generally indicated that the choice thereof should be based on information and local specifics connected to the most probable bacterial causers, which would possibly contaminate the surgical site and cause infection, and moreover, the mandatory compliance with the principles of providing adequate concentration of the drug at the time of the anticipated contamination. Objective Comparing the protective effect of two perioperative prophylactic antibiotic regimes using cefuroxime (second generation cephalosporin) and ceftriaxone (third generation cephalosporin) in the prevention of postoperative surgical site infections after elective and urgent cranial and spinal neurosurgical procedures at the University Clinic for Neurosurgery in Skopje in the period of the first three months of 2016. Design of the study Prospective randomized comparative study. Outcome measures Establishing the clinical outcome represented as prevalence of superficial and deep incision and organ/space postoperative surgical site infections. Material and method We analyzed prospectively 40 patients who received parenteral antibiotic prophylaxis with two antibiotic regimes one hour before the routine neurosurgical cranial and spinal surgical procedures; the patients were randomized in two groups, according to the order of admission and participation in the study, alternately, non-selectively, those persons who fulfilled inclusion criteria were placed in one of the two programmed regimes with cefuroxime in the first, and cefotaxime in the second compared group. All relevant demographic and perioperative patient data were analyzed for both comparative groups, especially the factors known to cause disposition (predisposition) to infections. The prevalence of postoperative infections was evaluated as the primary outcome in both comparative groups, while the secondary outcome was the postoperative infection rate after cranial and spinal neurosurgical procedures at the Neurosurgical clinic in Skopje (having in consideration that so far no data have been published in this context), as well as the prevalence of the risk factors for occurrence of postoperative infections, pre-surgically in patients undergoing neurosurgical interventions locally in the Republic of Macedonia. Results A total of three cases of postoperative infections were registered, two of which classified as superficial incisional, while one case organ/space infection - meningitis (elective intervention) without etiological confirmation. Both comparative groups were statistically similar, without any statistically significant differences in the basic demographic and perioperative characteristics, especially in relation to the incidence of the factors, which, regardless of the antibiotic prophylaxis, show predisposition to postoperative infections. All three cases with infections were registered in the group of persons who received prophylaxis with ceftriaxone preoperatively, with isolated etiological S. aureus agent (elective intervention) in one of them, and methicillin resistant staphylococcus aureus (MRSA) in another (urgent intervention) with superficial incisional SSI. There was no case of SSI in the group of patients who received cefuroxime before surgery. Conclusion Administration of parenteral antibiotics before surgery reduces the incidence of postoperative infections after neurosurgical procedures, especially in cases with increased risk factors for SSI, such as ACA score of ≥ 2/3, the duration of the surgical intervention ≥ 4 hours, contaminated wound and comorbidities. Perioperative antibiotic prophylaxis should be directed to better coverage of the S.aureus arrays.
Collapse
|
16
|
Njoku CO, Njoku AN. Microbiological Pattern of Surgical Site Infection Following Caesarean Section at the University of Calabar Teaching Hospital. Open Access Maced J Med Sci 2019; 7:1430-1435. [PMID: 31198449 PMCID: PMC6542387 DOI: 10.3889/oamjms.2019.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Surgical site infection (SSI) is among the most common problems of patients who undergo a caesarean section, despite improved infection control practices. It contributes to increased morbidity and negative impact on the mental, social and economic aspect of patients’ life. AIM: To determine the incidence, risk factors and the bacteriological aetiology for SSI following caesarean section and their antimicrobial susceptibility patterns at UCTH. METHODS: This was a prospective study of 600 patients who had a caesarean section over 6 months. Wound swab was collected from the patients who developed clinical evidence of SSI during this study period were recorded. Microbiology culture and antibiotic sensitivity were conducted for both aerobic and anaerobic organisms. The data obtained were analysed using the SPSS version 22 statistical program. RESULTS: Out of the 600 participants who had a caesarean section, 51 patients had SSI, giving an incidence of 8.5%. The common isolates were S. aureus (37.3%), Klebsiella pneumonia (27.1%) and E. coli (22.0%). Independent risk factors significantly associated with post caesarean section wound infection in the logistic regression model were emergency caesarean section, prolonged rupture of membrane rupture greater than 24 hours, prolonged labour, intra-operative blood loss greater than one litre, duration of surgery greater than one hour and post-operative PCV less than 30%. Most isolates were highly resistant to cephalosporins, gentamycin and amoxicillin; moderately resistant to fluoroquinolones and highly sensitive to amikacin and imipenem. CONCLUSION: The post-caesarean wound infection rate in our centre of 8.5% was high. Imipenem and amikacin antibiotics were very sensitive for SSIs and can be used as evidenced-based sensitive antibiotics to be commenced initially when wound infection is identified in our wards while awaiting the result of wound swab microscopy, culture and sensitivity to reduce the complications of post-caesarean wound infection in our centre.
Collapse
Affiliation(s)
- Charles Obinna Njoku
- Department of Obstetrics and Gynaecology, University of Calabar, Calabar, Nigeria
| | - Amarachi Nnaemezie Njoku
- Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria
| |
Collapse
|
17
|
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.
Collapse
|
18
|
Risk factors for surgical site infection after cesarean delivery: A case-control study. Am J Infect Control 2019; 47:164-169. [PMID: 30253904 DOI: 10.1016/j.ajic.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The cesarean delivery (CD) rate is increasing worldwide. Surgical site infection (SSI) incidence is likely to follow an upward trajectory. We examined the incidence and risk factors for SSI after CD. METHODS A case-control study of women who had a lower-segment CD during the study period was performed at Ireland's Cork University Maternity Hospital. Cases were patients who presented to the hospital with SSI and who met the criteria of the U.S. Centers for Disease Control and Prevention. Controls were randomly selected from the discharge register of CDs at a ratio of 2:1. Data were extracted from the medical records. A multivariable stepwise logistic regression model approach was used, and the results were expressed as adjusted odds ratios (aORs). RESULTS The SSI rate was 2%. The greatest contribution to risk of SSI was associated with maternal obesity (aOR, 4.76; 95% confidence interval [CI], 2.00-11.32) and hypertensive disorders (aOR, 6.67; 95% CI, 1.54-28.99]. There was also an increased risk for women who underwent an emergency CD (aOR, 3.50; 95% CI, 1.09-11.30), for women who had ≥5 vaginal examinations (aOR, 3.24; 95% CI, 0.92-11.41), and for women without hypertensive disorders who delivered a baby weighing <3,500 g (aOR, 2.18; 95% CI, 1.08-4.37). CONCLUSIONS Obesity, hypertensive disorders, emergency CD, and multiple vaginal examinations were independent risk factors for SSI after CD.
Collapse
|
19
|
|
20
|
Childs C, Wright N, Willmott J, Davies M, Kilner K, Ousey K, Soltani H, Madhuvrata P, Stephenson J. The surgical wound in infrared: thermographic profiles and early stage test-accuracy to predict surgical site infection in obese women during the first 30 days after caesarean section. Antimicrob Resist Infect Control 2019; 8:7. [PMID: 30637101 PMCID: PMC6323776 DOI: 10.1186/s13756-018-0461-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/27/2018] [Indexed: 01/04/2023] Open
Abstract
Background Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI).Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman's community physician with logistic regression models derived to model dichotomous outcomes. Results Fifty-three women aged 21-44 years with BMI 30.1-43.9 Kg.m- 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for 'professional' opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%. Conclusions IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.
Collapse
Affiliation(s)
- Charmaine Childs
- Faculty of Health and Wellbeing, Montgomery House, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S102BP England
| | - Nicola Wright
- Faculty of Health and Wellbeing, Montgomery House, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S102BP England
| | - Jon Willmott
- Department of Electronic and Electrical Engineering, Portobello Centre, University of Sheffield, Sheffield, S1 4ET England
| | - Matthew Davies
- Department of Electronic and Electrical Engineering, Portobello Centre, University of Sheffield, Sheffield, S1 4ET England
| | - Karen Kilner
- Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP England
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| | - Hora Soltani
- Faculty of Health and Wellbeing, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP England
| | - Priya Madhuvrata
- Obstetrics and Gynaecology, Jessop Hospital, Tree Root Walk, Sheffield, S10 2SF England
| | - John Stephenson
- Biomedical Statistics, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| |
Collapse
|
21
|
Empirical Antibiotic Treatment of Obstetric and Gynecologic Surgical Site Infections: Are the Right Pathogens Being Targeted? J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
22
|
Hyldig N, Vinter CA, Kruse M, Mogensen O, Bille C, Sorensen JA, Lamont RF, Wu C, Heidemann LN, Ibsen MH, Laursen JB, Ovesen PG, Rorbye C, Tanvig M, Joergensen JS. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. BJOG 2018; 126:628-635. [PMID: 30066454 PMCID: PMC6586160 DOI: 10.1111/1471-0528.15413] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the reduction of surgical site infections by prophylactic incisional negative pressure wound therapy compared with standard postoperative dressings in obese women giving birth by caesarean section. Design Multicentre randomised controlled trial. Setting Five hospitals in Denmark. Population Obese women (prepregnancy body mass index (BMI) ≥30 kg/m2) undergoing elective or emergency caesarean section. Method The participants were randomly assigned to incisional negative pressure wound therapy or a standard dressing after caesarean section and analysed by intention‐to‐treat. Blinding was not possible due to the nature of the intervention. Main outcome measures The primary outcome was surgical site infection requiring antibiotic treatment within the first 30 days after surgery. Secondary outcomes included wound exudate, dehiscence and health‐related quality of life. Results Incisional negative pressure wound therapy was applied to 432 women and 444 women had a standard dressing. Demographics were similar between groups. Surgical site infection occurred in 20 (4.6%) women treated with incisional negative pressure wound therapy and in 41 (9.2%) women treated with a standard dressing (relative risk 0.50, 95% CI 0.30–0.84; number needed to treat 22; P = 0.007). The effect remained statistically significant when adjusted for BMI and other potential risk factors. Incisional negative pressure wound therapy significantly reduced wound exudate whereas no difference was found for dehiscence and quality of life between the two groups. Conclusion Prophylactic use of incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women giving birth by caesarean section. Tweetable abstract RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI. RCT: prophylactic incisional NPWT versus standard dressings postcaesarean in 876 women significantly reduces the risk of SSI.
Collapse
Affiliation(s)
- N Hyldig
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - C A Vinter
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M Kruse
- Danish Centre for Health Economics (DaCHE), Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - O Mogensen
- Department of Pelvic Cancer, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - C Bille
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - R F Lamont
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Division of Surgery, Northwick Park Institute of Medical Research Campus, University College London, London, UK
| | - C Wu
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L N Heidemann
- Department of Plastic Surgery, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark
| | - M H Ibsen
- Department of Gynaecology and Obstetrics, Hospital of Southern Jutland, Esbjerg, Denmark
| | - J B Laursen
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P G Ovesen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - C Rorbye
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - M Tanvig
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynaecology and Obstetrics, Lillebaelt Hospital, Kolding, Denmark
| | - J S Joergensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
23
|
Hutchinson AM, Nagle C, Kent B, Bick D, Lindberg R. Organisational interventions designed to reduce caesarean section rates: a systematic review protocol. BMJ Open 2018; 8:e021120. [PMID: 30002008 PMCID: PMC6082465 DOI: 10.1136/bmjopen-2017-021120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/10/2018] [Accepted: 06/01/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a growing body of evidence to indicate that both primary and subsequent caesarean sections are associated with increased maternal and perinatal morbidity. Efforts to reduce the number of clinically unnecessary caesarean sections are urgently required. Our objective is to systematically review published evidence on the effectiveness of maternity service organisational interventions, such as models of maternity care, that aim to reduce caesarean section rates. METHODS AND ANALYSIS Databases will be searched, including the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS. Search terms related to caesarean section and organisational intervention will be used. Research published before 1980 will be excluded and only randomised controlled trials, cluster-randomised controlled trials, quasi-randomised controlled trials, controlled before and after studies and interrupted time series studies will be included. Data extraction and quality assessments will be undertaken by two authors. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review. The results of this study will be disseminated via peer-reviewed publication and presentation at professional conferences. PROSPERO REGISTRATION NUMBER CRD42016039458.
Collapse
Affiliation(s)
- Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Deakin University, Geelong, Victoria, Australia
- Deakin Centre for Quality and Patient Safety Research, Monash Health, Clayton, Victoria, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Bridie Kent
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK
| | - Debra Bick
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Rebecca Lindberg
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
24
|
Marchocki Z, Vinturache A, Collins K, O' Reilly P, O'Donoghue K. Amniotic fluid C-reactive protein as a predictor of infection in caesarean section: a feasibility study. Sci Rep 2018; 8:6372. [PMID: 29686267 PMCID: PMC5913132 DOI: 10.1038/s41598-018-24569-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the feasibility of maternal C-reactive protein (CRP) in amniotic fluid (AF) as a predictor of post-partum infection in women who undergo emergency or elective caesarean section (CS). AF bacterial culture and levels of hs-CRP in maternal serum and AF were evaluated in Day 0 and three days thereafter (Day 3) in 79 women undergoing CS. Univariate analyses assessed the clinical and demographic characteristics, whereas the ROC curves assessed the feasibility of hs-CRP as marker of inflammation in women who undergo CS. There was no difference in AF, Day 0, and Day 3 serum hs-CRP levels between women with sterile compared to those with bacterial growth in AF. Among women with positive AF cultures, AF and Day 0 serum hs-CRP levels were higher in women who underwent emergency compared to those who had elective CS (p = 0.04, and p = 0.02 respectively). hs-CRP in Day 0 and Day 3 serum but not in AF has a fair predictor value of infection in emergency CS only (AUC 0.767; 95% CI 0.606-0.928, and AUC 0.791; 95% CI 0.645-0.036, respectively). We conclude that AF hs-CRP is not feasible in assessing the risk of post-cesarean inflammation or infection.
Collapse
Affiliation(s)
- Zbigniew Marchocki
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Angela Vinturache
- John Radliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Kevin Collins
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Paddy O' Reilly
- Department of Microbiology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| |
Collapse
|
25
|
Sandy-Hodgetts K, Carville K, Leslie GD. Surgical wound dehiscence: a conceptual framework for patient assessment. J Wound Care 2018; 27:119-126. [DOI: 10.12968/jowc.2018.27.3.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kylie Sandy-Hodgetts
- Clinical Trials Coordinator, Joondalup Health Campus, Adjunct Research Fellow, School of Anatomy, Physiology and Human Biology, University of Western Australia
| | - Keryln Carville
- Professor, Primary Health Care and Community, School of Nursing and Midwifery, Curtin University, Silver Chain Group
| | - Gavin D. Leslie
- Professor, Director of Research Training, School of Nursing and Midwifery, Curtin University
| |
Collapse
|
26
|
Martin EK, Beckmann MM, Barnsbee LN, Halton KA, Merollini KMD, Graves N. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses. BJOG 2018; 125:956-964. [DOI: 10.1111/1471-0528.15125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Affiliation(s)
- EK Martin
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - MM Beckmann
- Mater Health Services; Brisbane QLD Australia
| | - LN Barnsbee
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KA Halton
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KMD Merollini
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast; Maroochydore QLD Australia
| | - N Graves
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| |
Collapse
|
27
|
Scheck SM, Blackmore T, Maharaj D, Langdana F, Elder RE. Caesarean section wound infection surveillance: Information for action. Aust N Z J Obstet Gynaecol 2017; 58:518-524. [DOI: 10.1111/ajo.12755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/06/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Simon M. Scheck
- Wellington Regional Hospital; Capital and Coast District Health Board; Wellington New Zealand
| | - Timothy Blackmore
- Wellington Regional Hospital; Capital and Coast District Health Board; Wellington New Zealand
| | - Dushyant Maharaj
- Wellington Regional Hospital; Capital and Coast District Health Board; Wellington New Zealand
- School of Medicine; University of Otago; Otago New Zealand
| | - Fali Langdana
- Wellington Regional Hospital; Capital and Coast District Health Board; Wellington New Zealand
- School of Medicine; University of Otago; Otago New Zealand
| | - Rosalie E. Elder
- Wellington Regional Hospital; Capital and Coast District Health Board; Wellington New Zealand
| |
Collapse
|
28
|
Aulakh A, Idoko P, Anderson ST, Graham W. Caesarean section wound infections and antibiotic use: a retrospective case-series in a tertiary referral hospital in The Gambia. Trop Doct 2017; 48:192-199. [PMID: 29108473 DOI: 10.1177/0049475517739539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ours is the first published study to examine post-Caesarean section (CS) wound infections in The Gambia. We explored risk factors and clinical management retrospectively at a large referral hospital over a 12-month period. A total of 777 cases were identified and records for 682 (88%) were retrieved. The CS rate was 21.8% and the wound infection rate 13.2%. Risk factors included: length of labour; decision-to-incision time and stillbirth. Only 7.4% of women received preoperative antibiotic prophylaxis, but all women received multiple-dose, postoperative antibiotics. The wound infection rate found is likely to be an underestimate owing to loss to follow-up. The adherence to international guidelines regarding preoperative antibiotic prophylaxis needs to be improved.
Collapse
Affiliation(s)
- Alex Aulakh
- 1 Foundation Year 2 Doctor, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Patrick Idoko
- 2 Consultant Obstetrician and Gynaecologist, University of The Gambia Medical School, Banjul, The Gambia
| | - Suzanne T Anderson
- 3 Head of Clinical Services, Medical Research Council Unit The Gambia, Banjul, The Gambia
| | - Wendy Graham
- 4 Professor of Obstetric Epidemiology, Department of Infectious Disease Epidemiology, 4906 London School of Hygiene and Tropical Medicine , London, UK.,5 Emeritus Professor of Obstetrics and Epidemiology, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
29
|
Jasim HH, Sulaiman SAS, Khan AH, Dawood OT, Abdulameer AH, Usha R. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1179559x17725273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hanan Hussein Jasim
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Omar Thanoon Dawood
- Department of Medical Services, Ministry of Science and Technology, Baghdad, Iraq
| | - Aseel Hadi Abdulameer
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - R Usha
- Department of Anesthesia and Pain Management, Hospital Pulau Pinang, Penang, Malaysia
| |
Collapse
|
30
|
Childs C, Siraj MR, Fair FJ, Selvan AN, Soltani H, Wilmott J, Farrell T. Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis. J Wound Care 2017; 25:499-512. [PMID: 27608511 DOI: 10.12968/jowc.2016.25.9.499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. METHOD Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. RESULTS We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. CONCLUSION Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.
Collapse
Affiliation(s)
- C Childs
- Professor of Clinical Science, Midwifery Researcher, Professor of Maternal and Infant Health, Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield
| | - M R Siraj
- ST7 Obstetrics and Gynaecology, Consultant, Jessop Wing, Sheffield Teaching Hospital NHS Trust, Tree Root Walk, Sheffield
| | - F J Fair
- Professor of Clinical Science, Midwifery Researcher, Professor of Maternal and Infant Health, Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield
| | - A N Selvan
- Associate Lecturer, Materials and Engineering Research Institute, Sheffield Hallam University, Howard Street, Sheffield
| | - H Soltani
- Professor of Clinical Science, Midwifery Researcher, Professor of Maternal and Infant Health, Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield
| | - J Wilmott
- EPSRC Research Fellow, University of Sheffield, Portobello Centre, Sheffield
| | - T Farrell
- ST7 Obstetrics and Gynaecology, Consultant, Jessop Wing, Sheffield Teaching Hospital NHS Trust, Tree Root Walk, Sheffield
| |
Collapse
|
31
|
A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries. Infect Control Hosp Epidemiol 2017; 38:610-613. [PMID: 28069094 DOI: 10.1017/ice.2016.322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610-613.
Collapse
|
32
|
Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt) 2016; 17:510-9. [DOI: 10.1089/sur.2015.241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Erik Woelber
- University of Washington School of Medicine, Seattle, Washington
| | - Emily J. Schrick
- University of Washington College of Arts and Sciences, Seattle, Washington
| | | | | |
Collapse
|
33
|
Chandrananth J, Rabinovich A, Karahalios A, Guy S, Tran P. Impact of adherence to local antibiotic prophylaxis guidelines on infection outcome after total hip or knee arthroplasty. J Hosp Infect 2016; 93:423-7. [DOI: 10.1016/j.jhin.2016.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
|
34
|
Halwani MA, Turnbull AE, Harris M, Witter F, Perl TM. Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies. Am J Infect Control 2016; 44:455-7. [PMID: 26706153 DOI: 10.1016/j.ajic.2015.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section. METHODS We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance. RESULTS One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients. CONCLUSIONS Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates.
Collapse
Affiliation(s)
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Frank Witter
- Department of Obstetrics and Gynecology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Trish M Perl
- Department of Medicine, Division of Infectious Diseases, Department of Pathology, and Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
35
|
De Nardo P, Gentilotti E, Nguhuni B, Vairo F, Chaula Z, Nicastri E, Nassoro MM, Bevilacqua N, Ismail A, Savoldi A, Zumla A, Ippolito G. Post-caesarean section surgical site infections at a Tanzanian tertiary hospital: a prospective observational study. J Hosp Infect 2016; 93:355-9. [PMID: 27125664 DOI: 10.1016/j.jhin.2016.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022]
Abstract
Few data are available on the determinants and characteristics of post-caesarean section (CS) surgical site infections (SSIs) in resource-limited settings. We conducted a prospective observational cohort study to evaluate the rates, determinants, and microbiological characteristics of post-CS SSI at the Dodoma Regional Referral Hospital (DRRH) Gynaecology and Obstetrics Department in Tanzania. Spanning a three-month period, all pregnant women who underwent CS were enrolled and followed up for 30 days. SSI following CS occurred in 224 (48%) women. Only 10 (2.1%) women received pre-incision antibiotic prophylaxis. Urgent intervention is needed to prevent and control infections and contain the rising rate of post-CS SSI at the DRRH.
Collapse
Affiliation(s)
- P De Nardo
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy.
| | - E Gentilotti
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; Department of Infectious Diseases, Tor Vergata University Hospital, Rome, Italy
| | - B Nguhuni
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - F Vairo
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - Z Chaula
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - E Nicastri
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - M M Nassoro
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - N Bevilacqua
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| | - A Ismail
- University of Dodoma - UDOM, Department of Statistics, Dodoma, Tanzania
| | - A Savoldi
- Resource Centre for Infectious Diseases, Dodoma Regional Referral Hospital, Dodoma, Tanzania; Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - A Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre at UCL Hospitals NHS Foundation Trust, London, UK
| | - G Ippolito
- 'Lazzaro Spallanzani' National Institute for Infectious Diseases-IRCCS, Rome, Italy
| |
Collapse
|
36
|
SHREE R, Park SY, Beigi RH, Dunn SL, Krans EE. Surgical Site Infection following Cesarean Delivery: Patient, Provider, and Procedure-Specific Risk Factors. Am J Perinatol 2016; 33:157-64. [PMID: 26344010 PMCID: PMC5064434 DOI: 10.1055/s-0035-1563548] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aims to identify risk factors for cesarean delivery (CD) surgical site infection (SSI). study design: Retrospective analysis of 2,739 CDs performed at the University of Pittsburgh in 2011. CD SSIs were defined using National Healthcare Safety Network (NHSN) criteria. Chi-square test and t-test were used for bivariate analyses and multivariate logistic regression was used to identify SSI risk factors. RESULTS Of 2,739 CDs, 178 (6.5%) were complicated by SSI. Patients with a SSI were more likely to have Medicaid, have resident physicians perform the CD, an American Society of Anesthesiologists (ASA) class of ≥ 3, chorioamnionitis, tobacco use, and labor before CD. In multivariable analysis, labor (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.65-3.38), chorioamnionitis (OR, 2.24; 95% CI, 1.25-3.83), resident teaching service (OR, 2.15; 95% CI, 1.54-3.00), tobacco use (OR, 1.70; 95% CI, 1.04-2.70), ASA class ≥ 3 (OR, 1.61; 95% CI, 1.06-2.39), and CDs performed for nonreassuring fetal status (OR, 0.43; 95% CI, 0.26-0.67) were significantly associated with CD SSI. CONCLUSION Multiple patient, provider, and procedure-specific risk factors contribute to CD SSI risk which may be targeted in infection-control efforts.
Collapse
Affiliation(s)
- Raj SHREE
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Seo Young Park
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh, 200 Meyran Avenue, Pittsburgh, PA 15213, (412) 864-3022, Fax (412) 586-9672
| | - Richard H. Beigi
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Shannon L. Dunn
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology and RS, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, (412) 641- 4220, Fax (412) 641-1133
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, (412) 641-6085, Fax (412) 641-3170
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Gomes AEB, Cavalcante RDS, Pavan ÉCP, Freitas EDS, Fortaleza CMCB. Predictive factors of post-discharge surgical site infections among patients from a teaching hospital. Rev Soc Bras Med Trop 2014. [DOI: 10.1590/0037-8682-0069-2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
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.
Collapse
|
40
|
Stitely M, Sweet M, Slain D, Alons L, Holls W, Hochberg C, Briggs F. Plasma and Tissue Cefazolin Concentrations in Obese Patients Undergoing Cesarean Delivery and Receiving Differing Pre-Operative Doses of Drug. Surg Infect (Larchmt) 2013; 14:455-9. [PMID: 23859672 DOI: 10.1089/sur.2012.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Stitely
- Department of Women's and Children's Health, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Michael Sweet
- Center for Quality Outcomes, West Virginia University, Morgantown, West Virginia
| | - Douglas Slain
- Departments of Clinical Pharmacy and Infectious Diseases, Schools of Pharmacy and Medicine, West Virginia University, Morgantown, West Virginia
| | - Lindsy Alons
- Department of Obstetrics and Gynecology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - William Holls
- Department of Obstetrics and Gynecology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Charles Hochberg
- Department of Obstetrics and Gynecology, School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Frank Briggs
- Center for Quality Outcomes, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
41
|
Risk Factor Analysis and Microbial Etiology of Surgical Site Infections following Lower Segment Caesarean Section. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/283025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background. Lower segment caesarean section (LSCS) is a common mode of delivery now and surgical site infection is the second most common infectious complication in these patients. This study was planned with this background to have a comprehensive approach to SSI following LSCS. Methods. 500 consecutive patients undergoing LSCS, irrespective of indication, were studied. A questionnaire was developed to assess the risk factors associated with development of SSI. All patients were followed up from day one of surgery till discharge and then up till the postoperative day 30 after discharge. Results. SSI was identified in 121 (24.2%) out of 500 patients. In all age groups, Gram-negative bacilli were the commonest finding. The commonest isolate was Acinetobacter species (32.03%) followed by Staphylococcus aureus and coagulase negative Staphylococcus (21.09%). 23.8% of Staphylococcus aureus strains were MRSA. By multivariate logistic regression premature rupture of membrane (PROM), antibiotics given earlier than 2 hours and increased duration of stay in the hospital were found to be significant. Conclusions. A proper assessment of risk factors that predispose to SSI and their modification may help in reduction of SSI rates. Also, frequent antimicrobial audit and qualitative research could give an insight into the current antibiotic prescription practices and the factors affecting these practices.
Collapse
|
42
|
Wilson J, Wloch C, Saei A, McDougall C, Harrington P, Charlett A, Lamagni T, Elgohari S, Sheridan E. Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect 2013; 84:44-51. [PMID: 23507051 DOI: 10.1016/j.jhin.2013.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Short postoperative stays following caesarean section delivery make it difficult to assess accurately the risk of surgical site infection (SSI). Methods of case-finding that minimize variation are required to support effective surveillance systems, especially where used for benchmarking. AIM To evaluate the efficacy of case-finding methods for SSI following caesarean delivery and their utility in establishing benchmark rates of SSI. METHODS Hospitals conducted surveillance over one or two 13-week periods. Patients were reviewed during their inpatient stay, post partum by community midwives and via patient questionnaire at 30 days post delivery. To estimate the reliability of case-finding methods, case-note reviews were undertaken in a random sample of four hospitals. FINDINGS A total of 404 SSIs were detected in 4107 caesarean deliveries from 14 hospitals. The median time to SSI was 10 days, 66% were detected in-hospital or by community midwives, and an additional 34% were patient-reported. The rate of SSI was 9.8% but the proportion of patients followed up varied significantly between centres. The estimated sensitivity and specificity of case-finding was 91.4% [95% confidence interval (CI): 53.4-98.4] and 98.6% (95% CI: 98.4-98.8), the positive predictive value 91.0% (95% CI: 82.4-96.1) and negative predictive value 98.6% (95% CI: 93.9-99.5). CONCLUSIONS Combined case ascertainment methods are a feasible way to achieve active post-discharge surveillance and had high negative and positive predictive values. Additional SSIs can be detected by patient questionnaires but rates of SSI were strongly influenced by variation in intensity of both healthcare worker- and patient-based case-finding. This factor must be taken into account when comparing or benchmarking rates of SSI.
Collapse
Affiliation(s)
- J Wilson
- Department of Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Leaper D, Tanner J, Kiernan M. Surveillance of surgical site infection: more accurate definitions and intensive recording needed. J Hosp Infect 2013; 83:83-6. [DOI: 10.1016/j.jhin.2012.11.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 11/30/2012] [Indexed: 11/30/2022]
|
44
|
Nevill M, Tanner J, Robertson D, Myers A, Lohr PA. Surveillance of surgical site infection post vasectomy. J Infect Prev 2013. [DOI: 10.1177/1757177412471410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to determine the incidence of surgical site infection (SSI) after vasectomy and to identify associated patient and perioperative risk factors, including the operating room environment (non-ventilated treatment room or ventilated operating theatre). This study used an active 30-day surveillance follow-up programme with telephone interviews and home visits. Patients were recruited over an 18 month period. Demographics, patient details and perioperative procedures were documented on the day of surgery. Patients were telephoned 10 and 30 days post procedure. Of 1,155 patients enrolled, 994 (86%) completed the full 30-day follow-up. Of these, 25 (2.5%) developed an SSI. The mean number of days until presentation with an SSI was 13. No statistically significant difference was found in rates of SSI when vasectomies were undertaken in either ventilated operating theatres or non-ventilated treatment rooms.
Collapse
Affiliation(s)
- Michael Nevill
- bpas, 20 Timothy’s Bridge Road, Stratford Enterprise Park, UK
| | | | - David Robertson
- bpas, 20 Timothy’s Bridge Road, Stratford Enterprise Park, UK
| | - Amanda Myers
- bpas, 20 Timothy’s Bridge Road, Stratford Enterprise Park, UK
| | | |
Collapse
|
45
|
Sullivan C, McNeish J, Mullings A, Reilly J. Surgical site infection surveillance: a Scottish perspective (2003–2010). J Infect Prev 2013. [DOI: 10.1177/1757177412462753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health Protection Scotland facilitates national surveillance of surgical site infection (SSI) in Scotland with all hospitals participating in the SSI programme. For the period January 2003 to December 2010, there were 1883 inpatient SSIs, resulting from 192,007 procedures in the selected surgical categories. The inpatient SSI incidence density rates in Scotland over the duration of the SSI surveillance programme (2003–2010) showed a reduction over the eight years of surveillance for all procedures, with a significant reduction in caesarean section, hip arthroplasty, knee arthroplasty, and open reduction of long bone fracture. For all procedures, the highest proportion of SSIs detected were superficial. Data from Scotland includes information on infections occurring post-discharge from hospitals, which is an increasingly important aspect of monitoring, as length of stay in hospital is reducing over time. The introduction of readmission surveillance until day 30 post-operatively for hip arthroplasty in 2007 and post-discharge surveillance (PDS) to day 10 for caesarean section in 2009 has resulted in a higher proportion of SSIs being detected following discharge from hospital.
Collapse
Affiliation(s)
| | - Jane McNeish
- HAI and IC group, Health Protection Scotland (HPS), UK
| | | | - Jacqui Reilly
- HAI and IC group, Health Protection Scotland (HPS), UK
| |
Collapse
|
46
|
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]
|
47
|
Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012; 119:1324-33. [DOI: 10.1111/j.1471-0528.2012.03452.x] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
48
|
Wilson APR, Kiernan M. Recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct. J Antimicrob Chemother 2012; 67 Suppl 1:i23-8. [DOI: 10.1093/jac/dks198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Salim R, Braverman M, Teitler N, Berkovic I, Suliman A, Shalev E. Risk factors for infection following cesarean delivery: an interventional study. J Matern Fetal Neonatal Med 2012; 25:2708-12. [DOI: 10.3109/14767058.2012.705394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
50
|
Avila C, Bhangoo R, Figueroa R, Santorelli J, Ogburn P, Desan PH. Association of smoking with wound complications after cesarean delivery. J Matern Fetal Neonatal Med 2012; 25:1250-3. [PMID: 22081871 DOI: 10.3109/14767058.2011.636462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether smoking is an independent risk factor for wound dehiscence after cesarean delivery. METHODS In this case-control study, medical records were reviewed for all patients with wound dehiscence after cesarean delivery during a 7-month period. Wound dehiscence was defined as separation of wound edges requiring treatment. Three control patients without such complications were randomly selected for each case patient. Univariate associations were assessed using t test or Fisher's exact test; univariate odds ratios (OR) and 95% confidence intervals (CI) were calculated with logistic regression. Multivariate associations were assessed with logistic regression on variables with a univariate association significant at p ≤ 0.10. RESULTS Of 597 cesarean deliveries, 30 cases (5 %) with wound dehiscence were identified. As individual variables, smoking (46.7 vs. 21.1%, p < 0.01, cases vs. controls), histological chorioamnionitis (27.6 vs. 6.7%, p < 0.01) and preoperative hematocrit (34.0 ± 3.2 vs. 35.4 ± 3.4, p < 0.05) were significantly associated with wound complications. In a multivariate logistic regression model, only smoking (OR 5.32; 95% CI 1.77-15.97, p < 0.01) and histological chorioamnionitis (OR 5.62; 95% CI 1.43-22.11, p < 0.01) were independently associated with wound dehiscence. CONCLUSIONS Smoking and histological chorioamnionitis are independently associated with wound dehiscence after cesarean delivery.
Collapse
Affiliation(s)
- Cecilia Avila
- Department of Obstetrics, Gynecology and Reproductive Medicine, Division of Maternal-Fetal Medicine, Stony Brook University, Stony Brook, NY 11794-8091, USA.
| | | | | | | | | | | |
Collapse
|