SurgicalsiteinfectionpostCaesareansection;Prospectivesurveillancestudy Mairead OHanlon*, Gabriela Dornikova, Seosamh O'Coigligh, RoseMary Curran, Tracy Doherty, Margaret Swords, Colette McCann, L Crinion, Brigid Russell, Claire Shannon, Mary R. Costello, Nora Hourigan. *Corresponding author: Mairead OHanlon, Surveillance scientist, Microbiology Department, Our Lady of Lourdes Hospital Drogheda, County Louth, Ireland. E-mail: Mairead.OHanlon@hse.ie.

INTRODUCTION AND PURPOSE

Surgical site infection (SSI) post CS increases maternal morbidity and cost and is thus an important problem. The current study aimed to assess risk factors in relation to SSI post CS rate in Louth-Meath region, Ireland.

METHODS

A survey of both, in hospital diagnosed surgical site infection (SSI) and post discharge SSI was conducted in Our Lady of Lourdes Hospital (OLOLH) in Drogheda from January 2012 to Jun 2012. OLOLH is a 339 bed Acute General Hospital incorporating a Maternity Unit, Regional School of Midwifery and a Regional Neonatal Intensive Care Unit. The Maternity Unit is the only such unit within the Louth/Meath Hospital Group. The hospital serves population of 307 032 people in Louth Meath region.

RESULTS

Of the 540 cases who underwent CS in OLOLH in the time period January 2012 to June 2012, 395(73.1%) patients who replied to questionnaire were included into the study. SSI's were diagnosed in 52 cases (13%). Majority of SSI, 48 (92.3%), were diagnosed in post-discharge period and only 4 SSI (7.7%) were found within in-hospital period. The study showed, that SSI were more frequent in cases, where epidural anesthetic was used (17.4%) , in elective surgical procedures (14%), in mothers with BMI >30 (20.8%), in CS performed by SpR (17.6%), where blood loss was 0 999 ml 13,4%) and as skin closure method was used Monocryl (16.1%). Further analyses and audits are needed in the field of surgical prophylaxis in Caesarean section.

Graph 1. SSI rate in relation to BMI Graph 2. SSI rate in relation to skin closure material

0.00%5.00%

10.00%15.00%20.00%25.00%

normal BMI18.5-24.9

overweightBMI 25-29.9

obese BMI>30

unknown0.00%

10.00%

20.00%

clips/staples Dexon Monocryl Vicryl other/not recorded

Graph 4. SSI rate in relation to type of anaesthesia

0.00% 5.00% 10.00% 15.00% 20.00%

General

Spinal

Epidural

Graph 3. SSI rate in relation to grade of operator

0.00%

5.00%

10.00%

15.00%

20.00%

Consultant Registrar SpR SHO

CONCLUSION

Our study showed 13% SSI rate post CS in monitored time period. There is need of continuous and accurate monitoring of SSI, implementation and auditing appropriate guidelines for surgical prophylaxis, as well as sampling of patients diagnosed with SSI. All these measures could improve management of patients post CS, including decreased cost implications related to extended hospital stay or re-admission and antibiotic treatment for health care associated infections.

REFERENCES

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