Risk factors for post caesarean surgical site infection at a tertiary care center in Eastern Nepal

Abstract

Background & Objectives: Post cesarean surgical site infection (SSI) is one of the commonly encountered complications which considerably increase the burden to health care. It is caused due to the interplay of various patient related, procedure related and iatrogenic factors. This study aims at identifying common risk factors for post cesarean SSI at our centre. Materials & Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included and their risk factors were studied. Results: Emergency procedures (82.97%) were more likely to develop SSI as compared to elective cesarean (17%). Among the patient related risk factors most of them were nulliparous (48.9%), term gestation (42.6%), malnourished (53.1%) and had history of prolonged leaking (44.68%) The mean age was 24.04±4.6years.Most of the patients who developed SSI were operated for repeat cesarean and fetal indications. Most patients who had SSI had at three to five per vaginal examinations (2.72±2). 66% of patient who had SSI had duration of surgery more than one hour. 68% of the surgeries which developed SSI were done by residents as compared to 32% of those done by consultants Conclusion: The commonly associated risk factors linked with post cesarean SSI are maternal age, emergency procedures, prolonged membrane rupture, multiple vaginal examinations, malnutrition and the experience of surgeon. 3,4,6 One of the patient related factors is young maternal age as most of the infections (92%) occurred in women less than thirty years of age, this is in accordance with other studies. 7,8 Hypertensive disorders in pregnancy which is linked with chronic alteration in peripheral blood supply have been found to a risk factor for SSI.9, 10 In this study 27.7% of patients with SSI suffered from this condition. Both obesity and malnutrition have been associated with increased risk of SSI. 7,8 The association of obesity with SSI could be due to relative avascularity of adipose tissue and hence poor healing, difficulty in handling of tissues and hence more chance of micro-trauma and also failure in obliteration of dead spaces. Likewise malnutrition can lead to SSI due to poor healing of tissues and decreased immunity. In our study population malnutrition was a more common risk factor (53.1%) as compared to obesity (14.9%) and it is a reflection of the general population characteristic of our part of the world where most childbearing women are anemic and malnourished. Prolonged rupture of membrane (>8hrs) are established risk factors of SSI. 3,6,11 Even in the present study they were found to be significantly associated with SSI with prolonged PROM in 44.5% of patients and most patients with more than three per vaginal examinations. Loss of protective cervical mucus plug and barrier effect of fetal membranes and amniotic fluid after rupture of membranes are thought to be the culprits. The more the vaginal examinations the m...

Assessment of risk factors for surgical site infection following caesarean section

“…In group I, mean duration of labour was 8.46±4.09 hours and 6.97±2.92 hours in group II (p <0.05). This was found to be in accordance with study conducted by Chhetry et al 9 In the present study we found that multiple per vaginal examinations (>3) significantly led to an increase of SSI following caesarean section. This was found to be in accordance with the study carried out by Chhetry et al where it was concluded that more the number of vaginal examinations, more the risk of introduction of infections.…”

“…This was found to be in accordance with the study carried out by Chhetri et al in which 42.6% of patients developing SSI were term patients. 9 In the present study, we found that a total of 8 (20%) women in group I and 83(8.64%) in group II had history of PROM (p <0.01). Chhetry et al carried out a prospective observational study in all patients who were admitted with post caesarean SSI or developed SSI during their stay were included and their risk factors were studied and found that PROM and multiple vaginal examinations were significantly associated with SSI.…”

“…Chhetry et al carried out a prospective observational study and found that most cases of SSI (92%) were seen more commonly in young women of age less than 30 years. 9 Majority of the women developing SSI were nulliparous i.e. 22 (55%) and 706 (73.54%) in group I and II, respectively.…”

“…Chhetry et al carried out a prospective observational study in all patients who were admitted with post caesarean SSI or developed SSI during their stay and found that 27.7% of patients with SSI suffered from hypertension. 9 Majority of the women developing SSI following caesarean were term patients. This was found to be in accordance with the study carried out by Chhetri et al in which 42.6% of patients developing SSI were term patients.…”

“…This was found to be in accordance with the prospective observational study carried out by Chhetry et al, in which 17% of cases of SSI were due to caesarean section for foetal distress. 9 Type of skin incision has been found to be significantly associated with SSI. According to Killian et al, transverse incision has less chance of wound dehiscence.…”