An Audit of Post-caesarean Infections Prior to and After the Introduction of a Prevention Care Bundle
Author(s)
Hettiarachchi, N
Ellepola, H
Griffith University Author(s)
Year published
2021
Metadata
Show full item recordAbstract
Introduction: In an attempt to reduce the number of postcaesarean Section (CS) infections (surgical site infections (SSIs), endometritis and other post-CS infections with a clear source) the obstetrics department at a busy metropolitan hospital introduced a prevention bundle. It included not only re-education on evidence-based practices such as perioperative prepping, prophylactic antibiotic therapy and rigorous hand hygiene, but also the use of unidirectional tissue control devices for rectus sheath and skin closure. These innovative barbed sutures were coated in antibacterial agents to minimise colonisation. Post-operatively, ...
View more >Introduction: In an attempt to reduce the number of postcaesarean Section (CS) infections (surgical site infections (SSIs), endometritis and other post-CS infections with a clear source) the obstetrics department at a busy metropolitan hospital introduced a prevention bundle. It included not only re-education on evidence-based practices such as perioperative prepping, prophylactic antibiotic therapy and rigorous hand hygiene, but also the use of unidirectional tissue control devices for rectus sheath and skin closure. These innovative barbed sutures were coated in antibacterial agents to minimise colonisation. Post-operatively, negative pressure dressings were recommended in high-risk patients. Methods: An audit of all C-sections six months before and six months immediately following the intervention was performed. The incidence of SSIs and endometritis/other post-CS infections were analysed pre- and post-transition. Results: The percentage of SSIs dropped from 2.9% to 1.7%. The incidence of endometritis and other infections; however, showed no appreciable decrease. SSIs were more prevalent postemergency C-sections as opposed to endometritis which was seen almost exclusively after electives. The average BMI in SSI cases was 36. There was no correlation between SSIs and the presence of gestational diabetes. The usage of negative pressure dressings was found to be too surgeon dependant for comparison. Discussion: Carefully designed re-education programmes have a positive effect on the reduction of SSIs. More extensive evidence of this nature may justify the routine use of knotless antibacterial sutures in C-sections. Suggested areas for further exploration include mandating vaginal prepping and negative pressure dressings for BMI > 35.
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View more >Introduction: In an attempt to reduce the number of postcaesarean Section (CS) infections (surgical site infections (SSIs), endometritis and other post-CS infections with a clear source) the obstetrics department at a busy metropolitan hospital introduced a prevention bundle. It included not only re-education on evidence-based practices such as perioperative prepping, prophylactic antibiotic therapy and rigorous hand hygiene, but also the use of unidirectional tissue control devices for rectus sheath and skin closure. These innovative barbed sutures were coated in antibacterial agents to minimise colonisation. Post-operatively, negative pressure dressings were recommended in high-risk patients. Methods: An audit of all C-sections six months before and six months immediately following the intervention was performed. The incidence of SSIs and endometritis/other post-CS infections were analysed pre- and post-transition. Results: The percentage of SSIs dropped from 2.9% to 1.7%. The incidence of endometritis and other infections; however, showed no appreciable decrease. SSIs were more prevalent postemergency C-sections as opposed to endometritis which was seen almost exclusively after electives. The average BMI in SSI cases was 36. There was no correlation between SSIs and the presence of gestational diabetes. The usage of negative pressure dressings was found to be too surgeon dependant for comparison. Discussion: Carefully designed re-education programmes have a positive effect on the reduction of SSIs. More extensive evidence of this nature may justify the routine use of knotless antibacterial sutures in C-sections. Suggested areas for further exploration include mandating vaginal prepping and negative pressure dressings for BMI > 35.
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Conference Title
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume
61
Issue
S1
Subject
Paediatrics and Reproductive Medicine
Public Health and Health Services
Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology