Surgical site infections following caesarean section at Royal Darwin Hospital, Northern Territory

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Contents Vol 17(2)

doi:10.1071/HI11027

Official Journal of the Australasian College for Infection Prevention and Control

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Surgical site infections following caesarean section at Royal Darwin Hospital, Northern Territory

Katie Henman ^A ^F, Claire L. Gordon ^B ^F ^G, Tain Gardiner ^A, Jane Thorn ^C, Brian Spain ^D, Jane Davies ^B and Robert Baird ^A ^B ^E

^A Infection Prevention and Management Unit, Royal Darwin Hospital, Darwin, NT 0810, Australia.
^B Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT 0810, Australia.
^C Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT 0810, Australia.
^D Department of Anaesthesiology, Royal Darwin Hospital, Darwin, NT 0810, Australia.
^E Department of Microbiology, Royal Darwin Hospital, Darwin, NT 0810, Australia.
^F Co-first authors: both authors contributed equally to the manuscript.
^G Corresponding author. Email: clairegordon28@gmail.com

Healthcare Infection 17(2) 47-51 http://dx.doi.org/10.1071/HI11027
Submitted: 19 October 2011 Accepted: 27 February 2012 Published: 15 May 2012





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Abstract

Surgical site skin infections (SSIs) are a preventable complication of delivery via caesarean section (c-section). After observing a high rate of SSIs following c-section, we reviewed SSIs following c-section over a 14-month period. In addition, we assessed all women undergoing c-section during the final 6 months of the study period to determine the risk factors for SSIs in our population. During the review period, 6.9% (40 of 583) of women developed a SSI following c-section. The rate of SSIs was five times higher in Indigenous women compared with non-Indigenous women (16.6% v. 3.3%, P = 0.001). Diabetes mellitus, high ASA score and the use of staples to close the wound were also associated with SSIs (6 of 18 v. 24 of 199, P = 0.02; 2 v. 1, P = 0.003; 10 of 18 v. 49 of 199, P = 0.002). Length of stay was increased by 4 days in women who had the SSI diagnosed during their initial admission (P = 0.001), and a quarter of women with a SSI required readmission. Sixty-four percent (18 of 28) of isolates were Staphylococcus aureus, of which 44% were community-associated methicillin-resistant S. aureus (8 of 18). Twenty-nine percent of isolates were not susceptible to cephazolin, the standard antimicrobial prophylaxis used. After changing surgical skin preparation to alcoholic 2% chlorhexidine, adding gentamicin to cephazolin for preincisional antibiotic prophylaxis and educating staff, the rate of SSIs halved to 3.3%. Many of the SSIs that occurred after the new measures were introduced were in women who had not received gentamicin prophylaxis, highlighting the importance of ongoing staff education.

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