CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Healthcare Infection   
Healthcare Infection
http://www.acipc.org.au
  Official Journal of the Australasian College for Infection Prevention and Control
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Structure
Contacts
Content
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
For Authors
General Information
Scope
Submit Article
Author Instructions
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates
For Advertisers

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with HI
blank image
TwitterIcon

red arrow Connect with CP
blank image
facebook twitter LinkedIn

red arrow COPE Member
blank image
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE) CopeLogo

 

Article << Previous     |     Next >>   Contents Vol 17(2)

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


 
PDF (138 KB) $25
 Export Citation
 Print
  
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.



References

[1]  Victorian Department of Health Surgical Site Infections. 2011. Available from: http://www.vicniss.org.au/Resources/VICNISSAnnualReport2009-10.pdf [verified 18 September 2011].

[2]  Dinsmoor MJ, Gilbert S, Landon MB, Rouse DJ, Spong CY, Varner MW, et al Perioperative antibiotic prophylaxis for nonlaboring cesarean delivery. Obstet Gynecol 2009; 114: 752–6.
CrossRef |

[3]  Rauk PN. Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections. Am J Infect Control 2010; 38: 319–23.
CrossRef |

[4]  Healthcare Associated Infections Advisory Committee. Introduction to National Guidelines for Surveillance. Canberra: The Office of the Australian Council for Safety and Quality in Health Care; 2004.

[5]  VICNISS Hospital-acquired Infection Surveillance. Type 1 Surveillance Manual. Melbourne: Victorian Hospital-acquired Infection Surveillance System Coordinating Centre; 2008.

[6]  Owens SM, Brozanski BS, Meyn LA, Wiesenfeld HC. Antimicrobial prophylaxis for cesarean delivery before skin incision. Obstet Gynecol 2009; 114: 573–9.
CrossRef |

[7]  Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol 2007; 196: 455.e1–455.e5.

[8]  Johnson A, Young D, Reilly J. Caesarean section surgical site infection surveillance. J Hosp Infect 2006; 64: 30–5.
CrossRef | CAS |

[9]  Darouiche RO, Wall MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al Chlorhexidine-alcohol versus povidone–iodine for surgical-site antisepsis. N Engl J Med 2010; 362: 18–26.
CrossRef | CAS |

[10]  Tong SY, Bishop EJ, Lilliebridge RA, Cheng AC, Spasova-Penkova Z, Holt DC, et al Community-associated strains of methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus in indigenous Northern Australia: epidemiology and outcomes. J Infect Dis 2009; 199: 1461–70.
CrossRef |

[11]  Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008; 29: 477–84.
CrossRef |

[12]  Therapeutic Guidelines. Aminoglycosides: Dosing and Monitoring. Antibiotic Guidelines. 14th edn. Melbourne: Therapeutic Guidelines Limited; 2010.

[13]  Lamont RF, Sobel JD, Kusanovic JP, Vaisbuch E, Mazaki-Tovi S, Kim SK, et al Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG 2011; 118: 193–201.
CrossRef | CAS |

[14]  Clay FS, Walsh CA, Walsh SR. Staples vs subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2011; 204: 378–83.
CrossRef |

[15]  Hawn MT, Houston TK, Campagna EJ, Graham LA, Singh J, Bishop M, et al The attributable risk of smoking on surgical complications. Ann Surg 2011; 254: 914–20.
CrossRef |

[16]  Rumbold AR, Bailie RS, Si D, Dowden MC, Kennedy CM, Cox RJ, et al Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative. BMC Pregnancy Childbirth 2011; 11: 16–25.
CrossRef |

[17]  Couto RC, Pedrosa TM, Nogueira JM, Gomes DL, Neto MF, Rezende NA. Post-discharge surveillance and infection rates in obstetric patients. Int J Gynaecol Obstet 1998; 61: 227–31.
CrossRef | CAS |

[18]  Cardoso Del Monte MC, Pinto Neto AM. Postdischarge surveillance following cesarean section: the incidence of surgical site infection and associated factors. Am J Infect Control 2010; 38: 467–72.
CrossRef |


   
Subscriber Login
Username:
Password:  

 
    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2015