Henman K

Gordon CL

Gardiner T

Thorn, Jane

Spain, Brian

Davies, Jane

Baird, Robert

2012-06-01

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.

(Henman, K., Gordon, C. L., Gardiner, T.) Infection Prevention and Management Unit, Royal Darwin Hospital, Darwin, NT 0810, Australia

(Thorn, J.) Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT 0810, Australia

(Spain, B.) Department of Anaesthesiology, Royal Darwin Hospital, Darwin, NT 0810, Australia

(Davies, J.) Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT 0810, Australia

(Baird, R.) Infection Prevention and Management Unit, Department of Infectious Diseases and Department of Microbiology, Royal Darwin Hospital, Darwin, NT 0810, Australia

Henman, K., Gordon, C. L., Gardiner, T., Thorn, J., Spain, B., Davies, J., & Baird, R. (2012). Surgical site infections following caesarean section at Royal Darwin Hospital, Northern territory. Healthcare Infection, 17(2), 47–51.

1835-5617

https://hdl.handle.net/10137/12062

17

Surgical wound infections, prevention

Health risk assessment

Cesarean section, Complications

Women

Health and hygiene

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

Journal Article

Publication