Post-caesarean section surgical site infections: A retrospective audit and case note review at an Ethiopian referral hospital

Anna F. Rose; Bazezew Fekad; Jolene N. Moore; Wendy J. Graham

doi:10.15761/ogr.1000126

Post-caesarean section surgical site infections: A retrospective audit and case note review at an Ethiopian referral hospital

Anna F. Rose^* (Corresponding Author)
, Bazezew Fekad
, Jolene N. Moore
, Wendy J. Graham

^*Corresponding author for this work

NHS Greater Glasgow and Clyde
Felege Hiwot Referral Hospital
London School of Hygiene and Tropical Medicine
Aberdeen Royal Infirmary

Research output: Contribution to journal › Article › peer-review

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Abstract

In low-income settings, infections acquired during childbirth contribute to maternal mortality and delivery by caesarean section is a leading risk factor, largely due to complications from surgical site infections. The risk of surgical site infection depends on intrinsic (patient) and extrinsic factors.

Objective: To explore the incidence, risk factors and management of post-caesarean surgical site infections at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.

Methods: A retrospective audit and case note review of all caesarean deliveries at Felege Hiwot Referral Hospital from 1st October 2016 to 31st November 2016. For women who developed a surgical site infection, details of pre- and post-operative management were recorded. Potential associations between surgical site infection and risk factors (including maternal, delivery and operative characteristics) were explored using binary logistic regression to generate odds ratios and 95% confidence intervals.

Results: Of 1,043 deliveries, 325 were by caesarean (31.2%) with data available for 247 (76%). Among nulliparous women (n=117) the leading indication for caesarean was failure to progress in labour (34/117, 29.1%) followed by cephalo-pelvic disproportion (27/117, 23.1%); for parous women, it was previous CS. The overall incidence of surgical site infection was 8.6% (21 cases), including 14 incisional (14/21, 66.6%) and 7 organ/space (7/21, 33.3%). Factors associated with a significantly reduced risk of surgical site infection included attending antenatal care, normal pre-operative haemoglobin, the absence of pregnancy complications and intact membranes before caesarean. A large number of women did not receive pre-operative antibiotic prophylaxis, mostly due to poor prescribing practices.

Conclusion: This study highlights the need to improve the use of strategies such as pre-operative prophylactic antibiotic usage in low-income settings, where there may be a higher risk of SSI.

Original language	English
Pages (from-to)	1-6
Number of pages	6
Journal	Obstetrics and Gynecology Reports
Volume	2
Issue number	2
DOIs	https://doi.org/10.15761/ogr.1000126
Publication status	Published - 29 Aug 2018

Bibliographical note

Acknowledgements
We thank the administrative and clinical staff of the maternity department at FHRH, Ethiopia, for their contributions to data collection and allowing the audit to take place.

Funding sources
A. Rose received funding from several sources to complete this audit while an undergraduate medical student (The Hospital Saturday Fund, The British Medical and Dental Students’ Trust, The European Wound Management Association, The Highland Council Ross & Cromarty Educational Trust and The Royal College of Physicians and Surgeons of Glasgow).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

antibiotics
caesarean
prophylaxis
surgical site infection

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10.15761/ogr.1000126Licence: CC BY

Rose_etal_OGR_Post_Caesarean_Section_VOR
©2018 Rose AF. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Final published version, 431 KBLicence: CC BY

Cite this

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title = "Post-caesarean section surgical site infections: A retrospective audit and case note review at an Ethiopian referral hospital",

abstract = "In low-income settings, infections acquired during childbirth contribute to maternal mortality and delivery by caesarean section is a leading risk factor, largely due to complications from surgical site infections. The risk of surgical site infection depends on intrinsic (patient) and extrinsic factors. Objective: To explore the incidence, risk factors and management of post-caesarean surgical site infections at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Methods: A retrospective audit and case note review of all caesarean deliveries at Felege Hiwot Referral Hospital from 1st October 2016 to 31st November 2016. For women who developed a surgical site infection, details of pre- and post-operative management were recorded. Potential associations between surgical site infection and risk factors (including maternal, delivery and operative characteristics) were explored using binary logistic regression to generate odds ratios and 95\% confidence intervals. Results: Of 1,043 deliveries, 325 were by caesarean (31.2\%) with data available for 247 (76\%). Among nulliparous women (n=117) the leading indication for caesarean was failure to progress in labour (34/117, 29.1\%) followed by cephalo-pelvic disproportion (27/117, 23.1\%); for parous women, it was previous CS. The overall incidence of surgical site infection was 8.6\% (21 cases), including 14 incisional (14/21, 66.6\%) and 7 organ/space (7/21, 33.3\%). Factors associated with a significantly reduced risk of surgical site infection included attending antenatal care, normal pre-operative haemoglobin, the absence of pregnancy complications and intact membranes before caesarean. A large number of women did not receive pre-operative antibiotic prophylaxis, mostly due to poor prescribing practices. Conclusion: This study highlights the need to improve the use of strategies such as pre-operative prophylactic antibiotic usage in low-income settings, where there may be a higher risk of SSI.",

keywords = "antibiotics, caesarean, prophylaxis, surgical site infection",

author = "Rose, \{Anna F.\} and Bazezew Fekad and Moore, \{Jolene N.\} and Graham, \{Wendy J.\}",

note = "Acknowledgements We thank the administrative and clinical staff of the maternity department at FHRH, Ethiopia, for their contributions to data collection and allowing the audit to take place. Funding sources A. Rose received funding from several sources to complete this audit while an undergraduate medical student (The Hospital Saturday Fund, The British Medical and Dental Students{\textquoteright} Trust, The European Wound Management Association, The Highland Council Ross \& Cromarty Educational Trust and The Royal College of Physicians and Surgeons of Glasgow).",

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doi = "10.15761/ogr.1000126",

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T2 - A retrospective audit and case note review at an Ethiopian referral hospital

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AU - Fekad, Bazezew

AU - Moore, Jolene N.

AU - Graham, Wendy J.

N1 - Acknowledgements We thank the administrative and clinical staff of the maternity department at FHRH, Ethiopia, for their contributions to data collection and allowing the audit to take place. Funding sources A. Rose received funding from several sources to complete this audit while an undergraduate medical student (The Hospital Saturday Fund, The British Medical and Dental Students’ Trust, The European Wound Management Association, The Highland Council Ross & Cromarty Educational Trust and The Royal College of Physicians and Surgeons of Glasgow).

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N2 - In low-income settings, infections acquired during childbirth contribute to maternal mortality and delivery by caesarean section is a leading risk factor, largely due to complications from surgical site infections. The risk of surgical site infection depends on intrinsic (patient) and extrinsic factors. Objective: To explore the incidence, risk factors and management of post-caesarean surgical site infections at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Methods: A retrospective audit and case note review of all caesarean deliveries at Felege Hiwot Referral Hospital from 1st October 2016 to 31st November 2016. For women who developed a surgical site infection, details of pre- and post-operative management were recorded. Potential associations between surgical site infection and risk factors (including maternal, delivery and operative characteristics) were explored using binary logistic regression to generate odds ratios and 95% confidence intervals. Results: Of 1,043 deliveries, 325 were by caesarean (31.2%) with data available for 247 (76%). Among nulliparous women (n=117) the leading indication for caesarean was failure to progress in labour (34/117, 29.1%) followed by cephalo-pelvic disproportion (27/117, 23.1%); for parous women, it was previous CS. The overall incidence of surgical site infection was 8.6% (21 cases), including 14 incisional (14/21, 66.6%) and 7 organ/space (7/21, 33.3%). Factors associated with a significantly reduced risk of surgical site infection included attending antenatal care, normal pre-operative haemoglobin, the absence of pregnancy complications and intact membranes before caesarean. A large number of women did not receive pre-operative antibiotic prophylaxis, mostly due to poor prescribing practices. Conclusion: This study highlights the need to improve the use of strategies such as pre-operative prophylactic antibiotic usage in low-income settings, where there may be a higher risk of SSI.

AB - In low-income settings, infections acquired during childbirth contribute to maternal mortality and delivery by caesarean section is a leading risk factor, largely due to complications from surgical site infections. The risk of surgical site infection depends on intrinsic (patient) and extrinsic factors. Objective: To explore the incidence, risk factors and management of post-caesarean surgical site infections at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Methods: A retrospective audit and case note review of all caesarean deliveries at Felege Hiwot Referral Hospital from 1st October 2016 to 31st November 2016. For women who developed a surgical site infection, details of pre- and post-operative management were recorded. Potential associations between surgical site infection and risk factors (including maternal, delivery and operative characteristics) were explored using binary logistic regression to generate odds ratios and 95% confidence intervals. Results: Of 1,043 deliveries, 325 were by caesarean (31.2%) with data available for 247 (76%). Among nulliparous women (n=117) the leading indication for caesarean was failure to progress in labour (34/117, 29.1%) followed by cephalo-pelvic disproportion (27/117, 23.1%); for parous women, it was previous CS. The overall incidence of surgical site infection was 8.6% (21 cases), including 14 incisional (14/21, 66.6%) and 7 organ/space (7/21, 33.3%). Factors associated with a significantly reduced risk of surgical site infection included attending antenatal care, normal pre-operative haemoglobin, the absence of pregnancy complications and intact membranes before caesarean. A large number of women did not receive pre-operative antibiotic prophylaxis, mostly due to poor prescribing practices. Conclusion: This study highlights the need to improve the use of strategies such as pre-operative prophylactic antibiotic usage in low-income settings, where there may be a higher risk of SSI.

KW - antibiotics

KW - caesarean

KW - prophylaxis

KW - surgical site infection

U2 - 10.15761/ogr.1000126

DO - 10.15761/ogr.1000126

M3 - Article

SN - 2515-2955

VL - 2

SP - 1

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JO - Obstetrics and Gynecology Reports

JF - Obstetrics and Gynecology Reports

IS - 2

ER -

Post-caesarean section surgical site infections: A retrospective audit and case note review at an Ethiopian referral hospital

Abstract

Bibliographical note

UN SDGs

Keywords

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