Hospital Practices and Research

Risk Factors for Surgical Site Infection after Cesarean Section in a Multinational Population

Document Type : Original Article

Authors

Humberto Guanche Garcell 1
Rita M Desdin Rodriguez 1
Teresa Sandra Erice Rivero 1
Yolennis Martinez Fajardo 1
Orestes Morales Gaitan 1
Tania MF Fernandez Hernandez 1
Francisco MF Gutierrez Garcia 2

1 The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar

2 Hospital Joaquín Albarrán, La Habana, Cuba

https://doi.org/10.30491/hpr.2024.493615.1461
Abstract
Background: Surgical site infections (SSIs) are the most frequent healthcare-associated infections worldwide. Identifying risk factors is a key priority to focus prevention efforts, reduce their incidence, and improve patient safety.
Objectives: We aim to identify the risk factors for SSI in patients from various nationalities cared for in Qatar.
Methods: A nested case-control study was conducted at a community hospital in Dukhan, Qatar.
Results: One hundred and twenty-six patients from 45 nationalities were included in the study, with 42 SSI cases. The risk of SSI was 3.48 times greater when non-compliance with the timing of antibiotic prophylaxis was documented, 9.69 times for improper antibiotic selection, and the risk decreased by 63% for each postoperative consultation.
Conclusion: The study has identified key risk factors for SSI and areas for prevention and research in patients who underwent cesarean section.

Keywords

Cesarean Section
Risk Factors
Surgical Site Infection
Nested Case-Control
Qatar
  1. Adane F, Mulu A, Seyoum G, Gebrie A, Lake A. Prevalence and root causes of surgical site infection among women undergoing cesarean section in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2019;13:34. doi:1186/s13037-019-0212-6
  2. 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(6):477-84. doi:1086/ 587810
  3. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries J Hosp Infect. 2017;96(1):1-5. doi:1016/j.jhin.2017.03.0 04
  4. Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kbler A, Viet-Hung N, et al; International Nosocomial Infection Control Consortiuma. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005-2010. Infect Control Hosp Epidemiol. 2013;34(6):597-604. doi:10.1086/670626
  5. Al Jama FE. Risk factors for wound infection after lower segment cesarean section. Qatar Med J. 2013;2012(2):9. doi:10.5339/qmj.2012.2.9
  6. Guanche Garcell H, Jameela Al-Ajmi, Villanueva Arias A, Joji C Abraham Joji C. Fernandez Hernandez TM. Incidence of surgical site infection in appendectomies, hernia surgery, and Cesarean section in a community hospital in Qatar. East Mediterr Health J. 2024. [In Press]
  7. Young PY, Khadaroo RG. Surgical site infections. Surg Clin. 2014;94(6):1245-64. doi:1016/j.suc.2014.0 8.008
  8. Fuglestad MA, Tracey EL, Leinicke JA. Evidence-based prevention of surgical site infection. Surg Clin. 2021;101(6):951-66. doi:10.1016/j.suc.2021.05.027
  9. World Health Organization: Global guidelines for the prevention of surgical site infection, second edition. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
  10. Garcell HG, Arias AV, Sandoval CP, Gamboa ME, Sado AB, Serrano RN. Impact of a focused antimicrobial stewardship program in adherence to antibiotic prophylaxis and antimicrobial consumption in appendectomies. J Infect Public Health. 2017;10 (4):415-20. doi;10.1016/j.jiph.2016.06.006
  11. Vippadapu P, Gillani SW, Thomas D, Ahmed F, Gulam SM, Mahmood RK, et al. Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital. Front Pharmacol. 2022;13:849044. doi:10.3389/fphar.2022.849044
  12. Ullah K, Dogar AW, Jan Z, Bilal H, Tahir MJ, Hamza A, et al. Role of antibiotic prophylaxis on surgical site infection prevention in a low-risk population undergoing laparoscopic cholecystectomy: A randomized controlled study. Ann Med Surg. 2022;78: doi:10.1016/j.amsu.2022.103804
  13. Abbas M, de Kraker ME, Aghayev E, Astagneau P, Aupee M, Behnke M, et al. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect. 2019;102(3):267-76. doi:10.1016/j.jhin.2018.12.003
  14. Garcell HG, Arias AV, Olivares DC, Acosta PA, Redonet EM, Serrano RN. Incidence of surgical site infection and compliance with antibiotic prophylaxis in cesarean section in a community hospital in Qatar. Avicenna J Clin Microbiol Infect. 2017;4(4):11955. doi:5812/ajcmi.11955
  15. CDC/NHSN Surveillance Definitions for Specific Types of Infections. In: National Healthcare Safety Network (NHSN) Patient Safety Component Manual. January 2021. Available from: https://www.cdc.gov/ nhsn/pdfs/pscmanual/pcsmanual_current.pdf. [access December 18, 2021]
  16. Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. doi:10.1017/ice.2023 .67
  17. Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, et al. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2018(2):CD012653. doi:10.1002/14651858.CD01265 3.pub2
  18. Kvalvik SA, Rasmussen S, Thornhill HF, Baghestan E. Risk factors for surgical site infection following cesarean delivery: a hospital‐based case–control study. Acta Obstet Gynecol Scand. 2021;100(12): 2167-75. doi:10.1111/aogs.14235
  19. Corbett GA, O'Shea E, Nazir SF, Hanniffy R, Chawke G, Rothwell A, et al. Reducing caesarean section surgical site infection (SSI) by 50%: a collaborative approach. J Healthc Qual. 2021;43(2):67-75. doi:10.1097/JHQ.0000000000000271
  20. Hamel MS, Tuuli M. Prevention of postoperative surgical site infection following cesarean delivery. Obstet Gynecol Clin. 2023;50(2):327-38. doi:10.1016/j.ogc.2023.02.012
  21. Sood G, Argani C, Ghanem KG, Perl TM, Sheffield JS. Infections complicating cesarean delivery. Curr Opin Infect Dis. 2018;31(4):368-76. doi:10.1097/QCO. 0000000000000472
  22. Villers MS. Reducing cesarean delivery surgical site complications. Obstet Gynecol Clin. 2020;47(3):429-37. doi:10.1016/j.ogc.2020.04.006
  23. Manian FA. The role of postoperative factors in surgical site infections: time to take notice. Clin Infect Dis. 2014;59(9):1272-6. doi:10.1093/cid/ciu552
  24. Mdoe MB, Mselle LT, Kibusi SM. Protocol for designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania. Plos One. 2023;18(6):e0287004. doi:10.1371/journal.pone.02 87004
Hospital Practices and Research
Volume 9, Issue 4 - Serial Number 36
Autumn 2024
Pages 544-548

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