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Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors

Published online by Cambridge University Press:  21 June 2016

Piret Mitt ,
Katrin Lang ,
Aira Peri  and
Matti Maimets
Piret Mitt*
Affiliation:
Departments of Internal Medicine and Infection Control, Tartu University Hospital, Tartu, Estonia
Katrin Lang
Affiliation:
Department of Public Health, University of Tartu, Tartu, Estonia
Aira Peri
Affiliation:
Women's Clinic, Tartu University Hospital, Tartu, Estonia
Matti Maimets
Affiliation:
Departments of Internal Medicine and Infection Control, Tartu University Hospital, Tartu, Estonia
*
Department of Infection Control, Tartu University Hospital, Lina 6, 51004 Tartu, Estonia. Piret.Mitt@kliinikum.ee
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Abstract

Objectives:

To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.

Design:

Cross-sectional survey.

Setting:

Academic tertiary-care obstetric and gynecology center with 54 beds.

Patients:

All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.

Methods:

Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.

Results:

The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).

Conclusions:

The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 449 - 454
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Smaill, F, Hofmeyr, GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev 2002;CD000933.Google Scholar
2.Ott, WJ. Primary cesarean section: factors related to postpartum infection. Obstet Gynecol 1981;57:171–176.Google ScholarPubMed
3.Yalcin, AN, Bakir, M, Bakici, Z, Dokmetas, I, Sabir, N. Postoperative wound infections. J Hosp Infect 1995;29:305–309.Google Scholar
4.Noy, D, Creedy, D. Postdischarge surveillance of surgical site infections: a multi-method approach to data collection. Am J Infect Control 2002;30:417–424.Google Scholar
5.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002;30:458–475.CrossRefGoogle Scholar
6.Smyth, ET, Emmerson, AM. Surgical site infection surveillance. J Hosp Infect 2000;45:173–184.Google Scholar
7.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
8.Yokoe, DS, Christiansen, CL, Johnson, R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001;7:837–841.Google Scholar
9.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;61:227–231.Google Scholar
10.Roy, MC, Perl, TM. Basics of surgical-site infection surveillance. Infect Control Hosp Epidemiol 1997;18:659–668.Google Scholar
11.Tran, TS, Jamulitrat, S, Chongsuvivatwong, V, Geater, A. Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95:367–371.Google ScholarPubMed
12.Emmons, SL, Krohn, M, Jackson, M, Eschenbach, DA. Development of wound infections among women undergoing cesarean section. Obstet Gynecol 1988;72:559–564.Google ScholarPubMed
13.Killian, CA, Graffunder, EM, Vinciguerra, TJ, Venezia, RA. Risk factors for surgical-site infections following cesarean section. Infect Control Hosp Epidemiol 2001;22:613–617.CrossRefGoogle ScholarPubMed
14.Myles, TD, Gooch, J, Santolaya, J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 2002;100:959–964.Google Scholar
15.Lasley, DS, Eblen, A, Yancey, MK, Duff, P. The effect of placental removal method on the incidence of postcesarean infections. Am J Obstet Gynecol 1997;176:1250–1254.CrossRefGoogle ScholarPubMed
16.Mah, MW, Pyper, AM, Oni, GA, Memish, ZA. Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk. Am J Infect Control 2001;29:85–88.Google Scholar
17.Horan, TC, Edwards, JR, Culver, DH, Gaynes, RP. Risk factors for incisional surgical site infections after cesarean section: results of a 5-year multicenter study. Infect Control Hosp Epidemiol 2000;21:145.Google Scholar
18.Karki, T, Truusalu, K, Vainumae, I, Mikelsaar, M. Antibiotic susceptibility patterns of community- and hospital-acquired Staphylococcus aureus and Escherichia coli in Estonia. Scand J Infect Dis 2001;33:333–338.Google Scholar
19.Stockley, JM, Allen, RM, Thomlinson, DF, Constantine, CE. A district general hospital's method of post-operative infection surveillance including post-discharge follow-up, developed over a five-year period. J Hosp Infect 2001;49:48–54.CrossRefGoogle ScholarPubMed
20.Taylor, EW, Duffy, K, Lee, K, et al. Telephone call contact for post-discharge surveillance of surgical site infections: a pilot, methodological study. J Hosp Infect 2003;55:8–13.CrossRefGoogle ScholarPubMed
21.European Survey of Information Society. Estonia: Innovative IT Solutions. Tartu, Estonia: Foundation Archimedes, Inc.; 2004. Available at www.esis.ee/ist2004/403.html. Accessed March 1, 2004.Google Scholar
22.Seaman, M, Lammers, R. Inability of patients to self-diagnose wound infections. J Emerg Med 1991;9:215–219.Google Scholar
23.Whitby, M, McLaws, ML, Collopy, B, et al. Postdischarge surveillance: can patients reliably diagnose surgical wound infections? J Hosp Infect 2002;52:155–160.Google Scholar
24.Sands, K, Vineyard, G, Piatt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963–970.Google Scholar
25.Piatt, R, Yokoe, DS, Sands, KE. Automated methods for surveillance of surgical site infections. Emerg Infect Dis 2001;7:212–216.Google Scholar
26.Martone, WJ, Nichols, RL. Recognition, prevention, surveillance, and management of surgical site infections: introduction to the problem and symposium overview. Clin Infect Dis 2001;33(suppl 2):S67–S68.Google Scholar
27.Eriksen, HM, Chugulu, S, Kondo, S, Lingaas, E. Surgical-site infections at Kilimanjaro Christian Medical Center. J Hosp Infect 2003;55:14–20.CrossRefGoogle ScholarPubMed