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Decreased Rates of Nosocomial Endometritis and Urinary Tract Infection After Vaginal Delivery in a French Surveillance Network, 1997–2003

Published online by Cambridge University Press:  02 January 2015

Louis Ayzac ,
Emmanuelle Caillat-Vallet ,
Raphaële Girard ,
Catherine Chapuis ,
Florence Depaix ,
Anne-Marie Dumas ,
Chantal Gignoux ,
Catherine Haond ,
Joëlle Lafarge-Leboucher  and
Carine Launay
...Show all authors
Louis Ayzac*
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Emmanuelle Caillat-Vallet
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Raphaële Girard
Affiliation:
Infection Control and Hospital Epidemiology Unit, University Hospital, Pierre Bénite, France
Catherine Chapuis
Affiliation:
Department of Infection Control Rhône Sud, University Hospital, St. Genis Laval, France
Florence Depaix
Affiliation:
Department of Infection Control Rhône Sud, University Hospital, St. Genis Laval, France
Anne-Marie Dumas
Affiliation:
Department of Obstetrics and Gynecology, University Hospital, Pierre Bénite, France
Chantal Gignoux
Affiliation:
Departments of Obstetrics and Gynecology, University Hospital, Lyon, France
Catherine Haond
Affiliation:
Infection Control Rhône Centre, University Hospital, Lyon, France
Joëlle Lafarge-Leboucher
Affiliation:
Department of Obstetrics and Gynecology, University Hospital, Pierre Bénite, France
Carine Launay
Affiliation:
Obstetrics and Gynecology, University Hospital, Lyon, France
Françoise Tissot-Guerraz
Affiliation:
Infection Control and Hospital Epidemiology, University Hospital, Lyon, France
Agnès Vincent
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Jacques Fabry
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
*
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, Villa Alice, Hôpital Henry Gabrielle, 20 route de Vourles, BP 57, 69530 Saint Genis Laval Cedex, France (louis.ayzac@chu-lyon.fr)
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Abstract

Objectives.

To identify independent risk factors for endometritis and urinary tract infection (UTI) after vaginal delivery, and to monitor changes in nosocomial infection rates and derive benchmarks for prevention.

Design.

Prospective study.

Methods.

We analyzed routine surveillance data for all vaginal deliveries between January 1997 and December 2003 at 66 maternity units participating in the Mater Sud-Est surveillance network. Adjusted odds ratios for risk of endometritis or UTI were obtained using a logistic regression model.

Results.

The overall incidence rates were 0.5% for endometritis and 0.3% for UTI. There was a significant decrease in the incidence and risk of endometritis but not of UTI during the 7-year period. Significant risk factors for endometritis were fever during labor, parity of 1, and instrumental delivery and/or manual removal of the placenta. Significant risk factors for UTI were urinary infection on admission, premature rupture of membranes (more than 12 hours before admission), blood loss of more than 800 mL, parity of 1, instrumental delivery, and receipt of more than 5 vaginal digital examinations. Each maternity unit received a poster showing graphs of the number of expected and observed cases of UTI and endometritis associated with vaginal deliveries, which enabled each maternity unit to determine their rank within the network and to initiate prevention programs.

Conclusions.

Although routine surveillance means additional work for maternity units, our results demonstrate the usefulness of regular targeted monitoring of risk factors and of the most common nosocomial infections in obstetrics. Most of the information needed for monitoring is already present in the patients' records.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 487 - 495
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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