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Practices to Reduce Surgical Site Infections Among Women Undergoing Cesarean Section: A Review

Published online by Cambridge University Press:  20 May 2015

Rebeccah A. McKibben ,
Samantha I. Pitts ,
Catalina Suarez-Cuervo ,
Trish M. Perl  and
Eric B. Bass
Rebeccah A. McKibben*
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Samantha I. Pitts
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Catalina Suarez-Cuervo
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Eric B. Bass
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Address correspondence to Rebeccah A. McKibben, MPH, 624 North Broadway, Room 680A, Baltimore, MD, 21205 ([email protected]).
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Abstract

OBJECTIVE

Surgical site infections (SSIs) are a leading cause of morbidity and mortality among women undergoing cesarean section (C-section), a common procedure in North America. While risk factors for SSI are often modifiable, wide variation in clinical practice exists. With this review, we provide a comprehensive overview of the results and quality of systematic reviews and meta-analyses on interventions to reduce surgical site infections among women undergoing C-section.

METHODS

We searched PubMed and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses published between January 2000 and May 2014 on interventions to reduce the occurrence of SSIs (incisional infections and endometritis), among women undergoing C-section. We extracted data on the interventions, outcomes, and strength of evidence as determined by the original article authors, and assessed the quality of each article based on a modified Assessment of Multiple Systematic Reviews tool.

RESULTS

A total of 30 review articles met inclusion criteria and were reviewed. Among these articles, 77 distinct interventions were evaluated: 29% were supported with strong evidence as assessed by the original article authors, and 83% of the reviews articles were classified as good quality based on our assessment. Ten interventions were classified as being effective in reducing SSI with strong evidence in a good-quality article, including preoperative vaginal cleansing, the use of perioperative antibiotic prophylaxis, and several surgical techniques.

CONCLUSION

Efforts to reduce SSI rates among women undergoing C-section should include interventions such as preoperative vaginal cleansing and the use of perioperative antibiotics because compelling evidence exists to support their effectiveness.

Infect Control Hosp Epidemiol 2015;36(8):915–921

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 8 , August 2015 , pp. 915 - 921
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Osterman, MJ, Martin, JA. Trends in low-risk cesarean delivery in the United States, 1990–2013. National Vital Statistics Report Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 2014;63:1–16.Google Scholar
2. Brown, HL. Informing the patient and the community about the implications of primary cesarean. Semin Perinatol 2012;36:403–406.Google Scholar
3. Liu, S, Liston, RM, Joseph, KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176:455–460.CrossRefGoogle ScholarPubMed
4. Hillan, EM. Postoperative morbidity following Caesarean delivery. J Adv Nurs 1995;22:1035–1042.Google Scholar
5. Deneux-Tharaux, C, Carmona, E, Bouvier-Colle, MH, Breart, G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006;108:541–548.Google Scholar
6. Herwaldt, LA, Cullen, JJ, Scholz, D, et al. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol 2006;27:1291–1298.Google Scholar
7. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar
8. Lydon-Rochelle, M, Holt, VL, Martin, DP, Easterling, TR. Association between method of delivery and maternal rehospitalization. JAMA 2000;283:2411–2416.Google Scholar
9. Olsen, MA, Butler, AM, Willers, DM, Gross, GA, Hamilton, BH, Fraser, VJ. Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery. Infect Control Hosp Epidemiol 2010;31:276–282.Google Scholar
10. 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;29:477–484; discussion 485–476.Google Scholar
11. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
12. Alanis, MC, Villers, MS, Law, TL, Steadman, EM, Robinson, CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010;203(271):e271–e277.Google Scholar
13. Dempsey, JC, Ashiny, Z, Qiu, CF, Miller, RS, Sorensen, TK, Williams, MA. Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery. J Maternal Fetal Neonat Med 2005;17:179–185.Google Scholar
14. 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.Google Scholar
15. 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
16. Schneid-Kofman, N, Sheiner, E, Levy, A, Holcberg, G. Risk factors for wound infection following cesarean deliveries. Int J Gynecol Obstet 2005;90:10–15.Google Scholar
17. Tran, TS, Jamulitrat, S, Chongsuvivatwong, V, Geater, A. Risk factors for postcesarean surgical site infection. Obstet Gynecol 2000;95:367–371.Google Scholar
18. Dahlke, JD, Mendez-Figueroa, H, Rouse, DJ, Berghella, V, Baxter, JK, Chauhan, SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 2013;209:294–306.Google Scholar
19. Hofmeyr, JG, Novikova, N, Mathai, M, Shah, A. Techniques for cesarean section. Am J Obstet Gynecol 2009;201(5):431–444.Google Scholar
20. Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality (US), 2008.Google Scholar
21. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
22. White, CM, Ip, S, McPheeters, M, et al. Using existing systematic reviews to replace de novo processes in conducting comparative effectiveness reviews. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality (US), 2008.Google ScholarPubMed
23. Haas, DM, Morgan Al Darei, S, Contreras, K. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Revs 2010;3:CD007892.Google Scholar
24. Smaill, FM, Gyte, GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Revs 2010;1:CD007482.Google Scholar
25. Alfirevic, Z, Gyte, GM, Dou, L. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Revs 2010;10:CD008726.Google Scholar
26. Tita, AT, Rouse, DJ, Blackwell, S, Saade, GR, Spong, CY, Andrews, WW. Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol 2009;113:675–682.Google Scholar
27. Costantine, MM, Rahman, M, Ghulmiyah, L, et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol 2008;199(301):e301–e306.Google Scholar
28. Tooher, R, Gates, S, Dowswell, T, Davis, LJ. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Revs 2010;5:CD001689.Google Scholar
29. Mathai, M, Hofmeyr, GJ. Abdominal surgical incisions for caesarean section. Cochrane Database Syst Revs 2007;1:CD004453.Google Scholar
30. Altman, AD, Allen, VM, McNeil, SA, Dempster, J. Pfannenstiel incision closure: a review of current skin closure techniques. JOGC 2009;31:514–520.Google Scholar
31. Tuuli, MG, Rampersad, RM, Carbone, JF, Stamilio, D, Macones, GA, Odibo, AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol 2011;117:682–690.Google Scholar
32. Dodd, JM, Anderson, ER, Gates, S. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Revs 2008;3:CD004732.Google Scholar
33. Jacobs-Jokhan, D, Hofmeyr, G. Extra-abdominal versus intra-abdominal repair of the uterine incision at caesarean section. Cochrane Database Syst Revs 2004;4:CD000085.Google Scholar
34. Anderson, ER, Gates, S. Techniques and materials for closure of the abdominal wall in caesarean section. Cochrane Database Syst Revs 2004;4:CD004663.Google Scholar
35. Chelmow, D, Rodriguez, EJ, Sabatini, MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol 2004;103:974–980.Google Scholar
36. Hellums, EK, Lin, MG, Ramsey, PS. Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery—a metaanalysis. Am J Obstet Gynecol 2007;197(3):229–235.Google Scholar
37. Anorlu, RI, Maholwana, B, Hofmeyr, GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Revs 2008;3:CD004737.Google Scholar
38. Bamigboye, AA, Hofmeyr, GJ. Non-closure of peritoneal surfaces at caesarean section—a systematic review. S Afr Med J 2005;95(2):123–126.Google Scholar
39. Berghella, V, Baxter, JK, Chauhan, SP. Evidence-based surgery for cesarean delivery. Am J Obstet Gynecol 2005;193(5):1607–1617.Google Scholar
40. Gates, S, Anderson, ER. Wound drainage for caesarean section. Cochrane Database Syst Revs 2013;12:CD004549.Google Scholar
41. Hadiati, DR, Hakimi, M, Nurdiati, DS. Skin preparation for preventing infection following caesarean section. Cochrane Database Syst Revs 2012;9:CD007462.Google Scholar
42. Liabsuetrakul, T, Peeyananjarassri, K. Mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity. Cochrane Database Syst Revs 2011;11:CD008019.Google Scholar
43. Chelmow, D, Ruehli, MS, Huang, E. Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes: a meta-analysis. Am J Obstet Gynecol 2001;184:656–661.CrossRefGoogle ScholarPubMed
44. Clay, FS, Walsh, CA, Walsh, SR. Staples vs subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol Am J 2011;204:378–383.Google Scholar
45. Mackeen, AD, Berghella, V, Larsen, ML. Techniques and materials for skin closure in caesarean section. Cochrane Database Syst Revs 2012;11:CD003577.Google Scholar
46. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Revs 2012;9:CD004985.Google Scholar
47. Tanner, J, Woodings, D, Moncaster, K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Revs 2006:CD004122.Google ScholarPubMed
48. Hall, MJ, DeFrances, CJ, Williams, SN, Golosinskiy, A, Schwartzman, A. National Hospital Discharge Survey: 2007 summary. Nat Health Stat Repts 2010:1–20; 24.Google Scholar
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