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Background
Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order...
Context in source publication
Citations
... In Africa, the pooled prevalence of surgical site infection after cesarean section was 10.21% (10). In a study of Sub-Saharan Africa, the incidence of surgical site infection was 7.3% (11). After cesarean sections, 3.48% of women developed surgical site infections in Rwanda (12). ...
... The other differences may be the sampling method of the study population and the study design. The current study's estimate of surgical site infection is also somewhat consistent with the WHO report for middle-and low-income countries (9) and a study in Africa (10), but it is significantly higher than findings from studies conducted in sub-Saharan Africa (11) and Rwanda (12). The variation may be due to patient-related characteristics and inconsistent infection prevention strategies implemented across the countries. ...
Background
Although surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia.
Methods
We searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out.
Results
Twenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96–16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15–3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24–2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45–6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22–2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54–4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93–5.92) were independent risk factors for surgical site infections.
Conclusion
More than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.
... Also, this rate was slightly above the range of postcaesarean surgical site infection in Sub-Saharan Africa which was 7.3% (range 1.7-10.4 %) [19]. However, our obtained prevalence was lower when compared with an incidence of 16.2% in Nigeria [20]. ...
... However, our obtained prevalence was lower when compared with an incidence of 16.2% in Nigeria [20]. In contrast, our prevalence was relatively high compared to previous studies in China "3.34%" [19] and Israel "3.7% [2]. This differences and variations might be attributed to the differences between studies related to the design, sample size, settings and duration and also attributed to the difference in the quality of both surgical care provisions and service among Hospitals. ...
The global incidence of cesarean section deliveries has significantly increased, resulting in a rise in post-cesarean surgical site infections (SSIs). These infections pose a notable threat to maternal health, often leading to prolonged hospital stays, elevated costs, and direct health consequences, particularly in populations facing low socioeconomic status, limited resources, and conditions involving forced internal displacement due to conflict. Fort Portal Regional Referral Hospital lacked prior studies on SSIs, prompting the initiation of this research to ascertain the prevalence and specific factors linked to post-caesarean SSIs within the Maternity Ward at FPRRH. The study adopted a retrospective cross-sectional approach, utilizing a pretested checklist to gather information from 110 patient files admitted and operated on in Maternity Ward during the six months preceding the investigation. The collected data underwent entry and analysis using IBM SPSS version 25, incorporating the chi-square test to establish relationships between SSIs and associated risk factors. Results were presented through tables and charts. The mean age of study participants was 27.67 years, with a standard deviation of 6 and an age range of 16 to 45 years. A majority (64.3%) were over 30 years old, over 50% hailed from rural areas, and the majority identified as Christians and were married. The overall prevalence of post-caesarean SSIs stood at 12.7%. Statistically significant factors influencing SSIs included gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH. In conclusion, this study revealed a 12.7% prevalence of post-caesarean SSIs, with gestational age, diabetes mellitus, duration of membrane rupture, chorioamnionitis, preoperative hematocrit levels, and referral to FPRRH identified as significant contributing factors. Recognizing and addressing these factors early on could guide obstetricians in enhancing their daily practices, ultimately improving the outcomes of cesarean sections and diminishing the risk of post-caesarean SSIs.
... This view on BMI has been supported by Ousley et al [15]. According to Chu et al [27], younger age in women is associated with an increased risk for SSIs due to underdeveloped immunity to fight infections. Older age is associated with frailty and a suppressed immune system, which has been supported by Boncea et al [13], who also mentioned readmission and increased hospital stay resulting in exposure of patients to hospital surfaces with pathogenic organisms, thereby increasing the risk for nosocomial infections. ...
Background: Nosocomial infections are infections incubating or not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear, particularly for the hospitalized population of the United Kingdom.
... The incidence of surgical site infection post caesarian section during the study period was 2.1%, which is consistent with a fouryear study done in Brazil that demonstrated an incidence of 1.44% [23], but contradicts a review done in sub-Saharan Africa that indicated an incidence rate of 12.5% [31]. Superficial infections were the most common wound classification, 78.3% (18/23) consistent with two regional studies that found 93% and 61.4% superficial classification of wound infection [32,33]. Wound swabbing for microbiological culture in 47% of cases was similar to the 42.2% reported in a study in a tertiary hospital in Tanzania [34]. ...
Background
Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya.
Methods
This was a retrospective case-control (1:2 matched) study conducted between 1st November 2021 to 31st October 2022 at a tertiary hospital in Nairobi. Data was extracted on surgical site risk factors as per World Health Organization's recommended preoperative measures, for both cases and controls. Descriptive statistics was used to summarize the variables and the Chi-squared test and Fisher's Exact test were used for group comparisons.
Results
A total of 1,262 caesarian deliveries were performed, 2.1% (27/1262) of which developed surgical site infections post caesarian section. The risk factors identified were not significantly associated with surgical site infection development (gestational age P=0.152, body mass index P=0.615, premature rupture of membranes P=0.253, and antibiotic prophylaxis P=0.108).
Conclusions
There was no significant association of exposure to surgical site infection risk factors with surgical site infection despite a positive trend. Other prospective methods should also be used in addition to chart reviews to determine the level of effect each risk factor has on surgical site infection.
... Reported in Felegehiwot referral hospitals (7.8%), 30 Debretabor General Hospital (8%) 14 Nekemte referral hospitals (8.9%), 5 and Zewditu Memorial Hospital (8.4%). 18 This incidence is also higher than study conducted in other African countries such as 5.34% in Egypt, 6 7.3% in sub-Saharan Africa, 31 Asian countries, 5.8% in Pakistan, 17 and 1.7% in China 7 and others developed countries, the United States of America (5%), 21 and Ankara (6.2%). 22 Moreover, in agreement study conducted in Ayder referral hospital (11.7%) 19 and Sierra Leone (11%). ...
Background
Surgical site infections (SSI) after cesarean section are common in Ethiopia and result in maternal morbidity, mortality, hospitalization, and medical costs. This study aimed to determine the incidence, bacterial profile, and associated factors of surgical site infection after cesarean section (CS) in public and private referral hospitals.
Methods
A prospective observational cohort study was conducted on 741 pregnant women who underwent CS from July to September 2022. Women who had CS were followed up for at least 30 days. Infected wound specimens from those who had SSIs were collected and bacteriologically analyzed. The data were analyzed with SPSS version 25. The logistic regression model assessed the relationship between the independent variable and the outcome with 95% confidence interval.
Results
The incidence of post-cesarean surgical site infection was 11.6% (95% Cl: 9.4, 13.6). Staphylococcus aureus was the most common bacteria in CS wounds 10 (21.2%). Two to three antenatal care visits (ANC) (AOR: 3.11, 95% CI: 1.69, 5.75), delayed antenatal booking (AOR: 6.99, 95% CI: 2.09, 23.32), membrane rupture (AOR: 2.10, 95% CI: 1.04, 4.24), multiple vaginal examinations (AOR = 4.21, 95% CI: 1.35, 6.92) and public hospitals (AOR: 11.1, 95% CI: 1.48, 45, 14) were associated with increased risk of SSI after CS, in contrary shorter hospital stays (AOR = 0.37, 95% CI: 0.15, 0.91) and transversal incisions (AOR = 0.38, 95% CI: 0.15, 0.91) were associated with lower risk SSI after CS.
Conclusion
The incidence of SSI after CS was high. Delayed antenatal booking, two to three antenatal visits, multiple vaginal exams, membrane rupture, vertical incision, longer postoperative hospital stays, and procedures in public hospitals were associated with increased risk of SSI after CS. Therefore, intervention programs should focus on post-discharge surveillance and identification of risk to reduce and prevent SSI after CS rate.
... To our knowledge, this is the first study in Algeria that provides an overview of the rate of post-CS section infection with their predictive factors, as well as the first to provide the antibiotic resistance profile of associated bacteria. We report a rate of 1.9% in Algeria, which is low compared to similar studies elsewhere in Africa, with an incidence of 10.9% in Sierra Leone, 10 7.3% in sub-Saharan Africa, 22 and 5% in Tunisia. 23 Furthermore, this rate is low compared to studies carried out in Egypt with 5.3% 24 and in Brazil with 3.4%. ...
Surgical site infections (SSIs) are one of the most common healthcare associated infections in low and middle income countries. The aims of this cross-sectional descriptive study were to estimate the frequency of post-caesarean infection with associated clinical characteristics and the antibiotic resistance profile of bacterial isolates. Patients who underwent a caesarean section at the obstetrics and gynaecology department of the hospital in Annaba, Algeria were included. Each woman was followed postoperatively for 30 days and sociodemographic data was collected. Culture-based microbiological methods were used to identify the causative bacteria, and determine their antibiotic resistance phenotype and molecular characterisation. Among 1810 patients, we recorded 36 (1.9%) SSIs. Most patients had undergone an emergency delivery (75%) and low educational level (72.2%). The most frequent maternal pathologies were BMI ≥ 30 (63.9%), scarred uteri (58.3%), anaemia (55.6%) and an ASA score between II and III (33.3%). Of the 43 bacteria isolated, Enterobacteriaceae were the most frequent (62.8%), predominated by Escherichia coli strains (43.5%), a majority of which were ESBL carriers (62.9%). Although Gram-positive cocci were less frequent (37.2%), a majority of Enterococcus faecalis (56.2%) were observed and two strains of vancomycin-resistant Enterococcus faecium harbouring the vanA gene were identified. Extensive surveillance of at-risk populations should be integrated to prevent the occurrence of SSIs.
... Therefore, in line with these findings, the predominate NI found in this study was SSI 6 (30%) which is correlated with previous study findings showing the incidence of SSI was 7.3% (range = 1.7-10.4%) with longer hospital stays than those who did not have SSI [9]. In the study by Scherbaum et al. (2014), among other NIs, SSI was the most common (20, 44%) [10]. ...
Background
Poor nutritional status may lead to longer hospital stays, increased mortality and morbidity, increased cost, and higher suffering. Nosocomial infections (NI) are a global health concern, and several risk factors are associated with their higher incidence. This study aimed to reveal that compromised nutritional status is one of the risk factors for developing NIs.
Methodology
The study was conducted in a tertiary care hospital in Pune, India. This was a prospective cohort study with a sample size of 200 hospitalized participants. Data collection was based on standard tools and structured forms which had two parts. In the first part, the assessment of nutritional status was done for which patients were categorized into two groups, namely, well-nourished and undernourished. Additionally, biochemical parameters (serum albumin) were also assessed. The second part included a follow-up of participants to evaluate the development of NIs including their laboratory investigation. Results were analyzed statistically using R software.
Results
Among 200 participants, 60 were female, of whom 15% developed NIs. Of the 140 males, 8% had NIs. Among 200 participants, 101 (51%) were well-nourished, of whom two (2%) developed NIs. Of the 99 (49%) undernourished participants, 18 (18%) had NIs. Those who were undernourished (univariate relative risk = 6.10, 95% confidence interval) were more prone to developing NIs compared to the well-nourished group.
Conclusions
NIs are widespread globally but are less studied and given less emphasis in developing countries. This study reports various types of NIs along with their incidence in well-nourished and undernourished groups. The incidence of NI observed in this study may reflect the higher severity of illness, age, poor nutritional status, and longer hospital stays. Identifying risk factors that can contribute to developing NI may help in their prevention by maximizing patient safety.
... Comparatively, this rate is notably higher than the reported rates from various studies conducted in different locations, with incidence rates ranging from 0.5% to 10.9%. [21][22][23][24][25][26][27][28][29] The observed variation in rates could be attributed to disparities in SSI definitions, distribution of risk factors, study timelines, socioeconomic status, and healthcare systems. Regarding our study's validity, we believe the SSI incidence reported here to be accurate due to the complete follow-up response (100%) and adherence to CDC criteria for a 30-day observation period. ...
Background: Caesarean section is one of the most commonly performed surgical procedures in hospitals. Surgical site infections are a common complication after a caesarean section (C-section) and mainly responsible for increased maternal mortality and morbidity, the dissatisfaction of patients, longer hospital stays as well as higher treatment costs. Methods: This prospective cohort study at Bangladesh's Bangabandhu Sheikh Mujib medical university included 400 women (247 emergency CS, 153 elective CS) from September 2019 to August 2020. Data were collected through consent, medical record reviews, and questionnaires. SSI risk factors were assessed, and wound examinations were conducted before discharge. STATA 14.0 was used for analysis. Participants were educated about SSI symptoms and monitored for 30 days post-operation. Results: Nulliparous individuals were more common in the emergency CS group (61.5% vs. 32% in Elective CS). Ruptured membranes were higher in emergency CS (71.7% vs. 2.6% in elective CS). Prophylactic antibiotic usage differed significantly (88.7% in emergency CS vs. 3.9% in elective CS). Post-discharge wound infections were more prevalent in emergency CS (10.53% vs. 2.61% in elective CS). No significant differences were found in other parameters. High-risk factors included BMI >30 and operation time ≥45 min. Conclusion: SSI rates may be underestimated with limited hospital observation. Prolonged operation times (>38 min) and high BMI (>30) significantly increased SSI risk. Identifying high-risk subgroups and administering antibiotics accordingly can help prevent SSI and reduce unnecessary antibiotic use.
... The difficulty in determining the date of admission prior to the operative act in our study may be the cause of this discrepancy [22]. Previous studies' literature clearly identifies the factors we identified as risk factors, including the patient's mode of admission and the length of postoperative stay [23]; [24]; [25]; [26]; [27]. There is a need for ongoing staff training on nosocomial infections in order to strengthen their understanding of the risk infectious, according to interviews conducted with the staff of the university clinics of traumatology, orthopedics, and urology of the FRRH. ...
This study aimed at establishing the risk factors of surgical site infections among post-operative patients at Fort Portal Regional Referral Hospital. This was a cross-sectional and analytical study of 129 people operated on during the period of April-June 2022. Logistic regression was used to study the factors associated with surgical site infections. The associations between the dependent variable and the other variables were assessed by the odds ratio (OR) followed by their 95% confidence interval. The prevalence of surgical site infections was 7.81% CI 95% = (5.12-10.51). The factors linked to the surgical site infections in the studied population were the patient and post admission method [OR = 2.74; 95% CI = (1.08-6.95)] and the length of the postoperative stay [OR = 8.75; 95% CI = (2.83-26.98)]. The PI and direct observation identified health care system dysfunctions, medical errors, patient monitoring and financial unavailability as factors that could favor the onset of surgical site infections. Interventions should be focused on the factors identified for the effective management of operated patients. INTRODUCTION Surgical site infection (SSI) is an infection that develops within 30 days after an operation or within one year if an implant was placed, and the infection appears to be related to the surgery [1]; [2]; [3].SSIs remain a major cause of morbidity and death among the operated patients and continue to represent about a fifth of all healthcare-associated infections [1]; [3]. Although at least 5% of patients develop an SSI after surgery, these infections seem to cause remarkably little concern, remaining largely unreported in the media [4]. Despite improvements in operating room practices, instrument sterilization methods, better surgical technique and the best efforts of infection prevention strategies, surgical site infections remain a major cause of hospital-acquired infections and rates are increasing globally even in hospitals with most modern facilities and standard protocols of preoperative preparation and antibiotic prophylaxis. Moreover, in developing countries where resources are limited, even basic life-saving operations, such as appendectomies and cesarean sections, are associated with high infection rates and mortality [5]. Surgical site infections (SSIs) are real risks associated with any surgical procedure and represent a significant burden contributing to morbidity and mortality, and increased cost to health services around the world [6]. In the United States, between 500,000 and 750,000 SSIs occur annually [7]. According to the guidelines of the U.S. Centers for Disease Control and Prevention (CDC), more than 30 million operations are done each year at U.S. hospitals. Reported rates of SSI range from 2% to 3%, but these figures probably underestimate the true rate. Infections may total three-fourths of a million annually, two-thirds of which are limited to the incision [8]. A few retrospective studies in Nepal, a developing country in Asia have suggested the prevalence rate of SSI to be 4%-7% for all kinds of operation. Prospective studies of the incidence and risk factors for SSI in Nepalese hospitals are generally lacking [9]. In Tanzania, several recent studies done had shown an upward trend in the occurrence of SSI. A report from Tanzania shows the rate to be 19.4 percent [10]. In Uganda, data about SSI is still scarce and the true incidence and cost per patient is unknown. SSIs are classified as being either incisional or organ/space. Incisional SSIs are divided into those involving only skin and subcutaneous tissue (superficial incisional SSI), and those involving deeper soft tissues of the incision (deep incisional SSI) [11].
... The difficulty in determining the date of admission prior to the operative act in our study may be the cause of this discrepancy[34]. Previous studies' literature clearly identifies the factors we identified as risk factors, including the patient's mode of admission and the length of postoperative stay[18,35,36, 32,37]. There is a need for ongoing staff training on with the staff of the university clinics of traumatology, orthopedics, and urology of the FRRH. ...
This study aimed at establishing the risk factors of surgical site infections among post-operative patients at Fort Portal Regional Referral Hospital. This was a cross-sectional and analytical study of 129 people operated on during the period of April-June 2022. Logistic regression was used to study the factors associated with surgical site infections. The associations between the dependent variable and the other variables were assessed by the odds ratio (OR) followed by their 95% confidence interval. The prevalence of surgical site infections was 7.81% CI 95% = (5.12-10.51). The factors linked to the surgical site infections in the studied population were the patient and post admission method [OR = 2.74; 95% CI = (1.08-6.95)] and the length of the postoperative stay [OR = 8.75; 95% CI = (2.83-26.98)]. The PI and direct observation identified health care system dysfunctions, medical errors, patient monitoring and financial unavailability as factors that could favor the onset of surgical site infections. Interventions should be focused on the factors identified for the effective management of operated patients.
