Castillo Eliana, McIsaac Corrine, MacDougall Bhreagh, Wilson Douglas, Kohr Rosemary
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB; Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB.
Department of Nursing, University of Dalhousie, Halifax, NS; Health Outcomes Worldwide, Founder & CEO, New Waterford, NS; Health Outcomes Worldwide, New Waterford, NS.
J Obstet Gynaecol Can. 2017 Aug;39(8):645-651.e1. doi: 10.1016/j.jogc.2016.12.037.
Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]).
Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre.
Estimate the rate of SSIs and associated predisposing factors.
Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30.
A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos.
Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.
产科手术部位感染（SSIs）在医疗系统中很常见且成本高昂，但鉴于术后住院时间缩短和出院后监测系统欠佳，其报告率仍然较低。在本文中，SSIs根据疾病控制与预防中心（1999年）的定义，为手术操作（在此情况下为剖宫产[CS]）后30天内发生的感染。
证明在加拿大一个城市中心接受剖宫产的女性中，由患者驱动的出院后SSIs监测系统（由在线数据库和移动电话技术组成，即手术移动应用程序-how2trak）在实际应用中的可行性。
估计SSIs的发生率及相关易感因素。
对加拿大一家城市医院连续接受剖宫产的女性进行前瞻性队列研究。使用手术移动应用程序-how2trak收集预先确定的人口统计学数据、合并症、手术特征以及自我报告的感染症状和体征，并将其与患者产后第3天、第7天、第10天和第30天的切口自拍照（照片）相关联。
在5个月的时间里共纳入了105名患者。平均年龄为31岁，13%为糖尿病患者，大多数患者手术并发症风险较低。46%的手术为急诊剖宫产，104/105的患者接受了抗生素预防。45%的患者（47/105）提交了至少一张照片，其中，到产后第10天，通过照片外观和自我报告的症状检测到1例手术部位感染。上传照片的大多数患者多次上传，其中43%的患者直至第30天仍提交照片。诊断为糖尿病或自我报告为亚洲族裔的患者提交照片的可能性较小。
使用手术移动应用程序how2trak对与剖宫产相关的SSIs进行出院后监测是可行的，值得在出院后环境中进一步研究。
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