Shikha S S, Latif T, Moshin M, Hossain M A, Akter H, Shamsi S, Afrose R, Panna L K, Sharmin T, Dey S
Dr Sarmin Sultana Shikha, Junior Consultant (Obs & Gynae), Department of Obs & Gynae, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh.
Mymensingh Med J. 2018 Jul;27(3):480-486.
Surgical site infection (SSI) in postnatal period is a noteworthy misery for the mother as well as the family increasing both hospital stay and hospital expenses. SSI in post cesarean patients has not been well documented in study area despite considerable number of cesarean section performed and the relatively common occurrence of SSI. Hence this cross sectional observational study was intended in the department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh (MMCH), Bangladesh among 100 patients to assess the risk factors of incisional SSI after cesarean section from March 2012 to February 2013. The patients diagnosed as SSI were enrolled purposively. Age, status of antenatal checkup, indication of operation, duration of operation, thickness of subcutaneous fat, character and bacteriological study of wound discharge, post operative day of detection of wound infection, status of hemoglobin were considered as major variables. Among the patients 96% underwent emergency cesarean section which were done 40% due to obstructed labour, 35% had prolonged labour and 26% had PROM more than 24 hours. Most of the infections (50%) were detected on 5th post operative day. Duration of operation was more than one hour in 35% cases, 65% patient's subcutaneous fat thickness was more than 2cm. Regarding wound discharge, 65% were serosanguinous. Organisms from wound swab were detected in 55% cases. Among those 85% infection occurred by Staphylococcus and 15% by E. coli. Moderate to severe anaemia was diagnosed in 75% patients. Maximum (80%) patients were not under regular antenatal check up. Finally it was revealed that emergency CS, obstructed labour, prolonged ruptured membrane, prolong duration of operation, anaemia, irregular antenatal check up are possible considerable risk factors for surgical site infection. Obstetrician should meticulously follow surgical safety checklist and ensure the essential safety steps into their normal operative workflow specially during handling the patients with risk factors. Encourage for regular ANC & improvement of host factor also should consider as remedial measures.
产后手术部位感染（SSI）对母亲和家庭来说都是一个值得关注的痛苦问题，它会增加住院时间和住院费用。尽管在研究地区进行了相当数量的剖宫产手术，且手术部位感染相对常见，但剖宫产患者的手术部位感染情况在该地区尚未得到充分记录。因此，这项横断面观察性研究于2012年3月至2013年2月在孟加拉国迈门辛医学院医院妇产科进行，研究对象为100例患者，旨在评估剖宫产术后切口手术部位感染的危险因素。被诊断为手术部位感染的患者是有目的地纳入研究的。年龄、产前检查状况、手术指征、手术时间、皮下脂肪厚度、伤口分泌物的性质及细菌学研究、伤口感染检测的术后天数、血红蛋白状况被视为主要变量。在这些患者中，96%接受了急诊剖宫产，其中40%是由于产程梗阻，35%是产程延长，26%是胎膜早破超过24小时。大多数感染（50%）在术后第5天被检测到。35%的病例手术时间超过1小时，65%患者的皮下脂肪厚度超过2厘米。关于伤口分泌物，65%为血清样。55%的病例伤口拭子检测到微生物。其中85%的感染由葡萄球菌引起，15%由大肠杆菌引起。75%的患者被诊断为中度至重度贫血。80%的患者未进行定期产前检查。最后发现，急诊剖宫产、产程梗阻、胎膜破裂时间延长、手术时间延长、贫血、产前检查不规律可能是手术部位感染的重要危险因素。产科医生应严格遵循手术安全检查表，并确保在其正常手术流程中采取必要的安全措施，特别是在处理有危险因素的患者时。鼓励定期进行产前检查并改善宿主因素也应作为补救措施。
