Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340.
Wollongong Hospital, 348 Crown Street, Wollongong, NSW, Australia, 2500.
Infect Dis Health. 2020 Aug;25(3):158-167. doi: 10.1016/j.idh.2020.01.006. Epub 2020 Mar 9.
The past 20 years have seen increasing Caesarean section (CS) rates in Australia. Increasing antenatal morbidity means that post-CS surgical site infection (SSI) is an issue impacting Australian women, mostly low-socioeconomic and regional communities. Recent trends supporting development of evidence-based bundled approaches to SSI reduction, have not proved efficacy nor supported bundle implementation.
This pilot study aimed to develop, implement and assess an evidence-based Caesarean Infection Prevention ("CIP") bundled intervention to reduce post-CS SSI rates in a high risk population.
The study was a pre-post-intervention study, including women undergoing CS at one referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified women who developed a post-CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Data was collected for the subsequent 12 months on women undergoing CS.
A total of 710 procedures were monitored with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent over time. Post-CS SSI rates significantly reduced post-intervention (5.5% vs. 1.6%, p = 0.007), the greatest benefit in class II and III obese patients (12.2% vs. 2.5%, p = 0.019). Higher hypertension rates (24% vs. 9%, p = 0.01) and lower maternal mean age (27 vs. 30, p = 0.01) were seen in patients with SSI.
The "CIP" bundle effectively reduced post-CS SSIs in a high risk population. Our findings substantiate the need for development and evaluation of multifaceted, evidenced-based interventions to reduce post-CS SSIs.
Retrospectively registered.
ACTRN12619001001189, July 2019.
在过去的 20 年中，澳大利亚的剖宫产率不断上升。产前发病率的增加意味着剖宫产术后手术部位感染（SSI）是影响澳大利亚妇女的问题，主要是中低收入和地区社区的妇女。最近的趋势支持发展基于证据的减少 SSI 的捆绑方法，但这些方法既没有证明其疗效，也没有支持实施捆绑措施。
本研究旨在开发、实施和评估一种基于证据的剖宫产感染预防（“CIP”）捆绑干预措施，以降低高危人群的剖宫产术后 SSI 发生率。
这是一项干预前后的研究，包括 2016 年 12 月 1 日至 2018 年 12 月 31 日期间在一家转诊医院行剖宫产术的妇女。对 12 个月的回顾性干预前回顾发现了发生剖宫产术后 SSI 的妇女。全面的文献回顾为干预措施的制定提供了信息，该措施于 2017 年 12 月实施。随后对行剖宫产术的妇女收集了 12 个月的数据。
共监测了 710 例手术，干预前组和干预后组分别有 346 例和 364 例妇女。人口统计学和合并症变量在整个时间内保持一致。干预后剖宫产术后 SSI 发生率显著降低（5.5%比 1.6%，p=0.007），肥胖 II 类和 III 类患者的获益最大（12.2%比 2.5%，p=0.019）。SSI 患者的高血压发生率较高（24%比 9%，p=0.01），产妇平均年龄较低（27 比 30，p=0.01）。
“CIP”捆绑有效地降低了高危人群的剖宫产术后 SSI。我们的研究结果证实了需要制定和评估多方面的、基于证据的干预措施来降低剖宫产术后 SSI。
回顾性注册。
ACTRN12619001001189，2019 年 7 月。
