Reduce Maternal Mortality: Prevent Surgical Site Infections
Keywords:
Surgical site infection, delivery, mothers, cesarean.Abstract
Cesarean delivery is defined as a surgical procedure in which a baby is delivered through incisions made in the mother’s abdominal wall and uterus. When medically indicated, cesarean section plays a significant role in preventing severe complications, including obstetric fistula and birth asphyxia, thereby safeguarding the lives of both mother and child. Surgical site infections (SSIs) significantly contribute to increased healthcare costs, morbidity, and mortality associated with surgical procedures and remain a persistent global public health challenge. A study conducted in three hospitals in Cameroon reported a surgical site infection (SSI) prevalence of 9.2% among postoperative patients, with superficial infections being the most common type. A study conducted by Korol et al. (2013) identified several factors linked to an increased risk of surgical site infections (SSIs), including the presence of comorbid conditions, older age, higher surgical risk scores, patient frailty, complex surgical procedures, and diabetes. In addition, prolonged duration of surgery was shown to significantly elevate the likelihood of developing an SSI. In a bid to prevent surgical site infection in delivered mothers, a study was conducted to investigate factors influencing the incidence of SSI. The study revealed that personal hygiene of patient, duration of surgical procedure, frequent movement of visitor, poor hygiene of ward (irregularity of general cleaning), delayed detection of infections and inconsistencies in routine cleaning practices contributed to the occurrence of surgical site infections.
References
1. Martin, E., K., A. (2017). Cost-effectiveness modelling study of strategies to prevent post-caesarian surgical site infection, Ph.D. thesis, Queensland University of Technology, Brisbane, Australia
2. Pfeifer, S., M. (2012). Obsetetrics and Gynecology, Lippincott Williams & Wilkins, a Wolter Kluwer Business, Philadelphia, PA, USA, 7 editions
3. Betran, A., P., Torloni, M., R., Zhang, J. et al. (2015). “What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies,” Reproductive Health, vol. 12, no. 1, p. 57.
4. Ro´za˙, A., Nska, A., Jarynowski, K., K. Godlewska et al. (2018). “Does ´ surgical site infection after caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study,” American Journal of Infection Control, vol. 46, no. 1, pp. 20–25.
5. Mangram, A., J., Horan, T., C., Pearson, M., L, Silver, L., C. & Jarvis, W., R. (1999). The Hospital Infection Control Practices Advisory C, et al. Guideline for prevention of surgical site infection, Am. J. Infect. Control 27 (2) 97–134, https://doi.org/ 10.1016/S0196-6553(99)70088-X.
6. Badia, J., M., Casey, A., L., Petrosillo, N., Hudson, P., M., Mitchell, S., A. & Crosby, C. (2017). Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries, J. Hosp. Infect. 96 (1) 1–15, https://doi.org/10.1016/j.jhin.2017.03.004.
7. Dalhatu, A., Olaogun, A., Olayinka, A., T., Ahmed, S., Timothy, G. & Yunusa, U. (2014). Incidence of Surgical Site Infections (SSIs) among Patients Undergoing Major Surgery at General Hospital Funtua, Katsina State, Nigeria. IOSR Journal of Nursing and Health Science 3(3):16–21 www. iosrjournals.org.
8. National Collaborating Centre for Women's and Children’s Health. (2008). Surgical site infection prevention and treatment of surgical site infection: Clinical Guideline. NICE Available at: http://www.nice.org.uk/nicemedia/pdf/ CG74FullGuideline.pdf
9. Zelle, B., A. & Stahel, P.F. (2019). Lessons learned for postoperative wound healing: respect the past and embrace the future. Patient Saf Surg13(1):5.
10. Handaya, A., Y. & Werdana, V., A., P. (2019). Adherence to preoperative hand hygiene and sterile gowning technique among consultant surgeons, surgical residents, and nurses: a pilot study at an academic medical center in Indonesia. Patient Saf Surg. 13(1):11
11. Ntsama-Essomba, C., Avomo, J., Esiene, A., Leme-Banock, L. & Abologo-Azeme, L. (2013). Prevalence of surgical site infections and evaluation of risk factors after surgery, case of three public hospitals in Cameroon. J Med Med Sci [Internet] 4(6):241–6. Available from: http://www.interesjournals.org/ full-articles/prevalence-of-surgical-siteinfections-and-evaluation-of-risk-factorsafter-surgery-case-of-three-publichospitals-in-cameroon.pdf?view=inline
12. Osakwe, J.O., Nnaji, G.A., Osakwe, R.C., Agu, U. & Chineke, H.N. (2014). Role of premorbid status and wound related factors in surgical site infection in a tertiary hospital in sub-saharan Africa. herbert open access journals [Internet]. 1:1–7. Available from: http://www. hoajonline.com/journals/pdf/2056-5690-1-2. Pdf
13. Amoran, O.E., Sogebi, A.O. & Fatugase, O.M. (2013). Rates and Risk Factors Associated with Surgical Site Infections in a Tertiary Care Center in South-Western Nigeria. Int J Trop Dis Heal [Internet] 3(1):25– 36. Available from: sciencedomain.org/ download/OTk5QEBwZg
14. Nkurunziza, T., Kateera, F., Sonderman, K., Gruendl, M., Nihiwacu, E., Ramadhan, B., et al. (2019). Prevalence and predictors of surgicalsite infection after caesarean section at a rural district hospital in Rwanda. BJS 106(1):121–8.
15. Latifa, M., Nedia, M., Hajer, H., Massoudi, A., Olfa, E. & Manssouri, F. (2018). Incidence et facteurs de risque de l’infection du site opératoire après césarienne dans une maternité de Tunisie. Santé publique 3:339– 47. doi: 10.3917/spub.183.0339
16. Allegranzi, B., Nejad, S.B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., et al. (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet [Internet] 66(1):228– 41. Available from: http://dx.doi. org/10.1016/S0140-6736(10)61458-4
17. Al-mulhim, F.A., Baragbah, M.A., Sadatali, M., Alomran, A.S. & Azam, Q. (2014). Prevalence of Surgical Site Infection in Orthopedic Surgery: A 5-year Analysis. journalof Int Surg [Internet] 99(3):264–8. Available from: ttps://www.ncbi.nlm.nih. gov/pmc/articles/PMC4027911/
18. Korol, E., Johnston, K., Waser, N., Sifakis, F., Jafri, H., S., et al. (2013). A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients. PLoS ONE 8(12): e83743.doi: 10.1371/journal.pone.0083743
19. World Health Organisation. (2016). Health Care-Associated Infections Fact Sheet, World Health Organisation, Geneva, Switzerland.
20. World Health Organisation. (2016). Global Guidelines for the Prevention of Surgical Site Infection, World Health Organisation, Geneva, Switzerland.
21. Badia,, J., M., Rubio, P., I., Manuel, A., Membrilla, E., Ruiz-Tovar, J., Mun, C., et al. (2020). Surgical Site Infection Prevention Measures in General Surgery: Position Statement by the Surgical Infections Division of the Spanish Association of Surgery. Cir Esp. 98(4);187–203.
22. Zabaglo, M. & Sharman, T. (2023). Postoperative wound infection. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing.
23. Leaper, D. & Ousey, K. (2015). Evidence update on prevention of surgical site infection. Curr Opin Infect Dis. 28(2):158-63. doi:10.1097/qco.0000000000000144
24. Anderson, D., J., Podgorny, K., Berríos-Torres, S., I., et al. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 35(6):605-27. doi:10.1086/676022
25. Yao, K., Bae, L. & Yew, W. P. (2013). Post-operative wound management. Aust Fam Physician;42(12):867-870.
26. Petroze, R.T., Nzayisenga, A., Calland, J.F., Ntakiyiruta, G., International, F. (2013). Surgical Volumes at the District Hospital: A Retrospective Review of National Data in Rwanda. 2011;16
27. SSISS. (2013). Protocol for the Surveillance of Surgical Site Infection Surgical Site Infection Surveillance Service About Public Health England [Internet]. 2013. p. 1–82. Available from: https:// www.gov.uk/government/uploads/ system/uploads/attachment_data/ file/364412/Protocol_for_surveillance_ of_surgical_site_infection_June_2013. Pdf
28. CDC. (2019). Surgical Site Infection ( SSI ) Event ;1–29. Available from:http://www.cdc.gov/nhsn/ pdfs/pscmanual/9pscssicurrent. pdf#page=1&zoom=auto,-99,79819.
29. Uwamungu, E., Rutagengwa, W., Logan, J., Nkubito, P., Wong, R. A. (2019). Quality Improvement Study Project to Improve Post Cesarean Section Surgical Site Infection Surveillance in a District Hospital in Kigali City. J Manag Strateg ;10(2):18.
30. Martin, E.T. (2016). Diabetes and Risk of Surgical Site Infection: A systematic review and meta-analysis. nfect Control Hosp Epidemiol [Internet];37(1):88–99. Available from: https://www.ncbi.nlm. nih.gov/pmc/articles/PMC4914132/ pdf/nihms794109.pdf
31. Mawalla, B., Mshana, S., E., Chalya, P., L., Imirzalioglu, C., Mahalu, W. (2011). Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania ;11–21.
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Copyright (c) 2026 Nizeyimana Fidele, Irafasha Felicien, Gashongore Kevis, Ndayisaba Cleophas, Mukeshimana Jeanne d’Arc, Ndererimana Olivier, Mutabazi Placide, Uwiringiyimana Aline (Author)
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