INFECTION CONTROL
Reducing C-section wound complications
Wrightington, Wigan and Leigh NHS Foundation Trust has undertaken a study into the use of a disposable Negative Pressure Wound Therapy (NPWT) system for women with a BMI>35, undergoing Caesarean section deliveries. The results of a 30 month audit are highlighted.
The burden of surgical site infections (SSI) for the NHS is a significant one in both human and financial terms. NICE estimates that 5% of all patients undergoing surgery will develop a wound infection, while recent HPA data suggests 15.7% of all healthcare-acquired infections are post-surgical wound infection. (HPA 2011) In addition to the burden to patients, these episodes represent a significant financial burden to the health service. In a recent clinical and cost analysis in the Plymouth area, Jenks et al (2014) reviewed the impact of SSI following all surgical procedures to an individual hospital and found that they accounted for almost 4,700 avoidable bed days over a two year period.
Although Caesarean deliveries are
considered to be a clean surgical procedure, evidence from recent studies suggests that the rates of SSI are higher than might be expected. A recent study, supported by the Health Protection Agency, considered post-operative complications following 4,107 Caesarean deliveries across 14 hospitals in England and Wales (Wloch et al 2012). The overall SSI rate was 9.6% while it increased to 19.8% in women with a BMI>35 and 15.6% in women with diabetes. These are comparable to infection rates following dirty surgical procedures such as large bowel surgery which has an infection rate of 14.7% (Wloch et al 2012).
A second study from 2011 corroborates
these findings. Leth et al (2011) in a study of 2,492 patients, examined the role of diabetes and BMI in relation to post Caesarean section wound infection. Patients with a BMI of 30 or more were considered as obese. The infection rate for this group was 23.9% versus 17.5% in the non-obese patient group. A large scale review of the Pan Celtic Network examined 22151 Caesarean section procedures to establish the rate of SSI across Scotland, Ireland and Wales (HPS 2008). The cumulative incidence of SSI across the three networks was 8.5% (1881 patients in total). Obesity was linked with increased SSI in all networks (HPS 2008). It would therefore seem apparent from
the literature that patients with an elevated BMI of over 30 undergoing Caesarean section are more likely to develop an infection than someone who is of normal weight. This is a worrying trend given the increasing rates of obesity which have increased from 50.5% of women in 1993 to 60.4% in 2012 (HSCIC 2014). Importantly, these patients are at risk of developing significant complications at a time when they should be recovering and bonding with their new baby. Readmission to hospital for additional care at this time may increase anxiety both for the patient and their family. Some commentators have discussed
Fig1. PICO therapy in situ on a patient post Caesarean section. APRIL 2015
the nature of the relationship between obesity and infection. It is postulated that when operating on patients with excessive adipose tissue the surgeon may experience technical difficulties when closing the wound due to lack of muscle tone and the thickness of the adipose layer (Irvine and Shaw 2006). The wound is also at risk if there is a large pannus or overhanging
THE CLINICAL SERVICES JOURNAL 43
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68