INFECTION CONTROL


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0


30 (43%) 54 (49%) 30 (57%) 114 (49%)


Elective Emergency


40 (57%) 56 (51%) 23 (43%) 119 (51%) 2012 2013 Year Fig. 2b Number of C-section operations per year in high BMI patients, showing procedure type.


completed and patients were monitored for 30 days post-operatively. Infections were confirmed with both clinical observation and microbiological investigation. Wound assessment of infection would be carried out according to the criteria set out by Wilson, Treasure, Sturridge and Gruneberg (1986). The ASEPSIS scoring tool set out to provide a less subjective method of assessing wound infection. Criteria included the level of infection, superficial, deep or organ space, the presence of erythema and or cellulitis. In addition, the level and type of exudate, whether serous haemoserous or purulent in nature is monitored and recorded.


Results of the evaluation Demographic data Over a 30 month period between February 2012 and July 2014, the Trust conducted 1644 Caesarean deliveries. The average age of the patients undergoing a Caesarean section was 30.2 years (median 30, range 18-42 years). The average Body Mass Index of the patient undergoing a Caesarean was 39.4 Kg/m2


(median 37,


range 35-70). Of these, 239 Caesarean deliveries were conducted on women with a BMI>35. Almost one third of these patients (32.6%, n=78) had a BMI greater than or equal to 40. (See figure 4). In all cases, patients with a BMI>35 were treated with the PICO NPWT system while those with a BMI<35 were treated with the post-operative film dressing. (Table 1) shows the demographic data for the patient group including BMI.


Caesarean details


Information was available for the type (elective/emergency) of Caesarean in 233/239 PICO treated cases; 119


APRIL 2015


(51.1%) were elective and 114 (48.9%) were emergency (see table 2). Details of patient history were available from 190 patients; in 123 (64.7%) cases the Caesarean was the patient’s first Caesarean, in 60 (31.6%) it was the patient’s second Caesarean, in 4 (2.1%) it was the patient’s third Caesarean and in 3 (1.6%) it was the patient’s fourth Caesarean, (see table 2).


SSI outcomes


In all patients (n=1644) there were 52 recorded wound infections from February 2012 until July 2014 (~3.2%). This represents an overall reduction of 73.3% from the previous rate of 12% identified in the Trust during an audit in 2011. All infections identified were recorded as superficial infections and


1600 2014 Overall


no patients had an infection or wound dehiscence requiring readmission. In the patient group with BMI<35 (n = 1405), who were treated with Opsite Post-Op Visible, there were 51 confirmed infections, giving a rate of 3.6%. There were no wound dehiscences and no patients were readmitted as a result of infections in this group. This indicates that Opsite Post-Op Visible can help to significantly reduce wound infection rates and avoid unnecessary readmissions for patients in the lower risk category. In women with BMI>35 treated with PICO (n = 239), only one patient developed a wound infection (0.4%). The patient who developed an infection had gestational diabetes and was having her second Caesarean section. The infection was superficial in nature and the patient was not readmitted to hospital for treatment.


Discussion Obesity is strongly associated with the risk of developing an infection. Whether superficial, deep or organ/space, the risk of infection increases the more overweight the woman is (Health protection Agency, 2009).


Those patients who are overweight (BMI 25-30) are 1.6 times more likely to develop an infection, obese women (BMI 30-35) are 2.4 times more likely and those with a BMI over 35, 3.7 times more likely. According to Wloch et al (2013), patients with a high BMI were shown to have an SSI rate post Caesarean section of 19.2%, almost double the average. Analysis of data from a single hospital


Trust in England confirmed that women with high BMI were at increased risk of post-operative wound complications and readmission. The audit findings from 2011 indicated an overall infection rate of around 12%. Having put steps in place to


One patient developed a superficial wound infection following haematoma formation. The patient had gestational diabetes and her BMI was 45. The patient was not readmitted with this wound infection.


1200 C section patients 800


400


0


Number of patients with no infection


Number of patients with infection


Number of patients in PICO Group with infection (1)


Fig. 3 Number of wound infections. (Total patients = 1644) THE CLINICAL SERVICES JOURNAL 45


Number of patients in Opsite Post-Op Visible Group with infection (51)


Number of patients (% of patients)


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