Infection prevention
involves six acute hospitals and maternity units across the West of England. It aims to collect 30-day patient-reported SSI rates after Caesarean delivery; and to agree and implement an adapted care bundle for Caesarean births consistently in all West of England hospitals.3
Potential interventions Pre-operative decontamination: Bathing or showering the night before surgery is recommended by NICE [2019] to reduce the risk of SSI. This could be extended to a preoperative decontamination regime for women undergoing an elective Caesarean section. Staphylococcus aureus is a known risk factor
for developing SSI and has been identified as the causative organism in over 40% of post- caesarean wound infections.15
Up to 30% of
people in the UK are positive for skin or nasal carriage of Staphylococcus.19 NICE (2019) recommends the use of a
body wash “before procedures in which Staphylococcus aureus is a likely cause of a surgical site infection” as it “may reduce SSIs”. Evidence suggests “any additional costs incurred …. are likely to be more than recouped by savings associated with a lower incidence of surgical site infections.”20 There is research to support the efficacy
of preoperative decontamination with an octenidine-based antimicrobial. A large- scale trial reported a three-fold reduction in the MSSA infection rate, after a 5-day decontamination regime which included octenisan wash lotion. It also reported that significant cost savings resulted from the intervention.19
Skin preparation prior to Caesarean section: The skin is a major source of pathogens causing SSI; and pre-surgery skin preparation with antiseptic agents has been proven to reduce the risk of infection.21
While there is
no consensus regarding what type of skin preparation may be most efficient for the prevention of SSI,18
NICE (2021) recommends
the use of an alcohol-based chlorhexidine skin preparation before Caesarean birth to reduce the risk of wound infections.10
Antibiotic prophylaxis: A significant intervention affecting the SSI rate is the use of antibiotic prophylaxis. When comparing antibiotic prophylaxis to no prophylaxis or placebo for preventing infection following Caesarean section, the use of prophylactic antibiotics significantly reduced the incidence of wound infection.18
The benefit was noticed
in both elective and non-elective CS patients. Cephalosporins and penicillins were found to
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have similar efficacy in preventing immediate postoperative infections, including wound infection.18
NICE (2021) recommends that women having a
Caesarean birth should be offered prophylactic antibiotics before the procedure.10
Antibiotics
effective against endometritis, urinary tract and wound infections should be administered. This advice is based on the evidence that using prophylactic antibiotics before skin incision reduces the risk of maternal infection more than after, and that there is no known effect on the baby.10
Post-operative wound care: Daily inspection of the Caesarean incision is an essential part of the postoperative evaluation. The presence of fever, tenderness, erythema, purulent discharge, or induration should raise a suspicion of infection.
Given that most wound infections will not become clinically apparent until after discharge, women should be advised about appropriate skincare and daily wound evaluation.18
NICE (2021) offers advice
on post-operative wound care, which includes daily wound cleansing and monitoring for signs of infection.10
Periwound care: The skin surrounding a wound (the periwound area) is particularly vulnerable and although it may appear healthy, complications frequently occur.22
This may
contribute to delayed wound healing and increased wound size.23
Best practice guidelines
recommend cleaning the periwound area thoroughly but gently, using a skin-friendly cleanser (pH 4–6), with disposable moistened cloths or cleansing pads.24 As part of periwound care, octenidine
t
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