DOI: https://doi.org/10.14710/nmjn.v7i1.15127

Surgical Site Infection among Women Post Cesarean Section: An Integrative Review

*Shinta Novelia  -  Midwifery Department, Faculty of Health Science, Universitas Nasional, Indonesia
Wipa Sae Sia  -  Department of Surgical Nursing, Faculty of Nursing, Prince of Songkla University, Thailand
Praneed Songwathana  -  Department of Surgical Nursing, Faculty of Nursing, Prince of Songkla University, Thailand
Open Access Copyright (c) 2017 Nurse Media Journal of Nursing

Citation Format:
Abstract

Background: Surgical site infection (SSI) in cesarean section (CS) is a major cause of prolonged hospital stay and resource consumption, and causes morbidity and mortality for the mother and the baby.

Purpose: This literature review aimed to assess and identify risk factors, interventions, and prevention strategies of SSI for women post CS especially the obese women.

Methods: An integrative literature review was conducted by employing the databases of PubMed, ProQuest, Science Direct, Wiley online library, and Google scholar from 1999 to 2015. This review identified the studies conducted either in women post-CS or obese women post CS.

Results: A total of 58 articles were found, and 14 articles met the criteria. The risk factors of CS-SSI were classified into extrinsic and intrinsic factors. The intrinsic factors include limited mobility, poor nutrition, and comorbidity (diabetes) while the extrinsic factors include surgical technique, skin closure methods, prophylactic antibiotic, and the use of drains. Poor nutrition, diabetes, and limited mobility were the common factors found in obese women undergoing CS. Maintaining nutritional status and controlling blood glucose were proposed to prevent CS-SSI among obese women post-CS.

Conclusions: Nurses should have adequate knowledge about the risk factors of CS-SSI to assess the risk factors of CS-SSI especially in obese women. The intervention of CS-SSI might need a bundle of interventions which consist of pre-operative and post-operative prevention strategies.

Fulltext View|Download
Keywords: Obese women; wound infection; surgical site infection; cesarean section

Article Metrics:

Article Info
Section: Articles
Language : EN
Recent articles
Attitudes, Belief, and Barriers of Indonesian Oncology Nurses on Providing Assistance to Overcome Sexuality Problem Modified Pro-Self Pain Control to Increase Activity in Patients with Colorectal Cancer Surgical Site Infection among Women Post Cesarean Section: An Integrative Review Editorial Back Matter Editorial Front Matter More recent articles
Most cited articles
Spirituality Intervention and Outcomes: Corner stone of Holistic Nursing Practice The Effect of Dietary and Exercise Self-Management Support Program on Dietary Behavior Exercise Behavior and Clinical Outcomes in Muslim Patients with Poorly Controlled Type 2 DM in a Community Setting in Indonesia Social Support and Coping of Indonesian Family Caregivers Caring for Persons with Schizophrenia Development of a Community-Based Spiritual Life Review Program for Promoting Resilience of Elders Residing in Disaster-Prone Areas Development of Foot Massage Program on Nausea and Vomiting for Cancer Patients: A Literature Review More cited articles
  1. Alexander, C. I., & Liston, W. A. (2006). Review article: Operating on the obese woman—a review. British Journal of Obstetrics and Gynaecology: An International Journal of Obstetrics & Gynaecology, 113(10), 1167-1172. doi: 10.1111/j.1471-0528.2006.01073.x
  2. Anderson, V., Chaboyer, W., & Gillespie, B. (2013). The relationship between obesity and surgical site infections in women undergoing caesarean sections: An integrative review. Midwifery, 29(12), 1331-1338. doi: 10.1016/j.midw.2012.12.012
  3. Baugh, N., Zuelzer, H., Meador, J., & Blankenship, J. (2007). Wounds in surgical patients who are obese.The American Journal of Nursing, 107(6), 40-50. doi: 10.1097/01.NAJ.0000271848.07721.24
  4. Brown, J., Thompson, M., Sinnya, S., Jeffery, A., de Costa, C., Woods, C., ...& Raulli, A. (2013). Pre-incision antibiotic prophylaxis reduces the incidence of post-caesarean surgical site infection. Journal of Hospital Infection, 83(1), 68-70. doi: 10.1016/j.jhin.2012.08.014
  5. Derbyshire, E., Davies, J., Costarelli, V., & Dettmar, P. (2006). Prepregnancy body mass index and dietary intake in the first trimester of pregnancy. Journal of human nutrition and dietetics, 19(4), 267-273
  6. De Vivo, A., Mancuso, A., Giacobbe, A., Priolo, A., De Dominici, R., & Maggio Savasta, L. (2010). Wound length and corticosteroid administration as risk factors for surgical site complications following cesarean section. Acta Obstetricia et Gynecologica Scandinavica, 89(3), 355-359. doi: 10.3109/00016340903568175
  7. Dhar, H., Al-Busaidi, I., Rathi, B., Nimre, E. A., Sachdeva, V., & Hamdi, I. (2014). A study of post-caesarean section wound infections in a regional referral hospital, Oman. Sultan Qaboos University Medical Journal, 14(2), 211-217
  8. Dryden, M., Goddard, C., Madadi, A., Heard, M., Saeed, K., & Cooke, J. (2014). Using antimicrobial surgihoney to prevent caesarean wound infection. British Journal of Midwifery, 22(2), 111-115
  9. Ezechi, O. C., Edet, A., Akinlade, H., Gab-Okafor, C. V., & Herbertson, E. (2009). Incidence and risk factors for caesarean wound infection in Lagos Nigeria. Biomed Central Research Notes, 2(1), 1-5. doi: 10.1186/1756-0500-2-186
  10. Farret, T. C. F., Dallé, J., Monteiro, V. D. S., Riche, C. V. W., & Antonello, V. S. (2015). Risk factors for surgical site infection following cesarean section in a Brazilian Women's Hospital: A case-control study. Brazilian Journal of Infectious Diseases, 19(2), 113-117. doi: 10.1016/j.bjid.2014.09.009
  11. Graling, P. R., & Vasaly, F. W. (2013). Effectiveness of 2% CHG cloth bathing for reducing surgical site infections. Association of Peri Operative Registered Nurses Journal, 97(5), 547-551. doi: 10.1016/j.aorn.2013.02.009
  12. Harrington, P. (2014). Prevention of surgical site infection. Nursing Standard, 28(48), 50-58
  13. Harrop, J. S., Styliaras, J. C., Ooi, Y. C., Radcliff, K. E., Vaccaro, A. R., & Wu, C. (2012). Contributing factors to surgical site infections. Journal of the American Academy of Orthopaedic Surgeons, 20(2), 94-101. doi: 10.5435/JAAOS-20-02-094
  14. Hopkins, L., & Smaill, F. M. (2012). Antibiotic prophylaxis regimens and drugs for cesarean section. The Cochrane Library. Retrieved from http://apps.who.int/rhl/reviews/CD001136.pdf
  15. Ibrahim, M. I., Moustafa, G. F., Al-Hamid, A. S. A., & Hussein, M. R. (2014). Superficial incisional surgical site infection rate after cesarean section in obese women: A randomized controlled trial of subcuticular versus interrupted skin suturing. Archives of Gynecology and Obstetrics, 289(5), 981-986. doi: 10.1007/s00404-013-3098-z
  16. Joanna Briggs Institution, (2014). Joanna Briggs Institute Reviewers’ Manual. Retrieved from: http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2014.pdf
  17. Johnson, A., Young, D., & Reilly, J. (2006). Caesarean section surgical site infection surveillance.Journal of Hospital Infection, 64(1), 30-35. doi: 10.1016/j.jhin.2006.03.020
  18. Kasatpibal, N., Jamulitrat, S., Chongsuvivatwong, V., & Surgical Site Infection Study Group. (2005). Standardized incidence rates of surgical site infection: A multicenter study in Thailand. American Journal of Infection Control, 33(10), 587-594. doi: 10.1016/j.ajic.2004.11.012
  19. Kristian Opoien, H., Valbø, A., Grinde-Andersen, A., & Walberg, M. (2007). Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica, 86(9), 1097-1102
  20. Machado, L. S. (2012). Cesarean section in morbidly obese parturients: practical implications and complications. North American Journal of Medical Sciences, 4(1), 13
  21. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & Jarvis, W. R. (1999). Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection Control Hospital Epidemiology, 20, 250-278
  22. Ng, W., Brown, A., Alexander, D., Ho, M. F., Kerr, B., Amato, M., & Katz, K. (2015). A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive post discharge surveillance system. American Journal of Infection Control.43(8). 805-809. doi: 10.1016/j.ajic.2015.04.001
  23. Nobbs, S., & Crozier, K. (2011). Wound management in obese women following caesarean section. British Journal of Midwifery, 19(3), 150-156. doi: 10.12968/bjom.2011.19.3.150
  24. National Institute for Health and Clinical Excellence [NICE].(2008). Surgical site infection. Retrieved from https://www.nice.org.uk/guidance/CG74
  25. Nikpour, M., Shirvani, M. A., Azadbakht, M., Zanjani, R., & Mousavi, E. (2014).The effect of honey gel on abdominal wound healing in cesarean section: A triple blind randomized clinical trial. Oman Medical Journal, 29(4), 255.doi: 10.5001/omj.2014.68
  26. Olsen, M. A., Butler, A. M., Willers, D. M., Devkota, P., Gross, G. A., & Fraser, V. J. (2008). Risk factors for surgical site infection after low transverse cesarean section. Infection Control, 29(06), 477-484
  27. Ramsey, P. S., White, A. M., Guinn, D. A., Lu, G. C., Ramin, S. M., Davies, J. K., ...& Hauth, J. C. (2005). Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery.Obstetrics & Gynecology, 105, 967-973. doi: 10.1097/01.AOG.0000158866.68311.d1
  28. Rauk, P. N. (2010). Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections. American Journal of Infection Control, 38(4), 319-323. doi: 10.1016.ajic.2009.10.004
  29. Robinson, H. E., O’Connell, C. M., Joseph, K. S., & McLeod, N. L. (2005). Maternal outcomes in pregnancies complicated by obesity. Obstetrics & Gynecology, 106(6), 1357-1364. doi: 10.1097/01.AOG.0000188387.88032.41
  30. Skjeldestad, F. E., Bjornholt, J. V., Gran, J. M., & Erisken, H. M. (2015). The effect of antibiotic prophylaxis guidelines on surgical-site infections associated with cesarean delivery. International Journal of Gynecology & Obstetrics, 128(2), 126-130. doi: 0.1016/j.ijgo.2014.08.018
  31. Souza, M. T. D., Silva, M. D. D., & Carvalho, R. D. (2010). Integrative review: what is it? How to do it?. Einstein (São Paulo), 8(1), 102-106
  32. Suryati, T. (2013). Analisis lanjut data Riskesdas (2010) persentase operasi caesaria di Indonesia melebihi standard maksimal, apakah sesuai indikasi medis? [Percentage of sectio caesaria in Indonesia is passad the maximum standard, is it in accordance to medical indication?]. Health Systems Research Bulletin, 15. Retrieved from http://bpk.litbang.depkes.go.id/
  33. Thornburg, L. L., Linder, M. A., Durie, D. E., Walker, B., Pressman, E. K., & Glantz, J. C. (2012). Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery. Journal of Maternal-Fetal and Neonatal Medicine,25(9), 1544-1548. doi: 10.3109/14767058.2011.653422
  34. Tran, T. S., Jamulitrat, S., Chongsuvivatwong, V., & Geater, A. (2000).Risk factors for post cesarean surgical site infection.Obstetrics & Gynecology, 95(3), 367-371
  35. Vermillion, S. T., Lamoutte, C., Soper, D. E., & Verdeja, A. (2000). Wound infection after cesarean: effect of subcutaneous tissue thickness. Obstetrics & Gynecology, 95(6), 923-926
  36. Wall, P. D., Deucy, E. E., Glantz, J. C., & Pressman, E. K. (2003). Vertical skin incisions and wound complications in the obese parturient. Obstetrics & Gynecology, 102(5), 952-956
  37. Yeeles, H., Trinick, S., Childs, C., Soltani, H., & Farrell, T. (2014). Postpartum infection in morbidly obese women after c-section: Does early prophylactic oral antibiotic use make a difference. Journal of Women’s Health Care, 3(172), 2167-0420. doi: 10.4236/ojog.2014.49077

Last update:

  1. Effects and Interventions of Pressure Injury Prevention Bundles of Care in Critically Ill Patients: A Systematic Review

    Wenny Trisnaningtyas, Retnaningsih Retnaningsih, Nana Rochana. Nurse Media Journal of Nursing, 11 (2), 2021. doi: 10.14710/nmjn.v11i2.28881

  2. INCIDENCE AND RISK FACTORS OF SURGICAL SITE INFECTION FOLLOWING CESAREAN SECTION IN A TERTIARY CARE CENTRE IN NORTH KERALA, INDIA

    HIBA HASHIM BH, HEERA SHENOY T, CHELLAMMA VK, ABHILASH ANTONY. Asian Journal of Pharmaceutical and Clinical Research, 2022. doi: 10.22159/ajpcr.2022.v15i11.45968

Last update: 2024-04-18 13:52:17

  1. Effect of patient centered care application on inpatient outcomes in rskdia pertiwi and rsia ananda (Woman and child hospitals)

    Abubakar Z.. Open Access Macedonian Journal of Medical Sciences, 8 , 2020. doi: 10.3889/oamjms.2020.5217