Incidence and determinants of surgical site infection after caesarean delivery at Kenyatta national hospital

Abstract

Background: Caesarean delivery is one of the commonest operations worldwide. Caesarean delivery carries a risk of infection 5 to 20 times that of normal delivery. It is the single most important risk factor for postpartum maternal infection. Infection/sepsis is the second single leading cause of maternal mortality in Africa after hemorrhage contributing to 10 % of maternal mortality. Establishing the burden of SSI and its determinants is important in instituting specific measures to control SSI. Study objectives: This study aimed to determine the cumulative incidence and determinants of post caesarean surgical site infections at Kenyatta National hospital. Methods Design: A prospective cohort study where women who had caesarean delivery at Kenyatta National Hospital during the study period were followed up for duration of thirty days to determine the incidence of SSI at three days, fourteen days and thirty days after caesarean delivery. A total of two hundred women who had caesarean delivery were recruited. Study procedures: Data was collected using an interviewer administered questionnaire. The questionnaire was filled on the third postoperative day and at two weeks post natal review. A final telephone interview was done at 30 days post-operative. Socio-demographic data, antenatal details, details on any comorbidities and operation details were obtained on the third post-operative day. The surgical sites were inspected on the third day and two weeks post-operative. Data analysis: Data collected were cleaned, coded and entered into Epi data package and were later transferred to Statistical Package for Social Sciences (SPSS) version 20 for analysis. Descriptive statistics were be used. Graphs and tables were used to summarize data. Odd’s ratios, 95% confidence intervals and p value set at 0.05 was used to determine statistical significance of the associations between independent variables and risk of surgical site infection. Results. A total of 184 participants were followed up for 30 days. Sixteen were lost to follow up. The mean age of the participants was 27.43 years (SD-5.652) with a range of 16 to 46 years. The incidence of SSI was 1.63% at 3 days, 20.7% at two weeks and 0% at 30 days with a cumulative incidence of 22.3% at 30 days. Majority of the infections were superficial incisional CDC 1 (90.2 % (n=37)) and most of the infections developed after discharge (93 %). There were four deep incisional SSIs (CDC 2). None of the patients developed an organ space infection and there were no deaths. All the SSI that developed after discharge did so within two weeks post caesarean section. Significant association was found between prolonged labour and development of SSI (p=0.01) and presence of ruptured membranes (p=0.013).No significant association was noted with anemia, HIV status, duration of surgery or timing of administration of antibiotics. Conclusion: The incidence of SSI at KNH was found to be high with one in five women undergoing caesarean delivery developing a SSI. Prolonged labour was found to be significantly associated with risk of developing SSI. Use of appropriate tools to prevent prolonged labour should be enforced. Routine amniotomy should also be discouraged.