Cesarean delivery wound infection in high-risk patients

Abstract

Objective: To determine whether simple inexpensive measures can reduce the frequency and severity of cesarean delivery wound infections in high-risk patients in a nonteaching hospital.Methods: The charts of 286 patients were reviewed for duration of membrane rupture, duration of labor, number of pelvic examinations, patient’s weight, and coexisting medical conditions. Office visits, at least two for each patient, after hospital discharge also were reviewed for evidence of wound infection. The standard CDC criteria were utilized. The special measures were taken in January 1992. Surgical Techniques: No skin shaving was done. The abdominal wall was scrubbed with soap suds for 3 minutes before drying and “painting.” Copious irrigation with 3–4 liters of lactated Ringer’s was used in the peritoneal cavity, and 1/2 to 1 liter was used in the incision after fascial closure. Nothing was allowed to touch the wound after irrigation. Irrigation solution was poured 12 inches above the patient to dislodge debris. Gloves were changed after extraction of the fetal head from low in the vagina, especially with ruptured membranes. Gloves also were changed before closure of the abdominal wall. Ninety-five percent of the patients were on Medicaid.Results: Of 286 patients, 15% had elective repeat cesarean deliveries, 70% had primary cesarean deliveries, 8% had diabetes and were taking insulin, and 15% percent weighed more than 180 lb. No wound infections were diagnosed in the hospital. One questionable wound exudate was diagnosed after discharge in the office, with negative culture, for an incidence of 0.33%. No patient was readmitted to the hospital after discharge for wound infection.Conclusions: Duration of labor, number of pelvic examinations, stage of labor, and diabetes made no influence on the incidence of wound infection. With simple inexpensive measures, serious wound infection can be completely eliminated and minor infections could be a rare event.