Effectiveness of preoperative bath using chloroxylenol antiseptic soap on the incidence of post emergency cesarean section surgical site infection at Mbarara Regional Referral hospital, Uganda: a randomized controlled trial.

Henry Lukabwe,Musa Kayondo,Baraka Munyanderu,Rodgers Kajabwangu,Jolly Joe Lapat,Dale Mugisha,Joy Muhumuza,Joseph Ngonzi,Anthony Manyang,Francis Bajunirwe,Ronald Mayanja,Francis Banya,Horace Mayengo,Asanairi Baluku

doi:10.11604/pamj.2022.41.92.23687

Abstract

IntroductionSurgical Site Infections (SSIs) constitute 15%-45% of hospital acquired infections in sub-Saharan Africa. Cesarean section (CS) increases the risk of developing sepsis by 5-20 times and is highest when the operation is emergency. Therefore, the purpose of this study was to measure the effect of chloroxylenol in reducing the incidence of post cesarean SSIs at Mbarara Regional Referral Hospital (MRRH).Methodsa randomized controlled trial was conducted at MRRH maternity ward and mothers were randomized into either control or intervention arms. The intervention was a complete body bath with chloroxylenol antiseptic soap before the operation, while the control arm participants received a standard ward pre-operative preparation procedures. All participants were followed up for 30 days and assessed using an SSI screening tool.Resultsninety-six women were randomized, and 48 were assigned to each arm. The overall incidence of SSI was 30.21%. The incidence of SSI was significantly lower in the intervention compared to the control arm (6.25% in the intervention arm versus 54.17% in the control arm) (p-value <0.001). Chloroxylenol bath was protective of SSI with a 90% risk reduction for SSI (95% confidence interval of 67%–97%).Conclusiona preoperative bath with chloroxylenol for pregnant mothers is associated with a significantly lower risk of post cesarean section surgical site infections. Health facilities with a high burden of post SSI should consider adding this simple and effective intervention to the existing infection prevention measures. Clinical Trials.gov registration (NCT03544710).

Highlights

Surgical Site Infections (SSIs) are infections that occur at or near the surgical incision within 30 days of the surgery
Chloroxylenol bath was protective of Surgical site infections (SSI) with a 90% risk reduction for SSI (95% confidence interval of 67% – 97%)
All participants recruited were included in the final analysis and no participant was lost to follow-up, and neither did any participant withdraw after recruitment

Summary

Introduction

Surgical Site Infections (SSIs) are infections that occur at or near the surgical incision within 30 days of the surgery. Cesarean section (CS) is the single most important risk factor for postpartum infections, carrying a 5 to 20-fold increase in the risk of developing sepsis, with an even higher risk when the operation is an emergency. In sub Saharan Africa, the leading cause of maternal mortality is puerperal sepsis. Surgical site infections are the commonest hospital acquired infections in sub Saharan Africa (Rothe et al, 2013) with estimates of about 15%-45% (Arabshahi and Koohpayezade, 2006, Mangram et al, 1999). In sub Saharan Africa, surgical site infections remain a substantial cause of morbidity, prolonged hospitalization and mortality. Emergency Cesarean sections have been associated with a higher risk of infections than elective Cesarean sections (Beattie et al, 1994)

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