Incidence and risk factors associated with surgical site infection following cesarian section at Kibungo Referral Hospital, Rwanda – A prospective cohort study

Abstract

Introduction: Cesarian section (CS) is lifesaving both for the mother and the baby. Worldwide, there has been an increase in the incidence of CS. However, complications may arise postoperatively for both mother and newborn. Our aim was to determine the incidence rate of post-CS surgical site infection (SSI), identify factors associated with SSI, and identify the most frequent microorganisms associated with the presence of post-CS SSI.Methods: This is a prospective cohort study conducted at KRH, including all CS, performed from February to April 2020. Patient’s demographics, operative management, and outcomes were analyzed. Results: A total of 201 patients aged between 15 to 47 years were operated on and 3.48% developed SSI. 90% were from Ngoma district, 47% had secondary education followed by 36% with primary education. The majority (97%) had no comorbidities. Povidone and chlorhexidine combined was the most commonly used disinfectant. 53% were emergencies and 92% of CS were performed by general practitioners. The average duration of operation was between 30 to 45minutes. Showering prior to operation (RR=0.39) at 95% CI [0.005-0.29], not shaving 30 minutes prior to incision (RR: 25.5) at 95% CI [3.5-18.7] and use of both povidone and chlorhexidine for skin preparation (RR= 0.15) at 95% CI [0.1-1.6] are associated with reduced risk of developing SSI. Obstructed labor/dystocia ((RR=4.55) at 95%, CI [1.6-45.4]) increases the infection risk. Staphylococcus aureus was the most frequently isolated microorganism in post-CS SSI patients.Conclusion: Active hospital infection services and adherence to evidence-based guidelines for SSI prevention measures would reduce the post-CS SSI incidence rate and improve patient care.