Pathway to Optimizing C-Section Wound Healing The Health Protection Agency suggests that 1 in 10 women undergoing Caesarean section (C-section) may develop a wound infection. It is considered higher than other similar types of surgery. The risk of wound infection is increased by smoking, diabetes, poor nutrition, and being overweight. This makes emergency C-sections more challenging as the patient will not have sufficient time to reverse or minimise these risk factors. This article provides a concise overview of Surgical Site Infection (SSI) symptoms and risks, and a pathway to prevent SSI after C-Section, to optimize healing of the surgical wound.
Introduction
W
ound infection is defined as the colonization of the wound by proliferating bacteria to a degree which ellicits from the host a local, spreading and/ or systemic response. The increasing number of microorganisms in the wound causes the development of a range of virulence factors which overcome the defences of the host, which leads to local tissue damage and compromises normal wound healing.1,2,3
Surgical Site Infection (SSI) is a common complication following C-section, and the procedure has higher rates of this than other surgeries, affecting 1.8 - 9.2% of patients undergoing this procedure.7 The consequences are potentially devastating for the individual and costly for hospitals and healthcare systems. The Center for Disease Control (CDC) defines SSI as an infection at or near the site of a surgical procedure performed within the last 30 days, or within 90 days if the procedure involved the removal of an implant. The reduction of a patient’s risk factors is the main focus of strategies intended to prevent SSI. In addition to attempts to identify and reduce these individual patient risk factors, there is potential scope for the use of topical antimicrobials to prevent wound infection in high risk wounds.4 This potential should be carefully considered against the risks and established principles of antimicrobial stewardship. Table 1:
Mrs Cerys Stowe Lead Tissue Viability Clinical Nurse Specialist Basingstoke, United Kingdom
Patient
Procedure-Related
Facility
Preoperative
Intraoperative
Glycemic control
Complex surgery
Room ventilation
Pre-existing infection
Duration of surgery
Nicotine use, alcohol
Wound classification
Operating room traffic
Inadequate skin preparation
Blood transfusion
Nutritional status (albumin <3.5)
Emergency
Equipment sterilization
Hair removal
Maintenance of asepsis
Antibiotic choice, administration, duration
Poor-quality surgical hand scrubbing and gloving
Obesity
Immunosuppression
Hypothermia (temperature <36°C)
Advanced age
Poor glycemic control
Recent radiotherapy History of skin or soft tissue infection
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Wound Masterclass - Vol 1 - September 2022