Assessment of Surgical Site infections following Cesarean sections in Shyira District Hospital – Rwanda, 2018 -2021

Author(s):
Jean de Dieu Hategekimana; Emmerance Igihozo Hirwa; Jean Paul Niyomugabo; Mauwa Niyitegeka

Background:

Surgical site infections (SSIs) represent significant complications following cesarean section (CS) contributing to substantial post-surgical morbidity and mortality. As one of the prevalent obstetrical surgical procedures, understanding the burden of SSIs post-CS is vital to provide targeted prevention strategies. This study explores the incidence and risks leading to SSIs following Cesarean sections at Shyira District Hospital.

Hypothesis:

We hypothesize that certain procedural aspects and preoperative measures may contribute significantly to the incidence of SSIs post-CS. Specifically, inadequate vaginal preparation, lack of preoperative antibiotics, and insufficient education on postoperative hygiene and wound care may be associated with an increased risk of SSIs.

Methods:

A retrospective descriptive study with chart reviews for all women who had surgical site infections following CS at Shyira DH from 2018-2021. We described demographics, causative CS indications and procedural aspects using frequency and proportions and described relationships using fisher’s exact test.

Results:

A total of 1871 Cesarean sections were performed at Shyira DH within the Obstetrics and Gynecological department. 94 patients were documented to have SSIs accounting for incidence rate of 5%. Among the total, the majority were farmers, constituting 84(89.4%) instances. In terms of age distribution, 43(45.7%) cases felt within the 25-35 years range, 30(31.9%) within the 15-24 years range, and 20(21.3%) in other age groups. Of the 94 patients, 50(53.2%) had attained some primary education and 38(40.0%) had achieved at least some secondary education. The most common indication for CS resulting in SSI was emergency C/S, accounting for 73(77.7%), followed by elective C/S with 21(22.3%). For 59(62.8%) of patients with SSI, the duration of hospitalization ranged from 6 to 12 days. On procedural aspects: 26(27.7%) patients underwent CS without prior vaginal preparation, 8(8.5%) patients did not receive preoperative antibiotics; 18(19.1%) patients did not receive education on personal hygiene and wound care post-CS.

Conclusions:

The frequency of SSI following CS at Shyira DH are worrisome. To effectively reduce SSI incidence, targeting procedural aspects and improving overall practices is paramount. Regular training sessions are essential for reinforcing and maintaining the competence of general practitioners, midwives, and nurses, specifically emphasizing cesarean sections and labor monitoring to minimize risks and improve overall quality of care.