Prevention of Surgical Site Infections in Gynecologic Surgery: A Review of Risk Factors and Recommendations

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

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Risk factors related to surgical site infections among surgical patients in developing world: a systematic review

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1598614458 ◽

2020 ◽

pp. 1984-1992

Author(s):

Faihan Alotaibi ◽

Faisal Alnemari ◽

Alwaleed Alsufyani ◽

Aisha Al-sanea ◽

Abeer Al-Nashri ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Developing World ◽

Surgical Site Infections ◽

Surgical Patients

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Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

International Journal for Equity in Health ◽

10.1186/s12939-020-01327-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Christophe Millien ◽

Anatole Manzi ◽

Arlene M. Katz ◽

Hannah Gilbert ◽

Mary C. Smith Fawzi ◽

...

Keyword(s):

Risk Factors ◽

Mixed Methods ◽

Black Women ◽

Uterine Fibroids ◽

Mixed Methods Study ◽

University Hospital ◽

Gynecologic Surgery ◽

Cross Sectional ◽

Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

European Journal of Inflammation ◽

10.1177/2058739220960547 ◽

2020 ◽

Vol 18 ◽

pp. 205873922096054

Author(s):

Faiz Ullah Khan ◽

Yu Fang ◽

Zakir Khan ◽

Farman Ullah Khan ◽

Zafar Iqbal Malik ◽

...

Keyword(s):

Risk Factors ◽

Transurethral Resection ◽

Surgical Site Infections ◽

Exploratory Laparotomy ◽

Cross Sectional Study ◽

Surgical Patients ◽

Related Factors ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Associated Risk Factors

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

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Risk factors for surgical site infections after pediatric cardiovascular surgery

The Pediatric Infectious Disease Journal ◽

10.1097/01.inf.0000114904.21616.ba ◽

2004 ◽

Vol 23 (3) ◽

pp. 231-234 ◽

Cited By ~ 64

Author(s):

AMANDA L. ALLPRESS ◽

GEOFFREY L. ROSENTHAL ◽

KATHY M. GOODRICH ◽

FLAVIAN M. LUPINETTI ◽

DANIELLE M. ZERR

Keyword(s):

Risk Factors ◽

Cardiovascular Surgery ◽

Surgical Site Infections ◽

Pediatric Cardiovascular Surgery

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Risk Factors for Surgical Site Infections

Plastic Surgical Nursing ◽

10.1097/psn.0b013e31818ea81d ◽

2008 ◽

Vol 28 (4) ◽

pp. 201-204 ◽

Cited By ~ 2

Author(s):

Marcia Spear

Keyword(s):

Risk Factors ◽

Surgical Site Infections

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Incidence, Risk Factors and Etiology of Surgical Site Infections in a Tertiary Care Hospital

International Journal of Current Research and Review ◽

10.31782/ijcrr.2021.sp258 ◽

2021 ◽

pp. 154-159

Author(s):

Das SK ◽

Panigrahy R ◽

Jain S ◽

Baral P

Keyword(s):

Risk Factors ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Surgical Site Infections ◽

Care Hospital ◽

Incidence Risk

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Analysis of risk factors associated with caesarean section surgical site infections: a case control study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205250 ◽

2020 ◽

Vol 9 (12) ◽

pp. 5075

Author(s):

Riya Rano ◽

Purvi K. Patel

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Subcutaneous Tissue ◽

White Blood Cells ◽

Significant Risk ◽

Surgical Site Infections ◽

Patient Characteristics ◽

Factors Associated ◽

Operative Care ◽

Duration Of Surgery

Background: Surgical site infection (SSI) is defined as infection occurring within 30 days after a surgical procedure and affecting either the incision or deep tissues at the operation site. SSIs are the most common nosocomial infections, accounting for 38% of hospital-acquired infections. Despite the advances in SSI control practices, SSIs remain common causes of morbidity and mortality among hospitalized patients. This study was undertaken with an objective to determine and analyze the risk factors associated with cesarean section SSIs.Methods: The study was carried out at Medical College and SSG Hospital, Baroda. After obtaining informed consent to be a part of the study, 140 subjects having cesarean section SSI as per the definition, were included as cases in the study. The controls (140) were also selected from the hospital subjects. The primary post-operative care was similar for the cases as well as controls. For patients who had SSI, samples of discharge from the cesarean section wound were collected and transported for culture. Antibiotics were given accordingly. Details about patient characteristics and outcomes were collected in the proforma for cases and controls and data analyzed.Results: The cesarean section SSI rate was 4.78%. Of the parameters studied, maternal age, parity, gestational age, HIV status, meconium stained amniotic fluid, amount of blood loss, previous surgery, duration of surgery were not associated with cesarean section SSI.Conclusions: Number of antenatal care (ANC) visits, haemoglobin, total white blood cells (WBC) count, pre eclampsia, premature rupture of membranes (PROM), non-progression in 2nd stage and subcutaneous tissue thickness were the independent significant risk factors associated with post-cesarean SSI.

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Risk factors for surgical site infections after caesarean section at Yaounde, Cameroon

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214309 ◽

2021 ◽

Vol 10 (11) ◽

pp. 4048

Author(s):

Pierre M. Tebeu ◽

Aurelien Kamdem ◽

Jean P. Ngou-Mve-Ngou ◽

Esther Meka ◽

Jesse S. S. Antaon ◽

...

Keyword(s):

Risk Factors ◽

Caesarean Section ◽

Surgical Site Infections ◽

Biomedical Sciences ◽

Midline Incision ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Cross Sectional ◽

Factors Associated ◽

Chi Squared

Background: Surgical site infection is the invasion by microorganisms of the tissue layers affected by the surgical procedure. Maternal morbidity from infections has been shown to be higher after caesarean section compared to the vaginal delivery. Objective of the research was to analyze the risk factors associated with surgical site infections after caesarean section.Methods: This was a cross sectional (affected/non affected) study approved by the institutional committee for ethics and research of the faculty of medicine and biomedical sciences. A total of 310 medical files were assessed, 62 files from patients with surgical site infections and 248 files from patients without any complications. The data was collected using a pretested questionnaire and analyzed using the statistical package for the social sciences (SPSS) software version 22.0. The Chi squared and the Fisher exact tests were used to assess homogeneity between the 2 groups. Odd ratio 95% confidence interval was used to assess the association between the variables.Results: The proportion of surgical site infections during the study was 1.81%. Factors associated with surgical site infections were premature rupture of membranes (OR: 2.065; 95% CI 1.051-4.05; p=0.035); the vertical midline incision (OR=5.26; 95% CI; 1.41-19.57; p=0.013) and a operation by a resident physician doctor (OR=1.98; 95% CI 1.09-3.59; p=0.02).Conclusions: A factors associated with surgical site infections after caesarean section are a premature rupture of membranes, vertical midline incision and the qualification of the practitioner.

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