This study investigates the incidence of post-cesarean surgical site infections (SSIs), their associated risk factors, and effective management strategies. The primary objective is to assess the incidence rate, while secondary objectives include identifying risk factors and evaluating preventive measures. Results indicate that SSIs can significantly impact maternal health, with a focus on early diagnosis and adherence to best practices to reduce complications.

1. STUDY ON INCIDENCE OF POST CESAREAN SURGICAL SITE
WOUND INFECTION,IDENTIFY ITS ASSOCIATED RISK FACTORS
AND ETIOLOGICAL AGENT ,MEASURES TO REDUCE ITS
INCIDENCE ,MANAGEMENT AND OUTCOME IN A TERITARY CARE

2. PRESENTOR-
DR. SABITHA BAANU.M
FIRST YEAR POST
GRADUATE
DEPT OF OBSTETRICS AND
GYNAECOLOGY
HOD:
DR.T.V.INDIRANI MD OG
GUIDE:
DR.THENNARASI MS OG
CO-GUIDE:
DR.GEETHA RENUKA DNB OG
DEPT OF OBSTETRICS AND
GYNAECOLOGY
INSTITUTE:
GOVT SIVAGANGAI MEDICAL
COLLEGE AND HOSPITAL

3. •Cesarean section is an operative procedure by which a fetus, placenta, and membranes are delivered
through an abdominal and uterine incision which is performed whenever abnormal conditions
complicate labor and vaginal delivery that threatening the life or health of the mother or the baby.
•In 1985, WHO declared that, the optimal threshold for cesarean section rate should be 10–15%.
•But recent studies have reported that the rate of cesarean section is rising rapidly that leads to
actual, potential, and life-long maternal and neonatal complications.
•Women having fewer children, increased maternal age, Malpresentation especially breech
presentation, Decreased frequency of forceps and vacuum delivery, Increased rate of labor
induction, obesity dramatically raises and vaginal birth after cesarean section decreased are some
of the possible explanations for increased incidence of cesarean section delivery.
INTRODUCTION

4. •Despite cesarean section a lifesaving medical intervention and procedures to the decrease adverse
birth outcome, controlling different postoperative neonatal and maternal complications are
challenging in terms of patient safety; postpartum fever, surgical site infection, puerperal sepsis
and maternal mortality are common complications of CS.
•One of the short term morbidity which takes place after CS is Surgical Site Infection (SSI).
•Globally, surgical site infections is potential complication associated with any type of surgical
procedure, and is defined as infection which occurs within 30 days of a postsurgical procedure
involving skin, subcutaneous tissue, soft tissue, or any other part of the body.
•Mothers undergoing cesarean delivery have a 5 to 20-times greater chance of getting an infection
compared with mothers who give birth vaginally.
•Even though SSIs are one among the most preventable hospital-acquired infections(HAI), it is the
second most common cause of maternal morbidity and mortality after PPH.

5. •To determine the magnitude, risk factors and
etiological agent that contribute for SSI
following cesarean delivery and measures to
reduce its incidence, management and
outcome in GOVERNMENT SIVAGANGAI
MEDICAL COLLEGE AND HOSPITAL,
which is a step ahead for preventing and
reducing the problem
AIM OFTHE STUDY

6. OBJECTIVES
• Primary Objective:
Incidence of post-cesarean SSWIs.
• Secondary Objective:
Identification of risk factors, common etiological agents, effectiveness of preventive measures, management
strategies and patient outcomes.
Study Protocol
•Study Design: Institutional Based Prospective Cohort Study.
•Study Period: 1 Year from the date of ethics committee approval.
•Setting: Department of Obstetrics and Gynaecology, Government Sivagangai Medical College and
Hospital, Sivagangai.

7. • Methodology
• Sample Size: 136
• Study design - Institutional based prospective cohort study
• Randomisation: Simple sampling done by computer generated numbers
Single Proportion - Absolute Precision Metrics
Expected Proportion 0.15
Precision (%) 6
Desired confidence level (1- alpha) % 95
Required sample size 136

8. Statistics:
Statistical analysis will be done by IBM SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0.
Armonk, NY: IBM Corp). Mean and SD will be used to summarize the data. A ‘P’ value of <0.05 will be considered as
statistically significant difference.
Statistical tests:
1.Tests of Normality
2.Chi-square tests (if applicable)
3.Other tests if appropriately required.

9. INCLUSION CRITERIA
• Women who undergone cesarean section in GSMCH during study period.
• Women above 18 years so that to give informed consent on their own.
• Both elective and emergency cesarean section.
• Women who have at least one post operative follow up or who have been monitored for specific period.
E.g- 30 days post cesarean to detect wound infection.
• Women who have provided informed consent to participate in he study allowing the collection and
analysis of their medical data.
• Women who have stayed in the hospital for a minimum duration post cesarean to ensure adequate initial
observation for early signs of infection.

10. EXCLUSION CRITERIA
• Women with pre-existing infection that could influence wound healing. Eg- Active infection at
the time of surgery.
• Women with chronic illness that significantly affect immune function or wound healing. Eg- AIDS
• Women who receiving immunosuppressive therapy that could have affect infection rate and wound
healing. Eg- On chemotherapy, On steroids treatment.
• Women who do not comply with post operative follow up.
• Women with incomplete medical records or insufficient data to assess risk factors, surgical details
adequately.
• Women who do not provide informed consent to participate in the study.

11. INCIDENCE
The incidence of post-
cesarean SSWI varies
widely, reported to be
between 3% and 15%,
depending on factors
like geographic
location, healthcare
settings, and patient
demographics.

12. RISK FACTORS
• PRE OPERATIVE
• INTRA OPERATIVE
• POST OPERATIVE

13. PREOPERATIVE FACTORS
• Increased maternal age, Previous cesarean delivery, malnutrition.
• Obesity: Higher body mass index (BMI) increases the risk of infection.
• Diabetes: Both gestational and pregestational diabetes are associated with a
higher incidence of SSWI.
• Prolonged labor: Extended duration of labor before the cesarean increases
infection risk.
• Chorioamnionitis: Infection of the fetal membranes can lead to SSWI.
• Preoperative anemia: Reduced immune response and healing capability.

14. INTRAOPERATIVE FACTORS
• Type of cesarean: Emergency C-sections have a higher infection risk compared to
elective ones.
• Duration of surgery: Longer operative times are associated with a higher risk.
• Surgical technique: Techniques that cause more tissue trauma or use of certain types
of sutures can influence infection rates.
• Antibiotic prophylaxis: Failure to administer appropriate antibiotics prior to surgery.

15. POSTOPERATIVE FACTORS
• Postoperative care: Poor wound care and hygiene can increase the risk
• Hospital environment: Inadequate infection control practice .
• Patient compliance: Non-adherence to postoperative care instructions.

16. ETIOLOGICAL AGENT OF SSI:

17. Data Collection:
Demographic and Socioeconomic Data
Age
Body Mass Index(BMI)
Education level
Occupation
Obstetric History
Parity(number of previous pregnancies)
History of previous cesarean sections
Complications in previous pregnancies
Medical History
Pre-Existing Medical conditions(e,g- Diabetes, Hypertension)
Allergies
Medications Currently taken (Especially antibiotics and immunosuppressive
drugs)
Smoking and Alcohol use

18. Surgical Details
Type of cesarean section (elective or emergency)
Indication for cesarean section
Duration of surgery
Type of anesthesia used(e.g- General, Spinal, Epidural)
Intraoperative Blood loss
Type of skin incision(e.g- Pfannenstiel, vertical)
Type of uterine incision(e.g- low transverse, classical)
Intraoperative complications
Post-Operative care
Prophylactic antibiotic use(type, dose, duration)
Wound care practices(e.g- type of dressing, frequency of changes)
Use of any additional preventive measures(e.g- wound protectors, negative pressure wound
therapy)

19. Follow-up and Monitoring
Frequency and schedule of post-operative follow up visits
Monitoring parameters: vital signs, signs of infection(redness, swelling, pain, discharge),
wound healing progress
Duration of hospital stay
Infection Data
Date and time of onset of surgical site infection(SSI)
Clinical signs and symptoms of infection(e.g- Fever, purulent discharge)
Classifications of SSI(superficial, deep, organ/space)
Laboratory and microbiological data: wound swab culture results(type of organism, antibiotic
sensitivity)
Blood culture results(if applicable)
Complete blood count(CBC)
C-reactive protein(CRP) levels

20. PARAMETERS TO BE MONITORED:
Variables Category
Age < 30
> 30
Residence Urban
Rural
Marital status Married
Others
Educational status Educated
Uneducated
Parity
Primi-Para
Multi Para
Grand multi Para
ANC visit
No
Yes

21. Variables Category
Duration of labor
Not in labor
< 24hrs
24hrs
Gestational age
< 37wks
37_40wks
> 40wks
Number of vaginal examinations
Not done
1- 4
> 5
Duration of membrane rupture
Intact
Ruptured < 12hrs
Ruptured >12hrs
Present of meconium
Yes
No
Present of chorioamninitis
Yes
No
History of abortion
Yes
No
History of previous C/S
Yes
No

22. Variables Category
Who perform the operation
Emergency surgeon
Gynecologist
Preoperative HCT
< 30%
> 30%
Type of CS
Emergency
Elective
Type of anesthesia
Regional
General
Duration of operation
< 60minutes
> 60minutes
Type of abdominal incision
Transverse
Vertical
Prophylactic antibiotics
Yes
No
Post-operative antibiotics Yes
Number of dose of antbiotics Multiple dose
Post-operative HCT
< 30%
> 30%
Length of hospital stay
< 8 days
> 8 days
Blood transfusion
Yes
No

23. Investigations
• Hb% with RBC indices
• TC, DC
• Urine routine including urine albumin
• Weight
• Culture and sensitivity
• Swab from the wound
• Blood Culture
• Urine Culture
• High Vaginal Swab
• Kirby Bauer disc diffusion method to identify sensitivity of antibiotics
• ESR
• CRP (C Reactive Protein)
• LFT
• RFT
• Fundus examination of eyes
• RBS
• HbA1C level
• USG Abdomen and Pelvis

24. MEASURES TO REDUCE INCIDENCE
Preoperative Measures
• Optimize maternal health: Managing diabetes, obesity, and other comorbidities.
• Preoperative antibiotics: Administering prophylactic antibiotics 60 minutes before
incision.
• Skin preparation: Using antiseptic solutions like chlorhexidine-alcohol for skin
disinfection.

25. PROPHYLACTIC MEASURE WITH AZITHROMYCIN

26. INTRAOPERATIVE MEASURES
• Surgical technique: Minimizing tissue trauma and using appropriate suturing
techniques.
• Reducing operative time: Efficient surgical practices to minimize exposure
time.
• Maintaining sterile environment: Adhering to strict aseptic techniques.

27. POST OPERATIVE MEASURES
• Wound care: Educating patients on proper wound care and hygiene.
• Early mobilization: Encouraging movement to reduce the risk of complications.
• Monitoring: Regular monitoring for early signs of infection.

28. MANAGEMENT
• Diagnosis
• Clinical signs: Redness, swelling, pain, and discharge at the surgical site.
• Laboratory tests: Blood tests and cultures to identify the causative organism.
• Treatment .
• Antibiotics: Broad-spectrum antibiotics initially, followed by culture-specific therapy.
• Wound care: Regular cleaning, dressing changes, and, if necessary, surgical
debridement.
• Supportive care: Ensuring adequate nutrition and hydration.

29. Proforma
NAME OF THE PATIENT:
AGE: SEX:
IP /OP No:
Address:
OCCUPATION:
SOCIOECONOMIC CLASS:
OBSTETRIC SCORE:
PAST HISTORY:
TREATMENT HISTORY:
MENSTRUAL HISTORY:
MARITAL HISTORY:
OBSTETRIC HISTORY:
PERSONAL HISTORY:
FAMILY HISTORY:
GENERAL PHYSICAL EXAMINATION:
Built
Nourishment
Ht
Wt
BMI

30. On examination:
Vitals-
BP:
PR:
RR:
Spo2:
SYSTEMIC EXAMINATION:
CVS:
RS:
CNS:
Per ABDOMEN:
PROVISIONAL DIAGNOSIS
PROCEDURE DONE
INVESTIGATIONS: PREOP POSTOP
Complete blood count:
Total count:
Hb:
Platelet:
PCV:
RBS:
Blood Urea/Sr.Creatinine:

31. Urine routine including Urine albumin:
LFT:
S.Bilirubin:
SGOT/SGPT:
Culture and sensitivity:
Examination of eyes(fundus)
CRP
ESR
BLOOD CULTURE:
URINE CULTURE:
HIGH VAGINAL SWAB:
SWAB TAKEN FROM THE WOUND:
USG ABDOMEN $ PELVIS:
Incidence of complications during follow-up: Yes/No
If yes:
Management:
Outcome:

33. CONCLUSION
• The incidence of post-
cesarean SSWI can be
significantly reduced through
the identification and
management of risk factors,
adherence to best surgical
practices, and thorough
postoperative care.
• Early diagnosis and prompt
treatment are crucial for
favorable outcome

34. OUTCOME
• Short-term: Effective management can lead
to wound healing without significant
complications.
• Long-term: Most women recover fully, but
severe infections can result in prolonged
recovery and potential long-term
complications like scarring or chronic pain.
• Quality of life: Early and effective treatment
can minimize impact on the mother's quality
of life and ability to care for the newborn

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36. THANK YOU