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Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology

      Abstract

      Background

      Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]).

      Primary Objective

      Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app – how2trak) among women undergoing CS in a Canadian urban centre.

      Secondary Objective

      Estimate the rate of SSIs and associated predisposing factors.

      Methods

      Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app—how2trak—predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30.

      Results

      A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos.

      Conclusions

      Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.

      Résumé

      Contexte

      Les infections du site opératoire (ISO) sont courantes en obstétrique et représentent d'importants coûts pour le système de santé, mais elles demeurent sous-déclarées en raison de séjours à l'hôpital écourtés et de systèmes de surveillance après congé sous-optimaux. Aux fins du présent article, on entend par ISO toute infection survenue dans les 30 jours suivant une intervention approuvée par le National Healthcare Safety Network (ici, une césarienne), ce qui correspond à la définition des Centres pour le contrôle et la prévention des maladies (1999).

      Objectif primaire

      Démontrer la faisabilité d'utiliser un système de surveillance des ISO après congé reposant sur la participation des patientes et comprenant une base de données en ligne et une application pour téléphone cellulaire (how2trak) auprès de femmes ayant subi une césarienne dans un centre urbain du Canada.

      Objectif secondaire

      Estimer la prévalence des ISO et des facteurs prédisposants connexes.

      Méthodologie

      Il s'agissait d'une étude de cohorte prospective portant sur les femmes consécutives ayant accouché par césarienne dans un hôpital canadien en milieu urbain. Une application mobile, how2trak, a été utilisée pour recueillir des données prédéterminées – paramètres démographiques, comorbidités, caractéristiques de l'intervention et signes et symptômes autodéclarés d'infection – puis pour lier ces données à des photos prises par les patientes de leur incision aux jours 3, 7, 10 et 30 après l'accouchement.

      Résultats

      Au total, 105 patientes ont participé à l'étude sur 5 mois. L'âge moyen était de 31 ans, 13 % des participantes étaient diabétiques, et la plupart présentaient un faible risque de complications chirurgicales. En tout, 46 % des interventions étaient des césariennes d'urgence; 104 patientes sur 105 ont reçu une antibioprophylaxie. Quarante-cinq pour cent des patientes (47/105) ont envoyé au moins une photo; une infection du site opératoire a été détectée d'après la photo et les symptômes déclarés par la patiente au jour 10. La majorité des patientes qui ont téléversé des photos l'ont fait plus d'une fois, et 43 % ont soumis des photos jusqu'au jour 30. Les patientes diabétiques et celles qui se disaient d'origine asiatique étaient moins susceptibles d'envoyer des photos.

      Conclusions

      La surveillance après congé des ISO liées à une césarienne au moyen de l'application mobile how2trak est faisable, et le recours à cette approche devrait être approfondi.

      Key Words

      Abbreviations:

      ASA (American Society of Anesthesiologists), NNIS (Center for Disease Control National Nosocomial Infections Surveillance), PDS (post-discharge surveillance), PROM (premature rupture of the membranes), SSI (surgical site infection)
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