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)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 15,
2016
Received:
April 23,
2016
Footnotes
Competing interests: CM and RK are employees of Health Outcomes Worldwide, the makers of how2trak.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada
