INCIDENCE AND RISK FACTORS OF SURGICAL SITE INFECTION AFTER CESAREAN SECTION AT THREE TEACHING HOSPITALS IN ADDIS ABABA, ETHIOPIA

Abstract

ABSTRACT Background Surgical site infection (SSI) following cesarean delivery is a major cause of morbidity and mortality, increasing both the duration of patient hospitalization and hospital costs. Nearly 18.5 million CD are performed in the world each year. Today, in Ethiopia the CD rate is at 2%; and on the contrary one of every three deliveries at SPHMMC is by CD. SSI should be suspected within 30 days of a surgical procedure. The global estimate of surgical site infections (SSI) are from 0.5–15%. Objectives To determine the incidence and risk factors of surgical site infections after CD in 3 teaching hospitals in A.A. from January 1, 2019 to March 2, 2019. Methods Hospital based cross-sectional study was employed using patient interview in three teaching hospitals in Addis Abeba, Ethiopia, from January 1, 2019 to March 2, 2019. The Centers for Disease Control and Prevention (CDC) state that SSI should be suspected within 30 days of a surgical procedure if at least one of the following symptoms is present: localized swelling, with or without purulent discharge from the wound, pain or tenderness, redness, malodor or fever. And this was used to define cases. Results Amongst the 459 mothers who underwent CDs, 68 (14.8%) developed SSI, of which 59 (86.6%) were superficial SSI and 8 (11.7%) were deep SSI and 1 (1.7%) developed organ space SSI. Mothers who were uneducated were 1.21 times more likely to have SSI (AOR=1.55, 95% CI 1.15, 2.095). Having one or more comorbidities was 2.62 times more likely to develop SSI (AOR=2.51 95% CI 1.63, 3.89). ROM>12 hours was associated with 14.22 times risk of developing SSI than those who had intact membranes (AOR=28.00 95% CI 10.08, 77.78). Prematurity was also associated with the risk of developing SSI by 1.33 times (AOR=1.30, 95% CI 1.05, 1.62). Having >5 vaginal exams has 2.89 times more risk to develop SSI (AOR=1.00 95% CI 0.35, 2.86).Mothers who had longitudinal abdominal incision had a 3.13 odds of developing SSI (AOR=3.19 95% CI 1.19, 8.58). Conclusion The results obtained in this study show a significant number of SSI which is higher than other studies done in the country. Independent risk factors that are identified are prolonged ROM, repeated vaginal exam, comorbidities, fetal prematurity and type of abdominal incision.