Improving post C-section outcomes

At the 5th Ethicon sponsored SSI Symposium, Melissa Whitten, consultant obstetrician at University College London Hospitals (UCLH) in London, took to the stage to talk about the work being done at the hospital to continually improve post Caesarian-section (C-section) outcomes. Ms Whitten started her presentation by bringing the audience up to date with some figures from around the country. She said: “Currently, 25% of births are C-section deliveries. The UCLH rate is higher than the national average, with around 31% of deliveries being C-section. This is partly a reflection of our tertiary status. We perform many elective preterm deliveries and deliveries of babies with complex abnormalities which require Caesarian delivery.” Of the 31% of C-sections performed at UCLH, one-third are elective and twothirds are emergency. Most C-section deliveries are carried out in the obstetric theatres. “We practice along NICE guidelines for C-section and recently went through a CNST, a Clinical Negligence Scheme for Trust assessment, which included evidencing our practice against their standards,” said Ms Whitten.

 Intraoperative antibiotics

The use of intraoperative antibiotics is an important factor in reducing the C-section SSI rate. “Depending on the clinical circumstances, infection occurs 20 times more frequently following C-section delivery, when compared with vaginal delivery. “If we did not administer any intraoperative antibiotics we could expect infection to occur in up to 10% of C-section wounds,” said Ms Whitten. Discussing other measures being undertaken to reduce post-operative SSI rates, Ms Whitten said: “UCLH has an SSI prevention bundle which takes a Trust-wide approach. We give patients information on how to achieve optimal wound healing, and how to recognise infection. We have also recently introduced MRSA screening for all women having an elective C-section delivery. This is carried out at around 34 weeks of pregnancy so that we have time to implement antibiotic prophylaxis. We will soon be implementing MRSA screening for all women antenatally. “We also advise women not to shave prior to surgery, and have moved, in the last year, to preparing the skin before surgery with 2% chlorhexidine. We also use warming blankets to maintain skin temperature and are currently looking into the use of different types of dressings and the method of observation and documentation of the wound in the post delivery surveillance period. “Our standard prophylaxis procedure follows NICE guidelines which states that a single dose of co-amoxiclav 1.5g IV is given following delivery, or cord clamping, with alternatives for penicillinallergic women.”