Risk factors for infection following cesarean delivery: an interventional study

Objective: To identify risk factors for infection following cesarean delivery (CD) and to investigate the effect of intervention on modifiable risk factors (MRF). Methods: A prospective, two-period cohort intervention study. All CD performed between September 2006 and August 2007 (era 1) and between July 2009 and June 2010 (era 2) were included. Infection control program was implemented before era 2 and included a refresher course in aseptic and scrub techniques to all surgical teams. Infectious morbidity was recognized up to 30 days from the operation. Risk factors were identified by multiple logistic regressions. Results: A total of 1616 women included and analyzed during both eras. Logistic regression revealed that residency (rural as compared to urban), obesity and urgency of the CD were significant risk factors for infection. Prior to intervention, senior obstetricians had a lower infection rate than senior gynecologists (p = 0.02). Within both groups, the incidence in era 2 decreased and was comparable (obstetricians: 5.7 vs. 1.6%; p = 0.005; gynecologists: 12.7 vs. 1.1%; p = 0.003). Among the group of scrub nurses who took part in less than 20 CD during era 1, the intervention reduced significantly the infection rate during era 2 (p = 0.0002). Conclusion: Surgical team is a MRF for infection following CD. Intervention decreased this unintended clinical effect attributed to surgical teams.