Changing wound care protocols to reduce postoperative caesarean section infection and readmission

Research from the Health Protection Agency (HPA, 2012) undertaken across 15 NHS Trusts in England identified a 9.6% surgical site infection rate among women followed-up after caesarean sections. The majority of these infections were minor (88%), however, higher wound infection rates were found among patients who were diabetic (15%) or obese (19%). Within the Wrightington Wigan and Leigh NHS Foundation Trust, the infection rate following caesarean sections was found to be approximately 12% in 2011 – higher than the average reported by the HPA of 9.6%. This rate of infection is higher than would be expected for what is considered to be a relatively ‘clean’ operation (i.e. not in an area of the body with high bacterial levels, such as the large bowel – which has a 14.7% infection rate). The rate of infection following an abdominal hysterectomy is also much lower, at 6.6% (HPA, 2012). Of some concern were the readmissions due to infection – leading to full or partial wound dehiscence – in caesarean section patients with a high body mass index (BMI), with an average of three patients readmitted per month. Women with BMI ≥35kg/m2 were noted to be the most likely to be readmitted. Readmission among this group is far from ideal, with patients having just given birth and who should be bonding with their new baby. There is also a cost to the health service in relation to bed days, opportunity costs and the loss of tariff payments as a result of readmission within 30 days of surgery (Department of Health [DH], 2012). A 3-month audit was carried out to identify the issues relating to wound infection and readmissions in the caesarean section patient population. The audit revealed: A gap in wound care knowledge among staff. A lack of ownership relating to the patient’s wound. Inadequate postoperative wound management practices. A programme of change was undertaken to reduce wound infections, wound dehiscence and readmission of post-caesarean section patients. A multidisciplinary team comprising a tissue viability nurse, infection control nurse and the obstetricians and midwives set out to reduce the overall infection rates through a programme of wound education for staff, patient education and changes to the wound care products used in this patient group.