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Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta‐analyses
Author(s) -
Martin EK,
Beckmann MM,
Barnsbee LN,
Halton KA,
Merollini KMD,
Graves N
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15125
Subject(s) - caesarean section , perioperative , section (typography) , medicine , surgical site infection , meta analysis , systematic review , general surgery , best practice , intensive care medicine , surgery , medline , pregnancy , computer science , political science , biology , genetics , law , operating system
Background Surgical site infection ( SSI ) following caesarean section is a problem for women and health services. Caesarean section is a high volume procedure and the estimated incidence of SSI may be as high as 9%. Objectives The objective of this study was to identify a suite of perioperative strategies and surgical techniques that reduce the risk of SSI following caesarean section. Search strategy Six electronic databases were searched to systematically review literature reviews, systematic reviews and meta‐analyses published from 2006 to 2016. Search terms included: endometritis, SSI , caesarean section, meta‐analysis, review, systematic . Selection criteria Studies were sought in which competing perioperative strategies and surgical techniques relevant for caesarean section were identified and quantifiable infection outcomes were reported. General infection control strategies were excluded. Data collection and analysis Data on study characteristics and clinical effectiveness were extracted. Quality, including bias within individual studies, was examined using a modified A Measurement Tool to Assess Systematic Reviews ( AMSTAR ) checklist. Recommendations for SSI risk‐reducing strategies were developed using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) approach. Main results Of 466 records retrieved, 44 studies were selected for the evidence synthesis. Recommended strategies were: administer pre‐incision antibiotic prophylaxis, prepare the vagina with iodine‐povidone solution and spontaneous placenta removal. Conclusions We recommend clinicians implement pre‐incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal as an infection control bundle for caesarean section. Funding Queensland University of Technology. Tweetable abstract Infection control for caesarean: pre‐incision AB prophylaxis, vaginal prep, spontaneous placenta removal.