Determinants of Surgical Site Infections among Post Caesarean Section Women at Thika Level 5 Hospital, Kiambu County

Abstract

Surgical site infection refers to an infection that occurs at or near a surgical incision site within 30 days post operation. Caesarean section is one of the most performed surgical procedures carried out in obstetrics and constitutes about 15% of all deliveries globally, with Latin America being the highest at 29.2%. The study aimed to assess the determinants of surgical site infection following caesarean section among women at Thika level 5 hospital. The study design was a mixed unmatched case-control study which followed women who had undergone caesarean section in maternity unit at Thika Level 5 Hospital and who had or did not have surgical site infection from delivery up to two weeks post-delivery and nurse in-charges of maternity unit. The researcher adopted a census technique to sample clients who came for review at maternal child health clinic at 14th day post caesarean section. Study participants who met the inclusion criteria were recruited into the study as they sought the routine clinical care services in the clinic. Purposive sampling was used for the nurse in charges in maternity unit and maternal child health clinic. They provided qualitative data for the study. The findings revealed that factors associated with surgical site infections among post caesarean section women at Thika Level 5 Hospital were; age, duration of labor, duration of ruptured membrane and indication of CS. Women who were aged more than 35 years were 3.82 times more likely to have surgical site infections compared to those who were aged less than 35 years [3.82 95%CI=2.67 – 11.21, p=0.007]. Women who had labor more than 8 hours were 3.12 times more likely to have surgical site infections compared to those who had labor for a period of 4 to 8 hours [OR=3.12; 95%CI=1.88 – 8.28, p=0.003]. Also, women who experienced rupture of the membrane for more than 24 hours were 3.85 times more likely to have surgical site infections compared to women that experienced membrane rapture for 24 hours or less [OR=3.85; 95%CI=2.81 – 12.03, p=0.010]. Furthermore, women who experienced prolonged labor were 6.19 times more likely to have surgical site infections compared to women who did not have prolonged labor [OR=6.19; 95%CI=3.11 – 9.54, p=0.009]. Management of Thika Level 5 Hospital should pay a close attention to the maternal, labor and health systems related factors that are likely to cause surgical site infections among post caesarean section women admitted in the facility. Also, a continuous education program for healthcare workers and young new women is necessary and can be feasible and potentially successful, given the interest expressed by healthcare workers in the management of surgical site infections.