Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology

J Obstet Gynaecol Can. 2017 Aug;39(8):645-651.e1. doi: 10.1016/j.jogc.2016.12.037.

Abstract

Background: Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]).

Primary objective: Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre.

Secondary objective: Estimate the rate of SSIs and associated predisposing factors.

Methods: Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30.

Results: A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos.

Conclusions: Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.

Keywords: Caesarean section; cell phone; surgical wound infection.

MeSH terms

  • Adult
  • Antibiotic Prophylaxis
  • Canada
  • Cell Phone
  • Cesarean Section*
  • Cohort Studies
  • Feasibility Studies
  • Female
  • Humans
  • Internet
  • Mobile Applications*
  • Photography*
  • Postoperative Care
  • Pregnancy
  • Prospective Studies
  • Risk Factors
  • Self Report*
  • Surgical Wound Infection / diagnosis*
  • Surgical Wound Infection / prevention & control
  • Young Adult