Thursday, May 11, 2017

News from ACOG 2017: Changing gloves before abdominal closure brings down the rate of wound infection by almost 50% in Cesarean Section.


Results of a randomized controlled trial presented at the ACOG 2017 showed that changing the outer gloves before closing the abdomen decreases the wound complication of infection, cellulitis and dehiscence.

Wound infection after a cesarean section (CS) is a major cause of maternal morbidity, lengthy hospital stay and increased medical cost. The rate of surgical site infection after cesarean section range from 3% to 15%.

The nature of the procedure is such that surgeon’s and assistant’s gloves are contaminated by lower genital tract bacteria and seed an otherwise sterile operative field. Previous studies have not shown that a change of gloves decreases the rate of post-operative wound infection.   

The study was led by Dr. Buvana Reddy from Woodbury, Minnesota but the results were presented at the conference by coauthor Jonathan Scrafford, MD from University of Minnesota–Minneapolis.

A review of literature showed that only one small similar study of 92 patients was published in 2004 in Journal of Reproductive Medicine in 2004. The study concluded that “Obstetricians may decrease the number of postcesarean wound infections by having the entire team change surgical gloves after delivery of the placenta.” But, the study lacked power and the timing of change of gloves after the delivery of placenta was not very practical during the course of surgery.

The present study is larger, and focuses on a composite wound outcome score instead of just evaluating the surgical site infection and the timing of change of gloves was at the time of abdominal closure.

This single center study recruited 553 women who had a planned cesarean section at the center across a period of 15 months. Out of this cohort, data is available for a total of 250 patients in the control arm and 236 patients in the study arm who received the glove-changing intervention.

The patients were matched on demographics, total surgical time and the amount of blood loss. After statistical analysis 15 patients in the study arm suffered from wound infection as compared to 34 patients in the control group (P = .008). Statistical significant difference was also observed in wound dehiscence in the two group (5 in glove changing arm vs 14 in the control arm; P = .01)

Pre-operative vaginal preparation with antiseptic solution did not alter the results of the study.

The number need to treat for achieving the benefit of gloves changing was 14 and the added cost per procedure was just $5.



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