CDC encourages healthcare professionals to recognize early signs and symptoms of worsening infection and sepsis

Today is world sepsis day, the Center for Disease Control (CDC) urges healthcare professionals to recognize and educate patients and their families about the early signs and symptoms of worsening infection and sepsis.

Sepsis is a Global health crisis, affecting up to 30 000 000 people a year. Maternal Sepsis is one of the five-leading cause of death during pregnancy. Early recognition and prompt treatment of maternal sepsis is necessary to improve patient outcomes.

ACOG has recently issued guidance on prevention of surgical-site infection in gynecologic surgery. The practice bulletin includes guidelines about pre-operative and intraoperative prophylaxis, procedure-based antibiotic regimen, guidelines for patients with a history of Methicillin-resistant Staphylococcus aureus (MRSA) colonization, and penicillin allergy.

Find the guidelines here. Some other articles about preventing surgical site wound infection in obstetrics and gynecological surgeries are:

What is best for Cesarean Antisepsis? Chlorhexidine-Alcohol versus Povidone-Iodine

Chlorhexidine-Alcohol is not superior to Povidone-Iodine in reducing the rate of surgical site infection in Cesarean section reports the results of Chlorhexidine-Alcohol Versus Povidone-Iodine for Cesarean Antisepsis (CAPICA) Trial published ahead of print in American Journal of Obstetrics and Gynecology.

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.

Maternal clinical risk factors for the increased rate of post-cesarean infection identified

Preincisional extended antibiotic prophylaxis does not prevent the occurrence of maternal infections that significantly contributes to increased maternal morbidity in cesarean sections.

Maternal BMI, rupture of membranes to delivery interval, race and duration of surgery are important contributing factors towards maternal infection even after prophylactic antibiotics were given according to a study published online ahead of print in Journal of obstetrics and gynecology.

FDA clears CleanCision Wound Retractor to reduce surgical site infections

Prescient Surgical got the green signal from FDA’s Center for Devices & Radiological health for de novo clearance of its CleanCision wound retraction and protection system.  The clearance could not have come at a better time because "Hospitals are increasingly focusing on infection control to improve patient care as a primary goal. Prescient's success with the CleanCision device bodes well for providers driven towards the 'triple aim' of quality of care, patient satisfaction, and reduced costs," says Brant Heise, Managing Director at Summation Health Ventures.

Use of Monocryl suture minimizes wound complications in cesarean sections - News from SMFM 2017, Las Vegas

Use of poliglecaprone 25 (Monocryl) subcutaneous suture for abdominal wound closure in Cesarean Section reduces the wound complication rate by nearly 50 % as compared to use of polyglactin 910 (coated Vicryl) according to a study that will be presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas.

Vaginal cleaning before cesarean delivery significantly reduces infection: A Systematic Review and Meta-analysis

A simple and inexpensive intervention of vaginal cleaning with an antiseptic solution before cesarean delivery brings down the rate of endometritis note the results of a Systematic Review and Meta-analysis published August 4 in Journal of Obstetrics and Gynecology.

VIDEO: “WHAT IS SEPSIS? (SEPSIS EXPLAINED IN 3 MINUTES)”

Clinical review: Updates on Cesarean Section

Here is a roundup of the latest research on Cesarean Section.

In this article:

Subcuticular skin closure after cesarean delivery with poliglecaprone 25 suture IMONOCRYL) decreases the rate of cesarean wound complications by 39% as compared with polyglactin 910 suture (Coated VICRYL) says the result of randomized control trial published ahead of print in Journal Obstetrics and Gynecology.  https://obgynupdated.blogspot.com/2017/08/use-of-monocryl-for-subcutaneous-skin.html

A simple and inexpensive intervention of vaginal cleaning with an antiseptic solution before cesarean delivery brings down the rate of endometritis note the results of a Systematic Review and Meta-analysis published August 4 in Journal of Obstetrics and Gynecology. https://obgynupdated.blogspot.com/2017/08/vaginal-cleaning-before-cesarean.html

Double layer closure of uterus during previous cesarean section results in thicker third-trimester lower uterine segment and decreases rate of uterine rupture by 3 to 5fold during trial of labor after cesarean (TOLAC) and vaginal birth after cesarean reports results of multicenter prospective cohort study published in July issue of Journal obstetrics and gynecology. https://obgynupdated.blogspot.com/2017/07/double-layer-vs-single-layer-uterine.html

Chlorhexidine-Alcohol is not superior to Povidone-Iodine in reducing the rate of surgical site infection in Cesarean section reports the results of Chlorhexidine-Alcohol Versus Povidone-Iodine for Cesarean Antisepsis (CAPICA) Trial published ahead of print in American Journal of Obstetrics and Gynecology. https://obgynupdated.blogspot.com/2017/06/what-is-best-for-cesarean-antisepsis.html

Novel Cesarean Section Scalpel that increases fetal safety during surgery unveiled.

https://obgynupdated.blogspot.com/2017/02/novel-cesarean-section-scalpel-that_6.html

A C-section rate of approximately 19 percent seems to be ideal for the health of both women and newborns.

https://obgynupdated.blogspot.com/2017/02/a-c-section-rate-of-approximately-19.html

Use of Monocryl for subcutaneous skin closure minimizes wound complications in cesarean sections

courtesy: https://www.esutures.com/product/images/full/IMG-6441.jpg

courtesy:http://media.xn--benersttning-lcb.se/2012/05/vicryl1.jpg

Subcuticular skin closure after cesarean delivery with poliglecaprone 25 suture IMONOCRYL) decreases the rate of cesarean wound complications by 39% as compared with polyglactin 910 suture (Coated VICRYL) says the result of randomized control trial published ahead of print in Journal Obstetrics and Gynecology.

Monocryl is monofilament, absorbable suture which dissolves slowly and loses strength while Vicryl is braided, absorbable suture that dissolves quickly but maintain strengths.

The type of skin suture and rate of wound infection after cesarean section has not been widely studied. In this study, the researchers compared the two sutures in term of subsequent wound complication rates (SSI, hematoma, seroma, wound separation) after a cesarean section through a Pfannenstiel skin incision followed by subcuticular closure.

This single center RCT conducted at Montefiore Medical Center, New York recruited about 520 women over a course of 1.25 years. About 263 women were randomized to receive the wound closure with monocryl while in 209 women the wound was closed with vicryl.

The groups were similar in terms of demographics, medical comorbidities and perioperative characteristics. They were followed up for a period of 30 days for wound gaping of > 1 cm in length, hematoma or seroma and surgical site infections as per Centers for Disease Control and Prevention criteria’s.

Use of monocryl was associated with significant less infection as compared to vicryl (8.8% compared with 14.4% (relative risk 0.61, 95% CI 0.37-0.99; P=.04).

The researchers concluded that,” Closure of the skin after cesarean delivery with poliglecaprone 25 suture decreases the rate of wound complications compared with polyglactin 910 suture.”

The study was also presented at the 37th annual meeting of Society for Maternal-Fetal Medicine, January 23-28 Las Vegas.

Similar results obtained after use of Glue or subcutaneous Monocryl for cesarean wound closure -- News from SMFM 2017, Las Vegas.

Skin glue: Ethicon.com 

Monocryl 

Use of Glue(Dermabond ) or subcutaneous  Monocryl results in same outcome in terms of safety, healing,  wound complications or cosmetic appearance. The choice of using one over another depends on surgeons’ choice and patient’s preference.

The study will be presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas. Cesarean sections rates are on rise, it is the most common surgery performed in U.S. hospitals. Roughly, every one in three baby is born by Cesarean Section. In-spite this, there is still no consensus or evidence about best method for skin closure in Cesarean section.

Yari Daykan and his colleagues from Dept. of Obstetrics and Gynecology at Meir Medical Center in Kfar Saba and the Sackler School of Medicine in Tel Aviv conducted a RCT, in which women undergoing a scheduled Cesarean section were randomized to either have the wound glued using Dermabond or wound closed by using subcuticular Monocryl. [1]

The scars were assessed after 2 months by using Patient and Observer Scar Assessment Scale (POSAS) scores.   The POSAS is a comprehensive scale that is designed for the evaluation of all types of scars by professionals and patients.[2]

The scar site was also evaluated at 1 month for infection, discharge, redness or dehiscence as secondary outcome of the study.

Both the study groups were comparable in terms of indications for C-section, length of surgery, BMI and other demographics.

It was seen that at 8 weeks, scars were comparable in terms of patient score, physician score and subcutaneous thickness, wound infection or wound dehiscence.

Researchers concluded that both methods are safe, equally effective and the choice depends on surgeon and patient's preferences.

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[1] http://www.smfmnewsroom.org/2017/01/skin-closure-options-for-cesarean-delivery-glue-versus-subcuticular-sutures/#more-1584

[2] http://www.posas.org/

Use of Monocryl suture minimizes wound complications in cesarean sections - News from SMFM 2017, Las Vegas.

courtesy: https://www.esutures.com/product/images/full/IMG-6441.jpg

courtesy:http://media.xn--benersttning-lcb.se/2012/05/vicryl1.jpg

Use of poliglecaprone 25 (Monocryl) subcutaneous suture for abdominal wound closure in Cesarean Section reduces the wound complication rate by nearly 50 % as compared to use of polyglactin 910 (coated Vicryl) according to a study that will be presented at the 37th  annual meeting of Society for Maternal-Fetal Medicine , January 23-28 , Las Vegas.[i]

Monocryl is monofilament, absorbable suture which dissolves slowly and loses strength while Vicryl is braided, absorbable suture  that dissolves quickly but maintain strengths.

The first ever Randomized control trial was conducted by Dr. Arin Buresch and her colleagues from Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.[ii]

Over a course of little more than a year, 550 patients undergoing non-emergency cesarean section were recruited and randomly allocated to either receive poliglecaprone(275() or 275 receiving polyglactin for subcutaneous wound closure of the Pfannenstiel abdominal incision.

The groups were comparable demographically. These patients were evaluated and compared at 30 days for wound gaping of > 1 cm in length, hematoma or seroma and surgical site infections as per Centers for Disease Control and Prevention criteria’s.

8.8% patient had wound complication in poliglecaprone 25 (Monocryl) group as opposed to 14.4% patient in Vicryl group (p=.04).

Dr. Arin Buresch concluded “The difference in wound complications may occur due to the braiding in vicryl suture which conceivably allows bacterial growth in small nooks and crevices. In the future, we hope our study will help guide the decision-making on which suture type is used when closing the skin in cesarean births.”

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[i] https://www.smfm.org/meetings/2-37th-annual-pregnancy-meeting/registration

[ii] http://www.smfmnewsroom.org/2017/01/comparing-skin-closure-options-for-cesarean-delivery-to-determine-which-method-causes-the-least-wound-complications/#more-1609