Incidence and risk factors for surgical site infections following cesarean section in a tertiary care university hospital versus a rural hospital

Background Surgical site infection (SSI) after cesarean sections (CS) is a significant cause of maternal morbidity and represents a burden on health resources. The sepsis risks may be higher in rural communities where less attention is paid to sterile techniques and where access to recent guidelines may be more restricted. Aim of the study The aim of the present study was to identify the difference between incidence and risk factors for SSI after CS in a tertiary center university hospital and a rural public hospital in Egypt, and to determine clinically relevant independent risk factors for SSI in these two different establishments. Patients and methods In total, 437 patients attending Ain Shams Maternity University Hospital and 435 patients attending Damanhour Teaching Hospital admitted for CS were recruited in the study from January 2011 to December 2011. Women were followed up during the inpatient stay, on readmission to hospital and post discharge surveillance by phone contacts was reviewed by coordinator after 30–35 days. Results The incidence of wound complications in Ain Shams Maternity University Hospital (tertiary center) was 5.3%, whereas the incidence of wound complications in Damanhur Teaching Hospital (rural hospital) was 9%. This difference was statistically significant (P=0.039). On using a multiple logistic regression model, BMI, diabetes mellitus, steroid therapy (to enhance fetal lung maturity), wound depth, wound length, operative time, postoperative hospital stay, and presence of drain(s) were found to be the significant independent risk factors for wound complications in both hospitals. Conclusion The study documented a difference in SSI between a university hospital equipped with a special infection control unit maintaining high standards based on CDC guidelines and a teaching hospital that lacked these standards.