Antibiotics prophylaxis in connection with caesarean section--guidelines at Norwegian maternity departments.

BACKGROUND: The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations. MATERIAL AND METHODS: All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department's written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS). RESULTS: 38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward. INTERPRETATION: Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.

[Postoperative wound infections--systematic recording for seven years at a local hospital]. / Postoperative sårinfeksjoner--sju års registrering ved et lokalsykehus.

BACKGROUND: Norwegian law requires all health institutions to have programmes in place for systematic surveillance of infections. Recording of wound infections is mandatory in surgical departments. We here present data from seven years of follow-up at a local hospital. MATERIAL AND METHODS: 2,421 patients, who comprised the study population, underwent orthopaedic procedures (acute or elective) from 1.2.1998 through 31.12.2004. Patients with orthopaedic implants were followed up for 12 months after the operation and other patients for four weeks. Quarterly reports were prepared and preventive measures undertaken. RESULTS: One patient was lost to follow-up. 158 infections (mean: 6.5% of the patients, annual variation: 4.8-10.5%) were recorded; 56 of these were deep (2.3% of the patients) and 102 superficial. 28 of the deep infections occurred in primary hip replacement operations. The incidence of infections during three months varied from 1.6% to 8.9%. 72% of the infections were discovered after hospital discharge. Deep hip infections were detected from six days up to 18 months post-operatively. Multivariate analysis showed a positive correlation between surgeon and deep hip infection in primary hip replacement surgery. DISCUSSION: Systematic recording of post-operative wound infections is a time-consuming, but important quality assurance measure. Recording should be carried out for one year in hip replacement surgery and for at least four weeks after other operations. The incidence of infections varies largely during three months and long-term recording is required to obtain valid data in a single hospital. Deep infections in primary hip replacement surgery may be operator-dependant.