Evaluation of independent risk factors associated with surgical site infections from caesarean section.

BACKGROUND: The present study assessed factors associated with the risk of surgical site infections (SSI) after a caesarean section (C-section). METHODS: Data were collected in 1682 women undergoing elective (53.9%) and emergency (46.1%) C-sections between 1st August 2020, and 30th December 2021, at a National Health Service hospital (Surrey, UK). RESULTS: At the time of C-section, the mean age was 33.1 yr (SD ± 5.2). Compared to women with BMI < 30 kg/m2, those with a BMI ≥ 35 kg/m2 had a greater risk of SSI, OR 4.07 (95%CI 2.48-6.69). Women with a history of smoking had a greater risk of SSI than those who had never smoked, OR 1.69 (95%CI 1.05-2.27). Women with a BMI ≥ 30 kg/m2 and had a smoking history or emergency C-section had 3- to tenfold increases for these adverse outcomes. Ethnic minority, diabetes or previous C-section did not associate with any of the outcomes. CONCLUSIONS: High BMI, smoking, and emergency C-section are independent risk factors for SSI from C-section. Women planning conception should avoid excess body weight and smoking. Women with diabetes and from ethnic minority backgrounds did not have increased risks of SSI, indicating a consistent standard of care for all patients.

Reduction of adverse outcomes from cesarean section by surgical-site infection prevention care bundles in maternity.

OBJECTIVE: To reduce average surgical-site infection (SSI) rates to less than 7.5%, as well as other complications by incrementally implementing an SSI prevention care bundle in maternity: (1) ChloraPrep; (2) PICO dressings, performing elective cesarean sections in a main theater rather than a labor ward and warming blankets; (3) vaginal cleansing; and (4) Hibiscrub. METHODS: In this prospective cohort study, the association between categorical variables was assessed by χ2 tests, temporal trends in the monthly percentage change of SSI were measured using the Joinpoint Regression Program v4.7.0.0. RESULTS: In all, 1682 women (mean age 33.1 ± 5.2 years) underwent either elective (53.9%) or emergency (46.1%) cesarean section. After a small initial increase (10.0%-11.8%), SSI progressively declined to 4.4% (χ2  = 22.1, P < 0.001), as did sepsis, reoperation or readmission for SSI: from 12.5% to 0.5% (χ2  = 90.1, P < 0.001). The rates of SSI fell progressively with the cumulative introduction care bundle components. The average monthly percentage change was -14.0% (95% confidence interval -21.8% to -5.4%, P = 0.004), and the average SSI rate was kept below 7.5% for the last 12 months of the study. CONCLUSION: The maternal SSI prevention care bundle is simple and inexpensive; it effectively reduces SSI after a cesarean section and should be offered routinely to women undergoing cesarean section.

Older adults have difficulty decoding emotions from the eyes, whereas easterners have difficulty decoding emotion from the mouth.

Older adults and Easterners have worse emotion recognition (than young adults and Westerners, respectively), but the question of why remains unanswered. Older adults look less at eyes, whereas Easterners look less at mouths, raising the possibility that compelling older adults to look at eyes, and Easterners to look at mouths, might improve recognition. We did this by comparing emotion recognition in 108 young adults and 109 older adults from New Zealand and Singapore in the (a) eyes on their own (b) mouth on its own or (c) full face. Older adults were worse than young adults on 4/6 emotions with the Eyes Only stimuli, but only 1/6 emotions with the Mouth Only stimuli. In contrast, Easterners were worse than Westerners on 6/6 emotions for Mouth Only and Full Face stimuli, but were equal on all six emotions for Eyes Only stimuli. These results provide a substantial leap forward because they point to the precise difficulty for older adults and Easterners. Older adults have more consistent difficulty identifying individual emotions in the eyes compared to the mouth, likely due to declining brain functioning, whereas Easterners have more consistent difficulty identifying emotions from the mouth than the eyes, likely due to inexperience inferring mouth information.