A quality improvement project to identify the accurate rate of Post Cesarean Section Surgical Site Infections in a district hospital of Kigali City

Background: Post cesarean section infections (PCSIs) remain a burden in Low and Middle
Income Countries (LMICs) with an important need to be closely monitored and addressed.
Although, many hospitals have established PCSIs surveillance systems, these haven’t been able
to capture most of infections occurring after a patient has been discharged, leading to
inaccurately reports in PCSI rates.
Primary objective: To identify the accurate rate of post cesarean section infection in Kacyiru hospital
by April 2018.
Secondary Objective: To assess the potential risk factors associated with post cesarean section
infections in Kacyiru by April 2018.
Methodology: A new PCSI surveillance system was implemented in parallel with the existing
hospital system, from November 2017 to February 2018, targeting all women who had cesarean
section (CS) delivery. The new system observed and monitored a patient while at the hospital
(during hospitalization and readmissions) and telephone calls follow-up were made with the
patient on the 10th and 30th post-operation days after discharge.
Results: 540 women have had a CS delivery at Kacyiru hospital during the study period and 340
(63%) completed the new surveillance. The new system identified a PCSIs rate of 11.2% while
the hospital system reported 3.1%. During hospitalization and readmissions, the two systems
collected similar information, but the new system was able to identify many PCSIs after
discharge.
Women who have had a prolonged labor – longer than 12 hours - (odds ratio=5.9, p=0.003) and
those who have had rupture of membrane before CS procedure (odds ratio=2.1, p=0.024) were
found to be at high risk of PCSIs.
Conclusions: PCSIs surveillance using telephone call during post discharge period is feasible and
require relatively low cost. This method allowed identifying a disparity in the rate of reported
cases by the hospital. The new surveillance method should be implemented by the hospital on
periodic basis. An emphasis on early management of labor and close monitoring of women with
premature rupture of membranes is required.
Keywords: Post cesarean section infections, surveillance, risk factors, cesarean section.