Getting Back to Basics – reducing post-caesarean infections in rural and remote regions.
Charlotte Moss1, Jasmin Sekhon2, Jared Watts3
1 King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, charlotte.moss@health.wa.gov.au
2 King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, jasmin.sekhon@health.wa.gov.au
3 Rural Clinical School of Western Australia, PO Box 2293, Kununurra, WA, 6743, jared.watts@rcswa.edu.au
Noting a threefold higher rate of post-operative caesarean section infections in the west Kimberley, an audit was undertaken to determine potential underlying factors. Results did not demonstrate any statistically significant concerns related to surgical technique, surgeon or theatre team, but a strong association with patient factors and poorer social determinants of health. This included patients coming from overcrowded housing and remote communities and other host factors such as diabetes mellitus and obesity. Therefore, an evidence-based package was implemented at the hospital with the intent to reduce bacterial load and mitigate the impact of poor underlying social determinants of health.
To determine any effect of the package, a retrospective observational longitudinal audit study was undertaken. This included all women having a caesarean section in Broome Hospital between 1 January 2019 and 1 May 2019 or 1 January 2021 and 1 May 2021. The main outcome measure was infection within six weeks post-caesarean section. This study found a statistically significant improvement in post-operative infection rates in women between the audit periods. (41.7% vs 11.6%, P = 0.002).
Noting the positive findings of the audit, attempts have been undertaken to roll out the package to other hospitals with varying success. There have also been difficulties in maintaining the program within the primary hospitals. Further discussion of the elements of the package and the successes and challenges will be highlighted in this presentation.