glove⁢ Micro-Perforation ‌and Surgical Site Infection Risk After ⁢Cesarean Section: A Single-Center⁣ Observational Study

Abstract

Background: Cesarean section ‌(CS) ⁤is a common surgical procedure associated with a significant risk of surgical site infection (SSI). Maintaining surgical sterility is paramount, yet glove perforation, even microscopic, can⁣ compromise⁢ this. This study investigated ⁣the association between glove micro-perforation and superficial SSI ‌rates following ‌elective cesarean sections.

Methods: This single-center,observational study compared SSI rates in 537 patients⁤ undergoing elective cesarean section: 32 with documented glove micro-perforation and 505 in​ a control group without observed perforation. Exclusion criteria ⁤included pre-existing inflammatory conditions, multiple pregnancies, ASA class III ⁤or higher, midline incision, allergies⁣ to⁣ study materials, and loss to follow-up. Superficial SSI rates ⁢were the primary outcome. Statistical analysis included Mann-Whitney U tests, chi-square tests, Fisher’s exact tests, and multivariable logistic regression.

Results: ‍ The glove ⁢perforation group exhibited a substantially higher rate of superficial SSI (31.25%) compared to the control group (6.93%) (p < 0.001). multivariable logistic regression confirmed an independent association between glove micro-perforation and SSI, even after adjusting for confounding factors such as emergency CS, diabetes mellitus, obesity, surgical duration, and intraoperative blood loss. A post-hoc power analysis demonstrated sufficient statistical sensitivity (power > 99.9%).

Conclusion: Glove micro-perforation is independently⁢ associated with a substantially ⁣increased risk of superficial SSI following elective‍ cesarean section. These findings⁣ underscore the critical importance of‌ meticulous surgical technique,vigilant monitoring⁢ for glove integrity,and consideration of alternative glove ‌options to minimize perforation risk.

Introduction

cesarean section (CS) rates​ have been steadily increasing globally, ‍including in ⁢Turkey [1]. ​While CS can be ⁢life-saving, it is a major ⁤surgical intervention associated with higher morbidity compared to vaginal delivery, with surgical site infection (SSI) being a significant concern ​ [2]. SSI not only prolongs hospital stays and increases healthcare costs but also poses serious risks to maternal health, including wound dehiscence, sepsis, and even mortality [3].

Maintaining a sterile surgical field is basic to preventing SSI. However, breaches in sterile technique, even seemingly minor ones,⁢ can introduce pathogens and lead to infection. Glove perforation, whether visible or microscopic, represents a potential pathway for microbial contamination [4]. Despite advancements in glove technology, perforation remains a recognized risk‌ during surgical procedures [5].The true incidence of glove⁢ perforation is highly likely underestimated, as micro-perforations ⁣frequently enough go undetected [6]. Recent research highlights the need‌ for​ a deeper understanding of the‌ relationship between glove integrity and SSI rates, notably in‍ the context of CS. This study aimed to investigate the association between documented glove micro-perforation and the incidence of superficial SSI following elective cesarean sections in a single center. Understanding this relationship is crucial for developing targeted​ strategies to reduce SSI rates and improve ‍maternal outcomes. ‌ The increasing CS rates in Turkey [1] necessitate a focused approach to minimizing post-operative complications like SSI.

Methods

Study Design and setting

This was a single-center, observational study conducted at [Hospital Name Redacted for Privacy] between [Start Date Redacted] and [End Date Redacted]. The study was approved by the‌ institution’s ethics⁢ committee and conducted in accordance⁢ with the declaration of Helsinki. All patients ‍provided written ⁤informed consent prior to participation.

Participants

Patients undergoing elective cesarean section were eligible for inclusion. Exclusion criteria were: ⁢(1) lack ​of informed consent, (2) a history of inflammatory disease or clinical chorioamnionitis, (3) multiple pregnancies,‌ (4) american‌ Society⁣ of Anesthesiologists (ASA) physical status classification of III or higher, (5) undergoing midline skin​ incision, (6)⁤ known allergies to chlorhexidine, antibiotics, or latex, and (7) loss to follow-up during the study period.

Exposure and Outcome

The primary exposure was documented glove micro-perforation identified during the surgical​ procedure. Perforation was identified visually by the surgical⁣ team.The⁤ primary outcome was the advancement of a superficial SSI, defined according to the Centers for Disease Control ‌and‍ Prevention (CDC) ​national Healthcare Safety Network (NHSN) criteria [7]. Superficial SSI was characterized by redness, ‍swelling, and drainage within 30 days post-operatively. Deep incision or organ/space infections were specifically excluded from the analysis, as thay did not occur in ​either study group.

Sample Size Calculation

A priori sample size calculation was performed using G*Power version 3.1.9.7