Surgical site infection following caesarean section carries significant morbidity and cost. Despite using the same skin incision, surgical site infection following caesarean section is 9.6% compared to 2% following abdominal hysterectomy.¹

If one could explain why caesarean section carries a higher risk of surgical site infection than a hysterectomy, then it would follow that steps could be taken to reduce surgical site infection following caesarean section.

Hypothermia increases rates of surgical site infection. At caesarean section much more fluid is spilled onto the wound than at hysterectomy (Intraoperative loss is approximately 500 mls blood, 1 litre liquor) We wondered if the latent heat of vaporisation of spilled fluid caused surgical site hypothermia. This might explain the high infection rates following caesarean section.

Pre and post op surgical skin temperatures of a series of women undergoing caesarean section were recorded. And compared against the pre and post op skin temperatures of a series of women undergoing procedures other than caesarean section (And that took broadly the same time).

Results Surgical site skin temperature following caesarean section was very much lower than after other surgical procedures – suggesting that vaporisation of fluid spilled at the time of surgery causing surgical site hypothermia causes the high infection rate post caesarean section. The next step is to develop strategies to avoid surgical site hypothermia and determine if these cause reduction in caesarean section surgical site infection rates.

Reference

1. HPA. Healthcare-associated infections and antimicrobial resistance. 2009/10 [www. HPA.org.uk]. Accessed 8 October 2012