Since 2006, all health boards in Wales that deliver babies by Caesarean section are required by the Welsh Government to participate in surveillance to provide the associated infection rate with the procedure. Data are collected on all elective (or planned) and emergency procedures. Data collected includes demographic details of the patient, specific information during the procedure itself, particularly around the type of skin closure used (e.g. sutures used). Importantly, data are captured on whether a mother develops an infection after the surgery and this can be recorded for up to 30 days after surgery. Details are recorded on the type of infection that develops and if any bacteria are involved, including treatment with antibiotics. The patients’ risk of developing an infection is determined by collecting data on the patient BMI, the health of the patient before surgery, the nature of the wound and the length of the operation. For this scheme, the majority of midwives and surgical teams collect data on a paper-based form developed before returning to Public Health Wales for analysis. To ensure infections are captured, follow-up of the mother post-discharge occurs within the community by the community midwife.
The C-section SSI surveillance protocol includes detail on the data capture method used and analysis of the data (C-Section SSI surveillance protocol).
The following flow is recommended to define a C-section SSI in the community for surveillance purposes. The following patient information and wound care leaflet is recommended to mothers on leaving hospital
HARP has developed an SSI training package specific to C-section surgery that includes a training booklet and a presentation for local training, complete with trainer notes.
Details on the e-learning module available for training can be obtained by contacting HARP (harp@wales.nhs.uk)
Further information on risk factors associated with developing an infection after a C-section and evidence based interventions to reduce infections can also be downloaded
Feedback of data collected via reports are quarterly to hospitals themselves and published data on an annual basis at a Wales and hospital level. Hospitals are able to view progress on their infection numbers / rates and compliance with the scheme on an NHS dashboard