April is International Caesarean Awareness Month and in 2023 in England 42% of deliveries were by Caesarean section (CS) [NHS digital, 2024], compared to just 9% in 1980, [Wloch, 2020]. CS is usually recommended if a vaginal delivery (VD) could pose risks to the mother or baby. This may be in the event of prolonged or obstructed labour or foetal distress, [Angolile, 2023].
There has been a recent increase in planned ‘Maternal Request Caesarean Sections’ (MRCS), and NICE Guidance on Caesarean Birth (2024) recommends that women who request an MRCS should be able to give birth this way.
One of the most frequent complications of CS is surgical site infection (SSI); with an estimated incidence of around 16% [Health Innovation, W England, 2023]. This is high compared to 8.6% for large bowel surgery and 9.7% for cholecystectomy, [UKHSA, 2022].
Given the short length of hospital stay – around 24 hours for a caesarean delivery [NHS UK, 2024] – the overall rate of SSI could be significantly higher, as 91% of CS SSIs occur in the community following discharge from hospital, [Public Health, Wales Report, 2018].
Post-caesarean SSI causes additional anxiety and pain for the mother. It may extend the period of hospitalisation by 4 days, and cost an additional £3,173 per patient, [Stanirowski, 2016]. A BMI over 30 kg/m2 [Wloch, 2012] and diabetes – [Wloch, 2012] are recognised risk factors for SSI.
Whilst SSIs are common, they have been described as “the most preventable” healthcare associated infection, [Leaper, 2015] and it’s estimated that around 60% of SSIs could be prevented, [Collins, 2019]. Measures including skin and wound care can be effective in helping prevent infection.
Decontamination
Staphylococcus aureus is a known risk factor for developing SSI and has been identified as the causative organism in over 40% of post-caesarean wound infections, [Wloch, 2012].
Up to 30% of people in the UK carry Staphylococcus, [Jeans, 2018] and NICE Guidelines [2019] suggest the use of a body wash “before procedures in which Staphylococcus aureus is a likely cause of a surgical site infection” as it “may reduce SSIs”. Evidence suggests “any additional costs incurred …. are likely to be more than recouped by savings associated with a lower incidence of surgical site infections.” [NICE, 2019].
Research supports the efficacy of preoperative decontamination with an octenidine-based antimicrobial. A large scale trial reported a three-fold reduction in the MSSA infection rate, after a 5 day decontamination regime which included octenisan® wash lotion, [Jeans, 2018].
Post-operative wound care
NICE: Caesarean Birth (2024) offers advice on post-operative wound care, which includes daily wound cleansing and monitoring for signs of infection.
A study of 543 women undergoing elective or emergency caesarean section included the use of wound irrigation with octenidine solution as part of an infection prevention strategy, [Stanirowski, 2016].
Following abdominal surgery, a study of 45 patients showed significant improvements in scar appearance, pain, skin elasticity, and incidence of scar hypertrophy following management with octenidine-based hydrogel compared to conventional dry wound dressings, [Matiasek, 2018].
Periwound care
The skin surrounding a wound (the periwound area) is particularly vulnerable and complications frequently occur, [Bianchi, 2012], which can contribute to delayed wound healing and increased wound size, [Woo, 2017].
As part of periwound care, octenidine containing wash mitts could have a role, on intact skin [Dhoonmoon, 2024]. A 12-month community evaluation found the use of these mitts led to a reduction in the prescription of antibiotics for wound infections, a reduction in unwarranted infections and improvements in the quality of care delivered, [Dhoonmoon, 2020].
Octenidine
Octenidine is a broad spectrum antimicrobial that is less susceptible to bacterial resistance [Spencer, 2013]; is effective in a short contact time at low concentrations, [Assadian, 2016]; and is the only antiseptic that remains active locally for up to 48 hours, [Malanovic 2020]. It helps protect against microbial contamination [Chadwick, 2016] and reduces bioburden, [Eisenbeiss, 2012].
The octenidine-containing range
octenilin® wound irrigation solution removes wound coating and biofilm; and creates an ideal environment for wound healing.
octenilin® wound gel effectively moisturises and cleans wounds to support the natural healing process.
octenisan® wash lotion for mild and gentle whole body washing against MDRO.
octenisan® wash mitts are ready-to-use for cleaning and care of the skin; also for MDRO decontamination.
octenicare® repair creme contains panthenol to support the natural regeneration of the skin and is suitable for epithelialised wounds.
Case Study
Expecting her first child, 32 year old Zoe was diagnosed as clinically obese with a BMI of 38, and therefore at increased risk of pregnancy complications. She was referred for Consultant-led care and closely monitored for pregnancy-related diabetes and hypertension. Zoe was advised to have an elective caesarean section at 40 weeks. Before admission, she followed a 5-day body-washing regime using octenisan wash mitts. Following delivery of a baby boy, she was discharged home two days after surgery and continued using wash mitts as part of her periwound care. She found them easy to use, particularly in the skin folds around her caesarean wound site. Zoe and her baby did well and she is already following a gradual weight loss programme.
References
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