Surgical Site Infection after Cesarean Delivery in Times of COVID-19

Abstract Objective To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections. Methods A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation asml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period. Results There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period. Conclusion The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement.摘要 目的：分析新型冠状病毒肺炎（COVID-19）疫情对个人防护装备及用品（personal protective equipment and products, PPEP）消耗量的影响，以及巴西接受剖宫产术的非新冠肺炎患者的手术部位感染（surgical site infection, SSI）发生频率。方法：本研究为回顾性研究，纳入巴西南里奥格兰德州阿雷格里港某未作为新冠肺炎诊疗定点服务机构的公立教学医院产科单元，对比该市报告首例新冠肺炎病例前后的月度时段，分析剖宫产术后PPEP消耗量与SSI的发生情况。PPEP消耗量以口罩、手套、手术衣、帽子的使用单位数，以及手卫生用醇类消毒剂或皂液的asml/患者·日数进行量化。SSI指数以研究期间每月剖宫产手术总例数中SSI病例的占比进行计算。结果：所有监测的PPEP项目消耗量均有所上升：疫情前期一次性口罩消耗量中位数为1450单位，疫情后期为2550单位，增幅达75.9%。SSI发生率下降49%，疫情前期中位数为1.74，疫情后期为0.89。结论：PPEP消耗量的上升可能缘于新冠肺炎疫情出现后，医护人员采取了更为规范的安全操作流程，而这一变化或直接导致了SSI发生率的下降。尽管此次疫情危机形势严峻，但可以认为，极端情境能够带来宝贵的反思与改进契机。