Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-01T14:52:08.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreased Rates of Nosocomial Endometritis and Urinary Tract Infection After Vaginal Delivery in a French Surveillance Network, 1997–2003

Published online by Cambridge University Press:  02 January 2015

Louis Ayzac ,
Emmanuelle Caillat-Vallet ,
Raphaële Girard ,
Catherine Chapuis ,
Florence Depaix ,
Anne-Marie Dumas ,
Chantal Gignoux ,
Catherine Haond ,
Joëlle Lafarge-Leboucher  and
Carine Launay
...Show all authors
Louis Ayzac*
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Emmanuelle Caillat-Vallet
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Raphaële Girard
Affiliation:
Infection Control and Hospital Epidemiology Unit, University Hospital, Pierre Bénite, France
Catherine Chapuis
Affiliation:
Department of Infection Control Rhône Sud, University Hospital, St. Genis Laval, France
Florence Depaix
Affiliation:
Department of Infection Control Rhône Sud, University Hospital, St. Genis Laval, France
Anne-Marie Dumas
Affiliation:
Department of Obstetrics and Gynecology, University Hospital, Pierre Bénite, France
Chantal Gignoux
Affiliation:
Departments of Obstetrics and Gynecology, University Hospital, Lyon, France
Catherine Haond
Affiliation:
Infection Control Rhône Centre, University Hospital, Lyon, France
Joëlle Lafarge-Leboucher
Affiliation:
Department of Obstetrics and Gynecology, University Hospital, Pierre Bénite, France
Carine Launay
Affiliation:
Obstetrics and Gynecology, University Hospital, Lyon, France
Françoise Tissot-Guerraz
Affiliation:
Infection Control and Hospital Epidemiology, University Hospital, Lyon, France
Agnès Vincent
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
Jacques Fabry
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, University Hospital, St. Genis Laval, France
*
Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, Villa Alice, Hôpital Henry Gabrielle, 20 route de Vourles, BP 57, 69530 Saint Genis Laval Cedex, France (louis.ayzac@chu-lyon.fr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives.

To identify independent risk factors for endometritis and urinary tract infection (UTI) after vaginal delivery, and to monitor changes in nosocomial infection rates and derive benchmarks for prevention.

Design.

Prospective study.

Methods.

We analyzed routine surveillance data for all vaginal deliveries between January 1997 and December 2003 at 66 maternity units participating in the Mater Sud-Est surveillance network. Adjusted odds ratios for risk of endometritis or UTI were obtained using a logistic regression model.

Results.

The overall incidence rates were 0.5% for endometritis and 0.3% for UTI. There was a significant decrease in the incidence and risk of endometritis but not of UTI during the 7-year period. Significant risk factors for endometritis were fever during labor, parity of 1, and instrumental delivery and/or manual removal of the placenta. Significant risk factors for UTI were urinary infection on admission, premature rupture of membranes (more than 12 hours before admission), blood loss of more than 800 mL, parity of 1, instrumental delivery, and receipt of more than 5 vaginal digital examinations. Each maternity unit received a poster showing graphs of the number of expected and observed cases of UTI and endometritis associated with vaginal deliveries, which enabled each maternity unit to determine their rank within the network and to initiate prevention programs.

Conclusions.

Although routine surveillance means additional work for maternity units, our results demonstrate the usefulness of regular targeted monitoring of risk factors and of the most common nosocomial infections in obstetrics. Most of the information needed for monitoring is already present in the patients' records.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 487 - 495
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Allen, VM, O'Connell, CM, Liston, RM, Baskett, TF. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol 2003;102:477–482.Google Scholar
2.Gibbs, R. Clinical risk factors for puerperal infection. Obstet Gynecol 1980;55 (5Suppl):178S–184S.CrossRefGoogle ScholarPubMed
3.Kressel, A, Linnenmann, C. Nosocomial infection in obstetrical patients. In: Mayhall, C, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2004:927–935.Google Scholar
4.Liu, S, Liston, RM, Joseph, KS, Heaman, M, Sauve, R, Kramer, MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176:455–460.Google Scholar
5.Malavaud, S, Bou-Segonds, E, Berrebi, A, Castagno, R, Assouline, C, Connan, L. Determination of nosocomial infection incidence in mothers and new-borns during the early postpartum period [in French]. J Gynecol Obstet Biol Reprod (Paris) 2003;32:169–174.Google Scholar
6.Vincent-Boulétreau, A, Caillat-Vallet, E, Dumas, AM, et al. Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000 [in French]. J Gynecol Obstet Biol Reprod (Paris) 2005;34:128–136.Google Scholar
7.Société Française d'Hygiène Hospitalière. Guide pour la surveillance et la prevention des infections nosocomiales en maternity. Deuxieme edition: Laboratoire Roche-Nicholas, 2003. Available at: http://www.sfhh.net/telechargememt/recommandations_guidematernite.pdf. Accessed May 9, 2008.Google Scholar
8.Mead, P, Hess, S, Page, S. Prevention and control of nosocomial infections in obstetrics and gynecology. In: Wenzel, RP, ed. Prevention and control of nosocomial infections. 2nd ed. Baltimore: Williams & Wilkins; 1993:776–795.Google Scholar
9.Horan, TC, White, JW, Jarvis, WR, et al. Nosocomial infection surveillance, 1984. MMWR CDC Surveill Summ 1986;35:17SS–29SS.Google Scholar
10.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
11.Mattock, N, Casna, R, eds. Pregnancy, childbirth, postpartum and newborn care: a guide of essential practice. Geneva: World Health Organization; 2003:189.Google Scholar
12.Tissot-Guerraz, F, Moussy, L, Agniel, F, et al. Hospital infection in the maternity department: 3 years of surveillance in 9,204 deliveries of which 1,333 were cesarean sections [in French]. J Gynecol Obstet Biol Reprod (Paris) 1990;19:19–24.Google Scholar
13.Girard, R, Chemorin, C, Lafarge, J, et al. Diminution de l'incidence des infections nosocomiales au cours d'une surveillance en obste'trique. Méd Hyg 1998;56:1864–1869.Google Scholar
14.From the Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est. Available at: http://cclin-sudest.chu-lyon.fr/reseaux/mater/mater.htm. Accessed May 9, 2008.Google Scholar
15.Newton, ER, Prihoda, TJ, Gibbs, RS. A clinical and microbiologic analysis of risk factors for puerperal endometritis. Obstet Gynecol 1990;75(3 Pt 1):402–406.Google Scholar
16.DuPlessis, HM, Bell, R, Richards, T. Adolescent pregnancy: understanding the impact of age and race on outcomes. JAdolesc Health 1997;20:187–197.Google Scholar
17.Criscuolo, J, Kibler, M, Micholet, M, et al. The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients [in French]. JGynecol Obstet Biol Reprod (Paris) 1990;19:909–918.Google Scholar
18.Dumas, A, Girard, R, Vincent-Bouletreau, A, et al. Does intrapartum antibiotic prophylaxis decrease the incidence of maternal group B streptococcal infections? J Hosp Infect 2004;58:85–93.Google Scholar
19.Queuille, E, Girard, R. Qu'est ce qui favorise l'infection urinaire de la femme accouchant par voie basse sous analgesie peridurale? Hygiène S 1999;VII:432–433.Google Scholar
20.Liu, S, Heaman, M, Joseph, KS, et al. Risk of maternal postpartum readmission associated with mode of delivery. Obstet Gynecol 2005;105:836–842.Google Scholar
21.Baker, C, Luce, J, Chenoweth, C, Friedman, C. Comparison of case-finding methodologies for endometritis after cesarean section. Am J Infect Control 1995;23:27–33.Google Scholar
22.Norusis, MJ. SPSS 13.0 Base System User's Guide. Chicago: SPSS Inc.; 2003.Google Scholar
23.Yokoe, DS, Christiansen, CL, Johnson, R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001;7:837–841.Google Scholar
24.Hirsch, HA, Niehues, U, Decker, K. Decrease in nosocomial infection based on continuous monitoring and control. 7 years' experience in a women's clinic [in German]. Dtsch Med Wochenschr 1985;110:1930–1935.CrossRefGoogle Scholar
25.Evaldson, GR, Frederici, H, Jullig, C, Mannerquist, K, Nystrom, B. Hospital-associated infections in obstetrics and gynecology. Effects of surveillance. Acta Obstet Gynecol Scand 1992;71:54–58.Google Scholar
26.Stamm, W. Urinary tract infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 4th ed. Philadelphia: Lippincott-Raven Press; 1998:477–485.Google Scholar
27.Ray, JG, Vermeulen, MJ, Shapiro, JL, Kenshole, AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. OJM 2001;94:347–356.Google Scholar
28.Girard, R, Huot, C, Lafarge, J, Bert, G, Dumas, A, Berland, M. Infections nosocomiales: que se passe-t-il apres la sortie de la maternity? Hygiene S 2002:345–348.Google Scholar
29.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar