الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Caesarean section (CS) is defined as a surgical procedure in which a viable baby is delivered through an incision of the abdomen and the uterus (Carbonnela et al, 2021). CS continues to be the surgery most often performed in obstetrics (Dessu et al, 2021). Women undergoing cesarean delivery have a five to 20-fold higher chance of receiving an infection compared with women who give birth vaginally (Adane et al, 2019).
The incidence of infection following caesarean section varies depending on the socio-economic factors, and the use of antibiotics before the surgery has significantly changed. The typical timeframe for the appearance of surgical site infection (SSI) symptoms is 3-7 days after the delivery, and as per definition, they have to occur within 30 days post-surgery (Zabaglo & Sharman, 2021), it’s may happen in 3 to 15 % of the patients (Aidyn et al, 2021).
Postpartum SSIs after CS is a major cause of long hospital stays and there is an increased cost burden on the public healthcare systems as well as on mothers and their families (Aicher et al., 2017). It a leading cause of morbidity and mortality; it’s can range from mild wound discharge without complications to life-threatening sepsis. Moreover, SSI is associated with a maternal mortality rate of up to 3% (Zuarez-Easton et al, 2017). Patients who develop SSIs were five times more likely to be readmitted to hospital and two times more likely to die compared with patients without SSIs (Legesse et al, 2017).
Prevention of post-cesarean infection requires adherence to guidelines by surgeons and professionals’ nurses’ as well as participation by patients and their families. Woman’s education surrounding preoperatively, it is essential to identify and address modifiable risk factors and appropriately counsel the patient regarding anticipated risk
(Anderson, 2017), as well as postoperatively wound care, appropriate hand hygiene, and signs of infection should be delivered (Seligman,
2018).
The Purpose of the current study was to assess the effect of pre cesarean section wound care guidelines on occurrence of postoperative infection among women. The present study was conducted at the Obstetrics and Gynecological Department & outpatient clinic at Beni- suef University Hospital in Beni-suef Governorate. A quasi-experimental design was utilized in carrying out the study.
Non-probability (Purposive sample) consisted of (200) pregnant women. The participants were divided equally into a group (1) a study group of (100) women who received wound care guidelines before cesarean section and group (2) a control group of (100) who received routine hospital care only.
Inclusion criteria of the participants:
Both groups have the following criteria:
1. Pregnant women both primipara and multipara.
2. Either elective or emergency CS.
3. No previous surgery in uterus other than cesarean section.
4. Pregnant women at the gestational age of (31weeks and more until delivery), based on the advice of an Obstetrician and Gynecologist
at the study setting, data collection started at eight months of pregnancy since that time is the best when the decisions about labor whether normal vaginal delivery or caesarean section is confirmed.
Exclusion Criteria:
• Women who have any physical or psychiatric disorders.
Throughout the present study, data were collected using fifth instruments which were developed by the researcher after reviewing related literature and revised by a jury of qualified experts, then tested for validity and reliability. These instruments were as follows:
Instrument 1: A Socio-Demographic Data Questionnaire: included Socio-demographic data, previous obstetrical history, data about the current pregnancy, caesarean section indication, Present cesarean section delivery (Operative data).
Instrument 2: Pregnant women’s knowledge regarding pre-cesarean section wound care guidelines: included questions related to the definition of caesarean section, types, indications, complications of cesarean section, risk factors for cesarean section wound infection, signs, complications of wound infection, and methods of wound care.
Instrument 3: Pregnant women’s beliefs regarding caesarean section wound healing: included 8 statements as follow, increasing woman age contribute to poor healing, psychological state affects low wound healing,
increase body weight delay wound healing, increase cesarean numbers means increased days for wound healing, wound healing depends on the type of suture, wound healing depends on sterilization of operation’s equipment, antibiotics before surgery fast the process of healing, and good nutrition facilitates wound healing.
Instrument 4: Checklist for evaluating women knowledge about self-care practice guidelines regarding pre cesarean section wound care:included preoperative preparation, wound care after suture removed or absorbable, women practice regarding nutrition, hygiene, rest and daily activities, and postpartum warning signs and sexual relationship.
Instrument 5: A postnatal Follow up assessment tool: included the assessment of the postoperative wound healing.approval from the Committee of Hearing and Ethics was obtained from the Faculty of Nursing, Menoufia University. Also, approaches to ensuring the ethical issues were considered in the study regarding confidentiality and informed written consent. The researcher introduced herself to the women in the sample and explained the purpose of the study and the nature of the research to obtain their acceptance to be recruited in the study as well as gain their cooperation.
Confidentiality was achieved by the use of closed sheets with the names of the participants replaced by numbers. All the participating women were informed that the information they provided during the study would be kept confidential and used only for statistical purposes after finishing the study, the findings would be presented as group data with no personal participant information remaining.
After explanations before enrollment in the study, informed consent was obtained verbally and written from all women. Each woman was informed that participation in the study was voluntary and that they could withdraw from the study whenever she decided and each woman was allowed to freely refuse participation. They were freely asked any questions about the study details.
Upon completion of data collection, each pre/posttest was coded and scored. The researcher coded the data into a coding sheet so that data could be prepared for computer use. Data were statistically analyzed using a statistical package for social sciences (IBM SPSS 20.0). A test of significance was used to evaluate the program’s effectiveness in improving knowledge, beliefs, and practice.
The findings of this study support the study hypothesis that pregnant women who followed wound care guidelines before caesarean section experienced better wound healing and have less possibility of post cesarean wound infection than those who did not follow.
The findings of the present study showed that:
- There was no statistically significant difference between the both groups regarding the sociodemographic data, and operative data, except for some chronic diseases which means that both groups had similar characteristics.
- There was a statistically significant difference between both groups regarding preoperative showering by using antiseptic soap (Dettol soap).
- There was a poor level of pregnant women’s knowledge, and beliefs and an unsatisfactory level of self-care practice regarding cesarean section wound care guidelines before-intervention between both groups.
- There were statistically significant differences in the women’s total knowledge score regarding wound care guidelines for women undergoing cesarean section at pre-intervention and post due to improved knowledge after implementing the standardized wound care guidelines.
- There were statistically significant differences in the women’s totalpractice score regarding wound care guidelines for women undergoing cesarean section at before-intervention and post due to improved practice after implementing the standardized wound care guidelines.
- There were statistically significant differences in the women’s total beliefs score regarding wound care guidelines for women undergoing cesarean section at pre-intervention and post due to acquired positive beliefs after implementing the standardized wound care guidelines.
- There was statistically significant difference between the studied groups regarding the incidence of post cesarean wound infection.
- There was a statistically significant difference regarding the days of wound healing among study groups.
- There was no statistically significant difference between both groups regarding signs of infection. This means that both groups had nearly similar signs of infection.
- The critical point for wound infection among studies groups was at 10 days, while the critical point for wound healing was at 25 days where no women in the study group had an infection.
The findings showed that women who are undergoing cesarean section and follow wound care guidelines before cesarean section have
less incidence of post cesarean wound infection than those who didn’t apply it, was accepted.