Evaluation of Cesarean Section Endometritis Case-Finding Methods

BACKGROUND/OBJECTIVES: The epidemiology of endometritis associated with cesarean section is not well defined. This is in part due to limitations of traditional surveillance methods to detect endometritis cases that frequently become evident prior to hospital discharge. To enhance case finding of endometritis following cesarean section we evaluated post-discharge surveillance and screening discharge diagnosis codes as adjunct methods to established traditional surveillance. METHODS: All women who had a cesarean section from July 1, 2004 through March 30, 2005 were enrolled in the study (n = 869). Post-discharge surveillance in addition to traditional case finding methods utilizing microbiology data and readmission reports were compared to monthly computer generated discharge diagnosis coding reports to assess efficacy of case detection methods. The NNIS (National Nosocomial Infections Surveillance) definition of infection was used to standardize case documentation. RESULTS: Post-discharge surveillance plus traditional case finding methods yielded 13 endometritis cases (infection rate = 1.5/100 procedures). Physician compliance with returning monthly patient surveys was 65% and identified 23% (3/13) of cases. Screening of discharge diagnosis codes detected an additional 13 cases (infection rate = 3.0/100 procedures); p = 0.03. 4.1% (36/869) of patients had a coded diagnosis for endometritis. Healthcare-associated endometritis was documented in 72% (26/36) of these patients. CONCLUSIONS: Post-discharge surveillance in addition to traditional case finding methods resulted in significant underreporting of endometritis post-cesarean section at our facility. Implementation of monthly screening of discharge diagnosis codes to supplement daily review of microbiology and readmission reports provided an effective and less resource intense assessment of the incidence of these postpartum infections. Evaluation of case detail resulting from enhanced surveillance may provide a focus for infection prevention process improvement initiatives in this patient population.