title: Postdischarge surveillance for infection following cesarean section: A prospective cohort study comparing methodologies.
abstract: OBJECTIVE
  To assess how enhanced postdischarge telephone follow-up calls would improve case finding for surgical site infection (SSI) surveillance after cesarean section.
  
  
  METHODS
  We conducted a prospective cohort study of all patients who delivered by cesarean section between April 22 and August 22, 2010. In addition to our routine surveillance, using clinical databases and electronic patient records, we also made follow-up calls to the patients at 7, 14, and 30 days postoperation. A standard questionnaire with questions about symptoms of SSI, health-seeking behaviors, and treatment received was administered. Descriptive statistics and univariate analysis were performed to assess the effect of the enhanced surveillance.
  
  
  RESULTS
  One hundred ninety-three patients underwent cesarean section during this study period. Standard surveillance identified 14 infections with telephone follow-ups identifying an additional 5 infections. Using the call as a gold standard, the sensitivity of the standard methodology to capture SSI was 73.3%. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients.
  
  
  CONCLUSIONS
  Results suggest that follow-up telephone calls to patients following cesarean section identifies 26.3% of the total SSIs. Enhanced surveillance can provide more informed data to enhance performance and avoid underestimation of rates.
authors.affiliation: Faculty of Medicine, Al Baha University, Al Baha, Saudi Arabia. Electronic address: mhalwani@bu.edu.sa.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Halwani
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Alison E
authors.initials: AE
authors.lastname: Turnbull
authors.affiliation: The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Meredith
authors.initials: M
authors.lastname: Harris
authors.affiliation: Department of Obstetrics and Gynecology, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Frank
authors.initials: F
authors.lastname: Witter
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Department of Pathology, and Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D055815:Young Adult
keywords: Cesarean section infection; Post-discharge surveillance; Surgical site infections