title: Surgical site infection in cesarean sections with the use of a plastic sheath wound retractor compared to the traditional self-retaining metal retractor.
abstract: OBJECTIVE
  A cesarean section rate of up to 19.4% is reported worldwide. Surgical site infection occurs with rates of up to 13.5%. Plastic-sheath wound retractors show reduced rates of surgical site infections in abdominal surgery. There is limited evidence in women having cesarean sections. This study evaluates the use of the Alexis(®) O C-Section Retractor in the prevention of surgical site infection in patients undergoing their first planned cesarean section compared to the traditional Collins self-retaining metal retractor.
  
  
  METHODS
  A single center, prospective, randomized, controlled, observational trial. The primary outcome is surgical site infection as defined by the Centers for Disease Control and Prevention. The secondary outcomes included intraoperative surgical parameters, postoperative pain scores and the short and long-term satisfaction with wound healing. From October 2013 to December 2015 at the Charité University Hospital, Berlin. 98 patients to the Alexis(®) O C-Section Retractor group and 100 to the traditional Collins self-retaining metal retractor group.
  
  
  RESULTS
  A statistically significant reduction in the rate of surgical site infections, when the Alexis(®) O C-Section Retractor was used for wound retraction compared to the traditional Collins metal self-retaining wound retractor, 1% vs. 8% (RR 7.84, 95% CI (2.45-70.71) p=0.035).
  
  
  CONCLUSIONS
  The use of plastic-sheath wound retractors compared to the traditional self-retaining metal retractor in low risk women, having the first cesarean section is associated with a significantly reduced risk of surgical site infection.
authors.affiliation: Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin 13353, Germany. Electronic address: Larry.Hinkson@charite.de.
authors.forename: Larry
authors.initials: L
authors.lastname: Hinkson
authors.affiliation: Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin 13353, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Siedentopf
authors.affiliation: Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin 13353, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weichert
authors.affiliation: Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin 13353, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008670:Metals; D017060:Patient Satisfaction; D010969:Plastics; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014481:United States
chemical_list: D008670:Metals; D010969:Plastics
keywords: Cesarean section; Plastic sheath wound retractor; Surgical site infection; Wound retraction