Surgical site infection (SSI) is one of the most relevant complications associated with cesarean delivery, directly impacting maternal morbidity, length of hospitalization, and hospital costs. SSI is estimated to account for up to 10% of global maternal deaths, and in Brazil, 73% of deaths are due to puerperal infection, which is the third leading cause of maternal death. Preventing SSI involves measures related to patient preparation, surgical technique, and the operating environment. This study aimed to identify risk factors associated with the development of SSI in patients undergoing cesarean section, with special focus on intraoperative variables.

After the surveillance system for Healthcare-Associated Infections (IRAS) identified a significant 83% increase in SSI incidence in cesarean sections in August 2023, a univariate analysis (among potential SSI predictors) and logistic regression (binomial multivariate), to control for confounders, were performed between January and June 2023. Twenty-nine patients with SSI and 62 controls who underwent cesarean section on the same day were included. Variables analyzed included age, body mass index (BMI), comorbidities, procedure duration, skin preparation, performance and timing of preoperative bathing, hair removal, antibiotic prophylaxis, and staff gowning. Univariate analysis and logistic regression were performed to control for confounders.

In the univariate analysis, SSI occurrence was associated with BMI greater than 30 (OR=3.80; 95% CI 1.25–11.52; p=0.014), surgical duration greater than 60 minutes (OR=3.00; 95% CI 1.20–7.50), and inadequate skin preparation (OR=2.83; 95% CI 1.13–7.09; p=0.033). In the adjusted analysis, only inadequate skin preparation remained significantly associated (OR=3.43; 95% CI 1.22–10.08; p=0.021).

Intraoperative practices, especially inadequate skin preparation, showed a strong association with SSI risk in cesarean sections. These findings reinforce the need for strict adherence to intraoperative prevention protocols as an essential strategy to reduce SSI in the studied context.