A clinical issue

 3. Identify the PICO Components

Full Answer Section

         

Describe the current practice (if known)

  Current practice in many low-resource settings regarding C-sections and SSI prevention often faces significant limitations, even when attempting to adhere to international guidelines. While general principles of asepsis and prophylactic antibiotics are ideally followed, the reality can be challenging. Common practices and their associated limitations include:

• Pre-operative antibiotic prophylaxis: This is a standard recommendation, but the type, timing, and dosage of antibiotics might be inconsistent or suboptimal due to drug availability, cost, or lack of adherence to local protocols. Resistance to commonly used prophylactic antibiotics can also be an issue.
• Surgical technique: While efforts are made to maintain sterile technique, overcrowding in operating rooms, insufficient sterilization of instruments, and less experienced surgical teams can compromise adherence to best practices. Factors like the type of incision (e.g., vertical vs. transverse) might also be influenced by the urgency of the C-section.
• Wound care post-operatively: Post-operative wound care might be inconsistent due to high patient volumes, limited nursing staff, and inadequate supplies for dressings and wound management. Patients may also be discharged early due to bed limitations, with limited follow-up for wound monitoring.
• Infection control infrastructure: Many facilities lack robust infection prevention and control programs, including reliable access to clean water, proper waste disposal, adequate hand hygiene facilities, and consistent surveillance for SSIs.
• Patient-related factors: Patients in low-resource settings often present with pre-existing conditions that increase their risk of SSI, such as anemia, malnutrition, prolonged labor, or premature rupture of membranes, which may not be adequately addressed pre-operatively due to limited resources.
• Training and adherence: There might be gaps in continuous training for healthcare workers on current SSI prevention guidelines, and challenges in ensuring consistent adherence to established protocols due to workload, lack of supervision, or limited availability of resources.

 

3. Identify the PICO Components

  Based on the clinical issue of high rates of SSIs following C-sections in low-resource settings, here are the PICO components:

• P (Population/Patient/Problem): Women undergoing C-sections in low-resource settings.
• I (Intervention): (This will depend on the specific intervention you want to investigate, as the prompt asks not to include a solution in the initial description. However, for the PICO, you need to identify a potential intervention.) For example, an enhanced multimodal SSI prevention bundle (e.g., including standardized antibiotic prophylaxis, improved surgical skin preparation, strict aseptic technique, and specific post-operative wound care protocols).
• C (Comparison/Control): Standard/current SSI prevention practices in low-resource settings.
• O (Outcome): Reduction in the incidence of surgical site infections (SSIs) after C-sections.

Putting it together into a PICO Question: "In women undergoing C-sections in low-resource settings (P), does implementing an enhanced multimodal SSI prevention bundle (I), compared to current standard SSI prevention practices (C), lead to a reduction in the incidence of surgical site infections (O)?"

Sample Answer

       

PICO Question Worksheet

   

1. Clinical Issue Description

  Clinical Issue: High rates of surgical site infections (SSIs) following C-sections in low-resource settings. Supporting References: Surgical site infections (SSIs) following C-sections are a significant clinical issue, particularly prevalent in low-resource settings. While C-sections are life-saving procedures, SSIs can lead to substantial maternal morbidity and even mortality. Studies from Sub-Saharan Africa, for instance, report SSI rates after C-sections ranging from 8% to as high as 48% in some areas, significantly higher than the 1-4% observed in high-income countries (Allegranzi et al., 2011; Baklola et al., 2025; Sibomana et al., 2024). Why it is important: SSIs in this context are critical because they:

• Increase maternal morbidity: Leading to prolonged pain, delayed wound healing, fever, wound dehiscence, and potential for more severe infections like sepsis, which can be life-threatening.
• Contribute to maternal mortality: Sepsis following SSIs is a significant cause of maternal death, especially in settings with limited access to intensive care and advanced medical interventions.
• Lead to prolonged hospitalization: This places an increased burden on already strained healthcare systems and resources, occupying beds that could be used for other patients.
• Increase healthcare costs: For both the healthcare system and the patient/family, due to extended hospital stays, additional medications (especially antibiotics, contributing to antimicrobial resistance), and potential need for re-operations.
• Cause socioeconomic consequences: For families, the extended recovery period and potential for long-term disability can lead to lost income, increased out-of-pocket expenses, and a cycle of poverty, especially when the mother is a primary caregiver or income earner.

The problem/issue: The problem is the unacceptably high incidence of SSIs after C-sections in low-resource settings, leading to severe adverse maternal outcomes and significant healthcare burdens. This is often multifactorial, encompassing challenges in infection prevention and control practices, inadequate infrastructure, limited access to appropriate antibiotics, patient-related risk factors (e.g., anemia, prolonged labor), and sometimes suboptimal surgical techniques.