Knowledge, Attitudes, and Practices of Obstetricians in Managing Postpartum Surgical Site Infections in India: A Cross-sectional Survey

Introduction: Caesarean section and surgical procedures during vaginal delivery are significant contributors to Surgical Site Infections (SSIs). SSIs are associated with extended hospitalisation and increased financial and clinical burden. Antibiotic prophylaxis, chlorhexidine skin preparation, clipperbased hair removal, and vaginal cleansing with povidoneiodine are recommended preventive measures. Topical agents, mupirocin and antiseptics are increasingly used, but adoption remains inconsistent in countries like India due to limited training, resources and varying protocols. Aim: To assess the Knowledge, Attitudes and Practices (KAP) of obstetricians in India for the prevention and management of post-partum SSIs. Materials and Methods: A descriptive cross-sectional survey was conducted at GlaxoSmithKline (GSK), Mumbai, India, which included 200 obstetricians across metro, tier 1 and tier 2 cities in India between May 2024 and August 2024. Participants were obstetricians practising in India with at least 5 years of experience, spending 70% or more of their time in patient care, handling a minimum of 20 deliveries per month, having treated at least 3 SSI cases in the month prior to the survey, and residing in one of 12 selected cities. Data on the knowledge, attitudes and beliefs and practices followed by the obstetricians for the prevention and management of post-partum SSIs were collected using a 7-item questionnaire through face-to-face computer-assisted personal interviews. Statistical analyses were primarily explorative and descriptive and were performed using R software (version 4.3.1 or higher). Results: Among the 200 participants, 105 (52.5%) practiced in large hospitals, 58 (29%) in multispecialty hospitals, and 37 (18.5%) in standalone maternity clinics. The average clinical experience was 17 years. In the knowledge assessment, 144 (72%) of participants scored between 50-90%, while 56 (28%) scored below 50%; none scored above 90%. The most common knowledge gaps were related to the appropriate duration of topical antibiotic use, bacterial coverage, and indications for antiseptics versus antibiotics. Conclusion: The present study reveals that while obstetricians generally follow consistent practices for managing post-partum SSIs, significant gaps remain, especially in the use of topical antiseptics and antibiotics, highlighting the need for standardised guidelines and targeted training to ensure evidence-based care and better maternal outcomes.