Clean and sterile delivery: two different approaches to infection control

Although the World Health Organization recommends not using sterile technique for low-risk delivery and literature doesn't report a significant association between clean delivery and higher risk for infection, sterile technique remains a prevalent practice. We conducted our study in the obstetric clinics of two hospitals of Piemonte Region (Italy) that use different operative care models ('clean' vs. 'sterile').

Aim of the study was to describe practices and procedures used by midwives during delivery, according to the model adopted, and to compare the incidence of perineal infection between use of 'clean' versus 'sterile' practices for intrapartum care.

Prospective cohort study. 200 women for each hospital were included in the study. Health care behaviour and practices performed during the different stages of delivery were observed and recorded on an observation sheet. Follow-up was conducted for 1 month after discharge in order to detect infections of reproductive organs.

Many differences were described in procedures and health care worker practices between the two hospitals and even among operators of the same ward, but a greater compliance with the theoretical model adopted was described among midwives and physicians of the 'clean' delivery model. No infections were detected in either of the two samples of women included in the study.

From our observations we can conclude that many reasons support the adoption of 'clean' technique for low-risk deliveries: reducing inappropriate use of resources and costs for health care, less medicalization, less frequent use of episiotomy and shaving, major compliance of operators with simple and coherent practices and procedures.