An Evidence‐Based Preoperative Bundle to Reduce Infection Rates Among Women with Cesarean Births

Abstract

<h2>Poster Presentation</h2><h3>Objective</h3> To address the following clinical questions: For women with cesarean births, does the use of a standardized antibiotic and timing reduce the incidence of postoperative infection? For women with cesarean births, does the use of a chlorhexidine‐alcohol based combination reduce the incidence of postoperative infection compared with a betadine‐alcohol based combination? <h3>Design</h3> The evidence‐based project was designed to create guidelines for the selection of antibiotics with weight‐based dosing and timing of administration and for the selection and standardized use of an intraoperative surgical skin preparation. <h3>Sample</h3> Preintervention data consisted of infection rates for 12 months prior to the new practice and postintervention data consisted of infection rates following the practice change. <h3>Methods</h3> Following an extensive literature search and appraisal of the evidence, a multidisciplinary committee was formed consisting of nurses, physicians, and pharmacists. Decisions based on the evidence were made to implement the use of a chlorhexidine product, and cefazolin was chosen as the antibiotic for use. Another schedule was created for patients allergic to penicillin that included clindamycin and gentamicin. <h3>Implementation Strategies</h3> The chief of obstetrics communicated the practice changes to all associated physicians. Nurses were educated through a joint effort by the unit clinical educator, the nurse manager, and a nurse representative from the product company. Written and verbal communications from the project leader and management announced the implementation date. Nurses from infection prevention and control monitored the incidence of surgical site infection post implementation. <h3>Results</h3> Data obtained for the 12 months following the practice change demonstrated a significant decrease in the rate of surgical site infections for women with cesarean births. <h3>Conclusion/Implications for Nursing Practice</h3> Application of current evidence is needed to establish a guideline designed to improve patient care. A multidisciplinary team is needed to effect a practice change that is sustained. Further work is needed to address surgical site infection rates among obese women.