Antibiotic Prescription Review Improves Cesarean Section Surgical Site Infection Surveillance

Abstract

BACKGROUND Post cesarean section (CS) surgical site infections (SSI) surveillance may be challenging due to short postoperative hospital stays and time and resource intensive post discharge surveillance methods. At our obstetrical/gynecological facility, which is housed within a large pediatric hospital, surveillance was limited to inpatient readmissions and patients who presented to an urgent care center. Our purpose was to expand CS SSI surveillance to include outpatient clinics in our system by creating and implementing the use of a custom surveillance tool in October 2018. METHODS Reports of patients who underwent CS within the past 30?days were generated from the electronic data warehouse. Of these, patients who presented to our outpatient clinics and were prescribed antibiotics were considered. After chart review, two infectious diseases physicians further refined the list of antibiotics based on local prescribing patterns for wound infections. Patients queried through this tool received an additional full medical chart review by an infection preventionist to determine the possibility of SSI following CS. RESULTS After two months of implementation, 4 of 8 (50%) of CS SSI were identified through the use of this surveillance method. Compared to the previous year, enhanced surveillance resulted in a 1.7 fold increase in the CS SSI rate. CONCLUSIONS CS SSI surveillance using antibiotic prescription data in the outpatient setting is an efficient method to enhance traditional SSI surveillance. In our facility, implementation of this tool has improved the identification of CS SSI. Accurate case identification will aid in identifying trends and guide targeted interventions.