Abstract
INTRODUCTION: Surgical site infections (SSI) following cesarean delivery (CD) are a major cause of morbidity and economic burden. Our tertiary-care hospital implemented a multidisciplinary SSI surveillance system and preventative bundles to reduce rate of SSI after CD. Our objective was to measure the effect of 3 bundles on post-CD SSI. METHODS: A retrospective single-center cohort study of all CD July 2012 to December 2017 was performed. Infections were identified via 30-day active surveillance using CDC definitions by one infection preventionist and reviewed by one physician. Patient demographics and procedural details were stored for submission to CDC. Unadjusted and adjusted risk factors were identified using logistic regression. Bundle 1 (2014) included enhanced surgical instrument sterilization, bandage removal POD2, preoperative sage cloth, 3 grams Cefazolin for women >120 kg, recommended patient warming, staples removal POD7, and provided silver dressings. Bundle 2 (2015) included nurses prepping with prolonged prep time using two chlorhexidine applicators. Bundle 3 (2016) included preoperative vaginal prep and 500 mg Azithromycin in unscheduled CD in labor and encouraged post-placental glove change. RESULTS: Over 5.5 years, 2.2% (176/8150) of women developed post-CD SSI. 79% (138/176) were superficial incisional primary SSI. The first bundle had no significant effect on the odds of post-CD SSI (odds ratio [OR] 0.48, confidence interval [95% CI] 0.15 - 1.61). We observed decreased odd of post-CD SSI for both bundle 2 (OR 0.63, 95% CI 0.45 - 0.87) and bundle 3 (OR 0.61, 95% CI 0.42 - 0.88). CONCLUSION: Evidence-based bundles should be considered at institutions experiencing high post-CD SSI rates.
Published Version
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