Evidence-Based Approach to Reduce Surgical Site Infections After Cesarean Delivery

Abstract

INTRODUCTION: The objective of this study was to determine if implementing infection control policies and an evidence-based checklist would reduce surgical site infection rate after cesarean delivery and identify which surgical site infection Centers for Disease Control and Prevention (CDC) classification will improve the most. METHODS: Infection control policies and a presurgical checklist of seven different evidence-based practices (ie, chlorhexidine, etc) were bundled and implemented at our institution. This is a retrospective chart review of 2,436 patients who had cesarean deliveries from January 2008 to September 2012. Patients were allocated into: group A (January 1, 2008, to January 31, 2010): 1,250 patients without intervention, group B (February 1, 2010, to September 31, 2012): intervention with checklist including 1,186 patients. Patients with surgical site infections were identified and then subdivided into CDC classifications: superficial incisional (SSI-1), deep incisional (SSI-2), and organ or space (SSI-3). Groups and surgical site infection subgroups were compared with χ2 test, Fisher's exact test, and standard Z test for statistical analyses. RESULTS: Our baseline surgical site infection rate after cesarean delivery was 6.2% with most infections being SSI-1 (84%) followed by SSI-3 (10.4%) and SSI-2 (5.2%). By implementing the checklist, the surgical site infection rate was 3.0%, a 51.61% reduction. If broken down into surgical site infection CDC classifications, we observed a 61.54% decrease in SSI-1 and 34.68% in SSI-3; SSI-2 had no reduction (Table 1). Implementation of our checklist can potentially reduce 95.92% of surgical site infections.CONCLUSIONS: Our evidence-based checklist effectively reduces the incidence of surgical site infections after cesarean deliveries. Most SSIs are SSI-1, primarily decreased with the checklist. The checklist did not affect deep incisional infections (SSI-2). Research geared toward identifying risk factors may be useful in establishing best practices to further decrease SSI-2.