The Impact of a Care Bundle on the Prevention of Post-cesarean Surgical Site Infection

Abstract

Background: The most common complication in the first 10 days after a cesarean section is surgical site infection (SSI), leading to poorer health outcomes, financial consequences, and maternal mortality. However, about 40 to 60% of such complications are preventable. Objectives: The present study aimed to examine the effect of a care bundle on the prevention of post-cesarean surgical site infection. Methods: This clinical trial was conducted on pregnant women undergoing cesarean section at Ali Ibne Abitalib Hospital, Zahedan, in the summer of 2022. A total of 60 full-term pregnant women who were candidates for cesarean section were selected using convenience sampling based on the inclusion criteria and were divided into two groups (each with 30 members) using random permuted blocks. The patients in the intervention group received preoperative, intraoperative, and postoperative care using an infection prevention care bundle, while the patients in the control group received routine care in the surgical department and operating room. The participants’ demographic, pregnancy, and surgical data were collected through interviews with the patients and by reviewing their medical files and were recorded in a checklist. The surgical incision was checked using the wound assessment checklist and the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) Scale, 24 hours after surgery and on the 10th and 30th days after surgery to confirm or reject wound infection. A score greater than 6 confirmed a surgical site infection. The data were analyzed with SPSS-21 software using independent samples t-test and chi-square test. The level of significance in this study was set at P < 0.05. Results: The data in this study showed that the patients in the two groups did not have statistically significant differences in terms of demographic, pregnancy, and surgical variables, except for the history of infection (P > 0.05). The mean REEDA scores for the patients in the intervention group 24 hours after surgery and on the 10th and 30th days after surgery were 2.52 ± 4.6, 1.3 ± 2.7, and 0, respectively. The corresponding values for the patients in the control group were 3.64 ± 5.26, 1.7 ± 3.07, and 0.08 ± 0.3, respectively. The independent samples t-test showed that the mean REEDA scores in the intervention and control groups 24 hours after surgery and on the 10th and 30th days after surgery did not have a statistically significant difference (P > 0.05). Moreover, 2 patients (6.67%) in the intervention group and 5 patients (16.67%) in the control group showed signs and symptoms of SSI, but the chi-square test did not show a significant intergroup difference (P > 0.05). Conclusions: The findings suggested that the care bundle was not effective in the prevention of cesarean wound infection, but we cannot deny the positive effects of care bundles on the prevention of surgical site infections. Thus, the components of the care bundle should be carefully examined, and any potential issues need to be more carefully analyzed in subsequent studies, especially intraoperative interventions that should be performed with extensive collaboration between surgical and operating room nurses and technicians.