The Role of Surgical Attire in the Prevention of Postoperative Infections: A Before and After Study [24T

Abstract

INTRODUCTION: Rates of postoperative infection (PI) related to cesarean delivery (CD) range from 2 to 7 percent. Traditional operating room attire consists of surgical cap, mask, and shoe cover. In August 2015, our institution adopted policy based on Association for Perioperative Registered Nurses (AORN) guidelines. Policy dictates use of surgical hood, laundered scrubs, beard cover, and disposable jacket before scrubbing. The objective of the study is to investigate the rate of PI in women undergoing CD before (Group 1) and after (Group 2) policy implementation. METHODS: A retrospective chart review was performed of women with term pregnancies who underwent elective CD for two years before (Group 1) and after (Group 2) new policy. Institutional Review Board approval was obtained. Inclusion criteria are as follows: hospital readmission, fever, positive wound culture, antibiotic treatment, cellulitis, endometritis, intra-abdominal abscess. Exclusion criteria included labor, ruptured membranes, intrapartum infection, and cerclage. RESULTS: The primary outcome measure was the rate of PI between the two groups. Group 1 consisted of 131 and Group 2 159 patients. Maternal characteristics and antepartum complications were similar between groups (p < 0.05). Mean gestational age at delivery was 38.96 weeks (Group 1) and 38.89 weeks (Group 2). Both groups had similar incidences of primary versus repeat CD. Rate of infection in group 1 was 4.5 percent vs 2.5 percent in group 2 (p > 0.05). CONCLUSION: The addition of surgical hood and jacket did not lead to a statistically significant decrease in postoperative infection. Further investigation may determine if the additional cost yields benefits.