Vaginal Cleansing and Azithromycin at Cesarean Delivery; A Quality Improvement Study [OP01-1C

Abstract

INTRODUCTION: The objective was to assess the stepwise implementation of pre-operative vaginal cleansing and intravenous (IV) azithromycin on the rate of surgical site infection (SSI) for women who undergo cesarean delivery (CD) intrapartum or after rupture of membranes. METHODS: This was a quality improvement study comparing 3 groups: 1). 12 months of pre-intervention; 2). 14 months of vaginal cleaning as infection prophylaxis; 3). 16 months of both vaginal cleansing and azithromycin IV as infection prophylaxis. The primary outcome, which was analyzed by control charts, was the rate of SSI as defined by the Center for Disease Control and Prevention (CDC). This study was IRB approved. RESULTS: There were 1,033 patients included from the 3 study periods. The total rate of SSI rate decreased from 22% to 12.5% after implementing vaginal cleansing. Special cause variation was seen with an 8-point shift starting 4 months after implementation of vaginal cleansing. This decrease was sustained during the following 26 months. Adding azithromycin IV did not significantly further lower the rate of SSI. When examined separately, deep SSI (P=.009) and endometritis (P=.001) significantly decreased in the post-intervention periods. Pre-operative vaginal cleansing compliance rose to 74%, and then further increased to 85% 1 year after implementation. Azithromycin IV compliance rose to 75%. CONCLUSION: In this quality improvement study, implementation of vaginal cleansing decreased the SSI rate by 43%, from 22% prior to either intervention to 12.5% after addition of vaginal cleansing. The addition of azithromycin IV did not result in any further change in SSI rate.