Major article
Reduction of surgical site infections in low transverse cesarean section at a university hospital

Presented at the 19th Annual Scientific SHEA Meeting in March 2009 and Annual APIC Conference in July 2010.
https://doi.org/10.1016/j.ajic.2011.12.011Get rights and content

Background

We implemented evidence-based interventions to reduce risk of surgical site infection (SSI) following low transverse cesarean section (LTCS).

Methods

An observational study was conducted to determine LTCS SSI rates and the impact of infection control interventions at an academic teaching hospital during the period October 2005 to December 2008, including the use of 2% chlorhexidine gluconate (CHG) for surgical skin preparation before LTCS and no-rinse CHG cloths for preoperative skin cleansing. We compared overall and risk strata specific SSI rates and standardized incidence ratios during 4 study periods and estimated cost savings.

Results

Of 1,844 LTCSs performed, 99 patients were identified with SSI. SSI rates per 100 LTCS declined from 6.27 at baseline and 10.84 during the outbreak period to 5.92 in intervention 1 period and 2.29 in intervention 2 period. Overall, a 63.5% reduction in SSI rate from baseline was achieved by ensuring compliance with SSI prevention guidelines and improving skin antisepsis (P = .003). In intervention 2 period, the standardized incidence ratio was 0.99 compared with 2.64 at baseline and 4.50 during the outbreak period.

Conclusion

A multidisciplinary approach including evidence-based SSI prevention practices, effective infection prevention products, and staff and patient engagement substantially reduced infection risk and improved patient safety following LTCS.

Section snippets

Study method

We conducted an observational study to determine rates of SSI associated with LTCS and the impact of interventions at a 520-bed, academic teaching hospital performing an average of 550 LTCS surgical procedures annually. To identify rates of SSI associated with LTCS procedures, we obtained a list of the LTCS patients each month. Thirty days after each procedure, we reviewed all inpatient and outpatient electronic medical records and microbiologic reports for each LTCS patient to identify cases

Results

From October 2005 to December 2008, 1,844 LTCS procedures were performed. Of these, 99 patients were identified with SSI, including 44 (44.4%) superficial infections, 11 (11.1%) deep incision infections, and 44 (44.4%) organ spaces infections (endometritis). Twelve wound cultures (12.1%) were obtained from the 99 SSI cases. The most frequent isolates were Enterococcus spp (67%), coagulase-negative staphylococci (44%), Corynebacterium spp (44%), and Proteus spp (33%).

From October 2005 to March

Discussion

We utilized a multidisciplinary approach to reduce LTCS SSI rates 63.5% over a 39-month period by identifying critical control points, developing an action plan, implementing evidence-based SSI prevention recommendations, improving practices, providing timely feedback of SSI rates and compliance with performance measures to the OBGYN clinicians, and continuous evaluation of the SSI prevention program. Of note, the proportion of patients in NNIS risk categories 2 and 3 increased during the

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Conflicts of interest: None to report.

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