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Infection prevention methods in US vary after cesarean delivery
A survey of U.S. academic centers revealed marked variability in the practices used to prevent infections after cesarean delivery.
“Additional clinical trials and specific guidelines are needed to better define best practices in this patient population,” Cynthia Argani, MD, director of labor and delivery at Johns Hopkins Bayview Medical Center and assistant professor of gynecology and obstetrics, and colleagues wrote in their study.
From August to December 2014, the researchers conducted telephone interviews with staff at 197 academic medical centers in the continental U.S. They interviewed the charge nurse, clinical specialist, nurse educator or nurse manager of each labor and delivery unit.
Antibiotic use before skin incision was common. Argani and colleagues found that 98% of hospitals deployed antibiotics before skin incision. Three hospitals did not universally use antibiotics; one hospital dispensed antibiotics after cord clamping, they wrote.
Cynthia Argani
Choice of antibiotic was fairly consistent, with 90.9% of hospitals relying on first-generation cephalosporins and five using combination therapy, according to the researchers. In addition, the results showed that five hospitals prophylactically used second-generation cephalosporins.
Assessing appropriate weight-based antibiotic dosing posed a challenge in this patient population due to the lack of accurate BMI measurements. In this survey, 55.3% of hospitals reported using higher doses of antibiotics for obese patients. Three respondents were unsure if dosing was modified; two hospitals adjusted dosing only sometimes, the researchers wrote.
Many of the hospitals relied on skin antisepsis measures. In all, 77.2% of hospitals used some type of chlorhexidine-based antisepsis routine before cesarean delivery. Twelve hospitals used either chlorhexidine or a povidone-iodine-based preparation, depending on physician preference, according to Argani and colleagues.
“We found that very few academic centers are using povidone-iodine vaginal antisepsis despite strong evidence favoring this intervention,” the researchers wrote.
Preoperative vaginal antisepsis procedures were less common, they found. Twenty-five hospitals consistently used it before delivery; six others used it sometimes, based on physician preference. – by Colleen Owens
Disclosure: The researchers report no relevant financial disclosures.