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Multifaceted strategy reduces SSI during cesarean section
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Use of a multifaceted surgical site infection prevention strategy — which included antibiotic prophylaxis, a surgical checklist and patient education — led to a significant reduction in the rate of infection among patients who underwent cesarean section, according to recent research published in the American Journal of Infection Control.
“Using data from our intensive [post-discharge surveillance system] of patients who underwent [cesarean section (CS)], a 50% reduction in post-CS [surgical site infection (SSI)] rates was achieved and sustained for a prolonged period after implementing a series of prevention strategies,” Wil Ng, MHSc, from North York General Hospital in Toronto, and colleagues wrote. “Our data suggest that implementation of the strategies is feasible and effective.”
Ng and colleagues employed a five-phase series of SSI-prevention initiatives, with each phase adding to the strategies from previous phases of the study. These included:
- introducing inpatient and post-discharge surveillance for patients who underwent CS;
- adding prenatal education, including instruction not to self-remove hair prior to being admitted;
- changing the timing of administering prophylactic antibiotics from after the cord clamp to before the incision;
- adding a surgical checklist and improved patient education on hair removal; and
- replacing povidone-iodine with 2% chlorhexidine gluconate as the skin antisepsis of choice, and adding patient education posters discouraging hair removal for obstetrics patients.
Of the 9,442 patients analyzed, 85% completed post-discharge surveillance forms. The researchers found SSI in 5.6% of patients, with 91% superficial SSI cases and 9% deep infections. From baseline to final phase, the incidence of SSI decreased from 8.2% to 4.1% (P < .001). Ng and colleagues noted that significant decreases in the incidence of SSI took place during the phases when the timing of administering prophylactic antibiotics was changed, the use of a surgical checklist was added, and when efforts to educate patients about hair removal were increased.
For patients who had nonelective CS, there was a greater risk for developing SSI compared with patients who electively underwent CS (6.3% vs. 3.2%; P < .001). The researchers also found that 9.7% of patients who underwent CS more than 12 hours after rupture of membranes developed SSI compared with 3.7% of patients with less time between rupture of membranes and surgery, or patients with intact membranes (P < .001). – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
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