Highlights
- •Find, Organize, Clarify, Understand, Select–Plan, Do, Check, Act is used to identify opportunity for improvement of the cesarean section surgical site infection rate.
- •An innovative and evidence-based cesarean section surgical site infection reduction bundle is developed.
- •Implementing the bundle is associated with a 98.4% reduction of cesarean section surgical site infection rate.
Background
We found cesarean section (C-section) surgical site infection (SSI) at our institution
was significantly higher than the national benchmark.
Methods
A retrospective cohort study was conducted under 4 phases from January 2008-December
2014. The hospital infection control (IC) policies and a presurgical checklist were
bundled and implemented. The study was conducted with 3,334 cesarean deliveries: phase
A (January 1, 2008-January 31,2010): 1,250 patients without intervention (baseline
SSI rate), phase B (February 1, 2010-July 31, 2011): 682 patients were intervened
with IC policies, phase C (August 1, 2011-December 31, 2012): 591 patients with an
SSI reduction bundle, and phase D (January 1, 2013-December 31, 2014): 811 patients
were monitored for C-section SSI sustainability. Patients not following strict protocols
because of emergency C-section deliveries were excluded. The χ2 test, Fisher exact test, and standard Z test were used for statistical analyses.
Results
C-section SSI rates were 6.2% (77/1,250) in phase A, 3.7% (25/682) in phase B, 1.7%
(10/591) in phase C, and 0.1% (1/811) in phase D, respectively. By implementing the
IC policies and bundle, the C-section SSI rate was reduced 40.3% (phase B vs phase
A), 72.6% (phase C vs phase A), and 98.4% (phase D vs phase A). All statistics were
significantly different.
Conclusions
We conclude that implementing a C-section SSI reduction bundle was associated with
reduced C-section SSI rate down toward zero. A future prospectively randomized controlled
trial is warranted.
Key Words
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Article info
Publication history
Published online: June 14, 2016
Footnotes
Conflicts of Interest: None to report.
Additional Information: Publication of this quality improvement project was approved by Nassau University Medical Center Institutional Review Board.
Identification
Copyright
© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
