Reducing Cesarean Delivery Surgical Site Infection: Successful Implementation of a Bundle of Care [20].

INTRODUCTION: Postoperative surgical site infection (SSI) affects 8-14% of cesarean deliveries (CD), impacting approximately 175,000 births and costing over $600 million annually. The relatively high SSI occurrence may partly be attributable to the relative lack of standardization across Labor & Delivery operating rooms. This study aims to assess the impact of a multidisciplinary and stepwise quality improvement approach to collect best practices surrounding CD and to implement an evidence-based bundle of care to reduce post-operative SSI.

METHODS: We gathered a multidisciplinary task-force to 1) systematically review surgical and post-operative care best practices, 2) develop protocols encompassing preoperative, intraoperative, and postoperative care, 3) implement a care bundle initiative, and 4) assess outcomes and process improvement measures, including SSI and protocol compliance rates. The bundle of care included preoperative patient education and use of 2% chlorhexidine skin cloths, identification and treatment of active infections, staff education regarding skin preparation and OR protocols, perioperative normothermia, perioperative antibiotic prophylaxis, perioperative skin preparation, and incision dressing application and removal. A plan-do-study-act (PDSA) approach was used.

RESULTS: SSI rate declined from 8.6% to 2.9% (P=.01), as assessed over two three-month sampling periods before and one year after bundle initiation. Qualitative measures indicated relative ease of implementation with routine compliance with a new standard of care.

CONCLUSION/IMPLICATIONS: Implementation of a multi-disciplinary bundle significantly reduced SSI rates and was met with staff approval and compliance.