An audit of the implementation of guidelines to reduce wound infection following caesarean section.
OBJECTIVE
National guidelines suggest that antibiotic prophylaxis should be given at all emergency Caesarean sections and considered at elective procedures in an attempt to reduce wound infection rates. It is recommended that both infection rates and the administration of antibiotics should be audited. In the absence of a local protocol an audit was designed aiming to audit the infection rate against a gold standard of a wound infection rate less than 5%.


METHODS
A retrospective case note review was performed for all Caesarean section occurring over a six month period. Guidelines were introduced to address deficiencies and the audit repeated a year later.


RESULTS
The wound infection rate in the absence of local guidelines for antibiotic prophylaxis was 10%. The major factor related to infection was a failure to give antibiotics particularly at elective Caesarean section. Re-audit following the introduction of a protocol for the administration of antibiotics at all Caesarean sections found a compliance rate of over 97% with a reduction of the infection rate to around 3%.


CONCLUSIONS
This study supports the use of audit in the implementation of guidelines based on published evidence and local results.
Taylor
G M
GM
Department of Obstetrics & Gynaecology, Ninewells Hospital and Medical School, Dundee.
D019072:Antibiotic Prophylaxis / Q000592:standards / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000009:adverse effects / Q000592:standards*; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012606:Scotland / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*