Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections.
BACKGROUND
In 2005, of the approximately 4 million births in the United States, 30% were by cesarean section (C-section) delivery, which translates to roughly over 1 million C-sections in 2005 alone. C-section is associated with higher morbidity than vaginal delivery. Women who undergo C-section are 5 times more likely to develop a postpartum infection after delivery than women who undergo vaginal delivery.


OBJECTIVE
Estimates of surgical site infection (SSI) after C-section range from 1.50 to 2.64. A quality improvement initiative was implemented at the University of Minnesota Medical School to reduce rates of SSI using changes based on recommended care initiatives.


METHODS
The multidisciplinary team developed a comprehensive staff education and training program, added a preoperative skin preparation protocol using chlorhexidine gluconate (CHG) no-rinse cloths, added CHG with alcohol for interoperative skin preparation, and modified instrument sterilization techniques.


RESULTS
Data analysis revealed a statistically significant reduction in the overall SSI rate from 7.5% (33/441) in January-July 2006 to 1.2% (5/436) in January-July 2007 (chi(2) test statistic, 21.2; P < .001; relative reduction of 84%).


CONCLUSIONS
Interventions, including staff education, use of CHG no-rinse cloths for preoperative skin prep, CHG with alcohol for intraoperative skin prep, and appropriate instrument sterilization management led to reductions in SSI rates in patients undergoing C-section at our institution. Rates of endometritis were also noted to be lower after implementation of the interventions.
Rauk
Phillip N
PN
Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal-Fetal Medicine, University of Minnesota, 620 24th Ave. South, Minneapolis, MN 55454, USA. raukxx004@umn.edu
D002585:Cesarean Section / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004202:Disinfectants / Q000008:administration & dosage; D004203:Disinfection / Q000379:methods*; D004493:Education; D005260:Female; D006801:Humans; D015994:Incidence; D008910:Minnesota / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D013242:Sterilization / Q000379:methods*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*
D004202:Disinfectants; C010882:chlorhexidine gluconate; D002710:Chlorhexidine