title: Effect of interventions in reducing the rate of infection after cesarean delivery.
abstract: BACKGROUND
  Post-cesarean delivery (CD) surgical site infections can cause considerable maternal morbidity. We aimed to estimate the efficacy of a medical personnel education program in aseptic and scrub techniques on the rate of infectious morbidity after CD.
  
  
  METHODS
  A prospective, 2-period cohort intervention study was performed at a single institution. The first era, which included all CDs performed between September 2006 and August 2007, was used to obtain baseline infection rates. During this period, prophylactic antibiotics were given only to women undergoing elective CD. In era 2, July 2009 through June 2010, prophylactic antibiotics were given to all women. In addition, medical personnel underwent an education program, refresher course, and retraining in aseptic and scrub techniques. The study's primary outcome included any infectious morbidity related to the CD within 30 days from the operation.
  
  
  RESULTS
  The 1,616 CDs analyzed included 751 performed in era 1 and 865 performed in era 2. The incidence of any infectious morbidity dropped from 6.4% in era 1 to 2.5% in era 2 (P = .001). The incidence of any infectious morbidity in women undergoing elective CD fell from 5.3% to 0.9% (P = .001). Among women undergoing nonelective CD, the difference between the first and second eras was not statistically significant (7.5% vs. 4.5%; P = .09). However, the rate of incisional surgical site infection fell significantly, from 4% in era 1 to 1.5% in era 2 (P = .05).
  
  
  CONCLUSIONS
  The interventions implemented at our institution led to a considerable decline in post-CD infectious morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel. salim_ra@clalit.org.il
authors.forename: Raed
authors.initials: R
authors.lastname: Salim
authors.forename: Meirav
authors.initials: M
authors.lastname: Braverman
authors.forename: Ilanit
authors.initials: I
authors.lastname: Berkovic
authors.forename: Abeer
authors.initials: A
authors.lastname: Suliman
authors.forename: Nava
authors.initials: N
authors.lastname: Teitler
authors.forename: Eliezer
authors.initials: E
authors.lastname: Shalev
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods; D002585:Cesarean Section / Q000009:adverse effects*; D004203:Disinfection / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*