title: A journey to zero: reduction of post-operative cesarean surgical site infections over a five-year period.
abstract: BACKGROUND
  Surgical site infections (SSI) are a substantial concern for cesarean deliveries in which a surgical site complication is most unwelcome for a mother with a new infant. Steps taken pre- and post-operatively to reduce the number of complications may be of substantial benefit clinically, economically, and psychologically.
  
  
  METHODS
  A risk-based approach to incision management was developed and implemented for all cesarean deliveries at our institution. A number of incremental interventions for low-risk and high-risk patients including pre-operative skin preparations, standardized pre- and post-operative protocols, post-operative nanocrystalline silver anti-microbial barrier dressings, and incisional negative pressure wound therapy (NPWT) were implemented sequentially over a 5-y period. A systematic clinical chart review of 4,942 patients spanning all cesarean deliveries between 2007-2012 was performed to determine what effects the interventions had on the rate of SSI for cesarean deliveries.
  
  
  RESULTS
  The percentage of SSI was reduced from 2.13% (2007) to 0.10% (2012) (p<0.0001). There were no substantial changes in the patient population risk factors over this time. As a result of the changes in incision management practice, a total of 92 cesarean post-operative SSIs were avoided: A total cost saving of nearly $5,000,000.
  
  
  CONCLUSIONS
  Applying a clinical algorithm for assessing the risk of surgical site complication and making recommendations on pre-operative and post-operative incision management can result in a substantial and sustainable reduction in cesarean SSI.
authors.affiliation: 1 Perinatal Clinical Nurse Specialist, MultiCare Health System , Puyallup, Washington.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hickson
authors.forename: Jeanette
authors.initials: J
authors.lastname: Harris
authors.forename: David
authors.initials: D
authors.lastname: Brett
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
references.citation: Int Wound J. 2015 Apr;12(2):195-201
references.pmid: 23647737
references.citation: Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8
references.pmid: 20816153
references.citation: Am J Infect Control. 2009 Dec;37(10):783-805
references.pmid: 20004811
references.citation: Surg Innov. 2014 Aug;21(4):345-9
references.pmid: 24056202
references.citation: J Trauma. 2006 Jun;60(6):1301-6
references.pmid: 16766975
references.citation: Adv Skin Wound Care. 2012 Sep;25(9):414-9
references.pmid: 22914038
references.citation: J Orthop Trauma. 2006 Nov-Dec;20(10):705-9
references.pmid: 17106382
references.citation: Obstet Gynecol Surv. 2005 Jul;60(7):462-73
references.pmid: 15995563
references.citation: BJOG. 2012 Oct;119(11):1324-33
references.pmid: 22857605
references.citation: Bone Joint Res. 2013 Dec 18;2(12):276-84
references.pmid: 24352756
references.citation: Dis Colon Rectum. 2011 Aug;54(8):1014-9
references.pmid: 21730792
references.citation: Ann Vasc Surg. 2007 Sep;21(5):598-602
references.pmid: 17521872
references.citation: NCHS Data Brief. 2010 Mar;(35):1-8
references.pmid: 20334736
references.citation: Infect Control Hosp Epidemiol. 2010 Mar;31(3):276-82
references.pmid: 20102279
references.citation: Cochrane Database Syst Rev. 2013;3:CD003949
references.pmid: 23543526