title: A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system.
abstract: BACKGROUND
  We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system.
  
  
  METHODS
  Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis.
  
  
  RESULTS
  Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001).
  
  
  CONCLUSIONS
  A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada. Electronic address: wil.ng@nygh.on.ca.
authors.forename: Wil
authors.initials: W
authors.lastname: Ng
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Brown
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Alexander
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Man Fan
authors.initials: MF
authors.lastname: Ho
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Kerr
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Amato
authors.affiliation: North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
keywords: Antibiotic prophylaxis; C-section; Hair removal; Segmented regression analysis; Surgical safety checklist; Surgical site infection