title: Practices to Reduce Surgical Site Infections Among Women Undergoing Cesarean Section: A Review.
abstract: OBJECTIVE
  Surgical site infections (SSIs) are a leading cause of morbidity and mortality among women undergoing cesarean section (C-section), a common procedure in North America. While risk factors for SSI are often modifiable, wide variation in clinical practice exists. With this review, we provide a comprehensive overview of the results and quality of systematic reviews and meta-analyses on interventions to reduce surgical site infections among women undergoing C-section.
  
  
  METHODS
  We searched PubMed and the Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses published between January 2000 and May 2014 on interventions to reduce the occurrence of SSIs (incisional infections and endometritis), among women undergoing C-section. We extracted data on the interventions, outcomes, and strength of evidence as determined by the original article authors, and assessed the quality of each article based on a modified Assessment of Multiple Systematic Reviews tool.
  
  
  RESULTS
  A total of 30 review articles met inclusion criteria and were reviewed. Among these articles, 77 distinct interventions were evaluated: 29% were supported with strong evidence as assessed by the original article authors, and 83% of the reviews articles were classified as good quality based on our assessment. Ten interventions were classified as being effective in reducing SSI with strong evidence in a good-quality article, including preoperative vaginal cleansing, the use of perioperative antibiotic prophylaxis, and several surgical techniques.
  
  
  CONCLUSIONS
  Efforts to reduce SSI rates among women undergoing C-section should include interventions such as preoperative vaginal cleansing and the use of perioperative antibiotics because compelling evidence exists to support their effectiveness.
authors.affiliation: 1Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Rebeccah A
authors.initials: RA
authors.lastname: McKibben
authors.affiliation: 1Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Samantha I
authors.initials: SI
authors.lastname: Pitts
authors.affiliation: 2Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Catalina
authors.initials: C
authors.lastname: Suarez-Cuervo
authors.affiliation: 1Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.affiliation: 1Department of Medicine,Johns Hopkins University School of Medicine,Baltimore,Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
mesh_terms: D019072:Antibiotic Prophylaxis; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D014621:Vagina / Q000382:microbiology; D044364:Vaginal Douching