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A2021
October 14, 2018
10/14/2018 7:30:00 AM - 10/14/2018 9:30:00 AM
Room North, Hall D, Area D
Development and Implementation of A Surgical Site Infection Bundle for Cesarean Section
Katherine Seligman, M.D., Kar-Wei Leung, M.D., Emily R. Bui, M.D., Nichole P. Bordegaray, M.D.
University of New Mexico, Albuquerque, New Mexico, United States
Disclosures: K. Seligman: None. K. Leung: None. E.R. Bui: None. N.P. Bordegaray: None.
Background: Surgical site infections (SSI) are associated with increased morbidity, increased hospital length of stay, and re-admission (1). SSIs following cesarean delivery (CD) occur in 7-10% of cases (2). As cesarean delivery is the most common operative procedure in the US, this amounts to a large annual complication rate (3). There has been a recent push by the Institute for Healthcare Improvement and the Joint Commission to implement standardized care bundles to decrease the rates of SSI. This has been piloted in joint surgery, colorectal surgery, and gynecological surgery. Our OB Anesthesia division set out to develop a SSI bundle for CD at our academic hospital with 3,000 annual deliveries a year and a CD rate of 24%. Methods: Until recently, our institution did not track post CD SSI nor possess appropriate measures to reduce its occurrence. We conducted a literature review of best practices to examine the measures most appropriate for an SSI bundle for CD. These measures were discussed within our surgical site infection committee with the subsequent production of a SSI bundle with buy in from Family Medicine, Obstetrics, and Nursing. The bundle consisted of measures to be taken by both the patient and the surgical team in the pre-operative, intra operative and post-operative phases. Pre-op measures included 4% chlorhexidine showers, abstention of shaving after 37 weeks gestation and clipping hair at the surgical site. Intraop measures included appropriate antibiotic prophylaxis with a 1st generation cephalosporin & addition of azithromycin if in labor, placenta removal via traction on cord, surgical glove change before closure of fascia and deep tissue layers, and maintenance of maternal temperature of >36C. Post-op measures included new patient education handouts in English and Spanish and emphasis on surgical site hygiene and returning to obstetric triage for any early signs of infection. Discussion Our CD SSI bundle was implemented in November 2017 following provider and nursing education. Audits have indicated that all the bundle elements are being followed 80-90% of the time for elective and urgent CD. Challenges with implementation included resistance to glove change, OR temperature change, and new antibiotic recommendations. We will continue to review SSI rates over the next year with the goal of reducing morbidity associated with SSI. 1. JAMA Surg 2017;152(8):784-7912. Emerg Infect Dis 2001 Sep-Oct;7(5):837-41 3. Am J Perinatol 2014 Apr;31(4):299-304
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