Reduction of cesarean delivery surgical site infections using an evidence-based care bundle

Cesarean delivery surgical site infections (SSI) are associated with significant patient morbidity, hospital readmissions, and increased costs to healthcare systems. We developed an evidence-based bundle of initiatives to reduce cesarean delivery SSIs. Beginning in January 2016, we implemented a bundle of initiatives aimed at the reduction of SSIs in women undergoing cesarean delivery. The bundle components consisted of: preoperative skin preparation with 2% chlorhexidine cloths and preoperative vaginal cleansing with chlorhexidine gluconate in all patients. Negative pressure wound therapy was utilized in women with a BMI ≥ 40 or with a high risk of post-operative infection. We continually assessed protocol compliance and outcomes. We compared the SSI rate from January-June 2016 to the rate from January-June 2014. Bivariable analysis performed using chi-square and Mann-Whitney U tests. Logistic regression models were fitted to adjust for significant covariates. The pre-bundle cohort includes 311 women who underwent cesarean delivery and the post-bundle cohort includes 514 women. Compliance with all components of the bundle was 78%. Compared to the post-bundle cohort, the pre-bundle cohort has a higher rate of gestational diabetes (11% vs 6%, p = 0.02) and lower closure rate of subcutaneous tissue (80% vs 93%, p<0.001). The SSI rate decreased from 9% to 2% after implementation of the bundle. The overall wound complication rate, which includes infection, seroma, and hematoma, decreased from 10% to 4% after bundle implementation. After adjusting for GDM and subcutaneous closure, the odds of SSI was significantly lower after implementation of the bundle (adjusted OR 0.3, 95% CI 0.1-0.5). (Table) Development and implementation of an evidence-based care bundle optimized for our patient population resulted in a significant reduction of cesarean delivery surgical site infections.