Surgical Site Infection Reduction among Patients Undergoing Cesarean Section in a Tertiary Care Academic Facility
Background: The incidence of delivery via Cesarean section (CSEC) in the US has increased significantly over the past decade, now accounting for 33% of all births. Because of the often emergent nature of CSEC deliveries patients are at an increased risk of developing complications, including surgical site infections (SSI). Our facilities SSI rate for CSEC was almost double the National Healthcare Safety Network (NHSN) benchmark of 1.84 for calendar year (CY) 2012.
Methods: SSI surveillance was conducted according to NHSN definitions. Denominators are collected at the end of the month via a report from the Labor & Delivery operating room census. Events were declared after 100% case review by an Infection Control Practitioner and validation by the Hospital Epidemiologist. The Hospital Epidemiologist conducted a clinical review of all events and their microbiology, when available. During Quarter (Q) 1 of CY2012 pre-operative antibiotic prophylaxis was changed from Cefazolin to Cefotetan and Azithromycin. A providine-iodine vaginal prep was added to the surgical preparation process. CSEC SSI rates from CY2012 were compared to those for Q2 and Q3 of CY2013.
Results: The mean CSEC SSI rate for CY2012 was 3.47. This included a total of 16 SSI’s. Of these infections, 8 (50%) were superficial SSI’s and 8 (50%) were organ space consisting of Endomyometritis, Intra-abdominal, and other reproductive sites. Microbiologically significant organisms were identified for 9 of the infections. The mean CSEC SSI rate for the post-implementation phase of CY2013 Q2 and 3 was 1.87. These infections consisted of 4 events. Of these infections 1 (25%) was superficial and 3 (75%) were organ space. All 4 included identification of the organism associated with the infection.
Conclusion: After clinical and microbiological review of the events and organisms associated with each, we determined that the most significant epidemiology of infections were host contamination from vaginal flora. After implementing expanded antibiotic coverage and adding a pre-operative vaginal prep we have seen a significant reduction in CSEC infections. More time is needed to determine if this reduction will be sustained.
C. Argani, None
J. M. Zenilman, None
T. M. Perl, None
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