Strategies for the Prevention of C-section Incision Site Infections in High Risk Patients

Introduction: The CDC reports the rate of women having cesarean section has increased by 53% from 1996 to 2007. In 2007, 32% of all deliveries were by cesarean section. The average age of a woman having her first child is 29.4 years. 48% of women between the age of 40 and 54 years will have a cesarean section.  In addition, with the growing obesity epidemic many women have a prepregnancy BMI greater than 30. These women present with additional risk factors such as smoking and diabetes which increases chance of post delivery complications. A large pannus holds moisture, bacteria, and fungus, which can interfere with development of a healing ridge at the incision site.

Purpose/Objective: To develop a program to identify high risk c-section patients, pre-, intra-, and post-operatively and implement a standardized order set including use of a Nanocrystalline Silver rope dressing to eliminate the post-operative complication of surgical site infection and incision dehiscence. Program includes a risk assessment, order set, and patient education tools. Of the 524 c-sections performed during the first 6 months of 2011, 152 (29%) were considered high risk and were entered into this program. 

Outcomes: Prior to the implementation of this program, 1 to 2 patients per month were identified as having cesarean surgical site infection. After implementation our rate decreased to less than 1 patient per month.

This program was well received by the OB/GYN medical department. Our goal is to expand this program to our population of bariatric abdominal surgical candidates.