Using a Multi-Faceted Active Change Process and Infection Prevention to Reduce Post Op C-Section Infections

Purpose: To describe a program this has successfully reduced SSIs. C-section patients have a five to twenty-fold greater risk for infection as compared to vaginal delivery. Surgical site Infection rates are estimated to be as high as 6.6%. A single readmission due to post-op infection can range from $5,000-$100,000. Method: The site is an inner city women and newborn department doing 90-95 C-sections a month with a significant number of high risk patients.  A C-section Bundle was developed and implemented for all C-section patients. Inclusion Criteria for intervention: BMI>38 Diabetic with poor glucose control, large panus/evidence of skin breakdown, steroids, wound complications, >2 previous C-sections, keloid development, pregnancy induced hypertension (PIH), hemolysis, elevated liver enzymes, low platelet count (HELLP). Emergent patients: CHG scrub over the surgical site and blotted to dry by a sterile towel. Post op wound interventions: Dressings changed day three unless saturation required changing. Staples removed on day 7-10, not at discharge. Staples on obese patients stay in longer as needed. Negative pressure wound therapy for high risk patients.  Results: 83% infection reduction from January 2007 to December 2011. 92 post-op C-sections have been avoided since intervention yielding approximate cost savings of $4,600,000. (average of $50,000/readmission). Conclusions: Patient involvement is crucial for success. C-section SSI IS avoidable, even in high risk populations. It is hoped that studies of this type will allow for enhanced clinician education, patient safety and prove beneficial to facilities.