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Purpose: To reduce surgical site infections in women requiring a cesarean section at a Catholic Regional Level II Trauma Center in the Midwest.
Strategy and Implementation: A evidence based practice and product approach was taken to reduce cesarean section surgical site infections. Postoperative wound care was standardized by developing high risk criteria for the use of foam boarder dressing verses foam AG boarder dressings. It was soon identified upon review and outcomes that the foam AG dressing was the dressing of choice and added as the standard dressing. The practice of using preoperative Chlorhexidine (CHG) wipes either at home or upon arrival to the hospital were changed to CHG showers and a CHG pre-op scrub was added as part of the operative prep process. Iodine infused incise drape, and closing trays were implemented.
Evaluation: A >50% reduction in cesarean SSIs occurred after standardized incision and dressing practices. In 2015, there was a spike in SSIs when the CHG scrub was added as part of the OR prep. It was determined the fenestrated drape was not adhering. Rapid replacement of drape type occurred and closing trays were implemented. SSI rates have remained at 0.5%, compared to NHSN mean of 1.8%.
Implications for Practice: Evidence and outcomes demonstrate that a standardized pre and postoperative approach is required to prevent SSIs in women requiring a cesarean section. Prepping patients preoperatively with both CHG showers and scrubs is necessary along with contained OR traffic control. In addition, the use of foam AG dressings on the surgical incision for 7 days. Collaboration amongst the multidisciplinary team is essential along with thorough case review of infections to identify gaps, opportunities, and actions needed to continue rates well below the benchmark.