Reducing Caesarean Section Surgical Site Infection (SSI) by 50%: A Collaborative Approach

Abstract

Objective: Caesarean section surgical site infection (SSI) is a surgical wound site infection occurring within 30 days of surgery with a reported incidence of 3–15%. This quality improvement (QI) project aimed to reduce caesarean section SSI by 50% in a tertiary maternity center. Methods: Using multidisciplinary team approach, the project was designed with evidence-based interventions. The Royal College of Physicians of Ireland/Royal College of Surgeons in Ireland “Preventing Surgical Site Infections Key Recommendations for Practice” guideline was used as standard perioperative care. A care bundle was designed targeting preoperative personal patient preparation, preoperative prophylactic antibiotics, and strict skin preparation technique, all measured using a patient survey. The rate of SSI was followed for 14 months. The Model for Improvement methodology was used to implement change. Results: Surgical site infection rate decreased from 6.7% (n = 684 caesarean sections, n = 46 SSI) to 3.45% (n = 3,206 caesarean sections, n = 110 SSI), p = .0006. Reduction occurred in both elective (4.4%–2.7%) and emergency (9.1%–4.1%) caesarean section groups. There was excellent adherence to all three elements of the care bundle. The 50% reduction in caesarean section SSI was sustained over the 14-month period, significantly reducing maternal morbidity. Conclusions: The success of this QI project is attributable to frontline ownership and empowerment of patients and staff.

Surgical Site Infections During the Pandemic: The Impact of the “COVID Bundle”

“…Analysis of the pre-pandemic era indicated that SSI rates significantly reduced month-on-month throughout this period, likely reflecting the phased introduction of SSI bundles as part of a large institutional QIP to reduce SSI rates launched in 2016. SSI intervention bundles have been proven to reduce rates of SSI in patients undergoing colorectal, obstetric, gynecology, and spinal orthopedic surgery [9][10][11][12][13]. A further drop in SSI rates was evident at the pandemic onset.…”

Successful Interventions to Improve Efficiency and Reduce Patient Visit Duration in a Retina Practice

“…The benefits of using a multidisciplinary team-based approach for quality improvement projects have been well established in the literature. [16][17][18] This study has shown that improving clinic efficiency can be accomplished by reducing bottlenecks in clinic workflow. Reallocation of resources, including reorganizing equipment and training clinic personnel for new responsibilities, is a more cost-effective solution than only focusing on capital purchases or hiring additional personnel.…”

“…The benefits of using a multidisciplinary team-based approach for quality improvement projects have been well established in the literature. 16–18…”

Medical-Grade Honey Enhances the Healing of Caesarean Section Wounds and Is Similarly Effective to Antibiotics Combined with Povidone-Iodine in the Prevention of Infections—A Prospective Cohort Study

“…SSIs are also associated with increased healthcare costs, longer hospitalization, and more patient dissatisfaction [11]. Globally, the rate of SSI following CSs varies roughly between 3 to 15%, with higher levels in developing countries [12]. However, higher SSI rates are also described and attributed to the quality of care, study sample size, and predisposing factors (e.g., diabetes mellitus, obesity, smoking, malnutrition, and age) [13][14][15][16].…”

“…However, higher SSI rates are also described and attributed to the quality of care, study sample size, and predisposing factors (e.g., diabetes mellitus, obesity, smoking, malnutrition, and age) [13][14][15][16]. It is estimated that half of all SSIs can be prevented [11,13], as was recently proven in Dublin, Ireland [12].…”