Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections

Haas, David M.; Morgan, Sarah; Contreras, Karenrose; Kimball, Savannah

doi:10.1002/14651858.cd007892.pub7

Cited by 37 publications

(50 citation statements)

References 45 publications

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“…12,13 However, those studies are outdated due to the emerging new evidence such as vaginal cleansing and preoperative intravenous azithromycin. 4,5,14 A secondary analysis of a randomized controlled trial found that women who had 4 evidence-based interventions (preoperative cefazolin prior to skin incision, chlorhexidine-alcohol skin antisepsis, closure of subcutaneous layer, and suture subcuticular skin closure) compared to those who did not have all 4 interventions had 67% lower odds of surgical site infections. 12 However, the randomized controlled trial was conducted for a different purpose.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13] Further, newer evidence has made methods and results of previous studies obsolete. 4,14 The Accreditation Council for Graduate Medical Education (ACGME) implemented a requirement within all graduate medical education curricula for residents to perform patient safety and quality improvement projects. 15 Encouraged by this requirement, a residentdriven quality initiative using an evidence-based surgical bundle for cesarean delivery was implemented in December 2016 at MedStar Washington Hospital Center.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Cesarean Delivery Surgical Site Infections

Kawakita

Iqbal

Landy

et al. 2019

Obstetrics &Amp; Gynecology

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Objective: To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections. Methods: This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-based surgical bundle, excluding women who underwent emergency cesarean or had chorioamnionitis. The bundle included routine prophylactic antibiotics (both cefazolin and azithromycin), chlorhexidine alcohol skin preparation, use of clippers instead of a razor, vaginal cleansing with povidone iodine, placental removal by umbilical cord traction, subcutaneous tissue closure if wound thickness >2 cm, suture skin closure, dressing removal between 24 and 48 hours, and use of postoperative chlorhexidine soap. Our primary outcome was surgical site infections (superficial incisional, deep incisional, and organ or space surgical site infections) occurring up to 6 weeks postpartum. Outcomes were compared between the preimplementation period (January 2015-August 2016) and postimplementation period (December 2016-June 2018). Coarsened Exact Matching with k-to-k

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing Cesarean Delivery Surgical Site Infections

Kawakita

Iqbal

Landy

et al. 2019

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…A Cochrane review in 2018 concluded that vaginal preparation with povidone-iodine or chlorhexidine solution immediately before caesarean delivery probably reduces the rates of postoperative endometritis. 8 It was also recommended in a systematic review and meta-analysis of best practice perioperative strategies for preventing caesarean section SSIs published in the BJOG . 7 Vaginal preparation with povidone-iodine immediately before caesarean section is recommended by the WHO.…”

Section: Introductionmentioning

confidence: 99%

Implementation of vaginal preparation prior to caesarean section

et al. 2020

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IntroductionSurgical site infections following caesarean section are associated with significant morbidity. Vaginal preparation is the cleansing of the vaginal epithelium with an antibacterial solution to reduce the bacterial load and therefore reduce ascending genital tract infection. It is recommended by the WHO and a Cochrane review in 2018 concluded that vaginal preparation immediately before caesarean section probably reduces the rates of postoperative endometritis.ObjectiveTo implement vaginal preparation prior to caesarean section at Guy’s and St Thomas’ Hospital NHS Foundation Trust and reduce rates of deep surgical site infections.MethodsThe protocol (included within the appendices) for vaginal preparation prior to caesarean section was developed after reviewing the available evidence. Two vaginal preparation champions, a midwife and a scrub nurse, were selected to help promote and assist in the implementation. The first implementation cycle included elective and category II and III caesarean sections. To ensure acceptability, 20 women were asked to complete a questionnaire following vaginal preparation. Once the intervention was being performed in >85% of eligible women, the inclusion criteria was expanded to include category I caesarean sections.ResultsTwelve months following implementation, vaginal preparation was still being performed in 89% of eligible women. The deep surgical site infection rate is now the lowest recorded in the last 6 years. Vaginal preparation prior to caesarean section was acceptable to pregnant women and no adverse effects were reported.ConclusionsVaginal preparation prior to caesarean section has been successfully implemented at Guy’s and St Thomas’ Hospital NHS Foundation Trust. This simple, cheap intervention, performed with readily available materials, is still being performed in a high number of caesarean sections 12 months post-implementation. It has resulted in a reduction in deep surgical site infections. Involvement of key stakeholders and the recruitment of vaginal preparation champions were key to success.

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“…Patient safety process adherence rate: Rate of six indicators: use of pulse oximetry at the time of initiation of anaesthesia; administration of prophylactic antibiotics within 60 min before incision; oral confirmation, immediately before incision, of the identity of the patient, operative site and procedure to be performed; completion of an instrument, sponge and needle count at the end of the procedure; appropriate operative site cleansing (skin preparation with Chlorhexidine-alcohol or iodine-based solution); and vaginal preparation with povidone-iodine 2 13 34 64 65…”

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confidence: 99%

Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

et al. 2019

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IntroductionEffective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term.Methods and analysisOur design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania’s Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance.Ethics and disseminationThe study has received ethical approval from Harvard Medical School and Tanzania’s National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania’s Lake Zone region and other similar contexts.

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Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections

Abstract: Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.

Cited by 37 publications

References 45 publications

Reducing Cesarean Delivery Surgical Site Infections

Reducing Cesarean Delivery Surgical Site Infections

Implementation of vaginal preparation prior to caesarean section

Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

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