A Collaborative Quality Improvement Project to Reduce Surgical Site Infection in Cesarean Delivery.

Abstract

Introduction: Cesarean delivery (CD) facilitates delivery of the baby through an incision and is performed in situations where vaginal delivery poses risks to the mother, baby, or both. Over 1.2 million CDs are performed in the United States annually.

Methods: An interdisciplinary council was created to drive regular data analysis and sharing, interdisciplinary collaboration, and standardized processes to reduce surgical site infections (SSI) following CD. The standardized infection ratio (SIR), a summary measure used to track hospital-acquired infections at a national, state, or local level over time, was used. Bundle components included pre- and postsurgical education and access to follow-up, peri- and intraoperative practice changes, and a risk stratification tool for postoperative dressing selection.

Results: The bundle was initiated in April 2022. After use was established for 6 months, the SIR was evaluated in the fourth quarter of 2022. For this one quarter, the expected SIR for the hospital was 2.64, and the calculated SIR measured 0.38. In 2022, which included 3 months prebundle and 9 months postbundle, the expected SIR was 10.57, with a calculated SIR of just 0.66 for the full year. In 2023, the expected SIR was 11.10, with a calculated SIR of 0.27. The SSI rate reflects an observed 75% reduction in SSI between the years 2021 and 2023. Zero SSI have been observed from January to May 2024. For the patients who underwent planned CD, 98% received the full perioperative obstetric bundle.

Discussion: The ongoing analysis and sharing of data, the implementation of standardized processes, and interdisciplinary collaboration were imperative to the success of this hospital's quality improvement project to reduce SSI for patients undergoing CD.