Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods

Arch Intern Med. 2001 Oct 22;161(19):2357-65. doi: 10.1001/archinte.161.19.2357.


Background: Improving obstetric care in resource-limited countries is a major international health priority.

Objective: To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods.

Methods: Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate.

Results: Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04).

Conclusion: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ampicillin / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis*
  • Cephalosporins / therapeutic use*
  • Cephalothin / therapeutic use*
  • Cesarean Section / adverse effects*
  • Colombia
  • Endometritis / drug therapy
  • Endometritis / etiology
  • Endometritis / prevention & control
  • Female
  • Gentamicins / therapeutic use*
  • Hospitals, Voluntary
  • Humans
  • Obstetrics and Gynecology Department, Hospital
  • Penicillin G / therapeutic use*
  • Penicillins / therapeutic use*
  • Perioperative Care
  • Poverty
  • Pregnancy
  • Quality Indicators, Health Care
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control*
  • Total Quality Management*


  • Anti-Bacterial Agents
  • Cephalosporins
  • Gentamicins
  • Penicillins
  • Ampicillin
  • Penicillin G
  • Cephalothin