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

J Healthc Qual. 2021 Mar-Apr;43(2):67-75. doi: 10.1097/JHQ.0000000000000271.

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.

MeSH terms

  • Cesarean Section*
  • Female
  • Humans
  • Perioperative Care
  • Pregnancy
  • Quality Improvement
  • Surgical Wound Infection* / prevention & control