Evaluation of a bundled care approach to preventing surgical site infections post caesarean section in an Australian Rural Hospital

Abstract Background Elective and non-elective caesarean section (CS) rates have been increasing in Australia over the past 20 years. Increasing antenatal morbidity, has meant that surgical site infection (SSI) post CS is an important issue effecting Australian women. Populations most impacted include low socioeconomic and regional communities where high rates of antenatal comorbidity increase the incidence of SSI. Despite a recent trend towards supporting the development of evidence based bundled approaches to SSI reduction, there remains a paucity of data proving efficacy and supporting bundle implementation. Aims This study aimed to develop, implement and assess an evidence based caesarean infection prevention “CIP” bundled intervention to reduce SSI rates following CS in a high risk rural population. Methods The study was a pre-post-intervention study with 3 phases and included all women undergoing CS at a regional referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified all women who developed a post CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Prospective data was collected for a subsequent 12 month period on all women who underwent CS with pre and post comparative data analysis. Results A total of 710 procedures were monitored as part of the study with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent between the two time periods. Rates of CS associated SSI reduced significantly post-intervention (5.5% vs. 1.6%, p=0.007), the greatest benefit seen in class II and III obese patients (12.2% vs. 2.5%, p=0.019). Higher rates of hypertension (24% vs. 9%, p=0.01) and lower maternal age (mean age 27 vs. 30, p=0.01) were seen in patients with SSI. Rates of smoking were higher in women effected by SSI (24% vs 9%) but did not reach statistical significance. Conclusion The “CIP” bundle is an effective method of reducing caesarean associated surgical site infections in a high risk population. Our findings highlight the necessity for the development and evaluation of multifaceted, evidenced based interventions to reduce SSI in women requiring caesarean delivery.