Benjamin Dieplinger1, Margot Egger2, Christian Jezek3, Christine Heinisch-Finke3, Christian Altendorfer4, Thomas Pernerstorfer5, Lukas Hefler4, Norbert Pateisky6, Thomas Mueller7. 1. Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; Hospital Hygiene, Konventhospital Barmherzige Brueder Linz, Linz, Austria. Electronic address: benjamin.dieplinger@bs-lab.at. 2. Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; Hospital Hygiene, Konventhospital Barmherzige Brueder Linz, Linz, Austria. 3. Hospital Hygiene, Konventhospital Barmherzige Brueder Linz, Linz, Austria. 4. Department of Obstetrics and Gynecology, Konventhospital Barmherzige Brueder and Ordensklinikum Linz, Linz, Austria. 5. Department of Anesthesiology, Konventhospital Barmherzige Brueder Linz, Linz, Austria. 6. AssekuRisk AG, Vienna, Austria. 7. Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria; Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy.
Abstract
BACKGROUND: To evaluate whether using a comprehensive and multidisciplinary approach to implement an evidence-based bundle can reduce 30-day surgical site infection rates in women undergoing cesarean delivery. METHODS: This observational study with a preintervention and postintervention design included 2576 consecutive women undergoing cesarean delivery at our tertiary care hospital between January 1, 2013 and December 31, 2017. The primary outcome was 30-day surgical site infection rate after cesarean delivery defined according to the Centers for Disease Control and Prevention criteria. The preintervention period span from the January 1, 2013 to December 31, 2014. After initiation of a Comprehensive Unit-based Safety Program (ie, a continuous quality improvement program to improve patient safety using a comprehensive and multidisciplinary approach adapted on local demands), we introduced a bundle of evidence-based interventions (including preoperative shower, hair removal with clippers, correct antibiotic prophylaxis, maintaining normothermia, glycemic control, and strict compliance with hygiene standards as well as practice good hand hygiene) per January 1, 2015 into clinical routine. The postintervention period span from January 1, 2015 to December 31 2017. RESULTS: In the preintervention period the overall surgical site infection rate was 16 of 1,060 cesarean deliveries versus in the postintervention period the overall surgical site infection rate was 9 of 1,516 cesarean deliveries (1.50% vs 0.56%; P = .033). This corresponds to a relative risk reduction of over 60% after implementation of the evidence-based bundle (odds ratio 0.39, 95% confidence interval 0.17-0.89; P = .020). CONCLUSIONS: In the present study, we have adapted the Comprehensive Unit-based Safety Program strategy to implement an evidence based-bundle into clinical routine. Using this comprehensive and multidisciplinary approach, we could markedly reduce 30-day surgical site infections.
BACKGROUND: To evaluate whether using a comprehensive and multidisciplinary approach to implement an evidence-based bundle can reduce 30-day surgical site infection rates in women undergoing cesarean delivery. METHODS: This observational study with a preintervention and postintervention design included 2576 consecutive women undergoing cesarean delivery at our tertiary care hospital between January 1, 2013 and December 31, 2017. The primary outcome was 30-day surgical site infection rate after cesarean delivery defined according to the Centers for Disease Control and Prevention criteria. The preintervention period span from the January 1, 2013 to December 31, 2014. After initiation of a Comprehensive Unit-based Safety Program (ie, a continuous quality improvement program to improve patient safety using a comprehensive and multidisciplinary approach adapted on local demands), we introduced a bundle of evidence-based interventions (including preoperative shower, hair removal with clippers, correct antibiotic prophylaxis, maintaining normothermia, glycemic control, and strict compliance with hygiene standards as well as practice good hand hygiene) per January 1, 2015 into clinical routine. The postintervention period span from January 1, 2015 to December 31 2017. RESULTS: In the preintervention period the overall surgical site infection rate was 16 of 1,060 cesarean deliveries versus in the postintervention period the overall surgical site infection rate was 9 of 1,516 cesarean deliveries (1.50% vs 0.56%; P = .033). This corresponds to a relative risk reduction of over 60% after implementation of the evidence-based bundle (odds ratio 0.39, 95% confidence interval 0.17-0.89; P = .020). CONCLUSIONS: In the present study, we have adapted the Comprehensive Unit-based Safety Program strategy to implement an evidence based-bundle into clinical routine. Using this comprehensive and multidisciplinary approach, we could markedly reduce 30-day surgical site infections.