191: Reduction and sustainability of surgical site infections (SSI) after cesarean delivery (CD): seven years of experience


      To determine if implementing infection control policies and an innovative evidence-based bundle checklist would reduce and sustain SSI rate following CD.

      Study Design

      A retrospective cohort study under four phases was conducted from 1/2008 to 12/2014. The hospital infection control (IC) policies and a pre-surgical checklist (electric clipper for hair removal, chlorohexidine for skin preparation, antibiotics time and types: Cefazolin + Azithromycin, traction of cord to remove placenta, closure of deep subcutaneous layer >2 cm, and skin closure with suture) were bundled and implemented. 3,334 patients had CD between 1/2008 and 12/2014. Patients were divided into 4 phases: Phase A (1/1/2008-1/31/2010):1250 patients without intervention, Phase B (2/1/2010-7/31/2011): 682 patients intervened with strict IC policies, Phase C (8/1/2011-12/31/2012):591 patients with IC policies and SSI bundle checklist, Phase D (1/1/2013-12/31/2014):811 patients were monitored the sustainability of CD SSI. Patients without following strict protocols due to emergency CD were excluded. CD SSI reduction rates were calculated. Chi square test, Fisher’s Exact test, and standard Z test were used for statistical analyses.


      CD SSI rates were 6.2% (77/1250; Phase A), 3.7% (25/682; Phase B), 1.7% (10/591; Phase C), and 0.1% (1/811; Phase D) respectively. By implementing the IC policies, CD SSI reduction rate was 40.3% (Phase B vs. Phase A), 72.6% reduction after IC policies with bundle checklist (Phase C vs. Phase A), and 98.4% reduction (Phase D vs. Phase A). All statistics were significant.


      Our innovative evidence-based bundle checklist with IC policies at different phases during past 7 years effectively reduces the incidence of SSI rate following Cesarean deliveries. The reduction rate can be up to 98.4% overall and sustain down to approaching zero. We conclude the strategic plans through hospital IC policies as well as innovative bundle checklist can reduce CD SSI rate down to approaching zero. A future prospectively randomized clinical trial is warranted.