A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system

American Journal of Infection Control: August 1, 2015 Volume 43, Issue 8, Pages 805–809

We assessed the effects of the components of a multifaceted and evidence-based caesarean-section surgical site infection (SSI) prevention program on the SSI rate after cesarean section using a postdischarge surveillance (PDS) system.

Multiple prevention interventions were serially implemented. SSI case finding was undertaken through active inpatient surveillance and intensive PDS using a standardized form at the 6-week postdischarge visit. SSI diagnosis was made using the Centers for Disease Control and Prevention standardized criteria. All cesarean deliveries between July 2007 and December 2012 were included. Changes in SSI rate were analyzed using segmented regression analysis.

Nine thousand four hundred forty-two cesarean sections were assessed during the study period. PDS forms were completed for 7,985 women (85%). SSI was detected in 451 cases (5.6%): 91% were superficial, 9% were deep/organ-space infections. The SSI rate decreased incrementally from 8.2% at baseline to 4.1%; significant decreases were observed after optimizing antibiotic prophylaxis timing, using a surgical safety checklist, and enhancing prenatal education to discourage prehospital self-removal of hair. Nonelective surgeries or those undertaken after >12 hours of rupture of membranes had a significantly higher rate compared with those without either risk factor (6.3% vs 3.2%; P < .001).

A multifaceted SSI prevention strategy, with periodic feedback of data, led to a significant reduction in SSI rates after cesarean section.

via A multifaceted prevention program to reduce infection after cesarean section: Interventions assessed using an intensive postdischarge surveillance system – American Journal of Infection Control.


Wearing two sets of gloves reduces contamination in surgery

A simple intervention such as wearing double gloves and removing the outer layer after touching the patient during surgery can reduce contamination. This study tested, in a simulated environment, whether anaesthetists wearing two pairs of gloves reduced contamination in surgery. The outer set of gloves was removed immediately after placing a tube into the airway. In half of the 22 simulation sessions personnel wore a single pair of gloves and in the other half they wore two sets of gloves. Before the simulation, the lips and inside of the mouth of the mannequin were coated with a fluorescent gel to represent a pathogen. After the simulation, an observer examined 40 different sites to determine whether the ‘pathogen’ was transferred to the patient or the patient’s environment. There was a significant reduction in the rate of contamination with double gloves. Single gloves were associated with an average of 20 contaminated sites compared to five with double gloves.

Reference: Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesthesia and Analgesia. 2015 Mar;120(4):848-852