Reducing surgical site infections post-caesarean section in an Australian hospital, using a bundled care approach.

Autor: Bolte M; Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340. Electronic address: Michelle.Bolte@health.nsw.gov.au., Knapman B; Wollongong Hospital, 348 Crown Street, Wollongong, NSW, Australia, 2500. Electronic address: Blake.Knapman@health.nsw.gov.au., Leibenson L; Tamworth Rural Referral Hospital, Dean Street, Tamworth, NSW, Australia, 2340. Electronic address: Lilach.leibenson@health.nsw.gov.au., Ball J; Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300. Electronic address: Jean.ball@health.nsw.gov.au., Giles M; Hunter New England Nursing and Midwifery Research Centre, James Fletcher Campus 72 Watt Street, Newcastle, NSW, Australia, 2300. Electronic address: Michelle.Giles@health.nsw.gov.au.
Jazyk: angličtina
Zdroj: Infection, disease & health [Infect Dis Health] 2020 Aug; Vol. 25 (3), pp. 158-167. Date of Electronic Publication: 2020 Mar 09.
DOI: 10.1016/j.idh.2020.01.006
Abstrakt: Background: The past 20 years have seen increasing Caesarean section (CS) rates in Australia. Increasing antenatal morbidity means that post-CS surgical site infection (SSI) is an issue impacting Australian women, mostly low-socioeconomic and regional communities. Recent trends supporting development of evidence-based bundled approaches to SSI reduction, have not proved efficacy nor supported bundle implementation.
Aims: This pilot study aimed to develop, implement and assess an evidence-based Caesarean Infection Prevention ("CIP") bundled intervention to reduce post-CS SSI rates in a high risk population.
Methods: The study was a pre-post-intervention study, including women undergoing CS at one referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified women who developed a post-CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Data was collected for the subsequent 12 months on women undergoing CS.
Results: A total of 710 procedures were monitored with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent over time. Post-CS SSI rates significantly reduced post-intervention (5.5% vs. 1.6%, p = 0.007), the greatest benefit in class II and III obese patients (12.2% vs. 2.5%, p = 0.019). Higher hypertension rates (24% vs. 9%, p = 0.01) and lower maternal mean age (27 vs. 30, p = 0.01) were seen in patients with SSI.
Conclusion: The "CIP" bundle effectively reduced post-CS SSIs in a high risk population. Our findings substantiate the need for development and evaluation of multifaceted, evidenced-based interventions to reduce post-CS SSIs.
Trial Registration: Retrospectively registered.
Trial Registration: ACTRN12619001001189, July 2019.
(Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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