Reducing Cesarean Delivery Surgical Site Infections: A Resident-Driven Quality Initiative.

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Quality Improvement

Background:

• Cesarean delivery surgical site infections (SSIs) are a significant source of maternal morbidity.
• Quality improvement initiatives are crucial for reducing healthcare-associated infections.
• Resident involvement can drive impactful changes in clinical practice.

Purpose of the Study:

• To evaluate the effectiveness of a resident-driven quality initiative in reducing cesarean delivery SSIs.
• To assess the impact of a comprehensive surgical bundle on SSI rates.

Main Methods:

• A quasi-experimental, pre- and post-intervention study design was employed.
• A resident-developed, evidence-based surgical bundle was implemented, including prophylactic antibiotics, skin preparation, and wound care protocols.
• Coarsened Exact Matching was used to compare SSI rates between matched pre- and post-implementation cohorts.

Main Results:

• The overall SSI rate decreased significantly from 4.5% in the pre-implementation period to 2.2% in the post-implementation period (unmatched cohort).
• After matching, the SSI rate remained significantly lower in the post-implementation group (1.9% vs. 4.1%).
• The odds ratio for SSIs was significantly reduced post-intervention (OR 0.46).

Conclusions:

• Implementation of a resident-driven surgical bundle led to a significant reduction in cesarean delivery SSIs.
• This initiative demonstrates the success of multidisciplinary, evidence-based approaches in enhancing surgical safety.
• The findings support the widespread adoption of similar quality improvement programs to decrease postpartum infections.