Surgical bundle sustainability in caesarean section births: An integrative review

Surgical site infection (SSI) rates for Australian patients undergoing caesarean section births (CS) range from 5 % to 9 %. As CS rates are increasing, it is imperative to identify effective measures to reduce SSIs. Surgical bundles are one strategy used to prevent infections in various surgical procedures.

To identify and discuss the evidence supporting the combination of individual surgical bundle practices in CS births that contribute to SSI reduction and how these surgical bundle practices are sustained.

An integrative review was undertaken using articles from a systematic search of five research databases. The review examined studies that implemented or evaluated a surgical bundle for CSs.

Ten articles met the inclusion criteria. All reported SSI reductions post-intervention. Studies implementing four or fewer surgical bundle components demonstrated a larger reduction in infection rates and increased compliance compared to those with five or more components. Studies with shorter durations, prospective designs, and smaller sample sizes all reported a larger reduction in SSIs. Compliance was reported throughout the studies, but recommendations to achieve long-term sustainability were not supported by evidence.

This review identified a surgical bundle with four components that may reduce the SSI rate in CS births. Strategies to sustain evidence-based practices to reduce SSIs in CS have not been extensively studied. Future research should investigate factors that support compliance and track ongoing compliance with infection prevention surgical bundle elements, as well as their impact on SSI rates.