Changing gloves during caesarean birth: impact on maternity service budgets and capacity

Changing gloves after placental delivery during caesarean birth (CB) is associated with a significantly lower incidence of surgical site infection (SSI). This study analysed the impact that changing gloves would have on the budget and capacity of a typical National Health Service (NHS) maternity service, and on the English NHS as a whole, if it was adopted as a standard practice.

A budget impact model with a 5-year time horizon was developed and populated with base case data from the maternity service at Royal United Hospitals Bath NHS Foundation Trust (RUHB), where 1590 CBs were performed in 2023-2024. SSI incidence rates were obtained using a 30-day post-discharge questionnaire and combined with NHS England national cost data to quantify the current costs of all post-CB SSI treatment pathways. Future costs were obtained by adjusting incidence rates using the relative risk obtained from a published systematic review and meta-analysis of seven randomized controlled trials of the impact of changing gloves during CB. Net budget impact was calculated as the incremental difference between current and future costs, less the time and cost associated with changing gloves pre-closure. Uncertainty in the model was explored through one-way sensitivity analysis, and through alternative scenarios that investigated the impact of differing CB volumes, SSI incidence rates and re-admission lengths of stay.

Based on the current 30-day post-discharge SSI rate of 15%, the base case analysis estimated that changing gloves pre-closure at RUHB would deliver cost-savings of £59,478 in its first year of introduction and £339,654 over the 5-year time horizon of the model. The majority of this cost-saving (£254,507) would accrue through significant reductions in the number of community midwife postnatal visits and hospital re-admissions. Local general practices would see cost-savings of £85,147 from reductions in the number of appointments. Extrapolated across the whole of England, this analysis found that changing gloves could reduce the economic burden of post-CB SSIs by £45.1 million over 5 years. Sensitivity and scenario analyses confirmed the robustness and persistence of these results.

By reducing post-CB infections, changing gloves pre-closure may reduce costs and release meaningful capacity for both local maternity services and the English NHS as a whole. Inadequate post-discharge follow-up may have led to underestimation of the true incidence of post-CB SSI in previously published studies.