Impact of an Infection Prevention Bundle Modification on Post-Cesarean Delivery Surgical Site Infections

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Safety

Background:

• Surgical site infections (SSIs) are a significant concern following cesarean deliveries.
• Existing SSI prevention bundles often focus on pre-operative and intra-operative phases.
• The impact of modifications specifically targeting the closing phase of surgery on SSIs is less understood.

Purpose of the Study:

• To evaluate the effectiveness of a modified surgical site infection (SSI) prevention bundle on post-cesarean SSI rates.
• The modification specifically involved changes to equipment used during the closing phase of cesarean deliveries.
• To determine if enhanced closing-phase protocols offer additional benefits beyond standard SSI prevention.

Main Methods:

• A retrospective cohort study analyzed 2,467 cesarean deliveries from April 2018 to February 2025.
• An amended SSI prevention bundle, implemented in September 2021, included changes in glove, light handle, Bovie, and instrument usage during closure.
• Logistic regression models adjusted for maternal and gestational age; subgroup analyses considered labor status, prior cesarean, and BMI.

Main Results:

• The incidence of SSIs was 2.6% pre-implementation and 3.3% post-implementation (adjusted OR 1.27, p=0.313).
• No significant temporal trends in SSI rates were observed before or after the bundle's implementation.
• Subgroup analyses by labor status, prior cesarean, and BMI did not reveal significant associations between the modified bundle and SSI risk.

Conclusions:

• Implementing closing-phase equipment changes did not significantly reduce post-cesarean SSI rates.
• Standardized core SSI prevention measures (antibiotics, preparation, dressings) may be sufficient, with limited added benefit from equipment changes alone.
• Rigorous evaluation of process changes is crucial before widespread adoption in clinical practice.