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

This study aimed to evaluate the impact of a modified surgical site infection (SSI) prevention bundle, focused on closing-phase equipment changes, on post-cesarean SSI rates.

We conducted a retrospective cohort study of cesarean deliveries performed by a single, large, obstetrical and maternal-fetal medicine practice from April 1, 2018, to February 28, 2025. The amended bundle, implemented in September 2021, introduced universal glove changes, light handle replacement, suction catheter tip removal, Bovie replacement, sterile re-draping, and a new surgical tray and instruments for fascial closure. Standardized prophylactic antibiotics, abdominal and vaginal preparation, and dressing protocols remained unchanged. Deliveries were categorized as preimplementation (April 2018-August 2021) and postimplementation (October 2021-February 2025). SSI was defined as wound separation requiring packing or wound infection necessitating antibiotics within 30 days. Logistic regression models adjusted for maternal age and gestational age. Subgroup analyses stratified by labor status, primary versus repeat cesarean, and body mass index (BMI).

A total of 2,467 cesarean deliveries were included, with 1,271 in the preimplementation and 1,196 in the postimplementation group. SSI occurred in 2.6% of preimplementation versus 3.3% of postimplementation deliveries (adjusted OR = 1.27, 95% CI: 0.80-2.04; p = 0.313). No significant temporal trends were observed before (p = 0.151) or after (p = 0.221) bundle implementation. Subgroup analyses by labor status, prior cesarean, and BMI similarly showed no significant associations between the bundle and SSI risk.

Introducing closing-phase equipment changes on top of standardized SSI prevention practices did not reduce post-cesarean SSI rates. These findings suggest that once core measures such as antibiotics, prep, and dressings are standardized, additional equipment changes alone may not provide incremental benefit. These findings highlight the importance of rigorously evaluating process changes before widespread implementation.

· Closing-phase equipment changes did not lower cesarean SSI rates.. · Bundle showed no effect in subgroup analyses by labor status, prior cesarean, and BMI.. · Findings question the value of costly closure-phase SSI prevention bundles..