A change in policy to give prophylactic antibiotics before incision instead of after cord clamping significantly reduced the risk of surgical-site infections in women undergoing cesarean delivery at a tertiary care hospital.
More than 31% of infants in the United States are delivered by cesarean section, and the rate of surgical-site infection ranges from 1.46 to 3.82 per 100 cesarean deliveries, depending on patient risk factors. Until recently, usual practice was to wait to administer antibiotics until after umbilical cord clamping to avoid masking neonatal sepsis. Practice guidelines issued in 2011, however, recommend giving antibiotics to all women within an hour before cesarean delivery.
Between 2003 and 2010, Barnes-Jewish Hospital in St. Louis implemented several interventions to reduce the risk of postcesarean infection, including the administration of prophylactic antibiotics before incision instead of after delivery, a ban on artificial nails among surgical staff, and streamlined operating room cleaning and disinfection procedures. Researchers used time series analysis to determine the effects of these interventions (after adjusting for secular trends in patient risk factors) on rates of postcesarean surgical-site infection in the eight-year study period.
During the study, 8,668 women underwent cesarean delivery. Over the study period, the proportion of patients who had certain known risk factors for postcesarean surgical-site infection, including a body mass index of 35 or higher, hypertension or mild preeclampsia, and severe preeclampsia or eclampsia, rose significantly. Multivariate analysis showed that of the five interventions being studied, the prophylactic antibiotic policy was the only one that was significantly associated with lower rates of surgical-site infection. Implementation of the policy resulted in a 48% decrease in the number of surgical-site infections, or a reduction of 5.4 surgical-site infections per 100 cesarean deliveries.
The findings provide "compelling evidence in support of prophylactic antibiotic administration to pregnant women experiencing hypertension and obesity prior to cesarean surgery and have important implications for patients, health care providers, and insurers," said Marilyn Stringer, professor of women's health nursing at the University of Pennsylvania. "Based on these findings, nurses, in collaboration with other care partners, can develop evidence-based protocols supporting prophylactic antibiotic administration before surgical incision."-Karen Rosenberg
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