(734) Evaluation of a cesarean surgical site infection (SSI) prevention protocol on SSI and neonatal hypoglycemia

To evaluate trends in SSI and neonatal hypoglycemia before and after the implementation of a cesarean SSI prevention protocol to improve maternal pre- and post-cesarean care. This protocol includes a preoperative blood glucose (BG) check. Instances of neonatal hypoglycemia and maternal preoperative hyperglycemia in pregnant people who had not previously been diagnosed with diabetes were also assessed.

Study Design: This project utilized data from a single-center retrospective cohort of patients undergoing cesarean birth between 6/01/2019-6/28/2021 and neonates born via cesarean. The timeframe was divided into two periods: 1) before implementation of an SSI protocol and 2) after implementation of an SSI protocol. Continuous variables were analyzed using two-sample t-test, and categorical variables were analyzed using Chi-square.

Results:

2,735 mother-neonate dyads met inclusion criteria during the selected timeframe. Demographic, obstetric, surgical, and postpartum baseline characteristics pre- and post-SSI protocol implementation were similar except that unplanned cesarean birth (p < 0.005) and maternal postpartum length of stay (p=0.02) were different between the groups. Following implementation of an SSI protocol, SSI incidences dropped from 25 (2%) to 11 (1%) (p=0.02). Neonatal hypoglycemia decreased from 25% before to 24% after maternal BG check implementation (p=0.7). Among those without a prior diagnosis of diabetes, 64 (7%) had a preoperative BG over 110 mg/dL and 3 (0.33%) had a BG over 150 mg/dL. From 9 reported SSI, 1 (11%) case occurred in a patient with BG over 150 mg/dL.

Conclusion: Implementation of an SSI protocol, which included universal preoperative BG checks prior to cesarean birth reduced the incidence of reported SSI by 44%. Preoperative BG checks identified a significant number of patients with BG over 110 mg/dL who had otherwise not been diagnosed with diabetes through routine prenatal screening. While glycemic control did not significantly impact the incidence of neonatal hypoglycemia, this protocol did overall decrease the rate of maternal SSI.