(596) Implementation of Enhanced Recovery after Cesarean Section reduces surgical site infection

Objective: The cesarean section surgical site infection (SSI) rate for Barnes Jewish Hospital in 2019 rose to 2.2 infections per 100 procedures, the highest since achieving an average rate of 1.1 infections per 100. A multidisciplinary team was convened to create a cesarean section SSI bundle. Several studies demonstrated that implementing an Enhanced recovery after surgery, an evidenced-based protocol, could improve maternal outcomes and decrease SSI rates. This group implemented the Enhanced recovery after cesarean section with closure tray and glove change at the fascia closure to decrease the SSI rate.

Study Design: This quality improvement initiative was launched as the standard of care for all obstetrical patients undergoing a cesarean section at our institution in November 2020. The National Healthcare Surveillance Network (NHSN) definition was used to define SSI and are tracked by the hospital infection prevention staff.

Results: A total of 3585 deliveries were performed, with 1035 women undergoing cesarean sections in 2021. There were 544 primary cesarean sections and 481 repeat cesarean sections. The cesarean section SSI rate was 0.6 infections per 100 which included six superficial infections and zero deep infections. The patients’ baseline demographics did not change pre and post-implementation. Compliance with the ERAC pathway was > 70%.

Conclusion: Enhanced recovery after cesarean section decreases SSI. Implementation of this pathway should be considered in all labor and delivery units.