(433) Evidence-based care bundle to reduce cesarean delivery wound complications

The care bundle was implemented in February 2021 and consisted of weight-based prophylactic antibiotics given prior to skin incision, redosing of antibiotics for high blood loss or prolonged surgical time, and pre-incision azithromycin and vaginal preparation for patients in labor or with ruptured membranes. Primary outcomes were surgical site infections (SSI) and wound complications. SSI was defined in accordance with national quality measures as postoperative infections affecting the incision or deep tissue at the operation site, excluding patients with chorioamnionitis as this is considered a preexisting infection. Wound complications were defined as SSI and sterile wound complications such as wound dehiscence or seroma. This patient-centered wound complication metric did not exclude patients with chorioamnionitis. SSI rates, wound complication rates, and compliance with the care bundle were assessed starting 6 months prior to implementation until 12 months after implementation.


Results: Between September 1, 2020 and March 1, 2022, there were 1206 cesarean deliveries performed at our institution. Compliance with the care bundle increased from 58.4% pre-implementation to 78.5% at 12 months post-implementation, with increases in appropriate prophylactic antibiotics from 59.1% to 88.6% and vaginal preparation in eligible patients from 39.3% to 67.7%. SSI and wound complication rates decreased pre- to post-implementation from 1.95% to 0.63% (RR 0.32, p=0.036) and 8.5% to 5.5% (RR 0.65, p=0.046), respectively.

Conclusion: Implementation of an evidence-based care bundle was associated with significant reductions in post-cesarean SSI and wound complications at our institution.