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According to the latest Center for Disease Control and Prevention (CDC) data from 1999, an estimated 27 million surgical procedures are performed yearly in the United States. Surgical site infections related to these procedures are specifically defined and consistently monitored by the CDC through their National Nosocomial Infections Surveillance (NNIS) system. These surgical site infections are the third most frequently reported hospital acquired infection, leading to significant morbidity and mortality for patients as well as increased economic costs for hospitals. These costs are directly related to longer hospital stays, the need for supplies used to treat the infections, increased medication usage and reduction in insurance reimbursement for hospital-acquired infections. For obstetric patients, surgical site infections can also hamper initial bonding between patients, families and their newborn. A wound complication in the initial postpartum period can potentiate a very stressful time for women and their families.

At Vanderbilt Medical Center, we noted an infection rate for cesarean sections that from 2007 to the beginning of 2008 varied between 4.5% and 13.8%, which is higher than the current CDC benchmarking mean of 2.6 for cesarean sections. A literature review revealed that the incidence of surgical site infections related to cesarean deliveries ranged between 8.9-9.6% when reviewed at thirty days post delivery. In an effort to reduce our surgical site infections related to cesarean sections, a systematic literature review of best practices was begun.

Very little research was noted to be directly related to this issue in the obstetrical population. However, several key strategies to reduce surgical site infections were identified in other areas of the hospital such as vascular surgery and burn units. These strategies encompassed pre-operative, intra-operative, and post-operative practice changes. Strategies introduced to the L&D unit included better standardized timing and dose of pre-operative antibiotics and educational initiatives to increase staff knowledge about operative standards and to improve measures such as the prepping of the surgical patient and the wearing of appropriate surgical attire. Silver dressings were also introduced post-operatively for the cesarean section patients, as a means of reducing surgical site infections.

Although silver has been recognized as a means to combat wound infections for many years, it has only recently be adopted in a variety of dressings used for hospital patients, especially burn patients. While there are few randomized, controlled trials of silver dressings and none in the obstetrical patient population, there is clinical evidence that silver dressings can help reduce surgical site infections in certain patient populations. In an effort to identify if these dressings could assist in reducing our cesarean section rates, we started implementing the placement of silver dressings on cesarean section patients at Vanderbilt Medical Center.

This presentation will summarize data gathered from our efforts to incorporate the above mentioned operative best practice recommendations from the literature review of practices in a variety of specialties.