Purpose for the program: To share current evidence and best practices regarding prevention of complications such as infection and thromboembolism for women having cesarean births with the goal of improving outcomes.

Proposed change: Through ongoing evaluation of the literature, beginning in 2007 changes were implemented in a large tertiary center to improve safety of cesarean births by implementing knee high sequential compression devices, and changing the timing of preoperative antibiotics for women having cesarean birth.  Subsequent to this, preoperative skin preparation with chlorhexidine gluconate (CHG) was implemented for all cesarean births, as well as an algorithm for use of silver wound dressings for at risk populations.

Implementation, outcomes and evaluation: As evidence emerges to improve outcomes by preventing complications, a multidisciplinary group of nurses and physicians have sought to translate these practices to optimize care and outcomes for women having cesarean births.  In 2007, order sets were updated in a large multihospital system to ensure the use of mechanical thromboprophylaxis and optimal antibiotic timing for women having cesarean births.  As a result, postoperative infections dropped 50% for 2008-2009, and there were no incidences of venous thrombosis postoperatively for cesarean birth patients in 2009.  As the use of CHG preoperative skin preparation has become common practice in other areas of the hospital to decrease postoperative infection rates, this intervention was also implemented for obstetrics.  An algorithm for at risk populations (morbidly obese, diabetic, MRSA positive etc) was created to change wound dressings to further reduce infection potential.  Data will be evaluated to determine the success of these additional measures to reduce post operative cesarean infections.

Implications for nursing practice: Cesarean deliveries have increased by 53% from 1996 to 2007, with approximately one third of births in the US now happening by cesarean.  As with any major surgery, serious complications may result such as infection and thromboembolism.   Nurses are in a key position to improve patient safety by implementing prevention strategies aimed at reducing postoperative cesarean complications.

Keywords: cearean, infection, thromboembolism, surgical care improvement