CDC reports that in 2007, 32% of all deliveries were by cesarean birth.  Along with the growing obesity and diabetic epidemic, these women have an increased risk of developing a surgical site infection (SSI).  The program aim was to reduce the SSI rate by developing a program to identify high risk patients and implement a standardized risk assessment, order set, and patient education tools. 

Proposed change: Changes included development of a high risk assessment form, incorporating all best practices to reduce SSI, initiating a new order set for high risk patients and implementation of an education process for all cesarean birth patients.  A unique new order for high risk patients included use of nanocrystalline silver rope dressing on the cesarean incision.

Implementation, outcomes and evaluation: Implementation involved forming a committee, performing a literature review and subsequently incorporating evidence based practices to reduce SSI's. Some of these evidence based practices include; strict adherence to Chloraprep application and dry time, monitoring the temperature in the operating room and of the patient, careful antibiotic timing, maintaining strict glucose control of the patient, and lab orders consistent with clinical parameters. The new forms and processes were created and the education of the implementation of the program involved all health care providers.  Follow through involved creating a form to document interventions on each cesarean birth patient to be reviewed and completed before discharge. The committee met monthly to review and analyze program outcomes and incorporated necessary changes as needed.  A year after implementation, the SSI rate has consistently been reduced.

Implications for nursing practice:

Program changes have decreased the current SSI rate consistently.

Keywords:

Surgical Site Cesarean Infection

Silver rope dressing

Nanocrystalline

SSI education

Order set for SSI