Evidence-Based Bundles and Cesarean Delivery Surgical Site Infections

Carter, Ebony B.; Temming, Lorene A.; Fowler, Susan A.; Eppes, Catherine; Gross, Gilad A.; Srinivas, Sindhu K.; Macones, George A.; Colditz, Graham A.; Tuuli, Methodius G.

doi:10.1097/aog.0000000000002249

Cited by 71 publications

(31 citation statements)

References 50 publications

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“… 9 , 10 In a systematic review and meta-analysis of 44 studies, Martin et al 11 found similar surgical site infection reduction when preoperative antibiotic prophylaxis, vaginal preparation and spontaneous removal of the placenta were standardly performed. Carter et al 12 also demonstrated that evidence-based bundles were associated with reduced surgical site infection in a systematic review and meta-analysis. Interestingly, the techniques standardized varied among studies, suggesting that the act of bundling or standardization may independently contribute to improved outcomes rather than the specific techniques individually.…”

Section: Why Standardize Cesarean Delivery Surgical Technique?mentioning

confidence: 96%

The Case for Standardizing Cesarean Delivery Technique

Dahlke

Mendez‐Figueroa

Maggio

et al. 2020

Obstetrics &Amp; Gynecology

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Section: Why Standardize Cesarean Delivery Surgical Technique?mentioning

confidence: 96%

The Case for Standardizing Cesarean Delivery Technique

Dahlke

Mendez‐Figueroa

Maggio

et al. 2020

Obstetrics &Amp; Gynecology

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“…However, we cannot conclude with retrospective observational data whether earlier caesarean delivery could have prevented morbidity, which remains an area for further study. This study's findings are timely given the increasing emphasis and implementation of evidence‐based bundles to decrease surgical site infections, postpartum haemorrhage, venous thromboembolism and endometritis after caesarean delivery . Much of the earlier data characterising chorioamnionitis and its impact on maternal outcomes are now decades old .…”

Section: Discussionmentioning

confidence: 94%

“…The primary outcome was a composite of maternal intrapartum and postpartum morbidities as derived from clinical chart review and ICD‐9‐CM diagnostic codes, which included postpartum transfusion, endometritis, venous thromboembolism, hysterectomy, intensive care unit (ICU) admission, death, wound infection/separation for caesarean delivery, and perineal wound infection for vaginal delivery. These adverse maternal outcomes were selected because they have been shown to be associated with maternal infection in previous reports, and recently have been emphasised as part of evidence‐based bundles to decrease surgical site infections, postpartum haemorrhage, venous thromboembolism and endometritis . Adverse outcomes included in this study are currently under consideration for inclusion as part of a standardised core outcome set for maternal infectious outcomes after caesarean delivery by The COMET (Core Outcome Measures in Effectiveness Trials) Initiative.…”

Section: Methodsmentioning

confidence: 99%

Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study

Venkatesh

Glover

Vladutiu

et al. 2019

BJOG

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Objective To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery. Design A retrospective cohort study. Setting Data from the Consortium on Safe Labor Study in the USA (2002–2008). Population Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section). Methods The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery. Main outcome measures The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death. Results Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97–2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes. Conclusions Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis. Tweetable abstract Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery.

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“…They account for 14 to 16% of all hospital-acquired infections. With cesarean section (CS) rates rising (187)(188)(189)(190), the risk of surgical site infections is also subject to an increased frequency despite the use of prophylactic antibiotics, with the rate ranging between 2% and 15% (191)(192)(193)(194)(195)(196)(197). MRSA has caused a larger number of severe postpartum infections, especially after CS (198)(199)(200).…”

Section: Clinical Application In Obstetrics and Gynecologymentioning

confidence: 99%

The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology

2019

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SUMMARY Health care-associated infections (HAIs) are a global problem associated with significant morbidity and mortality. Controlling the spread of antimicrobial-resistant bacteria is a major public health challenge, and antimicrobial resistance has become one of the most important global problems in current times. The antimicrobial effect of copper has been known for centuries, and ongoing research is being conducted on the use of copper-coated hard and soft surfaces for reduction of microbial contamination and, subsequently, reduction of HAIs. This review provides an overview of the historical and current evidence of the antimicrobial and wound-healing properties of copper and explores its possible utility in obstetrics and gynecology.

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Evidence-Based Bundles and Cesarean Delivery Surgical Site Infections

Abstract: Evidence-based bundles are associated with a significant reduction in surgical site infection after cesarean delivery.

Cited by 71 publications

References 50 publications

The Case for Standardizing Cesarean Delivery Technique

The Case for Standardizing Cesarean Delivery Technique

Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study

The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology

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