Stepwise implementation of vaginal cleansing and azithromycin at cesarean: a quality improvement study.
Publication/Presentation Date
12-1-2022
Abstract
OBJECTIVE: We aimed to decrease our surgical site infection (SSI) rate by 30% by sequential implementation of vaginal cleansing and azithromycin for women who underwent a cesarean delivery (CD) after having labored or experienced rupture of membranes.
METHODS: This is a quality improvement project that assessed the stepwise implementation of two interventions within three time periods: (1) 12 months prior to implementation of either intervention; (2) 14 months of vaginal cleansing as infection prophylaxis; (3) 16 months of vaginal cleansing and azithromycin as infection prophylaxis. The primary outcome measure was the SSI as defined by the Center for Disease Control and Prevention and analyzed by control charts. The process measures were compliance rates of vaginal cleansing and azithromycin. Significance was detected by rules for determining a special cause variation. This study followed the SQUIRE 2.0 guidelines for reporting on quality improvement.
RESULTS: There were 1033 patients included from the three study periods. The total rate of SSI decreased from 22.8% to 15.2% after implementing vaginal cleansing. Special cause variation was detected with an 8-point shift starting 4 months after implementation of vaginal cleansing. This decrease was sustained during the following 26 months. Adding azithromycin did not significantly lower the SSI rate further. When examined separately, deep SSI (
CONCLUSION: In this quality improvement study, implementation of vaginal cleansing decreased the SSI rate by 33%, from 22.8% to 15.2%. The addition of azithromycin did not result in any additional change in SSI rate.
Volume
35
Issue
25
First Page
5346
Last Page
5353
ISSN
1476-4954
Published In/Presented At
Johanna, Q. N., Gomez, J., Felder, L., Di Mascio, D., Eckler, R., Paternostro, A., Baxter, J., Berghella, V., & Posencheg, M. (2022). Stepwise implementation of vaginal cleansing and azithromycin at cesarean: a quality improvement study. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 35(25), 5346–5353. https://doi.org/10.1080/14767058.2021.1879041
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
33525938
Department(s)
Administration and Leadership
Document Type
Article