Purpose for the Program:
To share the current evidence and the best practice methods regarding the prevention of complications, such as infection and thromboembolism, to improve the outcomes of women having cesarean births.
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 births. Subsequent to this, preoperative skin preparation with chlorhexidine gluconate was implemented for all cesarean births as well as an algorithm for the use of silver wound dressings for at risk populations (e.g., women who are morbidly obese, diabetic, and methicillin-resistant Staphylococcus aureus-positive).
Implementation, Outcomes, and Evaluation
As evidence emerges to improve the 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 decreased 50% in 2008-2009, and there were no incidences of venous thrombosis postoperatively for patients who had cesarean births in 2009. Because the use of chlorhexidine gluconate preoperative skin preparation has become common practice in other areas of the hospital to decrease postoperative infection rates, this intervention also was implemented for obstetrics. An algorithm for at risk populations was created to change wound dressings to further reduce the possibility of infection. Data will be evaluated to determine the success of these additional measures to reduce postoperative cesarean infections.
Implications for Nursing Practice
Cesarean births have increased by 53% from 1996 to 2007, with approximately one third of births in the United States now delivered 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.