Wound Breakdown in Cesarean Section Patients

Women’s Health Service LineDonna McCormackRichard BesingerJohn Gianopoulos

LuAnn Vis

Opportunity Statement

Historically LUHS obstetrical wound disruptions were internally monitored and reviewed. The National Perinatal Information Center (NPIC) monitors wound disruption in obstetrical patients, offering a benchmark for comparison. In FY00, LUHS’s obstetrical wound disruption rate was 1.18% compared to the NPIC rate of 0.47%

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Desired Outcome

To decrease the LUHS obstetrical wound disruption rate and to outperform the NPIC rate.

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Most Likely Causes

LUHS obstetrical wound disruptions were primarily cesarean section woundsHistorically, we focused on staff education With this project, we focused on infection related causes:

Common variables – same OR, same staff, etc.Aseptic techniqueAdministration of preoperative antibioticsPotential infectious agentsAbdominal scrub

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Solutions Implemented

January 2000A need for reducing the potential for wound disruptions was noted.Steps Taken:

Department committee formedAction plan createdTracking form developedDiscussed at obstetrical staff meetings

November 2000Infection control department reviewed charts for common variablesSteps Taken:

New policy to culture any open wounds Re-education of staff on problem and importance of aseptic technique

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Solutions Implemented

November 2001Wound breakdowns declined, we still did not meet our goalSteps Taken:

New abdominal scrub technique and agent introducedEmphasis placed on proper pre-operative antibiotic administration

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November 2002An opportunity for improvement was noted in regard to cleaning off gel from the abdomen prior to abdominal scrub in the operating room. Steps Taken:

A new policy was instituted to ensure proper cleansing.

LUHS Obstetrical Wound Disruptions Have Declined

0.67%0.73%

0.91%

1.18%

0.53%0.51%0.48%0.47%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

FY 00 FY 01 FY 02 Qtr 1 03

LOYOLA

NPIC

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Analysis & Learnings

LUHS wound disruption rates have decreased from 1.18% to 0.67% since FY00, bringing us closer to our goal of outperforming the NPIC rateLearnings:

Considering multi-factorial causes for wound disruptions was critical to our success Continuous monitoring was informativeWe must be persistent to reach our quality improvement goals

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Next Steps

Continue to monitor wound disruptionsFocus on timely administration of prophylactic preoperative antibioticsContinue to culture all open wounds

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