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Wound Breakdown in Cesarean Section Patients. Women’s Health Service Line Donna McCormack Richard Besinger John Gianopoulos LuAnn Vis. Opportunity Statement. Historically LUHS obstetrical wound disruptions were internally monitored and reviewed.

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Wound Breakdown in Cesarean Section Patients

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Wound breakdown in cesarean section patients l.jpg

Wound Breakdown in Cesarean Section Patients

Women’s Health Service Line

Donna McCormack

Richard Besinger

John Gianopoulos

LuAnn Vis


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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%

    Confidential Quality Improvement material


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Desired Outcome

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

    Confidential Quality Improvement material


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Most Likely Causes

  • LUHS obstetrical wound disruptions were primarily cesarean section wounds

  • Historically, we focused on staff education

  • With this project, we focused on infection related causes:

    • Common variables – same OR, same staff, etc.

    • Aseptic technique

    • Administration of preoperative antibiotics

    • Potential infectious agents

    • Abdominal scrub

      Confidential Quality Improvement material


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January 2000

A need for reducing the potential for wound disruptions was noted.

Steps Taken:

Department committee formed

Action plan created

Tracking form developed

Discussed at obstetrical staff meetings

November 2000

Infection control department reviewed charts for common variables

Steps Taken:

New policy to culture any open wounds

Re-education of staff on problem and importance of aseptic technique

Confidential Quality Improvement material

Solutions Implemented


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November 2001

Wound breakdowns declined, we still did not meet our goal

Steps Taken:

New abdominal scrub technique and agent introduced

Emphasis placed on proper pre-operative antibiotic administration

Confidential Quality Improvement material

November 2002

An 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.

Solutions Implemented


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LUHS Obstetrical Wound Disruptions Have Declined

LOYOLA

NPIC

Confidential Quality Improvement material


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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 rate

  • Learnings:

    • Considering multi-factorial causes for wound disruptions was critical to our success

    • Continuous monitoring was informative

    • We must be persistent to reach our quality improvement goals

      Confidential Quality Improvement material


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Next Steps

  • Continue to monitor wound disruptions

  • Focus on timely administration of prophylactic preoperative antibiotics

  • Continue to culture all open wounds

    Confidential Quality Improvement material


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