Evaluation of a bundled care approach to preventing surgical site infections post caesarean section in an Australian Rural Hospital

The intervention is comprised of a caesarean infection prevention "CIP" bundle that was developed and implemented across the study population. The CIP bundle had five elements including: 1) Identification of women at risk of surgical site infection (SSI) post caesarean section (CS) - Antenatal identification and education administered by booking midwives and medical officers 2) Pre-operative site skin preparation protocol - No shaving, clipping if required in the operating theatre by the medical officer - Neutral detergent bed bath prior to CS administered by the attending midwife 3) Antibiotics prophylaxis administered pre-operatively - Cephazolin 2g Intravenously 15-60 minutes before knife to skin administered by Anaesthetics - Clindamycin 600mg Intravenously if known MRSA carrier or cephalosporin allergy 4) Operative site skin preparation - 2% Chlorhexidine gluconate and 70% alcohol for skin preparation - Applied by the attending medical officer or scrub nurse prior to surgical draping 5) Negative pressure wound therapy (NPWT) for Body Mass Index (BMI) > 35 - Applied intra-operatively and left on incision wound for 7 days - Women with BMI < 35 have standard wound dressings applied The intervention begins prior to surgery and concludes at the end of the surgical procedure or upon removal of negative pressure dressings at day 7 for women with a BMI over 35. Participants are followed up until 30 days post operatively. The intervention is the responsibility of all clinical midwives, obstetric medical staff, anaesthetics and the Infection Control Clinical Nurse Consultant (CNC). Surveillance and adherence data is collected using a multifaceted process including review of all patients undergoing CS in the study period, emergency department encounters and hospital admissions for wound complications within a 30 day post operative period.