The PICS Project -Prevention of Infection after Caesarean Section

Two continuous cohorts each of three months duration. From the date of the trial commencing, patients undergoing Caesarean section will undergo routine care for three months (pre-implementation group) There will then be a four week/one month period of introduction of the intervention. Data during this time will NOT be collected. The subsequent three months, all patients undergoing Caesarean section will receive the bundled interventions described. For patients in the post-implementation group: 1) Vaginal aseptic cleansing prior to skin incision for all caesarean sections, including cleaning the vulva and perineum with gauze wetted with 2% chlorhexidene gluconate/70% iso alcohol solution (Theatre nursing staff/surgeon) 2) Complete coverage of the incisional area prior to skin incision with 2% chlorhexidine gluconate/70% iso-alcohol solution. Minimum of two minutes contact time; must be allowed to air dry, no cloths or towels used to dry the skin. (surgeon) 3) Cefazolin 2g (if <120kg)/3g (if >120kg) given intravenously prior to skin incision- weight-based regime. Repeat dose if EBL >1500ml or operating time over three hours; included in WHO Time Out. (Anaesthetist) 4) Before closing rectus fascia, remove or change one pair of surgical gloves (surgeon prompted by scrub nurse) 5) Assessment of normothermia - pre-operative and post-operative temperature checks within range 36.5-37.5 degrees Celsius. Active rewarming with warmed blankets and 3M BairHugger device when pre-operative temperature below 36 degrees. No temperature assessments will be made in theatre. Cohort of all patients over a three month period undergoing Caesarean section.