SSI in Cesarean Delivery with CHG Data
| Main Author: | Hamilton, Erin |
|---|---|
| Format: | Dataset |
| Terbitan: |
Mendeley
, 2018
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| Subjects: | |
| Online Access: |
https:/data.mendeley.com/datasets/42tkdb87bf |
Daftar Isi:
- This process improvement (PI) project was designed to determine whether surgical irrigation with a 0.05% CHG solution would reduce the number of Surgical Site Infections (SSI) following Cesarean Delivery (CD) at a 150-bed community hospital in San Antonio, TX. The control period was defined as Dec 2013 through Nov 2014 and the treatment period was between Dec 2014 and Nov 2015. All CD were performed by one of eleven physicians practicing at the facility. All data collected during both the control and the treatments cohorts was collected prospectively. There were no exclusions. The primary outcome was the presence or absence of post-cesarean SSI. The intervention used as the treatment was irrigation with 0.05% CHG in sterile water followed by a normal saline rinse. Treatment period SSI numbers were compared with SSI numbers among women who underwent CD by the same group of physicians during the control period. During the control period, in which there was no official irrigation protocol, the practice, if performed, was done with normal saline. Prospective data from the control period, including all patient and procedure characteristics, were tracked during the treatment period and extracted from EMRs by the women services’ management team. Cross-checks were done to verify accuracy. All patients were evaluated for infection using the CDC criteria for superficial, deep, and organ space SSI. The treatment group SSI rate was slightly lower (1.5% [5/343]) than the control group (1.8% [7/399]), but this was not statistically significant (p=0.780). Multiple logistic regression analysis revealed race Hisp/Latino and non-elective/urgent/emergent status as positive predictors of SSI. A significant interaction effect between irrigation with 0.05% CHG and antibiotic administration time (AAT) existed such that SSI occurrence in the control group was dependent on AAT (each additional minute between administration and incision lowering odds for SSI) while SSI occurrence in the treatment group was not dependent on AAT. The model indicates that AAT explains a portion of the protective effect against SSI occurrence, but only in the control group. Thus, treatment (0.05% CHG irrigation) is the effective factor in mitigating SSI risk in the treatment group, regardless of AAT. These results are consistent with subset correlation and simple logistic regression analyses. AAT was shown to be negatively correlated with SSI occurrence (lower time related to SSI) in the control subset only (r=-0.131, p-value=0.010), while no correlation was shown between AAT and SSI occurrence in the treatment subset only (r=-0.009, p=0.863). In subset simple logistic regression analysis, AAT was the only significant predictor (p-value=0.010) of SSI in the control subset, while it held no significance in predicting SSI in the treatment subset (p-0.372). This suggests a role for 0.05% CHG irrigation in mitigating SSI risk whether antibiotic prophylaxis timing is suboptimal or ideal.