1. Wound Breakdown in Cesarean Section Patients Women’s Health Service Line Donna McCormack Richard Besinger John Gianopoulos LuAnn Vis

2. 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

3. Desired Outcome To decrease the LUHS obstetrical wound disruption rate and to outperform the NPIC rate. Confidential Quality Improvement material

4. 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

5. Solutions Implemented 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

6. Solutions Implemented 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.

7. LUHS Obstetrical Wound Disruptions Have Declined LOYOLA NPIC Confidential Quality Improvement material

8. 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

9. 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