Intraoperative Measures Taken During a Cesarean Delivery

Posted by Lauren Burke on

A woman’s risk of death when undergoing this major surgery is between two to 11 percent, with one of the most significant risks being surgical site infection (SSI). In 2016, an interdisciplinary team working with the Association of periOperative Nurses (AORN) created a standardized protocol for the prevention of SSIs in patients who undergo a cesarean delivery. Understanding the standard interoperative measures necessary during the surgery may lower the risk for new mothers and improve outcomes for both patients.

Controlling Traffic in the Operating Room

The interdisciplinary team implemented a standard approach for intraoperative SSI prevention during cesarean delivery. One of the essential components is the limiting of traffic in the OR.

2014 study conducted at a Canadian hospital found that controlling the traffic in the operating room leads to a decrease in SSIs. The study team’s goal was to reduce door openings from their average of 42 to 72 to the new normal of three. With just three door openings during the procedure, SSIs dropped from 2.8 percent to 2.1.

Control Patient’s Body Temperature

Another standard, is to find ways to control the patient’s body temperature. There are several approaches to enhance warming in the OR. For example, there are warming cabinets that can sit back out of the way but give surgical nurses easy access to what they need to keep mothers warm. There are also fluid warming cabinets that allow for the delivery of warm IV fluids.

The goal is the same, though, no matter how they go about warming the patient. It is to maintain normothermia. A 2002 study published in Anesthesia and Analgesia found that babies born via cesarean delivery from a warmed mother had a significantly higher core temperature.

Why Warming Matters in SSI Prevention

Hypothermia is common in any surgical procedure for a variety of reasons, including:

  • Room temperature in the OR
  • Anesthesia
  • IV and irrigation fluids
  • Skin exposure
  • Patient anxiety

Studies demonstrate that interoperative warming reduces surgical site infections and complications of hypothermia, which can affect healing.

Effectiveness of the Standardized Surgical Site Infection Prevention Bundle

One hospital testing the efficacy of this standard and systemized approach to SSI prevention did show promising results. In the first quarter of 2016, their SSI rate per 100 procedures was 4.2. They did 283 cesarean deliveries in that time frame and saw 12 surgical site infections.

By the second quarter of that year, they already noted marked improvement. Of the 328 cesarean sections done in 2Q 2016, there were 11 SSIs — that is a rate of 3.4 per 100 procedures. The number continued to drop with the most significant change seen in the fourth quarter of 2016, where there was an SSI rate of .8 per 100 procedures. As of the second quarter of 2017, the facility was maintaining a considerably lower rate of infections.

With the introduction of these new standardized intraoperative SSI prevention protocols that include warming to prevent hypothermia, outcomes for mothers who undergo cesarean sections are improving.

Sources:

  1. http://www.hret-hiin.org/Resources/ssi/18/surgical-site-infections-change-package.pdf

 

  1. AORN’s Creating a Surgical Site Infection Prevention Bundle for Patients Undergoing Cesarean Delivery
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