The role of team engagement and a defined bundle approach in the reduction of surgical site infections associated with Lower Segment Caesarean Section

Beth Bint 1, Joanna Harris 1

Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia


This presentation describes our response to an 80% increase in the monthly rate of LSCS associated surgical site infections (SSI) in a 500 bed tertiary referral hospital in NSW. The service undertakes almost 650 LSCS annually with a monthly SSI rate of 1.7% (January 2012 to July 2014). In August 2014 the SSI rate was 12.3% (n=7).

A multimodal intervention strategy was implemented which included establishing a multi-disciplinary team and, following literature review, the development of a compliance bundle that was audited in tandem with the SSI surveillance process. Following implementation ongoing auditing identified any gaps that were addressed with the relevant discipline to ensure understanding of the management required and to improve bundled compliance.

Key stakeholder engagement provided opportunity for disciplines to take responsibility of the individual practice changes required for a standardised approach to reduce LSCS SSI rates. Initial overall bundle compliance was 63%. Timely reporting of bundle compliance enabled practice review opportunities and improved compliance. 12 months after the implementation of the bundle the compliance rate was 88% representing a 25% improvement. During the 12 months following the implementation of the bundle the number of average monthly SSI was 1 (range 0-3). The average rate being 1.9% (range 0% – 5.7%)

A multimodal approach that incorporates key stake-holder teams, active surveillance and continuous auditing of a compliance bundle can have an immediate and positive impact on surgical site infections associated with LSCS.

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